Thank you for your YouTube presentation @NicholasZaorsky . However, your talk provides incomplete information about the PACE-A study, both regarding efficacy and toxicity of SBRT vs RP. To help readers get more clarify information. PACE-A was originally designed as a non-inferiority trial to demonstrate oncological efficacy, the BCF, of SBRT vs RP. But, in fact, PACE-A changed its primary endpoint from BCF to patient report functional outcome and not follow the non-inferiority design anymore. So, the new primary endpoint is a co-primary PRO: number of pads >= 1 per day (one of these questions about urinary function in EPIC-26) and bowel EPIC score. The reason stated in the protocol was that accrual was too slow, making it no longer feasible to demonstrate non-inferiority in disease control. However, even after changing the primary outcome and reducing the sample size for the PRO, the new sample size target was still not met. (Enroll: 123 , target: 234) The oncology efficacy, BCF endpoint is now a secondary outcome; although median follow-up was 8 years, it must be emphasized that the sample size is rather small and the number of events is low (13 events). Therefore, the fact that BCF did not reach statistical significance in this study cannot be used to conclude that SBRT and RP are "basically, it's the same," as you claimed in your video. @nickva1 , @alison_tree

If you want to use your PACE-A study to counsel patients, then you must state clearly and honestly that this is a study with a small sample size that failed to meet its accrual target, even after you were changing the primary endpoint at mid-study from an oncological assessment (biochemical recurrence) to a patient-reported functional outcome, which is prone to bias from self-reporting. In addition to failing to meet the sample size target, the questionnaire response rate was low and the amount of missing information reached ~ 50% in each arm. Therefore, any estimates drawn from it are entirely uncertain. Furthermore, we object to your use of the conference #ASTRO to disseminate misleading information: replacing the co- primary endpoint of bowel function assessment by EPIC-26 bowel domain score which was unfavorable to SBRT to patient-reported moderate/big bowel function, thereby making the results appear nearly balanced between RP vs SBRT.