ABSTRACT
Comparison of radiotherapy versus surgery The relative merits of radical external beam radiotherapy or surgery for the individual will depend on the factors mentioned above. There are no adequate large randomized trials comparing radical radiotherapy with radical prostatectomy. The only randomized trial comparing radiotherapy and radical prostatectomy showed superior results for radical prostatectomy in “time to first evidence of treatment failure.”7 However, this trial has been criticized for violations in randomization, inadequate staging and follow-up, and possible selection bias,8 and was disregarded in the National Institutes of Health consensus recommendations.9 This issue has fueled nonrandomized comparisons of men with early localized prostate cancer treated by radical radiotherapy techniques and radical surgery. However, issues that can hamper interpretation of retrospective and nonrandomized
comparisons include case selection, lack of central pathologic review, uncertain quality assurance of treatment methods with variable lengths of follow-up and definitions of biochemical failure.
