Keywords: Prostate cancer, PSA screening, General practitioner, CyberKnife, EPIC-26 questionnaire;

Background:

Early detection of prostate cancer through PSA screening in primary care expands treatment
options and supports timely, patient-centered decisions. CyberKnife-based stereotactic body
radiotherapy (SBRT) offers a precise, minimally invasive option for localized prostate cancer.
As sexual function preservation is a key patient concern, this study examines whether early
diagnosis via PSA screening by GPs contributes to preserving sexual function after
CyberKnife SBRT.

Research questions:

Does CyberKnife SBRT preserve sexual function in men with localized prostate cancer
diagnosed early through PSA screening in general practice, as measured by the EPIC-26
questionnaire over one year?

Method:

This prospective cohort study was conducted at the Clinic of Radiation Oncology, University
Hospital “Sv. George,” Plovdiv, Bulgaria. Thirty men aged 50–75 years with localized
prostate cancer diagnosed via PSA testing in primary care were enrolled. All received
CyberKnife SBRT (five fractions of 7.25 Gy). The primary outcome was change in the sexual
function domain of the EPIC-26 questionnaire, completed at baseline and at 1, 3, 6, and 12
months post-treatment. Descriptive and comparative analyses assessed changes over time.

Results:

Patient-reported outcomes showed stable sexual function over the 12-month follow-up. Mean
EPIC-26 sexual domain score declined slightly from 52.84 ± 11.70 at baseline to 50.57 ± 9.09
at 12 months. Most patients retained pre-treatment erectile function. No severe sexual
dysfunction or grade ≥3 toxicities were reported.

Conclusions:

Early diagnosis of prostate cancer through PSA screening in general practice enables selection
of effective, less invasive treatment options like CyberKnife SBRT. Preliminary results
suggest that this approach not only offers oncologic control but also preserves sexual function
with minimal toxicity. These findings support the value of early screening and may guide
shared decision-making between patients, GPs, and specialists.

Points for discussion:

Role of GPs in early detection and functional outcome preservation