Counseling Patients With Localized Prostate Cancer

Radiation or Surgery?
  • Eric A. Klein
  • Patrick A. Kupelian
Part of the Current Clinical Urology book series (CCU)


The treatment of localized prostate cancer remains controversial because of the lack of conclusive well-controlled or randomized studies comparing outcomes of radiotherapy (RT) and radical prostatectomy (RP). A randomized trial published in 1982 showing an advantage to RP was never widely accepted because of randomization artifacts and worse than previously reported RT results (1,2). The Southwest Oncology Group closed a randomized study comparing these two modalities in the mid-1980s owing to poor accrual. In 1993, Stamey et al. (3) reported a 20% 5-yr biochemical cure rate with RT and suggested that radiation accelerates prostate cancer growth. Subsequently, large RT series were published with outcome results stratified by biopsy grade, T stage, and serum PSA, demonstrating similar short-term outcomes for RT and RP (4–6). A close examination of the patients treated by RT in the series of Stamey et al. (3) suggests that the observation of a 20% “cure” rate with RT can largely be explained by patient selection factors—all patients had high-volume cancers diagnosed by palpable lesions, 35% had clinical stage C disease, 50% had Gleason sum ≥7, and 15% had positive lymph nodes (7). Furthermore, Liebman et al. (8) have subsequently demonstrated that prostate-specific antigen (PSA) velocity is similar in those who fail radiation or surgery. None of these studies clearly answers the question of which is the best local therapy for localized prostate cancer. The unsettled nature of this issue is further complicated by the marked polarization of radiation oncologists and urologists in their counseling of patients with newly diagnosed localized disease, with surgeons recommending surgery and radiation therapists recommending radiation in virtually all circumstances (9).


Prostate Cancer Radical Prostatectomy Radiat Oncol Biol Phys Localize Prostate Cancer Pelvic Lymph Node Dissection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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© Springer Science+Business Media New York 2004

Authors and Affiliations

  • Eric A. Klein
  • Patrick A. Kupelian

There are no affiliations available

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