This is an update of a 2018 report that evaluated three technologies: irreversible electroporation (IRE), stereotactic radiation therapy (SBRT) and proton therapy (PT) for the treatment of localised prostate cancer (PCa) in terms of efficacy and safety.

No new RCTs were found for IRE and PT. Due to the absence of comparative studies, it was not possible to draw conclusions about the effectiveness of IRE and PT in terms of survival and quality of life. The evidence from five large observational studies (846 patients) on IRE remains very limited and insufficient to conclude on toxicity too. For PT, eight observational studies (5,514 patients) revealed varying trends in GI and GU toxicities, with long-term follow-up indicating persistent GI symptoms and a notable increase in severe GU toxicities, highlighting the need for ongoing monitoring.

For SBRT, three new RCTs (2,138 patients) and two observational studies (460 patients) were analysed. The findings indicate that the survival rates for SBRT compared to conventional fractionation—a type of external radiation therapy—exhibit minor and statistically insignificant differences after two and five years. However, cumulative Grade ≥1 GI toxicity was significantly lower in the SBRT group than in the control group both at the end of treatment and after one year. Initial GU toxicities were also lower in the SBRT group, though these differences were not statistically significant after one year. Observational studies further supported these results by reporting low acute GU toxicities shortly after treatment, aligning with the overall trends observed in the RCTs three months post-treatment.

Overall, the review results are in line with current clinical guidelines, but the evidence is not sufficient to conclude that IRE, SBRT, or PT can replace radical invasive procedures. The existing evidence suggests that SBRT is not inferior to conventional fractionation in terms of survival rates for patients with low to medium risk. Further high-quality research is required to assess the long-term effectiveness and safety of these therapies. Several relevant studies are currently underway that should provide additional data.