External beam radiation therapy does not offer long-term control of prostate cancer

In the absence of large, contemporary, randomized series comparing external beam radiation and radical prostatectomy, definitive conclusions regarding relative efficacy are difficult to establish. This article examines series in which an objective, comparable end point was used and prostate-specific antigen (PSA) response was assessed. With follow-up of less than 5 years, PSA-based recurrence rates are similar for external beam radiation and radical surgery; however, the 10- and 15-year control rates are significantly lower in the population of patients treated with external beam radiation. The authors conclude that external beam radiation therapy as a single modality does not equal radical prostatectomy in comparably staged and followed patients.