Treatment of localized prostate cancer: Radical prostatectomy versus radiation therapy

Between 1982 and 1990, 57 patients with prostate cancer (clinical stage T2-3) underwent pelvic lymphadenectomy at Fukui Medical School or Toyooka Public Hospital. The patients were subsequently treated either by radical prostatectomy (39 cases) or external radiation therapy (18 cases). The patients were between 56 and 85 years old (Mean 73). The outcome of the 47 patients without lymph node metastasis (prostatectomy 33, radiation 14) was examined. The 5-year disease-specific survival rate was 96% for the patients treated by prostatectomy and 93% for those treated by radiation. The 5-year progression-free survival rate for the prostatectomy group and radiation group was 94% and 41%, respectively (P = 0.004). The outcome of the 10 patients with lymph node metastasis (prostatectomy 6, radiation 4) was not satisfactory because of the high progression rate in the two groups (5-year progression-free survival, 22% in prostatectomy and 25% in radiation group). In the patients with no metastasized lymph nodes, we should choose radical prostatectomy, if our goal is to cure the patients.