The surgery of prostate cancer: An update of contemporary radical prostatectomy and brachytherapy series

Prostate cancer is the most commonly diagnosed malignancy among men in the United States. Radical prostatectomy has been the gold standard for treating clinically localized prostate cancer. Its morbidity and disease- control capabilities have been well studied. At 10 years after surgery, 50% to 70% of patients are disease-free. New advances in computerized dosimetry have rekindled interest in interstitial radiation therapy as an alternative form of therapy. Because of inadequate duration of followup, the selection of patients with less virulent tumors, and the inconsistent definitions of biochemical failure it is impossible to definitely compare the efficacy between these two different treatment options. Yet, even among highly selected patients with low-grade tumors, there may be a significant advantage in surgery as compared to interstitial monotherapy. The results of combined interstitial and external radiotherapy have yielded lower failure rates, but long-term data is very limited.