SBRT for High-Risk PCa in the U.S.

Stereotactic body radiation therapy use for high risk prostate cancer in the United States (2020, Letter communication)

"Background: Stereotactic body radiation therapy (SBRT) is increasingly utilized for localized prostate cancer (PCa). Although its use is more widely supported for low/intermediate risk disease, the 2020 National Comprehensive Cancer Network (NCCN) guidelines now endorse its use for high risk (HR) as well. Clinicodemographic factors associated with SBRT use in HRPCa in the United States remain unknown.
...
In conclusion, SBRT use for HRPCa increased threefold from 2004 to 2016 and will continue to rise given recent guideline support and emerging level one evidence. Favorable disease characteristics and, more concerningly, omission of ADT were associated with receipt of SBRT over EBRT. Randomized trials comparing SBRT with or without ADT for HRPCa are needed before considering omitting ADT."

[Emphasis mine]

Djin

I'm still of the opinion that the prior Standard of Care made good sense -- that with any form of EBRT, favorable intermediate risk cases could selectively exclude ADT, while it was recommended strongly that unfavorable intermediate risk cases include ADT in their treatment.

I admit that my case is only a "sample of 1" but with my favorable intermediate risk (G3+4=7, low % involvement) diagnosis, we excluded ADT, and now, 4 years along, things are going just as we hoped and planned.

I am encouraged to see, however, increasing support for the use of SBRT for even high-risk patients. To me, it just stands to reason that if SBRT is equal to or better than standard EBRT for lower risk patients, then it should also be so for higher risk patients. I'll take 5 treatments over 20 or 40 any time.