Controversies in management of apparently localized carcinoma of prostate

Advantages and disadvantages of radical prostatectomy versus radiation for treatment of apparently localized prostatic carcinoma are discussed. The only comparative study to date demonstrated longer disease-free survival after radical prostatectomy than after radiotherapy. However, significant differences of survival curves between these two treatment modalities are not apparent when comparing stage-matched results of uncontrolled studies. Morbidity of radical prostatectomy has decreased due to improved surgical techniques, but is still higher than morbidity following radiotherapy. Prostate-specific antigen (PSA) may indicate occult persistent disease after radical prostatectomy. Adjuvant radiation therapy can reduce PSA to zero in these cases. The need for comparative studies to further evaluate the effectiveness of radical prostatectomy and radiation for localized prostatic carcinoma is emphasized.