[Controversies in local therapy of early prostatic cancer]

We are comparing the long-term results of radical prostatectomy and percutaneous radiation therapy. The validity of these comparisons is hampered by changing selection criteria for radical prostatectomy, variations in endpoint reporting and statistical methods of data analysis, shortcomings of retrospective studies (the only prospective study has many problems associated with its design, analysis and reporting), simultaneous hormone therapy, influence of patient and tumor factors as concurrent mortality and variability of the natural history of the prostate cancer. Complications of both treatment modalities are different and often not well reported. Long-term outcome is similar and one may conclude that the two treatment modalities produce the same good success in controlling early disease. Unresolved issues concern the proper timing of hormonal therapy (simultaneous or sequential, pre- or postirradiation), the relevance of positive posttreatment prostatic biopsies as to prognosis and therapeutic decision-making and the indications of adjuvant radiation therapy after radical prostatectomy.