Radiation therapy versus radical prostatectomy in the PSA era: a urologist's view

In the absence of a randomized trial directly comparing outcomes in men with localized prostate cancer treated by radical prostatectomy with treatment by radiation therapy, only an approximate answer regarding the relative efficacies of these modalities can be achieved. However, retrospective studies which examined outcomes based on pretreatment parameters intrinsic to the tumors have demonstrated that when stratified by grade and prostate specific antigen (PSA), the rates of cancer control for these therapies are similar at 5 years posttreatment. These modalities differ in other important ways, including acute toxicity, patient satisfaction, posttreatment quality of life, and ease of salvage of treatment failures. A consideration of all of these factors is necessary to arrive at the appropriate choice of therapy for each patient.