{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T09:29:01Z","timestamp":1793179741576,"version":"4.5.0"},"reference-count":19,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2026,9,22]]},"abstract":"\n Importance<\/jats:title>\n The treatment of prostate cancer with radiotherapy is evolving. How quickly radiotherapy can be delivered, and the relative risks and benefits of such a treatment, is of significant public interest.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine whether stereotactic body radiotherapy (SBRT) was superior to moderately hypofractionated intensity-modulated radiation therapy (MH-IMRT) in terms of patient-reported urinary irritative\/obstructive and bowel quality of life and disease-free survival (DFS).<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n NRG-GU005 was a phase-3, international, open-label, randomized clinical trial. The study was activated on November 16, 2017, and closed to accrual on June 8, 2022. Date of last follow-up was October 13, 2024. There were 136 centers in Asia, Canada, Europe, and the United States that accrued patients to the study. Patients with localized prostate cancer, clinical stage T1-T2b with Gleason 3\u2009+\u20094 (grade group 2) and prostate-specific antigen (PSA) level less than 20 ng\/mL or Gleason 3\u2009+\u20093 (grade group 1) and PSA level 10 to 20 ng\/mL were eligible. Intended accrual of 692 patients provided reductions of 8% and 10% in minimal clinically important decline (MCID) frequency for urinary-irritative\/obstructive and bowel domains of the Expanded Prostate Cancer Index Composite\u201326 Item (EPIC-26) instrument at 2 years and greater than 80% power to detect a hazard ratio of 0.62 in DFS.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Patients were randomized 1:1 to receive SBRT (36.25 Gy in 5 fractions; n\u2009=\u2009353) or MH-IMRT (70 Gy in 28 fractions or 60 Gy in 20 fractions; n\u2009\u2009=345).<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Primary outcomes were the frequency of an MCID in the urinary irritative\/obstructive and bowel domains of the EPIC-26 at 2 years and DFS at 3 years.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 698 patients were randomized. Median age was 68 years; 3% were Asian, 13% Black, and 80% White. Median follow-up was 3.2 years (range, 0-6.5). At 2 years, there was no significant difference in the urinary-irritative domain (35.4% vs 33.7%,\n P<\/jats:italic>\n \u2009=\u2009.68). Urinary incontinence at 1 and 2 years after treatment and sexual function at 1 year after treatment favored SBRT. Fewer grade 3\u2009+\u20094 genitourinary adverse events occurred in the SBRT vs MH-IMRT group (0.6% vs 2.5%,\n P<\/jats:italic>\n \u2009=\u2009.04). There were significantly fewer MCIDs with SBRT vs MH-IMRT in the bowel domain (34.9% vs 43.8%,\n P<\/jats:italic>\n \u2009=\u2009.03). At 3 years, DFS for MH-IMRT was 92.1% (95% CI, 88.9%-95.2%) vs 88.6% for SBRT (95% CI, 85.2%-92.1%) (1-sided log-rank\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n Stereotactic body radiotherapy using a modest dose prescription improved multiple quality-of-life domains but was not superior to MH-IMRT in terms of DFS. The rate of PSA failure was not significantly improved in the SBRT vs MH-IMRT group.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT03367702<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2026.12627","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T15:30:28Z","timestamp":1786635028000},"page":"1029","source":"Crossref","is-referenced-by-count":3,"title":["Stereotactic Body Radiotherapy vs Moderately Hypofractionated IMRT for Localized Intermediate-Risk Prostate Cancer"],"prefix":"10.1001","volume":"336","author":[{"given":"Rodney J.","family":"Ellis","sequence":"first","affiliation":[{"name":"University South Florida and Tampa General Hospital, Tampa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie L.","family":"Pugh","sequence":"additional","affiliation":[{"name":"NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania"},{"name":"American College of Radiology, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James B.","family":"Yu","sequence":"additional","affiliation":[{"name":"Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix Y.","family":"Feng","sequence":"additional","affiliation":[{"name":"University of California, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andre A.","family":"Konski","sequence":"additional","affiliation":[{"name":"Chester County Hospital, West Chester, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"III","given":"Robert L.","family":"Grubb","sequence":"additional","affiliation":[{"name":"Medical University of South Carolina, Charleston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert E.","family":"Wallace","sequence":"additional","affiliation":[{"name":"Cedars-Sinai Medical Center, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Gladstone","sequence":"additional","affiliation":[{"name":"Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia","family":"M\u00e9nard","sequence":"additional","affiliation":[{"name":"CHUM\u2013Centre Hospitalier de l\u2019Universite de Montreal, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph A.","family":"Miccio","sequence":"additional","affiliation":[{"name":"Penn State Cancer Institute, Hershey, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arthur J.","family":"Frazier","sequence":"additional","affiliation":[{"name":"McLaren Cancer Institute-Macomb, Mount Clemens, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. 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G. Popular prostate cancer therapy is short, intense and unproven. The New York Times. Published 2017. 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