Because a randomized trial comparing radical prostatectomy to radiation for men with clinically localized prostate cancer has not been performed in the modern era, risk stratification must be used to compare contemporaneously treated patients. As an example, in a recent series from the Cleveland Clinic, the biochemical outcomes of 2127 men treated with either external radiation therapy or radical prostatectomy between 1987 and 1998 were compared.35 When patients were stratified by serum PSA, Gleason score and stage, there was no difference in biochemical relapse-free survival at 5 years.35
However, late recurrences following radiation therapy can occur, since the tumor may not be completely destroyed. As a result, 10 years or more after treatment, the outcome with radiotherapy may not be as favorable as with surgery.36 However, the available data on this issue using modern radiotherapy techniques are limited.
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