Randomized series of treatment with surgery versus radiation for prostate adenocarcinoma

In the early 1970s, a multicentered cooperative group effort was established by urologists and oncologists to examine the relative disease control provided by surgery, radiation therapy, or observation for patients with localized or regional disease. The data derived from this trial were controversial because they 1) did not support previous concepts regarding the relative impact of treatment and 2) raised provocative questions as to the interpretation of previous institutional reports that promoted a single treatment modality. The data from the randomized trial demonstrated that: 1) bipedal lymphangiography could not demonstrate accurately the presence or absence of microscopic involvement of pelvic lymphatic structures, 2) treatment selection should be based on the anatomic distribution of disease; 3) a clinician's use of first appearance of local or distant disease in a patient who was supposedly disease free after receiving the chosen therapy served as an accurate way to define the impact of the initial treatment; 4) radical surgery was more effective than radiation therapy in controlling disease that was clinically confined to the primary organ of origin; and 5) the apparent disease control produced by radiation on large-volume, localized disease might only reflect the natural history of the disease.