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. 2025 Oct 23;20(1):157.
doi: 10.1186/s13014-025-02739-z.

Correlations of biochemical and clinical outcomes with 10-year results after robotic stereotactic body radiotherapy for localized prostate cancer

Jae Sik Kim  1 , Younghee Park  2 , Hae Jin Park  3 , Won Il Jang  4 , Bae Kwon Jeong  5 , Hun-Jung Kim  6 , Ah Ram Chang  7
Affiliations

Correlations of biochemical and clinical outcomes with 10-year results after robotic stereotactic body radiotherapy for localized prostate cancer

Jae Sik Kim et al. Radiat Oncol. .

Abstract

Background: Long-term data on the efficacy of robotic stereotactic body radiotherapy (SBRT) for localized prostate cancer (LPC) remain limited. This study aimed to evaluate the 10-year treatment outcomes of SBRT in LPC patients and identify key prognostic factors.

Methods: A total of 82 patients with LPC who underwent five-fraction SBRT (doses of 35-37.5 Gy) were included. The median follow-up duration was 11.0 years (range, 3.3-15.9 years). Clinical outcomes, including the biochemical failure-free survival (BCFFS), clinical failure-free survival (CFFS), and prostate-specific antigen (PSA) kinetics, were analyzed to evaluate the impact of various clinical and treatment factors on prognosis.

Results: The 10-year BCFFS and CFFS rates were 86.3% (95% confidence interval [CI], 78.6-94.8) and 86.7% (95% CI, 78.8-95.4), respectively. Nine cases of biochemical failure were observed, alongside local (n = 1), regional (n = 2), and distant (n = 5) metastases. The cancer-specific survival rate was 100%. The median PSA nadir was 0.09 ng/ml (range, 0.0-3.12 ng/ml) and the median interval to PSA nadir was 52.8 months (range, 0.4-170.2 months). There was a negative correlation between the time to the PSA nadir and the PSA nadir value (r = -0.233, p = 0.035). Daily SBRT was associated with improved BCFFS compared to every-other-day treatment (hazard ratio [HR], 0.220; 95% CI, 0.067-0.720; p = 0.012), while a longer interval to PSA nadir (≥ 5 years) was associated with better CFFS (HR, 0.120; 95% CI, 0.015-0.944; p = 0.044).

Conclusions: Robotic SBRT for LPC demonstrates durable long-term efficacy. Daily treatment schedules and interval to PSA nadir were identified as crucial prognostic indicators. These findings highlight the importance of PSA kinetics in predicting treatment success following robotic SBRT.

Keywords: Biochemical failure-free survival; Clinical failure-free survival; Nadir; Prostate cancer; Prostate-specific antigen; Stereotactic body radiotherapy.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was approved by the Institutional Review Board of all participant institutions and conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was not required as the study involved a retrospective review with minimal risk to the participants. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Biochemical failure-free survival rates. (A) Entire patients. (B) Stratified by risk group. (C) Stratified by treatment schedule. EOD, every-other-day
Fig. 2
Fig. 2
Clinical failure-free survival rates. (A) Entire patients. (B) Stratified by risk group. (C) Stratified by the value of the prostate-specific antigen (PSA) nadir. (D) Stratified by the time to the PSA nadir
Fig. 3
Fig. 3
Association between the value of and interval to prostate-specific antigen nadir. PSA, prostate-specific antigen
See this image and copyright information in PMC

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