Radiation therapy or prostatectomy: an old conflict revisited in the PSA era. A radiation oncologist's viewpoint.

A close examination of the outcomes for the radical treatment of prostate cancer in the prostate-specific antigen (PSA) era shows no clear advantage to radical prostatectomy over external-beam radiation. Both modalities are highly effective against small impalpable tumors of low Gleason grade and with PSA values less than 10 ng/mL. Both modalities struggle against all other stages of prostate cancer. Radiation and surgery are currently in states of rapid evolution, and the results emerging become quickly outdated. It is hoped that the newer, more aggressive approaches will help a significant number of patients, perhaps the majority, not currently being cured by radical therapy.