PACE-A trial was a multi-centre trial conducted in United Kingdom with an objective to evaluate the patient reported outcomes (PRO) in men with low-intermediate risk prostate cancer undergoing RP vs SBRT.(1) Despite a 10yr study period and being conducted at 8 centres only 123 patients were randomised and the final data analysis, at 2yrs, was performed only in 32 in RP arm and 46 in SBRT arm. The authors reported a 43% higher use of pad after RP compared with SBRT. However, almost all the patients except 1 in each arm reported use of only one pad per day and they might be using a security pad to capture occasional incontinence and severe incontinence (>1pad per day) was similar in both arms. Also, the urinary irritative/obstructive domains were better in RP arm as were the mean IPSS score however the difference in IPSS score was small and the IPSS-QoL was similar in both groups. The overall bother in the urinary function were similar in both the arms. The authors also reported that the bowel function scores were better after RP but the percentage of patients having moderate to severe bother with bowel function, 2 yrs after the treatment, were similar in RP (0%) vs SBRT arms (2.1%). The authors also reported significantly better scores in the domain of sexual function in the SBRT arm and the chances of having IIEF-5 severe ED was higher after RP (67% vs 20%), however, the percentage of having moderate or severe problem in the sexual function 2yrs after treatment was similar in both groups (33% vs 18%). There were very few high grade complications in either of the arms and the authors ended up concluding that the incontinence and sexual functions are poorer after RP where as SBRT has slightly poorer bowel function. There are some shortcomings of the study including a very small sample size with majority of the patients being recruited at one centre and other contributing only a few patients each, making it an under-powered study. Secondly, 75% patients received SBRT and 25% VMAT whereas, 16% of the patients in surgical arm received lap prostatectomy and the surgical outcomes reported are way poorer than what generally reported with a 35% margin positivity rate. Also details of the only co-primary end point, the pad usage, are not presented to assess the amount of leakage as the bother regarding the urinary function is similar between the 2 groups.
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