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According to a recent article published in the Journal of Clinical Oncology, a radical prostatectomy and external-beam radiation therapy appear to provide equivalent disease-free survival in patients with localized prostate cancer.

The prostate is a male sex gland that is located between the bladder and the rectum and is responsible for creating a component of semen. Localized prostate cancer refers to cancer that has not spread from its site of origin. Several treatment options exist for patients with prostate cancer, including watchful waiting, surgical removal of the prostate (radical prostatectomy), radiation therapy, cryosurgery and/or hormone therapy. Researchers are beginning to directly compare different treatment modalities in patients with different stages of prostate cancer in order to determine optimal therapeutic regimens.

Prostate-specific antigen (PSA) are proteins that are shed by prostate cells into the bloodstream and when elevated, often indicate the presence of prostate cancer. If a man has an elevated PSA, the next step is to undergo biopsies of the prostate to determine if cancer is present and if so, how aggressive and/or extensive the cancer may be within the prostate. A Gleason score indicates the aggressiveness of the prostate cancer.

Researchers from the Cleveland Clinic Foundation recently conducted a clinical trial to directly compare treatment with a radical prostatectomy and radiation therapy in patients with localized prostate cancer. This study included 1,054 patients treated with a radical prostatectomy and 628 patients with radiation. Seventeen percent of patients treated with a radical prostatectomy had received hormone therapy (treatment to reduce male hormone levels) prior to surgery, compared to 23% of patients treated with radiation. Approximately 8 years following therapy, overall recurrence-free survival was 72% in patients treated with surgery and 70% in patients treated with radiation. The variables that attributed to a difference in recurrence rates were the following: extent of disease, pretreatment Gleason score, pretreatment PSA levels and radiation dose, for those patients treated with radiation.

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These researchers concluded that treatment with a radical prostatectomy and radiation therapy appears to provide equivalent long-term recurrence-free survival in patients with localized prostate cancer. Patients with higher pretreatment PSA levels and Gleason scores, as well as more extensive disease had a higher rate of recurrence, regardless of treatment regimen used. Patients with localized prostate cancer may wish to speak with their physician about the risks and benefits of specific treatment options or the participation in a clinical trial evaluating novel therapeutic options. Two sources of information regarding ongoing clinical trials include the National Cancer Institute ( and also provides personalized clinical trial searches on behalf of patients.

Reference: Kupelian P, Elshaikh M, Reddy C, et al. Comparison of the efficacy of local therapies for localized prostate cancer in the prostate-specific antigen era: a large single-institution experience with radical prostatectomy and external-beam radiotherapy.

Journal of Clinical Oncology. 2002;20:3376-3385.

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