--- title: "Prostate Cancer Treatment Without Surgery | St. George UT" description: "Non-surgical prostate cancer treatment in St. George, Utah - targeted radiation in as few as 5 sessions instead of 9 weeks. Call (435) 900-7060." canonical: https://www.5dcancerservices.com/adaptive-radiotherapy/prostate route: /adaptive-radiotherapy/prostate type: article lastUpdated: 2026-07-29 keywords: ["adaptive radiotherapy", "Akesis Gemini 360", "5D Cancer Services", "St. George Utah", "radiation oncology", "prostate cancer", "prostate SBRT", "prostate radiation", "PACE-B", "MIRAGE trial", "5 fraction prostate radiation"] --- # Prostate Cancer Treatment Without Surgery | St. George UT > Non-surgical prostate cancer treatment in St. George, Utah - targeted radiation in as few as 5 sessions instead of 9 weeks. Call (435) 900-7060. - HomeOur ApproachTreatment TypesFor PatientsOur Team (435) 900-7060Please do not send Protected Health Information (PHI) by email or voicemail. Standard email is not secure — call us and we will arrange a secure channel.Home - Adaptive Radiotherapy - Prostate CancerQuick summaryAdaptive SBRT for prostate cancer at 5D Cancer Services re-images the prostate at every session and adjusts the treatment plan before each beam delivery — accounting for daily shifts in prostate position caused by bladder and rectal filling. This precision enables treatment in as few as 5 sessions with fewer urinary and bowel side effects than conventional radiation. - Prostate shifts 5–15 mm daily due to bladder and rectal filling - Adaptive SBRT: 5 sessions over 1–2 weeks vs. 20–45 conventional fractions - MIRAGE trial: image-guided SBRT reduced acute GU toxicity by 68% vs. CT-guided SBRT - PACE-B trial: 5-fraction SBRT non-inferior to 39-fraction IMRT (Lancet Oncol 2019) - Daily CBCT on the Gemini 360 re-centers the plan on today's prostate anatomy - Delivered at 5D Cancer Services, St. George, Utah — serving UT, NV, AZLast reviewed: 2026-06-08 Medically reviewed by Ritchie Stevens, MD, Radiation Oncologist on June 8, 2026. Adaptive Radiotherapy # Prostate cancer treatment without surgery - in as few as 5 sessions The prostate shifts daily — sometimes by more than a centimeter — due to changes in bladder and rectal filling. Conventional radiation treats a fixed plan that can't account for this movement. Adaptive SBRT on the Akesis Gemini 360 re-images and re-plans at every session, placing the dose where the prostate actually is that day. [Call (435) 900-7060](tel:+14359007060)[Prostate Cancer overview](/conditions/prostate-cancer) As few as 5 sessions — outpatient, no hospital stay ## Prostate cancer treatment options in St. George, Utah If you have just been diagnosed with localized prostate cancer, you are likely choosing between active surveillance, surgery (radical or robotic prostatectomy), brachytherapy (seed implants), conventional external-beam radiation over 4 to 9 weeks, and stereotactic radiation (SBRT) in 5 sessions. 5D Cancer Services provides the non-surgical option: adaptive SBRT delivered on the Akesis Gemini 360. No incision, no catheter, no hospital stay, no general anesthesia. Most men drive themselves to each appointment and return to normal activity the same day. The comparison most men care about is surgery versus radiation. Surgery removes the prostate and carries well-documented rates of urinary incontinence and erectile dysfunction in the recovery period. Radiation preserves the prostate and has a different side-effect profile. Neither is universally correct - it depends on your stage, your Gleason score, your PSA, your age, and your priorities. We will tell you honestly if you are a better candidate for something we do not offer. Why adaptive RT? ## Why Prostate Cancer needs more than a fixed plan Prostate cancer radiation requires striking a precise target that refuses to stay still. These are the three anatomy-driven reasons why conventional radiation falls short. ### Daily prostate motion Bladder and rectal filling shift the prostate 5–15 mm between fractions and even within a single session. Conventional plans treat the prostate's average position — not its actual position today. ### Large PTV margins = more bowel and bladder dose To compensate for motion uncertainty, traditional planning adds a large planning target volume (PTV) margin around the prostate. That margin is the rectum, bladder wall, and urethra — and it absorbs full therapeutic dose. ### Long courses drift from anatomy Conventional prostate radiation runs 20–45 fractions over 4–9 weeks. Weight changes, dietary variation, and gradual anatomical shifts compound over that time, eroding the precision the original plan promised. Clinical Evidence ## What the evidence shows The evidence supporting adaptive SBRT for prostate cancer is among the strongest in radiation oncology. Three pivotal trials establish both safety and superiority over conventional approaches. ### PACE-B: 5-fraction SBRT matches long-course IMRT This international phase 3 randomized trial compared 5-fraction SBRT to 39-fraction IMRT for localized prostate cancer. SBRT was non-inferior for cancer control and produced similar toxicity — establishing ultrahypofractionation as a standard-of-care option for eligible patients. [doi.org/10.1016/S1470-2045(19)30569-8](https://doi.org/10.1016/S1470-2045(19)30569-8) ### MIRAGE: image guidance cuts acute toxicity by 68% The MIRAGE randomized trial found that precision image-guided SBRT reduced clinically meaningful acute genitourinary toxicity by 68% compared to CT-guided SBRT. The trial supports the principle that more precise daily targeting directly translates into fewer side effects. [doi.org/10.1001/jamaoncol.2022.6558](https://doi.org/10.1001/jamaoncol.2022.6558) ### HYPO-RT-PC: ultra-hypofractionation preserves quality of life at 5 years The HYPO-RT-PC randomized trial compared ultra-hypofractionated prostate radiation (42.7 Gy in 7 fractions over 2.5 weeks) to conventional fractionation (78 Gy in 39 fractions). Cancer control was non-inferior and patient-reported urinary, bowel, and sexual quality of life were equivalent between arms — establishing ultrahypofractionation as a well-tolerated standard option and validating the direction toward fewer, more precise fractions. [doi.org/10.1016/S1470-2045(19)30813-7](https://doi.org/10.1016/S1470-2045(19)30813-7) At 5D Cancer Services ## Your treatment workflow At 5D Cancer Services, prostate adaptive SBRT follows a streamlined workflow designed to fit treatment into your schedule with minimal disruption. 01 ### Simulation CT (day −7 to −3) A planning CT is acquired with the patient in treatment position. Bladder and rectal prep instructions are given. The radiation oncologist contours the prostate, seminal vesicles, bladder, rectum, and urethra. 02 ### Treatment plan optimization The medical physics team optimizes an SBRT plan to cover the prostate with high dose while keeping the rectum, bladder wall, and urethra within published tolerance limits. 03 ### Daily CBCT imaging and adaptation (sessions 1–5) Each session begins with a cone-beam CT. The Gemini 360 identifies where the prostate is today, shifts the plan to match, and delivers the adapted beam. Each visit takes approximately 30–45 minutes. 04 ### Follow-up (PSA at 3, 6, 12 months, then annually) PSA is drawn 3 months after the final fraction, then every 6 months for 2 years, then annually. Most patients experience the nadir PSA at 18–36 months post-treatment. Comparison ## Adaptive vs. conventional radiation Factor Adaptive RT (Gemini 360) Conventional Radiation Total sessions5 sessions over 1–2 weeks20–45 sessions over 4–9 weeks Daily imagingCBCT at every sessionPeriodic or no imaging Plan adaptationRe-optimized each sessionFixed plan throughout PTV marginReduced margins (≤3 mm)Standard margins (5–10 mm) Rectal doseMinimized with tight marginsHigher due to larger margins Time off workMinimal — outpatient, 5 visits9 weeks of daily visits Questions & Answers ## Frequently asked questions ### Is adaptive SBRT appropriate for all prostate cancer stages? Adaptive SBRT is most commonly used for low-, intermediate-, and high-risk localized prostate cancer. Your radiation oncologist will review your PSA, Gleason score, clinical stage, and imaging to determine whether SBRT or a longer course is the best fit for your specific situation. ### What urinary side effects should I expect? With adaptive SBRT, urinary side effects are typically mild and temporary. Some patients notice increased frequency or mild burning for a few weeks after treatment. Because the Gemini 360 adapts to daily prostate position, the bladder wall receives less radiation than with conventional approaches, reducing both the severity and duration of urinary symptoms. ### How does adaptive SBRT compare to prostatectomy (surgery)? Multiple studies show comparable 10-year cancer control rates between SBRT and radical prostatectomy for localized prostate cancer. SBRT avoids surgery, general anesthesia, hospital stays, and the recovery period associated with surgery. It also carries a lower risk of urinary incontinence. Your treatment team will discuss both options during your consultation. ### Will I need hormone therapy alongside radiation? For low-risk disease, SBRT alone is typically recommended. For intermediate- or high-risk prostate cancer, short-course or long-course androgen deprivation therapy (ADT) added to radiation improves outcomes in most cases. Your radiation oncologist will review the evidence and your specific risk profile to make that recommendation. ### Is prostate cancer curable with radiation? Radiation is a standard-of-care treatment for localized prostate cancer with well-documented long-term cancer control. In the PACE-B randomized trial, 5-fraction SBRT was non-inferior to 39-fraction IMRT for cancer control in eligible patients. Outcomes depend on your stage, Gleason score and PSA - we will review your specific case and give you an honest assessment of what radiation can and cannot achieve. ### What are the side effects of prostate radiation - will it affect erections or urination? The most common short-term effects are urinary urgency and frequency, and some bowel irritation, which usually settle within weeks. Sexual side effects can develop gradually over months to years and vary widely by age and baseline function. Precision matters: the MIRAGE randomized trial found that tighter image guidance reduced clinically meaningful acute urinary toxicity by 68% compared with standard CT-guided SBRT. Daily adaptation on the Gemini 360 is designed to keep dose off the urethra, bladder and rectum. ### How much does prostate cancer treatment cost, and does Medicare cover it? Adaptive radiotherapy is covered by Medicare and Medicaid, as well as Regence Blue Cross Blue Shield, Cigna, Motiv Health, Desert Mutual and University of Utah Health Plans. Our billing team verifies your benefits and handles pre-authorization before treatment starts, so you know your out-of-pocket cost in advance. A shorter course also means fewer copays and fewer trips. ### Can I get a second opinion on my prostate cancer treatment plan? Yes, and no referral is required. Bring your pathology report, PSA history and any imaging, and we will review your case and tell you plainly whether adaptive SBRT is a good fit - including if we think another approach or another center is the better choice. We contact you within one business day of a consultation request. Educational information — not medical advice The content on this page is provided for general educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read on this site. If you think you may have a medical emergency, call your doctor or 911 immediately. ## References - 1.Brand DH, Tree AC, Ostler P, et al. Intensity-modulated fractionated radiotherapy versus stereotactic body radiotherapy for prostate cancer (PACE-B): acute toxicity findings from an international, randomised, open-label, phase 3, non-inferiority trial. Lancet Oncol. 2019;20(11):1531–1543. doi.org/10.1016/S1470-2045(19)30569-8 - 2.Kishan AU, Ma TM, Lamb JM, et al. Magnetic Resonance Imaging-Guided vs Computed Tomography-Guided Stereotactic Body Radiotherapy for Prostate Cancer: The MIRAGE Randomized Clinical Trial. JAMA Oncol. 2023;9(3):365–373. doi.org/10.1001/jamaoncol.2022.6558 - 3.Widmark A, Gunnlaugsson A, Beckman L, et al. Ultra-hypofractionated versus conventionally fractionated radiotherapy for prostate cancer (HYPO-RT-PC): patient-reported quality-of-life outcomes of a randomised, controlled, non-inferiority, phase 3 trial. Lancet Oncol. 2020;21(3):392–402. doi:10.1016/S1470-2045(19)30813-7 doi.org/10.1016/S1470-2045(19)30813-7 Also see: Adaptive RT by cancer type [Lung Cancer](/adaptive-radiotherapy/lung)[Liver Cancer](/adaptive-radiotherapy/liver)[Gynecologic Cancer](/adaptive-radiotherapy/gynecologic)[Pancreatic Cancer](/adaptive-radiotherapy/pancreatic) Please do not send Protected Health Information (PHI) by email or voicemail. Standard email is not secure — call us and we will arrange a secure channel. ## Learn More About Your Care [### What Is Adaptive Radiotherapy? The complete evidence-based guide to adaptive radiotherapy — how it works, online vs offline workflows, imaging modalities, and clinical outcomes. Learn more](/adaptive-radiotherapy) [### Prostate Cancer — Condition Overview Symptoms, benefits of adaptive treatment, and what to expect during your prostate cancer care at 5D Cancer Services. Learn more](/conditions/prostate-cancer) [### Our Technology — Akesis Gemini 360 How the Gemini 360 delivers adaptive radiotherapy with onboard CBCT imaging, AI-assisted contouring, and per-fraction replanning. Learn more](/technology) [### Clinical Data & Case Studies Peer-reviewed evidence and real-world case studies demonstrating the Gemini 360's advantages across cancer types. Learn more](/clinical-data) [### Adaptive vs. Conventional Radiation Side-by-side comparison of adaptive radiotherapy and conventional, statically-planned radiation. Learn more](/compare/adaptive-vs-conventional-radiotherapy) Take the next step ## There is no time for cancer. You deserve the most advanced care available. Schedule a consultation with our physicians and staff today to discuss your treatment options. 1308 E 900 South, Unit B, St. George, UT 84790 [Call (435) 900-7060](tel:+14359007060)[Request Consultation](tel:+14359007060) Please do not send Protected Health Information (PHI) by email or voicemail. Standard email is not secure — call us and we will arrange a secure channel. Bringing the most advanced Adaptive Radiotherapy to Southern Utah. No time for cancer. [TikTok](https://www.tiktok.com/@5dcancerservices?lang=en)[LinkedIn](https://www.linkedin.com/in/5d-cancer-services-corporate-bb7990404/)[Facebook](https://www.facebook.com/profile.php?id=61567576677128)[YouTube](https://www.youtube.com/channel/UCO2OmZiBQ4zXfms6XsboNPQ) #### Navigation - Technology - What Is Adaptive RT? - Clinical Data - Our Team - Cancer Treatments - Non-Cancer Treatments - Insurance - FAQ - Blog - Email UsPlease do not send Protected Health Information (PHI) by email or voicemail. Standard email is not secure — call us and we will arrange a secure channel. #### Resources - Sitemap (XML) - llms.txt - llms-full.txt - Site Index (Markdown) - Blog RSS Feed #### Contact Us 1308 E 900 South, Unit B St. George, UT 84790 [www.5dcancerservices.com](https://www.5dcancerservices.com) [(435) 900-7060 Schedule a consultation](tel:+14359007060)Please do not send Protected Health Information (PHI) by email or voicemail. Standard email is not secure — call us and we will arrange a secure channel. The information on this site is for general educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. © 2026 5D Cancer Services. All rights reserved. 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