Radical prostatectomy, radiotherapy or deferred treatment for localized prostate cancer?

Before considering the possible biases discussed above, the results as reported in the current literature may indicate an advantage for radical prostatectomy in disease specific survival at 10 years' follow-up when compared with external radiation therapy and deferred treatment. It appears that most of the obvious biases found in the literature work in favour of radical prostatectomy. The actual advantage of radical prostatectomy with respect to disease specific survival at 10 years may therefore be less than the data complications suggest. The magnitude of these biases is, however, impossible to assess. A probable but perhaps marginal benefit for the majority of the patients must, however, be put in relation to possible side effects and long term complications of the various treatments as well as the patient's preferences when choosing treatment. Reliable controlled data on outcome and quality of life for the various treatments of localized prostate cancer are needed, but we may have to wait for many years for such data. It must also be remembered that the results presented in this overview derive from a series started in the late 1970s of patients treated with the surgical techniques and radiotherapy technology available at that time. Today, the frequent use of prostate specific antigen in early detection or screening programmes will definitely detect a larger number of low volume prostate cancers that may be more curable by surgery or radiotherapy. This, however, remains to be proved. Moreover, new technology in radiotherapy, such as conformal therapy, may enable radiotherapists to deliver higher local doses of radiation to the prostate, which in turn may improve the cure rate for radiotherapy.