Surgery vs. radiotherapy in localized prostate cancer. Which is best?

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.