Prostate cancer SBRT (stereotactic body radiotherapy) is a modern radiotherapy that concentrates a high dose precisely and finishes in 5 sessions over 1–2 weeks. In the phase 3 PACE-B trial, run at 38 hospitals in the UK, Ireland and Canada, 874 low- and intermediate-risk patients were compared: 95.8% of the 5-session group and 94.6% of the conventional 20–39-session group were free of recurrence at 5 years, an equivalent result (NEJM, October 2024). In Japan, SBRT for localized prostate cancer has an official insurance fee, and many hospitals offer it. This guide compares SBRT with carbon ion cancer treatment and proton therapy by eligibility, schedule and cost. If you want to know which option fits your PSA and Gleason score, send your records through our prostate cancer radiotherapy and cost consultation.
What is SBRT for prostate cancer?
Conventional prostate radiotherapy divides the dose into small daily fractions over 4 to 8 weeks. SBRT raises the dose per session and reduces the course to 5 sessions. In PACE-B, a total of 36.25 Gy was given in 5 fractions within 1–2 weeks.
Because each session carries a large dose, positioning must be exact. Images confirm the prostate position at every session, and the machine follows or pauses the beam if the prostate moves with breathing or bowel motion. CyberKnife is a well-known system, and image-guided high-precision linear accelerators (linacs) deliver the same treatment. Some hospitals first place gold fiducial markers or a spacer between the rectum and the prostate.
SBRT uses X-rays (photons). It differs from carbon ion therapy, which uses carbon ions, and proton therapy, which uses hydrogen nuclei. See What Is Carbon Ion Therapy? for how particle beams work.
Five-session results: the PACE-B phase 3 trial
PACE-B was a randomized phase 3 trial led by The Royal Marsden and The Institute of Cancer Research (ICR), London. From 2012 to 2018 it enrolled 874 men: 433 received 5-session SBRT and 441 received conventional treatment (62 Gy in 20 fractions or 78 Gy in 39 fractions). Hormone therapy was not used. Median follow-up was 74 months, about 6 years.
| Outcome (5 years) | SBRT, 5 sessions | Conventional, 20–39 sessions |
|---|---|---|
| Free of biochemical or clinical failure | 95.8% | 94.6% |
| Treatment period | 1–2 weeks | 4 to 7.5 weeks |
| Late grade 2+ urinary effects | 26.9% | 18.3% |
| Late grade 2+ bowel effects | 10.7% | 10.2% |
| Erectile dysfunction | 26.4% | 29.1% |
The trial met its non-inferiority goal: 5 sessions worked as well as the conventional course. There were 26 failures in the SBRT group and 36 in the control group. Chief investigator Professor Nicholas van As said that delivering treatment "just as effectively in five days as opposed to four weeks is hugely significant." Hospital visits drop to about a quarter, which helps patients keep their work and daily life.
Urinary frequency and urgency were somewhat more common after SBRT and are usually managed with medicine and lifestyle measures. Bowel effects and erectile function were similar between groups. Keeping a symptom diary before and after treatment makes management easier.
Who is eligible?
PACE-B enrolled patients with localized, non-metastatic low- or intermediate-risk prostate cancer: Gleason score 3+4 or lower and PSA 20 or lower. Japan's insurance fee schedule also lists "localized prostate cancer without metastasis" as an SBRT indication.
- Likely candidates: no metastasis, Gleason 6–7 (3+4), PSA 20 or lower, and a wish to avoid major surgery or keep treatment short
- Needs separate review: high risk (Gleason 8 or higher, PSA above 20, T3 or beyond), severe urinary symptoms, a very large prostate, or previous pelvic radiotherapy
High-risk disease still has options. Carbon ion cancer treatment in Japan accepts non-metastatic patients from T1c to T4 and combines hormone therapy according to risk. See eligibility for carbon ion therapy for prostate cancer and prostate cancer carbon ion therapy schedule and cost.
How does it differ from carbon ion and proton therapy?
All three treat prostate cancer with radiation and without surgery. They differ in the type of radiation, the number of sessions, access for overseas patients and cost. The table uses figures published by each institution.
| Item | SBRT | Proton therapy | Carbon ion therapy |
|---|---|---|---|
| Radiation | X-rays (photons) | Protons (hydrogen nuclei) | Carbon ions |
| Sessions and period | 5 sessions, 1–2 weeks | Set by hospital and risk group | About 3 weeks at QST Hospital |
| Main candidates | Low and intermediate risk (PACE-B) | Localized and locally advanced (insured in Japan) | T1c–T4 without metastasis, including high risk |
| Centers in Japan | Many hospitals registered for SBRT | Proton centers (e.g., National Cancer Center Hospital East) | 7 carbon ion centers (e.g., QST Hospital) |
| Published fee for overseas patients | No fixed fee; insurance points × hospital rate | 3.9 to 4.8 million yen (NCC Hospital East) | 5.786 million yen incl. tax (QST Hospital) |
Particle beams release their energy at a set depth and stop (the Bragg peak), lowering the dose to organs behind the tumor. Carbon ions are especially strong at damaging cancer cells, which allows fewer sessions and, with hormone therapy, treatment of high-risk patients. SBRT uses X-rays but achieves a short schedule through precise image guidance, and because many hospitals offer it, scheduling is often easier. For more on carbon ions and protons, read carbon ion vs proton therapy.
Cost structure in Japan
Overseas patients have no Japanese public insurance and are treated as self-pay. Costs are either calculated from a hospital rate per medical fee point or, as with particle therapy, published as a bundled treatment fee.
- SBRT technical fee: in Japan's 2026 medical fee schedule, SBRT is 63,000 points per course. Treatment spread over several days is counted once per course.
- Example rates for foreign patients: National Cancer Center Hospital East charges uninsured patients 30 yen per point plus consumption tax (updated March 3, 2026). At that rate the technical fee alone is 63,000 × 30 = 1.89 million yen. Another example: Saku Central Hospital applies 14 yen per point from July 13, 2026. Rates differ by hospital, so the treating hospital sets the actual estimate.
- Separate costs: planning CT and MRI, consultations, fiducial marker placement, follow-up tests, medical coordinator fee, interpreting, accommodation and flights
- Particle therapy for comparison: QST Hospital carbon ion therapy 5.786 million yen including tax (updated May 27, 2026; other care 33 yen per point); NCC Hospital East proton therapy 3.9 to 4.8 million yen (updated March 3, 2026)
Total cost can differ several-fold depending on the treatment that fits you. Send your diagnosis and PSA history and we will outline the options and how to obtain estimates before you consult a Japanese hospital. Request a cost comparison consultation
Schedule and what to prepare
SBRT itself takes 1–2 weeks, but with the first visit, planning scans and the settling period after marker placement, a stay in Japan is usually planned for several weeks. Some hospitals allow you to return home after the first visit and come back for treatment. Preparing these records speeds up hospital review:
- Biopsy pathology report (Gleason score, number of positive cores)
- PSA history (ideally the past year)
- Pelvic MRI and staging images such as a bone scan or PSMA PET (CD or files)
- Current medicines, hormone therapy status and urinary symptom records
- Records of previous surgery or radiotherapy
For translation and imaging files, see documents for carbon ion therapy. Contact details for Japanese institutions are in Japanese Institutions.
Frequently asked questions
Is prostate SBRT really finished in 5 sessions?
In PACE-B, 36.25 Gy was given in 5 fractions within 1–2 weeks, and 95.8% were free of recurrence at 5 years, equivalent to conventional 20–39 sessions (94.6%). Pre-treatment tests and follow-up visits are separate.
Are CyberKnife and SBRT the same thing?
SBRT is the name of the treatment method; CyberKnife is one machine that delivers it. Image-guided linear accelerators deliver the same treatment.
Can high-risk prostate cancer be treated with SBRT?
PACE-B included only low- and intermediate-risk patients. For high risk, it is worth reviewing carbon ion cancer treatment with hormone therapy and other options. Japanese carbon ion centers accept non-metastatic patients up to T4.
How do costs of carbon ion therapy in Japan and SBRT compare?
QST Hospital publishes 5.786 million yen including tax for carbon ion therapy. SBRT has no fixed fee: 63,000 insurance points are multiplied by the hospital rate, giving a 1.89 million yen technical fee at 30 yen per point. Tests and living costs are extra for both.
How are urinary symptoms managed after treatment?
Frequency and urgency are the most common and are managed with medicine and fluid habits. In PACE-B, grade 2+ urinary effects occurred in 26.9% after SBRT, while bowel effects (10.7%) and erectile dysfunction (26.4%) were similar to conventional treatment.
Related articles
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- Phase 3 Trial of Stereotactic Body Radiotherapy in Localized Prostate Cancer (PACE-B), N Engl J Med 2024 — abstract
- The Institute of Cancer Research, London — PACE-B 5-year results (2024-10)
- Urology Times — PACE-B: five-fraction SBRT noninferior (874 patients, 38 centers)
- Japan medical fee schedule 2026, M001-3 stereotactic radiotherapy 63,000 points
- National Cancer Center Hospital East — foreign patients, fees (updated 2026-03-03)
- National Cancer Center Hospital East — proton therapy insurance and fees
- QST Hospital — For patients from abroad (updated 2026-05-27)
- Saku Central Hospital — self-pay rate for uninsured foreign patients (from 2026-07-13)
General information based on public sources; not a substitute for diagnosis or treatment. Eligibility is decided by the treating physicians. Written by the FTH editorial team.