Clinical oncology · London
Prostate SBRT (5-fraction) - private in London.
A two-week course of ultra-hypofractionated prostate radiotherapy, delivered by a consultant clinical oncologist on an MR-Linac, CyberKnife or modern linac. Backed by five-year PACE-B data, NICE-recommended for suitable men.
Why patients choose us
- 01
A named clinical oncologist, in an SBRT-accredited unit
Not a general radiotherapy list. A consultant clinical oncologist with a high SBRT case volume, in a centre with MR-Linac or CyberKnife accreditation.
- 02
The right platform for your prostate
Not every prostate suits every machine. For anterior tumours we favour MR-Linac; for smaller glands, CyberKnife; for others, a modern linac with SpaceOAR.
- 03
Independent, and free
We are paid by no centre, so the recommendation is impartial and costs you nothing.
What it is
Five ablative fractions, over one to two weeks.
Prostate SBRT (stereotactic body radiotherapy, also called SABR) delivers a small number of very precisely targeted, high-dose fractions to the prostate. It is ultra-hypofractionated radiotherapy.
The dose in plain English
Approximately 36.25 Gy in five fractions of 7.25 to 8 Gy, delivered on alternate days.
Total treatment time is one to two weeks, versus 20 sessions over four weeks for moderate hypofractionation, or 39 sessions over eight weeks for conventional radiotherapy. The biological equivalent dose is broadly comparable to 78 to 80 Gy in 39 fractions - the traditional prostate dose - because the prostate responds better to larger fractions than most other tumours.
Why so few treatments
The prostate is uniquely radiobiologically suited to large fractions.
Prostate cancer has a low alpha/beta ratio (around 1.5), which means it responds more to larger doses per fraction than most cancers. Combined with sub-millimetre image guidance, real-time tracking of the prostate as it moves, and tight margins around the gland, this means five ablative fractions are as effective as the traditional eight-week course - with fewer visits and comparable side effects.
The evidence
PACE-B, five-year data, and NICE.
Five-fraction prostate SBRT is not experimental. It has multi-centre randomised evidence, five-year follow-up, and a formal place in national guidance.
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PACE-B trial
A UK, Ireland and Canada randomised trial comparing 5-fraction SBRT with conventional or moderately hypofractionated radiotherapy in low and favourable intermediate-risk disease. Five-year biochemical failure-free survival non-inferior, with comparable Grade 2 or worse toxicity.
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NRG-GU005
A large US randomised trial comparing 5-fraction SBRT with 28-fraction moderately hypofractionated radiotherapy. Follow-up ongoing, early toxicity data reassuring, results expected to reinforce PACE-B.
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NICE and RCR guidance
The National Institute for Health and Care Excellence recommends SBRT as a treatment option for suitable men with localised prostate cancer. The Royal College of Radiologists has published consensus dose and planning guidelines.
Indicative pricing
What private 5-fraction prostate SBRT costs in London.
Indicative all-inclusive ranges across our partner centres. Send the MRI and biopsy and we quote firm figures across two or three options.
In short
A full private 5-fraction prostate SBRT course in our London network: £12,000 to £22,000 all-inclusive, plus £1,800 to £3,500 for SpaceOAR.
| Item | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| Consultation and treatment planning review | £450–£850 | 45–60 min | Same visit |
| Fiducial marker insertion (day-case) | £1,800–£3,200 | 30 min | Same day |
| SpaceOAR hydrogel rectal spacer | £1,800–£3,500 | 30 min | Same day |
| 5-fraction prostate SBRT (CyberKnife, all-inclusive) | £12,000–£18,000 | 2 weeks | Course complete |
| 5-fraction prostate SBRT (MR-Linac, all-inclusive) | £16,000–£22,000 | 2 weeks | Course complete |
| Second-opinion review of MRI, biopsy and plan | £350–£650 | 45 min | 48 hours |
Prices vary by centre, by platform (MR-Linac costs more than CyberKnife or a linac), by whether SpaceOAR is used, and by whether hormone therapy is included. We come back with a firm quote within one working day.
Where in London (and beyond)
The private UK centres that deliver prostate SBRT.
Not every centre delivers 5-fraction SBRT, and platforms vary. We match you to the consultant and machine, not the postcode.
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Royal Marsden Private Care
Chelsea and Sutton. High-volume prostate SBRT, PACE-B trial site.
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UCLH Private (NHS Private Care)
Euston. Elekta MR-Linac (Unity) for adaptive prostate SBRT.
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GenesisCare Cromwell Hospital
South Kensington. MR-Linac and modern VMAT, SpaceOAR routine.
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Bupa Cromwell Hospital CyberKnife
South Kensington. Established CyberKnife robotic SBRT service.
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HCA London Bridge
The Shard. CyberKnife M6 with prostate SBRT pathway.
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The Christie Private Care
Manchester. MR-Linac and CyberKnife, national SBRT reputation.
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Rutherford Cancer Centres (proton)
Newport, Reading, Liverpool, Northumberland. Proton alternative where clinically indicated.
The journey
From referral to PSA follow-up - what happens, in order.
One team from first message to long-term PSA surveillance - including MDT, planning, delivery and toxicity review.
Phase 1 · Before your course
Concierge, off-stage for you
Phase 2 · Treatment days
Five visits, over 1 to 2 weeks
Phase 3 · After
Concierge, back on
- 01
Before
You send us the MRI and biopsy report
A short, confidential form. Multiparametric MRI, PI-RADS score, PSA history, Gleason grade group and any staging PET-PSMA if done.
- 02
Before
We come back with a recommendation
Within one working day: whether 5-fraction SBRT fits, or whether brachytherapy, surgery or conventional radiotherapy suits you better. Indicative price.
- 03
Before
Planning MRI, CT and fiducials
Gold fiducial markers or a rectal spacer are placed transperineally under local. A planning MRI and CT follow one to two weeks later.
- 04
Treatment
Arrival for fraction one
A comfortable bladder, an empty rectum, and a chat with the radiographers. Positioning takes longer than the beam itself.
- 05
Treatment
The SBRT delivery
20 to 45 minutes per fraction. Real-time imaging, adaptive replanning on MR-Linac, robotic tracking on CyberKnife.
- 06
Treatment
Home the same afternoon
Five fractions over one to two weeks, most centres alternate days. You drive yourself home. No sedation, no anaesthetic.
- 07
After
PSA follow-up and toxicity review
PSA at 3, 6 and 12 months, then six-monthly. Nadir usually reached at 18 to 36 months. Consultant review at 6 weeks and 6 months.
Typical end-to-end: 2 to 4 weeks from enquiry to fraction one. Course itself: 1 to 2 weeks. PSA nadir: 24 to 36 months.
Who it suits
When 5-fraction SBRT is the right step - and when it is not.
The risk groups, prostate volumes and urinary scores where PACE-B evidence applies - plus the situations where a different modality is safer.
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Low-risk localised prostate cancer
Gleason 3+3, PSA under 10, T1c to T2a. SBRT is a good alternative to active surveillance or brachytherapy in men who want treatment.
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Favourable intermediate-risk disease
Gleason 3+4 with limited volume, PSA 10 to 15, or T2b. Non-inferior to conventional radiotherapy in PACE-B at five years.
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Unfavourable intermediate-risk (selected)
Gleason 4+3, higher PSA or T2c. Considered with careful selection, MDT input and often 4 to 6 months of hormone therapy.
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Prostate volume under 90cc
Larger glands are harder to plan safely for SBRT. Cytoreductive hormone therapy or a different technique may be better.
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Minimal urinary symptoms (IPSS under 15)
A moderate or worse IPSS score raises the risk of acute urinary retention. Alpha-blockers or a different modality may be advised.
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Wants the shortest possible course
Five treatments over one to two weeks, versus 20 sessions over four weeks or 39 over eight. Fewer trips, faster return to normal life.
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Anterior or apical tumour
MR-Linac gives real-time soft-tissue visualisation for anterior lesions where CT-based image guidance is less reliable.
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Not suitable: metastatic or bulky T3b
Extensive extracapsular extension, seminal vesicle invasion beyond the base, or nodal or bone metastases need a different plan.
Delivery platforms
MR-Linac, CyberKnife, or a modern linac with SpaceOAR.
Three main routes to a safe, precise 5-fraction prostate SBRT, plus adjuncts (spacer, fiducials, hormones) and the proton alternative.
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MR-Linac (Elekta Unity)
Real-time MRI during treatment lets the team adapt the plan for the anatomy of the day. Best for anterior tumours, close-to-rectum dose sparing, and daily adaptive planning.
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CyberKnife robotic SBRT
A robotic linac with sub-millimetre tracking of gold fiducial markers. Non-coplanar beams, excellent for smaller prostates and re-irradiation.
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Conventional linac (VMAT + IGRT)
Modern volumetric-modulated arc therapy on Varian or Elekta linacs, with cone-beam CT image guidance. Widely available and clinically equivalent for suitable men.
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SpaceOAR hydrogel rectal spacer
A dissolvable hydrogel injected between prostate and rectum before SBRT. Creates a 10 to 15mm buffer, reduces late rectal toxicity by 60 to 70%.
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Gold fiducial markers
Three small gold seeds placed transperineally under local, used by the linac to track the prostate in real time. Standard for CyberKnife and non-MR linac SBRT.
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Neoadjuvant hormone therapy
Four to six months of LHRH agonist for unfavourable intermediate or high-risk disease. Reduces prostate volume and improves biochemical control.
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Proton beam therapy (alternative)
Theoretical dose-distribution advantage, no clear clinical benefit over photon SBRT for prostate. Longer courses, only at a handful of UK centres.
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Second-opinion review
A specialist review of your MRI, biopsy and radiotherapy plan. Sometimes the answer is active surveillance or brachytherapy, not SBRT.
SpaceOAR rectal spacer
A short day-case that halves late rectal toxicity.
A polyethylene glycol hydrogel injected transperineally between the prostate and the rectum before SBRT, creating a 10 to 15mm buffer.
How it is placed
A urologist or clinical oncologist inserts the hydrogel under transrectal ultrasound guidance, under local anaesthetic with light sedation, in around 20 to 30 minutes. Home the same afternoon.
What it does
Randomised trials show a 60 to 70% reduction in late Grade 2 or worse rectal toxicity, including rectal bleeding, urgency and quality-of-life impact. It also protects sexual function in some men.
What happens to it
The hydrogel holds its shape for around three months, then breaks down over the following three to six months and is cleared naturally in the urine. Nothing to remove afterwards.
How it compares
SBRT vs surgery, brachytherapy and proton.
No single modality is best for everyone. Trade-offs are honest, and depend on your risk group, anatomy, function and priorities.
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Radical prostatectomy
Definitive removal, immediate PSA drop, gives whole-gland pathology. Higher rates of urinary incontinence and erectile dysfunction (60 to 70%), longer recovery, hospital stay.
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Brachytherapy (LDR or HDR)
Proven equivalent for suitable men. LDR seeds are a single day-case; HDR is one or two afternoons. Not ideal for larger glands or high IPSS.
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Proton beam therapy
Theoretical dose-distribution advantage over photons, no proven clinical benefit for prostate. Longer courses, only a handful of UK centres, higher cost.
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5-fraction SBRT
Fewest visits, no incisions, comparable cancer control to conventional radiotherapy, low ED rate. Not suitable for bulky, node-positive or metastatic disease.
Our vetted UK network
A small panel of clinical oncologists, we picked them.
Consultant clinical oncologists with high prostate SBRT case volumes, in centres with the platforms and MDT structure to do it well.
Selection criteria
How we choose every clinical oncologist in our network.
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Consultant clinical oncologists with high prostate SBRT case volumes, PACE-B trial experience preferred
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Centres with MR-Linac or CyberKnife accreditation, or modern VMAT with cone-beam CT image guidance
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On-site SpaceOAR spacer placement and fiducial marker insertion pathways
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MDT discussion with urology, uro-radiology and specialist nurses before every SBRT booking
Side effects and recovery
What to expect - honestly.
5-fraction prostate SBRT is well tolerated. The things worth planning are the acute weeks 2 to 6 urinary flare, bowel disturbance, sexual function, and the long PSA follow-up.
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Acute urinary irritation, weeks 2 to 6
Frequency, urgency and burning peak two to four weeks after fraction five. Alpha-blockers help. Settles by 8 to 12 weeks in most men.
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Acute bowel disturbance
Mild loose stools, urgency or occasional bleeding, typically in weeks 3 to 8. SpaceOAR reduces this substantially. Rarely limits daily activity.
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Late urinary toxicity
Grade 2 or worse late urinary symptoms in around 5 to 10% at five years in PACE-B. Comparable to conventional radiotherapy, lower than surgery for incontinence.
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Late rectal toxicity
Grade 2 or worse in around 2 to 4% at five years with modern planning and SpaceOAR. Bleeding, urgency or mucus discharge, usually manageable medically.
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Erectile function
Around 30% of previously potent men develop erectile dysfunction by three years, versus 60 to 70% after radical prostatectomy. PDE5 inhibitors work well.
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Acute urinary retention
Uncommon, around 1 to 2%. More likely with larger prostates, high IPSS, or existing outflow symptoms. Managed with a short-term catheter.
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Second cancer risk
A very small long-term risk of radiation-induced second malignancy, in the region of 1 in 200 to 1 in 500 over decades. Weighed carefully in younger men.
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PSA bounce and nadir
A temporary PSA rise (bounce) occurs in 20 to 30% at 18 to 24 months and is not recurrence. True nadir usually reached at 24 to 36 months.
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Red flags after treatment
Inability to pass urine, heavy or persistent rectal bleeding, high fever, or new bone pain. Contact the unit or attend A&E the same day.
Reading your treatment summary
Your SBRT summary in four parts. Read the last one first.
Whichever platform was used, the end-of-treatment summary the clinical oncologist sends you keeps to the same shape.
A quiet reminder
Radiotherapy language is precise and can read coldly - we translate it for you.
If you would like us to talk you through the summary before your consultant review, just ask.
- 01 Header
Risk group, staging and prostate volume
Your NCCN or Cambridge risk group, clinical stage, Gleason grade group, PSA and pre-treatment prostate volume on MRI.
- 02 Technique
Platform, dose and fractionation
Which machine (MR-Linac, CyberKnife, VMAT), total dose (typically 36.25 Gy), fraction size (7.25 to 8 Gy), and whether SpaceOAR or fiducials were used.
- 03 Findings
On-treatment tolerance
Any acute toxicity during the course, alpha-blocker use, whether all five fractions were delivered as planned, and any adaptive replanning.
- 04 Impression
PSA follow-up and long-term plan
Read this first: your PSA schedule, when to expect nadir, the definition of biochemical failure, and when to escalate for salvage assessment.
Recognised by major UK insurers
Cover for prostate SBRT is usually funded where clinically indicated. SpaceOAR and MR-Linac cover varies by policy - we confirm before booking.
Frequently asked
Everything we get asked about 5-fraction prostate SBRT.
Quick answers on sexual function, bowel side effects, SpaceOAR, insurance, salvage and PSA nadir.
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Will 5-fraction SBRT affect my erections?
Around 30% of previously potent men develop new erectile dysfunction by three years after prostate SBRT, compared with 60 to 70% after radical prostatectomy. PDE5 inhibitors such as tadalafil work well and are usually offered from an early stage. Baseline function, age, and diabetes are the strongest predictors of outcome.
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What are the bowel side effects?
Mild loose stools, urgency and occasional bright bleeding can occur from week three to about week eight, and settle in most men by three months. Late Grade 2 or worse rectal toxicity is 2 to 4% at five years with modern planning and a SpaceOAR hydrogel spacer, which reduces late rectal side effects by 60 to 70% in randomised trials.
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Do I need SpaceOAR?
It is not mandatory, but strongly recommended for men whose rectum sits close to the posterior prostate on planning MRI, and for younger men where you want to minimise late toxicity risk. It adds £1,800 to £3,500 and a short day-case procedure. On MR-Linac with daily adaptive planning some centres deliver SBRT without a spacer.
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Will insurance cover it?
Most major UK insurers, including Bupa, AXA, Vitality, Aviva and WPA, cover prostate SBRT for suitable men where it is a NICE-recommended option. Cover for SpaceOAR and MR-Linac varies by policy. We confirm cover in writing before you commit and price the shortfall if there is one.
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Can I be re-treated if the cancer comes back?
Salvage options after SBRT include salvage prostatectomy, salvage brachytherapy (LDR or HDR), focal therapy such as HIFU or cryotherapy, and repeat SBRT in selected cases. Salvage is more technically demanding than primary treatment, so a specialist MDT review at a high-volume centre is essential.
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What PSA nadir should I expect?
PSA falls slowly after radiotherapy, unlike surgery. The nadir (lowest point) is usually reached at 24 to 36 months and is typically under 0.5 ng/mL, ideally under 0.2. A temporary PSA bounce of up to 2 ng/mL at 18 to 24 months occurs in 20 to 30% of men and is not recurrence. Biochemical failure is defined as nadir plus 2 ng/mL.
Related treatments
Looking for something else?
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Oligometastasis SBRT
SBRT for a small number of prostate cancer metastases.
Learn more -
Proton beam therapy
Proton alternative to photon SBRT for selected men.
Learn more -
HDR prostate brachytherapy
High-dose-rate brachytherapy for suitable prostates.
Learn more -
LDR seed brachytherapy
Permanent iodine seed implant, single day-case.
Learn more -
Robotic prostatectomy
Robotic-assisted radical prostate surgery.
Learn more -
MR-Linac adaptive radiotherapy
MRI-guided adaptive radiotherapy across tumour sites.
Learn more -
Prostate cancer
Everything we cover on prostate cancer, in one place.
Learn more -
Send Enquiry
Send us your MRI and biopsy for a same-day reply.
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Ready to send us your case?
Two weeks of treatment. A lifetime on the other side of it.
Send us your MRI, biopsy and PSA history. We come back within one working day with the right consultant, the right centre, and firm indicative pricing across two or three options.
- 5 fractions, over 1 to 2 weeks
- £12k–£22k all-inclusive private course
- ~30% erectile dysfunction at 3 years (vs 60–70% surgery)
- <1 working day to a personal recommendation