A trial comparing surgery, conventional radiotherapy and stereotactic radiotherapy for localised prostate cancer (PACE)

Cancer type:

Prostate cancer




Phase 3

This trial is looking at a type of radiotherapy called stereotactic radiotherapy and comparing it with either conventional radiotherapy or surgery. It is for men who have been diagnosed with prostate cancer that has not grown outside the prostate gland (localised prostate cancer). The trial is supported by Cancer Research UK.

More about this trial

If prostate cancer is diagnosed before it has spread outside the prostate gland, there are several treatment options including surgery to remove the prostate gland, external radiotherapy and internal radiotherapy (brachytherapy). Some men may now also be offered a new way of having external radiotherapy called stereotactic radiotherapy. You have stereotactic radiotherapy over a shorter period of time than conventional radiotherapy.

All of the treatments listed above work well, but doctors don’t know if one is better than the other or which one has the fewest side effects.

In this trial, some men will have keyhole surgery to remove the prostate gland (laparoscopic prostatectomy), some will have conventional radiotherapy and some will have stereotactic radiotherapy.

The aim of the study is to compare the different treatments to find out

  • How long men live after each treatment without any sign of their cancer coming back
  • More about the side effects of each treatment

Who can enter

You may be able to enter this trial if you

  • Have been diagnosed with prostate cancer by having a prostate biopsy during which the doctor was able to take at least 10 samples from your prostate gland
  • Have cancer that is completely contained within your prostate gland (stage T1or T2) and has not spread to lymph nodes Open a glossary item nearby or to other parts of your body
  • Have a Gleason score that is no more than 3+4 (your doctor can advise you about this)
  • Have a PSA level Open a glossary item of no more than 20 and your doctors think your cancer is low or intermediate risk
  • Are well enough to be up and about for at least half the day (performance status 0, 1 or 2)
  • Are at least 18 years old

You cannot enter this trial if you

  • Have had any other type of cancer in the last 2 years apart from non melanoma skin cancer
  • Have already had radiotherapy to the area between your hip bones (your pelvis Open a glossary item)
  • Have already had hormone therapy
  • Have had any other type of treatment for prostate cancer
  • Have had both your hips replaced or have had any other type of medical implant that could affect a CT scan
  • Have any other medical condition that means your doctors would not recommend you have radiotherapy
  • Are having treatment for prostate cancer as part of another clinical trial

Trial design

This phase 3 trial aims to recruit more than 1,700 men with localised prostate cancer. It is a randomised trial. The men taking part are put into treatment groups by a computer. Neither you nor your doctor will be able to decide which group you are in.

Before you agree to join the trial, your doctors will have discussed the different treatment options available to you.

If surgery would be an option for you and you agree to take part in the trial, you will have either surgery or stereotactic radiotherapy.

If you join the trial but you or your doctors don’t think surgery would be an option for you, then you have either conventional radiotherapy or stereotactic radiotherapy.

PACE study diagram

If you have conventional radiotherapy, you have treatment each day (Monday to Friday) for nearly 8 weeks. If you have stereotactic radiotherapy, you have 5 treatments over 1 to 2 weeks.

The trial team will ask you to fill out a questionnaire before you know which treatment group you are in, every 6 months for the 1st year and once a year after that. The questionnaire will ask about side effects and how you’ve been feeling.  This is called a quality of life study. There will also be questionnaires about specific side effects to complete more frequently.

Hospital visits

You see the trial team and have some tests before you start treatment. The tests include

If you are having surgery, you also have a hospital appointment called a pre assessment. This is to check that you are fit enough to have an operation. When you have your surgery, you stay in hospital for a few days.

If you are going to have either type of radiotherapy, you may have 3 to 4 small grains of gold put into your prostate to monitor the position of the gland during radiotherapy.

Having the gold grains put in is a bit like having a prostate biopsy. The doctor puts a probe into your back passage to guide them when placing the grains. It takes about 20 minutes and you can go home afterwards.

At least 7 days later, you have a CT scan and an MRI scan – both on the same day. Doctors will use images from these scans to plan your radiotherapy.

If you have conventional radiotherapy, you go to hospital everyday for nearly 8 weeks. Each treatments lasts about 15 minutes.

If you have stereotactic radiotherapy, you go to hospital 5 times over 1 to 2 weeks. Each treatment lasts between 20 minutes and an hour.

Side effects

The most common short term side effects of either conventional or stereotactic radiotherapy to the prostate include

The most common long term side effects of radiotherapy include

The side effects of surgery to remove your prostate gland include

  • Pain after the operation (this can usually be well controlled with painkillers)
  • Infertility
  • Erection problems
  • Temporary incontinence

We have more information about


Newcastle upon Tyne

Recruitment start:

Recruitment end:

How to join a clinical trial

Please note: In order to join a trial you will need to discuss it with your doctor, unless otherwise specified.

Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Chief Investigator

Dr Nicholas van As

Supported by

Accuray Incorporated
Cancer Research UK
Institute of Cancer Research (ICR)
NIHR Clinical Research Network: Cancer
The Royal Marsden NHS Foundation Trust

Other information

This is Cancer Research UK trial number CRUKE/12/025.

Questions about cancer? Contact our information nurses

Freephone 0808 800 4040

Last review date

CRUK internal database number:


Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Keith took part in a trial looking into hormone therapy

A picture of Keith

"Health wise I am feeling great. I am a big supporter of trials - it allows new treatments and drugs to be brought in.”

Last reviewed:

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