Surgery or radiotherapy: Determining factors in therapeutic decision-making for localized prostate cancer in Spain

The choice between radical prostatectomy (RP) and radiotherapy (RT) for localized prostate cancer depends on multiple factors. The aim of this study was to describe how urologists and radiation oncologists weigh these variables when recommending primary treatment, and to develop clinical decision support algorithms.

An online cross-sectional survey was designed for specialists in Urology and Radiation Oncology in Spain. The questionnaire was developed ad hoc and reviewed by an expert panel. Demographic data and treatment preferences were collected using a Likert scale (1-2 RP; 3 neutral; 4-5 RT) across hypothetical clinical scenarios. Clinical consensus was defined as agreement ≥75%.

The mean age of respondents was 41.3 years (SD 10.3), with 68.5% urologists and 31.5% radiation oncologists. Overall, in young patients (<50 years) with high IPSS (≥20), intravesical prostatic protrusion, Qmax < 10 mL/sec, and elevated post-void residual (PVR), the preference for surgery was high (>75%) (p < 0.001). In contrast, in patients older than 70 years with multiple comorbidities and body mass index (BMI) >35, a preference for radiotherapy (4-5) was observed in more than 75% of cases (p < 0.001).

Treatment preferences for localized PCa depend primarily on age, comorbidity, and urinary symptoms, with consistent differences between specialties. These findings reinforce the need to integrate shared decision-making tools and to develop clinical decision support algorithms.