Review articleLocalized prostate cancer: radiation or surgery?
Section snippets
Cancer control
The issue of cancer control or cure is difficult when considering prostate cancer. The long natural history of this disease means that there is limited overall or cancer-specific survival data, 21 years after Walsh [16] repopularized RP and 15 years after PSA came into widespread use. It is still not possible to tell patients which of the various treatments for localized or locally advanced disease results in the best survival. Furthermore, there is no comparative data on metastasis-free
Morbidity
A commonly held belief among radiation therapists is that the acute morbidity of EBRT or BT is lower than that for RP. A review of recent trends in the perioperative management of RP patients suggests that this is not true. Beginning with an institutionwide length-of-stay project in 1992 [33], we have shortened hospital stay progressively from 9 to 2 days, using a variety of preoperative, intraoperative, and postoperative strategies [33]. Reducing the length of stay to 2 days does not
QOL
Despite the advent of validated questionnaires, the perception of a patient's QOL after therapy remains subjective. All urologists have seen patients who are not bothered wearing one or two pads per day for stress incontinence after RP, and—on the opposite end of the spectrum—the occasional patient who wears no pads, leaks a few drops with abdominal straining, and is psychologically incapacitated by this event. Defining acceptable QOL after therapy is made more difficult by the marked
Salvage of failures
Because of the long natural history of prostate cancer, a discussion of salvage of treatment failures is relevant. In previous articles [18], [19], we discussed observations that the occurrence of biochemical failure after RP or EBRT is not predictive of survival 10 years after therapy. At times, it is extremely difficulty to decide whether to proceed with a second attempt at cure after primary treatment failure because of limitations in the ability to define who has a true local recurrence.
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