KEY POINTS
- The cross-sectional survey was distributed to genitourinary radiation oncologists in Australia and New Zealand during July and August 2025. It received 53 responses from 31 institutions, representing a response rate of 28%.
- Forty-one respondents (77%) offered prostate stereotactic ablative radiotherapy as standard care. It was offered by 95% for favourable intermediate-risk, 90% for unfavourable intermediate-risk, 35% for favourable high-risk and 5% for other high-risk disease; none offered it routinely for node-positive disease.
- Two-thirds applied a prostate-volume limit, and no respondent routinely treated glands larger than 100 cm³. Most assessed baseline International Prostate Symptom Score, but approximately half did not use a defined exclusion threshold.
- Prostate SABR was offered by 66% in patients with hip replacements and by 57% after transurethral resection of the prostate. Almost all respondents treating after resection waited at least three months.
- Fiducial markers were routinely used by 86%. Rectal spacers were used routinely by 54% and selectively by another 32%, frequently depending on patient preference or insurance coverage. Every respondent routinely requested planning magnetic resonance imaging.
- The most common target included the prostate and proximal 1 cm of seminal vesicles, used by 81%. Planning target volume margins ranged from 3 to 5 mm, with 5 mm except 3 mm posteriorly used by 56%.
- The dominant prescription was 40 Gy to the clinical target volume and 36.25 Gy to the planning target volume in five fractions. Focal intraprostatic boosts were offered by 45%, most commonly to 42 or 45 Gy.
- Standard computed tomography-based linear accelerators were used by 88%, and 84% of these clinicians used intrafraction motion monitoring. Among the 12 respondents not offering SABR, the most frequently cited barrier was insufficient expertise (42%).
CLINICAL TAKEAWAY
Prostate SABR has moved into routine practice across much of Australia and New Zealand, but implementation has extended beyond the populations and techniques tested in the strongest randomized trials. The variation in high-risk treatment, focal boosting, margins, spacers and access-dependent imaging supports the need for the planned binational clinical-practice guideline.