Comparative effectiveness of radical prostatectomy and radiotherapy in prostate cancer: observational study of mortality outcomes

One of the reasons why it is difficult for a patient to choose between available treatment modalities for prostate cancer, is that no randomized data is available on mortality outcomes between surgery and radiotherapy. Secondary endpoints such as the chance of side effects may therefore play a decisive role in the treatment-decision process. The lack of high quality evidence does however not mean that there is no difference in long-term prostate cancer specific death between therapies. It is unlikely that two such different treatment approaches will lead to the same results in all prostate cancer patients suitable for curative therapy. It may be more plausible that specific patient groups will benefit most from surgery, while another subset of patients might be better of with radiotherapy. Besides tumor characteristics, age and comorbidity should be used to decide on the best treatment option in a specific patient. The retrospective analysis of thousands of patients by Sooriakumaran et al provides very valuable information to demarcate which treatment may be most appropriate in which patient.