SABR Side Effects

User

Posted 26 Apr 2026 at 08:38

Hi All,

Newbie to this and thought I posted this question yesterday.

Have joint the club nobody wants to be in....

Diagnosed in January and given three options, active surveillance, prostatectomy or radiotherapy.

Not suitable for focal therapy after various consultations.

SABR is being recommended and was wanting to find peoples experiences please of this over the 5 day treatment and the side effects as i am being given different risk factors by the oncologist.

Thanks in advance

User

Posted 14 Sep 2026 at 14:54

High-quality evidence about long-term side effects from SBRT/SABR

Hello all!

I'm an oncologist involved in research. We have recently published what patients report about side effects from SABR/SBRT at five years below. This was from the PACE-B trial which is the highest-quality, level-1 evidence possible. It is for localised disease. I am struck by how professionals are good at sharing scientific advances with their colleagues, but I am really keen to get the information to people who it matters for, the actual patients. Please share widely with friends and family. We published this to be viewed alongside data published after surgery, again looking at patient-reported side effects. The aim is to help you with treatment decisions by giving you as much information as possible.

I hope you find this useful!

Article here:

https://www.sciencedirect.com/science/article/pii/S0302283826022128

Accompanying "waffle plots" here

https://siancooper.github.io/PACE-B-PROMs/

Surgical outcomes here:

https://www.sciencedirect.com/science/article/pii/S2666168324003665

Best,

Sian

The Royal Marsden Hospital/Institute of Cancer Research

User

Posted 26 Apr 2026 at 11:04

Hi, Gee.

Im sorry that youve had to join oir club, but welcome to the forum, mate.

I'm a regular on here and have found it surprising, despite it being a relatively new treatment, how little feedback we've had on SABR five day treatment. It sounds a great innovation to me.

Here's a decent video comparing all treatment options and possible side effects.

https://youtu.be/zYTU94-8pTc?si=xW83bOb0AVFQFD2l

Good luck with whatever you chose.👍

User

Posted 27 Apr 2026 at 20:00

No I didn’t have either of those and they were never mentioned to me.

I would say that my flow wasn’t too great before the treatment. But the main concern for my consultant was bladder control due to the length of time spent laying still for each session.

User

Posted 28 Apr 2026 at 13:42

After the success of the PACE-B trial a couple of years ago, in one of my local support groups we've had 3 people do the 5-session SABR treatment, which is often offered to same patients as seed brachytherapy which they were all offered too, but all chose SABR.

The reported side effects are similar to but less than the regular 20-session radiotherapy. The 5 sessions are either done every weekday for a week split over a weekend, or every alternate weekday over 2 weeks (depends on the hospital).

One of the things about radiotherapy is the side effects lag about 2 weeks behind the treatment, so these short treatment regimes tend to mean the side effects happen after the treatment, rather than during the treatment. At least with these 3 patients, the side effects were at the lower end of what I tend to see with the regular 20-session radiotherapy. These would be urgency mainly, and some change to bowel behaviour. Side effects peak a a couple of weeks after treatment and then tend to subside.

User

Posted 06 Jul 2026 at 22:39

Hi Casbar,

I've had my first PSA test since treatment and that came back as 2.2, I'm due to review this with my consultant at the beginning of August but I'm pretty happy that it's dropped so quickly.

I tried to ween off the Tamsulosin but I noticed my flow slowing down a bit so I'm back on them daily.

My blood pressure is a bit higher than normal which I'm getting checked out. I don't know if this is related at all.

Apart from that everything else seems to be good and back to normal.

User

Posted 14 Sep 2026 at 16:49

😂

User

Posted 15 Sep 2026 at 20:58

Adrian, impressed at your skill with lyrics. But.... don't call us we'll call you.

Sian, thanks. So the study is really just looking at the radiotherapy regimes. Very encouraging.

Show Most Thanked Posts

User

Posted 26 Apr 2026 at 11:04

Hi, Gee.

Im sorry that youve had to join oir club, but welcome to the forum, mate.

I'm a regular on here and have found it surprising, despite it being a relatively new treatment, how little feedback we've had on SABR five day treatment. It sounds a great innovation to me.

Here's a decent video comparing all treatment options and possible side effects.

https://youtu.be/zYTU94-8pTc?si=xW83bOb0AVFQFD2l

Good luck with whatever you chose.👍

User

Posted 27 Apr 2026 at 15:59

Hi Gee,

I'm sorry to hear that you've joined the club

I was diagnosed last year and all options were on the table for me.

I took a few months to research them and decided that I wanted to act now and chose SABR, 5 day treatment (over 10 days) on an MR-Linac machine.

I completed the treatment 8 weeks ago. I found the treatment challenging as I'm not keen on confined spaces and you can be in the machine for up to an hour depending on how much mapping they need to do. You also need a pretty full bladder which can get a bit uncomfortable.

The immediate side effects were: it was very painful to pass urine and the flow was very weak, which made it even more painful. I was given Tamsulosin and that cleared it all up pretty much the next day. Apart from an occasional bit of fatigue and still taking the Tamsulsoin, I have no side effects.

I've had my six week review with the consultant and the procedure all went to plan, I'm now weening myself off the tablets and I'm due to take a PSA test next week.

I'm really pleased that I chose this option but I would advise taking your time, research all the options and decide what's best for you.

If you have any other questions fire away

Thanks

Paul

User

Posted 27 Apr 2026 at 18:53

Hi thanks of the reply.

Did they perform a urine flow test and check for emptying of the bladder with ultra sound prior to treatment. I have to have these undertaken before they will undertake either SABR or Brachy.

Have been told that if not at acceptable level then treatment is not an option. This is concerning as I don't think I have a limited flow but that is subjective really.

If not suitable then it pushes me towards removal which i am not favouring to be honest

User

Posted 27 Apr 2026 at 20:00

No I didn’t have either of those and they were never mentioned to me.

I would say that my flow wasn’t too great before the treatment. But the main concern for my consultant was bladder control due to the length of time spent laying still for each session.

User

Posted 28 Apr 2026 at 13:42

User

Posted 30 Apr 2026 at 08:00

I am undergoing SABR at the moment for mets to the sternum and hip. After Mondays session, about two hours later, I felt like I had had maybe half a glass of wine too much other than that no problems. The same thing yesterday after my second treatment, this morning however I feel like I have spent the whole night in the gym.God only knows what I will be like after a Fridays session. I am only having three fractions to each site, If you have the same reaction as me with five factions I would lan on spending a couple of weeks on the sofa, and that is if you can get out of bed. Good luck with the treatment.

User

Posted 30 Apr 2026 at 09:08

If I may ask why do youbnot do active surveillance. You say its an option.

User

Posted 02 May 2026 at 16:30

Originally Posted by: Online Community Member

If I may ask why do youbnot do active surveillance. You say its an option.

Hi I must admit Its a consideration, but the urologist and nurse reckon just putting off inevitable and if delay too long that hormone therapy will be needed and additional side effects would be had.

They can't give a ball park figure of how long I could do it for and not sure I can just sit and wait......

User

Posted 06 Jul 2026 at 21:02

Paul, any update on how you are doing after SABR. I have offered SABR or Surgery, trying to decide. Thanks

User

Posted 06 Jul 2026 at 22:39

Hi Casbar,

I've had my first PSA test since treatment and that came back as 2.2, I'm due to review this with my consultant at the beginning of August but I'm pretty happy that it's dropped so quickly.

I tried to ween off the Tamsulosin but I noticed my flow slowing down a bit so I'm back on them daily.

My blood pressure is a bit higher than normal which I'm getting checked out. I don't know if this is related at all.

Apart from that everything else seems to be good and back to normal.

User

Posted 14 Sep 2026 at 14:54

High-quality evidence about long-term side effects from SBRT/SABR

Hello all!

I hope you find this useful!

Article here:

https://www.sciencedirect.com/science/article/pii/S0302283826022128

Accompanying "waffle plots" here

https://siancooper.github.io/PACE-B-PROMs/

Surgical outcomes here:

https://www.sciencedirect.com/science/article/pii/S2666168324003665

Best,

Sian

The Royal Marsden Hospital/Institute of Cancer Research

User

Posted 14 Sep 2026 at 16:48

Originally Posted by: Online Community Member

I'm an oncologist involved in research.

Wow! Welcome! Your private messages inbox will be full with in seconds. 🙂

User

Posted 14 Sep 2026 at 16:49

😂

User

Posted 14 Sep 2026 at 21:03

Thanks Sian, it is really appreciated to hear results direct from the investigator.

What doesn't seem to be mentioned in that study is whether the subjects had androgen deprivation therapy alongside their radiotherapy. It seems from what I read to be standard for 39- or 20-fraction RT but not for the newer hypofractionated (5-fraction) RT. It may make a difference since anecdotal evidence from patients on this forum suggest a fair proportion of men don't get full testosterone recovery after ADT, which would have an effect on the erectile side effect data.

My advice to newcomers to the forum, who are usually facing the dilemma of which treatment to choose, has been that the two main alternatives of surgery and RT have very similar success rates in terms of cancer recurrence, and the main difference is in the nature and timing of side effects. With the caveat that 5- and 10-year follow-up data is inevitably looking at the technology of a few years ago and things have moved on particularly in RT. It is good to be able to advise those people that the newer 5 fraction approach works as well as 20 or 39.

(On a personal level I experienced RT as salvage treatment following biochemical recurrence after prostatectomy. RT seems to have dealt with that - so far, I have a blood test next week - but exacerbated side effects. As with many men the sexual side is most frustrating hence my question about whether that is primarily due to the radiation or to the concurrent ADT).

User

Posted 15 Sep 2026 at 08:28

Good morning,

Apologies, yes, that was an oversight on my part to clarify that. PACE-B did not allow androgen deprivation therapy as part of the trial. Hope you are all well.

Best wishes,

Sian

User

Posted 15 Sep 2026 at 09:48

The trial results are very promising. SBRT obviously reduces hospital visits and must save NHS costs, without losing efficacy or exacerbating the side effects of conventional radiotherapy.

For those considering SBRT as a primary treatment. This appears to be the general criteria:

Strong consensus in favour of recommending prostate SBRT as standard treatment for patients with ISUP 2 to 3, cT1c to cT2c prostate cancer with a PSA-value <20 ng/mL. Experts treating patients with high-risk disease report that prostate SBRT is generally reserved for cases without a combination of multiple high-risk factors.

Localised disease, typically clinical T1-T2 stage, with a low likelihood of extra-capsular extension, a ISUP Grade Group 2–3, PSA levels <20 ng/mL represents the clinical scenario with the strongest evidence supporting SBRT. Although a large amount of literature is based on data coming from patients with low- and intermediate-risk prostate cancer, the increasing role of active surveillance in low-risk cases means that SBRT will mainly be used for NCCN intermediate-risk prostate cancer

https://www.thegreenjournal.com/article/S0167-8140(26)00549-9/fulltext

Unfortunately, with a high Gleason score and T3a staging, it wasn't a suitable treatment option for me. However, I've always been a big fan of it. So much so, that I adapted the lyrics of Mary Poppins Supercalifragilisticexpialidocious to sing it praises. 🙂

🎵 It's Ultra-hypo-fractionated-stereotactic radiation.

Even though the sound of it can cause intrepidation.

If you say it loud enough, it'll help eradication.

Ultra-hypo-fractionated-stereotactic-radiation.

Um-dittle-ittl-um-dittle-I

Um-dittle-ittl-um-dittle-I 🎵

Edited by member 15 Sep 2026 at 12:51 | Reason: Additional text

User

Posted 15 Sep 2026 at 20:58

Adrian, impressed at your skill with lyrics. But.... don't call us we'll call you.

Sian, thanks. So the study is really just looking at the radiotherapy regimes. Very encouraging.

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