title: Surgery vs. radiotherapy in localized prostate cancer. Which is best?
abstract: Surgery and radiotherapy are currently accepted alternatives for the treatment of localized prostate cancer. In the absence of relevant randomized trials no decision regarding the superiority of any of the given approaches can be made. Up to now several cohort-based approaches indicate similar outcomes for both treatments. Based on a new population based approach, Merglen and co-workers recently concluded that surgery would offer the best chance of long-term control in terms of 10-year survival for T1-T3 prostate cancer patients. Unfortunately the strength of this trial is limited by several shortcomings. Most importantly, issues of radiation dosage have not been taken into account. In addition, several relevant parameters including Gleason score and PSA are not well balanced between the arms and the assignment to arbitrary risk groups does not reflect the real biological behaviour. Thus, the data provided do not support the strong conclusion issued by the authors. Based on the data available, surgery and radiotherapy still have to be considered as equally effective.
authors.affiliation: Department of Radiation Oncology, Ludwig-Maximilians-University, Munich, Germany. stefan.welz@med.uni-tuebingen.de
authors.forename: Stefan
authors.initials: S
authors.lastname: Welz
authors.forename: Maximilian
authors.initials: M
authors.lastname: Nyazi
authors.forename: Claus
authors.initials: C
authors.lastname: Belka
authors.forename: Ute
authors.initials: U
authors.lastname: Ganswindt
mesh_terms: D002986:Clinical Trials as Topic; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000379:methods* / Q000639:trends; D011471:Prostatic Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D018787:Radiation Oncology / Q000379:methods; D012107:Research Design; D016896:Treatment Outcome
references.citation: Scand J Urol Nephrol. 2003;37(5):382-6
references.pmid: 14594685
references.citation: Jpn J Clin Oncol. 2006 Dec;36(12):789-93
references.pmid: 17082219
references.citation: J Cancer Res Clin Oncol. 2005 Jul;131(7):407-19
references.pmid: 15887028
references.citation: Arch Intern Med. 2007 Oct 8;167(18):1944-50
references.pmid: 17923593
references.citation: JAMA. 1998 Sep 16;280(11):969-74
references.pmid: 9749478
references.citation: J Urol. 2001 Sep;166(3):876-81
references.pmid: 11490237
references.citation: Cancer. 2002 Jul 15;95(2):281-6
references.pmid: 12124827
references.citation: Cancer. 2001 Jun 15;91(12):2302-14
references.pmid: 11413519
references.citation: Urology. 2001 Dec;58(6):843-8
references.pmid: 11744442
references.citation: J Natl Cancer Inst. 2000 Apr 19;92(8):613-21
references.pmid: 10772678
references.citation: Int J Radiat Oncol Biol Phys. 2004 Jan 1;58(1):25-33
references.pmid: 14697417
references.citation: J Clin Oncol. 2002 Aug 15;20(16):3376-85
references.pmid: 12177097
references.citation: Lancet. 2002 Jul 13;360(9327):103-6
references.pmid: 12126818
references.citation: Int J Radiat Oncol Biol Phys. 2006 Nov 15;66(4):1092-9
references.pmid: 16965872
references.citation: Urology. 1996 Sep;48(3):428-32
references.pmid: 8804497
references.citation: Int J Radiat Oncol Biol Phys. 2002 Aug 1;53(5):1097-105
references.pmid: 12128107