Radiotherapy or Surgery for Prostate Cancer? Ten and Fifteen-Year Results of External Beam Therapy

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Abstract
Ten and 15-year outcome results are reviewed that demonstrate the role of radiation therapy in the management of prostate cancer. Patients with favorable T2a (B1) cancers of unknown nodal status are shown to have equal 15-year survival whether treated with external beam radiation therapy or radical prostatectomy. Patients of unknown nodal status treated for T2b (stage B2) cancer with external beam radiation therapy show superior survival and disease-free survival when compared to results with radical prostatectomy. The role of radical prostatectomy in these patients is unproven. Patients with lymph node dissection negative clinical stages T1b (A2) and T2 (B) treated with external beam radiation therapy exceed their expected survival at 10 years (65% vs 60%), and 70% are free of any failure at 10 years with the majority of failures due to metastasis, not local disease. Similar results are obtained in selected surgical centers with radical prostatectomy in highly selected patients. Patients with stage T3, 4 (stage C) prostate cancer show 10 and 15-year survivals that offer curative therapy and hope to patients with these locally advanced cancers. No long-term data support a role for radical prostatectomy in these patients.