ClinicalTrials.gg
RecruitingNCT06834152X-SMILEUpdated Jul 6, 2026

Online Adaptive Stereotactic Body Radiotherapy for Localized Prostate Cancer

An observational study in Localized Prostate Carcinoma, Prostate Cancer (Adenocarcinoma) and Prostate Hyperplasia, sponsored by University of Zurich. Recruiting at 3 sites in 2 countries. Open to male participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-07-06.

Sponsored by University of Zurich · Observational

From the registry’s dates

  • Started Mar 2024; still recruiting 2 years 8 months later.
Study type
Observational
Model
Case-only
Time perspective
Prospective
Enrollment
75
Ages
18 Years and older
Sex
Male
01

Where this study stands

Counted across the records on this site · 2026-11-13

Among 332 studies in Prostatic Neoplasms with a site in Germany — 70 open to participants now, 116 under way, 36 of them phase 3. Prostatic Neoplasms · Germany.

Planned enrollment
54th of 61
75 · median 461
Started
2024
with 23 others
Observational
61 of 332
20 open now
Primary completion
2026-09
later than 32 of 115 live
Registered
292nd of 332
by date

Among the 332 studies in Prostatic Neoplasms with a site in Germany, this one is the 54th largest by planned enrollment of the 61 observational ones that give a count, is one of 24 that started in 2024, is one of 61 observational ones, reaches primary completion later than 32 of the 115 other live ones, and was the 292nd registered.

Prostatic Neoplasms

7,046 studies on the registry are indexed under Prostatic Neoplasms; 1,579 are open to participants now.

Browse Prostatic Neoplasms studies →

Open to participants now

70 of the 332 studies in Prostatic Neoplasms with a site in Germany are open now. Recruiting first, the newest first:

65 more — sign in →

All 70 open studies →

A study can be open while its sites in Germany have not opened yet or have stopped. Only those recruiting at a site in Germany →

Who these studies take

Of the 1,228 Prostatic Neoplasms studies recruiting now, 927 (75%) set no upper age limit and 76 (6%) stop at 75 or younger; 67 take children under 18; 82 take healthy volunteers.

This study: 18 Years and older · male · no healthy volunteers.

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Watch this landscapeDownload CSVNarrow it in search →With an account: a weekly mail of what changed among 332 studies in Prostatic Neoplasms with a site in Germany, or all of them as a file.
02

Study summary

The aim of this phase II international multicenter study is to evaluate the safety, feasibility, and efficacy of CT or MRI-adaptive SBRT, delivered in five weekly fractions, in patients with newly diagnosed localized prostate cancer who have lower urinary tract symptoms and/or prostatic hyperplasia.

Read the detailed description

Background: Stereotactic body radiotherapy (SBRT) for localized prostate cancer has demonstrated non-inferior oncological outcomes and toxicity profiles to conventionally or moderately hypofractioned radiotherapy regimens, while offering the advantage of shorter treatment durations. However, SBRT may not be suitable for all patients, particularly those with lower urogenital tract symptoms and/or prostatic hyperplasia.

Methods: This study aims to evaluate the safety and efficacy of weekly computed tomography (CT) or magnetic resonance image-guided (MRI) online adaptive SBRT in patients with intermediate to (very) high-risk localized prostate cancer who present with lower urinary tract symptoms (International Prostate Symptom Score [IPSS] > 12) and/or have prostate hyperplasia (prostate volume >60 mL). The primary outcome measure is urogenital toxicity grade ≥3 within 3 months after completion of SBRT (according to CTCAE V5.0 and RTOG) or discontinuation of therapy. Our aim is to show that the event rate is at 3% below a clinically acceptable threshold, which is set at 20%. Under the null hypothesis, this design with an alpha of 0.05 and power of 80% results in an expected number of cases of 30. In our validation cohort we assume that around 3% of patients will have grade 3 long-term urogenital toxicity (i.e. 2 patients). The rate of treatment discontinuation within 3 months is considered negligible. Our aim is to show with high probability, that the event rate is below a clinically acceptable threshold, which is set at 12%. Under the null hypothesis, this design with an alpha of 0.05 and power of 80% results in an expected number of cases of 75.

03

Conditions studied

  • Localized Prostate Carcinoma
  • Prostate Cancer (Adenocarcinoma)
  • Prostate Hyperplasia
  • Lower Urinary Track Symptoms

Keywords

  • radiotherapy
  • SBRT
  • MRI
  • CT
  • stereotactic radiotherapy
  • localized prostate cancer
  • lower urinary tract symptoms
  • prostate hyperplasia
  • prostate cancer
04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
Male
Accepts healthy volunteers
No
Sampling method
Non-probability sample

Study population

This international multicenter prospective phase II study, conducted in collaboration with several academic hospitals in Switzerland and Germany, will include patients with histologically confirmed intermediate to (very) high risk localized prostate cancer with lower urinary tract symptoms and/or prostate hyperplasia. These patients are planned to receive weekly CT or MRI online adaptive SBRT for localized prostate cancer.

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • confirmed localized prostate cancer
  • planned treatment is SBRT according to standard of care and consists of definitive CT or MRI online adaptive SBRT of the prostate according to the PACE trial which includes a total dose to clinical target volume 1 (CTV1, i.e. prostate and proximal 1 cm of the seminal vesicle) of 40.0 Gy in 5 weekly fractions (single dose of 8.0 Gy) and total dose to planning target volume 1 (PTV1) of 37.5 Gy in 5 weekly fractions (single dose of 7.5 Gy) with a compromise for bowel sparing allowed. For patients with unfavorable intermediate to very high-risk disease (according to NCCN guidelines) a total dose to the planning target volume 2 (PTV2, i.e. proximal 1-2 cm of the seminal vesicle) of 32.5 Gy in 5 weekly fractions (single dose of 6.5 Gy) will be delivered.
  • intermediate to (very) high risk localized prostate cancer (≤ cT3a and Gleason score ≤ 9 and/or PSA ≤ 20 ng/ml)
  • prostate volume > 60 cc and/or IPSS > 12;

Exclusion criteria

Exclusion Criteria:

  • Very high risk localized prostate cancer with indication for ADT and ARPI (i.e. Gleason ≥ 8 and cT3a)
  • Involvement of seminal vesicles (cT3b)
  • against definitive CT or MRI-adaptive radiotherapy of the prostate, e.g. inflammatory bowel disease (IBD); previous radiotherapy in the pelvis, previous local radiotherapy of the prostate, contraindication for MRI or CT;
  • Patients with severe genitourinary symptoms (e.g. recent urinary retention ≥ grade 3 according v.5.0);
  • Lymph node or distant metastases (i.e. no localised prostate cancer);
  • Participation in a clinical trial which might influence the results of this project.
Terms in these criteria, in plain language(4)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Histologically or cytologically confirmed

The diagnosis was confirmed by looking at a sample under a microscope: tissue from a biopsy or surgery (histology), or cells from a fluid or needle sample (cytology).

Your pathology report is the document that shows this.

Contraindication

A reason a treatment, test or procedure should not be given to a particular person, such as an allergy, another illness or a medicine they take.

CTCAE grade

The US National Cancer Institute’s scale of how severe an adverse event is — any unwanted medical event during a study, such as a symptom, an illness or an abnormal test result, whether or not a treatment caused it. Whether it did is judged separately.

1
Mild.
2
Moderate.
3
Severe.
4
Life-threatening.
5
Death due to the event.

“Side effects of earlier treatment resolved to grade 1 or less” means they have settled to mild or gone.

Metastases

Cancer that has spread from where it began to other parts of the body. “Metastatic” cancer is cancer that has spread this way.

05

Study design

Observational model
Case-only
Time perspective
Prospective
Enrollment
75 participants (estimated)
Patient registry
No

Groups and cohorts

  • Pilot study

    For our pilot study, we assumed that around 3% of patients would have grade 3 acute urogenital toxicity (i.e. 1 patient). The rate of treatment discontinuation within 3 months was considered negligible. Our aim was to show with high probability, that the event rate was below a clinically acceptable threshold, which was set at 20%. Under the null hypothesis, this design with an alpha of 0.05 and power of 80% results in an expected number of cases of 30. Dropouts prior to treatment start will be replaced.

    Radiation: radiotherapy

  • Validation Cohort

    For our validation study, we assume that around 3% of patients will have grade 3 long-term urogenital toxicity (i.e. 2 patients). The rate of treatment discontinuation within 3 months is considered negligible. Our aim is to show with high probability, that the event rate is below a clinically acceptable threshold, which is set at 12%. Under the null hypothesis, this design with an alpha of 0.05 and power of 80% results in an expected number of cases of 75. Dropouts prior to treatment start will be replaced.

    Radiation: radiotherapy

Interventions

  • Radiationradiotherapy

    Patients with prostate cancer in the medium or high risk range who are planned to receive definitive CT or MRI-adaptive SBRT.

06

What researchers measure

Primary outcomes

  1. acute grade ≥ III urogenital toxicity

    The primary endpoint is acute grade ≥ III urogenital toxicity ≤3 months after completion of radiotherapy (according to the NCI CTCAE V5 or RTOG) or treatment discontinuation related to treatment.

    Time frame: ≤ 3 months after completion of radiotherapy

Secondary outcomes

  1. Gastrointestinal toxicity of grade ≥3

    Gastrointestinal toxicity of grade ≥3 within 3 months after completion of radiotherapy (according to CTCAE V5.0 and RTOG)

    Time frame: ≤ 3 months after completion of radiotherapy

  2. Mortality

    Mortality (related to treatment and/or disease).

    Time frame: ≤1 year after initiation of radiotherapy

  3. Urogenital and gastrointestinal toxicities

    Number of urogenital and gastrointestinal toxicities within 5 years after completion of radiotherapy and their severity.

    Time frame: ≤ 5 years after completion of radiotherapy

  4. Biochemical progression-free survival

    Biochemical progression-free survival (determined from the start of therapy until the occurrence of PSA recurrence according to the Phoenix criteria i.e. post- therapeutic PSA nadir + 2 ng/ml),

    Time frame: ≤ 5 years after completion of radiotherapy

  5. Hormonal therapy-free survival

    Hormonal therapy-free survival (determined from the start of therapy until the start of hormonal therapy,

    Time frame: ≤ 5 years after completion of radiotherapy

  6. Overall survival

    overall survival (defined from the start of therapy until death or censoring)

    Time frame: 5 years after completion of radiotherapy

  7. Quality-of-life questionnaire C-30 from the European Organisation for Research and Treatment of Cancer

    Quality-of-life measured using the EORTC QLQ-C30 questionnaire during and after treatment All of the scales and single-item measures range in score from 0 to 100. A high scale score represents a higher response level. Thus a high score for a functional scale represents a high/healthy level of functioning, a high score for the global health status/QoL represents a high QoL, but a high score for a symptom scale/item represents a high level of symptomatology/problems.

    Time frame: ≤ 5 years after completion of radiotherapy

  8. Uroflowmetry (optional)

    Uroflowmetry prior to the start of radiotherapy (optional study procedure)

    Time frame: Uroflowmetry ≤ 6 weeks prior to the start of radiotherapy

  9. Quality-of-life questionnaire PR25 of the European Organisation for Research and Treatment of Cancer

    Quality-of-life measured using the QLQ-PR25 questionnaire during and after treatment All of the scales and single-item measures range in score from 0 to 100. A high score for the Sexual Activity and Sexual Functioning scales represents a high level of functioning, whereas a high score for the Urinary, Bowel, and Hormonal Treatment-Related symptoms scales and Incontinence Aid item represents a high level of symptomatology or problems.

    Time frame: ≤ 5 years after completion of radiotherapy

07

Study locations

1 of 3 sites recruiting
  • Klinik für Radioonkologie und Strahlentherapie, Universitätsklinikum Heidelberg
    Heidelberg, Baden-Wurttemberg 69120, Germany
    Not yet recruiting
  • Klinik und Poliklinik für Strahlentherapie und Radioonkologie, Universitätsklinikum LMU
    Munich, Bavaria 81377, Germany
    Not yet recruiting
  • University Hospital Zurich, Department of Radio-Oncology
    Zurich, Canton of Zurich 8090, Switzerland
    Recruiting
    • Matthias Guckenberger, Prof. Dr. med. · Contactmatthias.guckenberger@usz.ch · +41 44 255 31 50
    • Tiuri E. Kroese, MD PhD · Principal investigator
    • Matthias Guckenberger, Prof. Dr. med. · Principal investigator
08

References and documents

Publications

  • Kroese T, Andratschke N, Belka C, Corradini S, Marschner S, Liermann J, Horner-Rieber J, Fink C, Debus J, Silvia F, Tanadini-Lang S, Pouymayou B, Mencarelli A, Fesslmeier D, Schiess A, Guckenberger M, Mayinger M. Online adaptive stereotactic body radiotherapy for localized prostate cancer in patients with lower urinary tract symptoms and/or prostate hyperplasia (X-SMILE). Radiat Oncol. 2025 May 28;20(1):90. doi: 10.1186/s13014-025-02653-4. PubMed 40437508 ↗

Individual participant data

Plan to share: Yes — Individual participant data that underlie the results reported in this trial after de-identification. Other documents may be shared include the study protocol.

Supporting information: Study protocol

Time frame: Beginning 9 months and ending 36 months after article publication.

Access criteria: Proposals to access study data should send request to matthias.guckenberger@usz.ch. To gain access, data requesters must sign data access agreement.

09

Timeline

Tracking since Sep 25, 2026
ElapsedEstimatedEstimated, not yet reachedSimilar studies: half by the dot; the band is the middle halfHalf of similar studies reached it by the dot; the band is the middle half, from a quarter to three quarters

Started Mar 2024 (actual). Primary completion is estimated for Sep 2026, 30 months after the start.

Of 540 non-industry observational studies under Prostatic Neoplasms, half reached primary completion within 67 months of starting (the median), counting those still running; a quarter within 29 and three quarters within 162. This study's planned 30 months is below that.

Counting every sponsor, half of 649 studies reached it within 60 months; a quarter within 29 and three quarters within 141.

How these figures are worked out, and which studies are left out of them.

Registered
Feb 6, 2025
First posted
Feb 19, 2025
StartActual
Mar 1, 2024
Primary completionEst.
Sep 1, 2026
CompletionEst.
Jun 30, 2031
Last update
Jul 6, 2026
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
No changes since tracking began. The registry record was last updated on Jul 6, 2026, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT06834152
Responsible party
Sponsor
First posted
Feb 19, 2025
Start date
Mar 1, 2024
Primary completion
Sep 1, 2026 (estimated)
Completion
Jun 30, 2031 (estimated)
Last update
Jul 6, 2026

Study contacts

Radiation Oncology Study Office
Contact
RAO_akademischesoffice@usz.ch
+41442554108
Matthias Guckenberger, Prof. Dr. med.
study chair · University of Zurich
Tiuri E. Kroese, MD, PhD
principal investigator · University of Zurich
Matthias Guckenberger
principal investigator · University of Zurich

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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