Treatment of localized prostate cancer - Choosing the best alternative

Opinions among national experts vary regarding the best treatment for organ-confined prostate cancer, and the medical literature offers little evidence to support one option over another. For patients 70 years of age or younger who have a low Gleason score and a low prostate-specific antigen level, surgery is the preferred treatment; however, radiation therapy may be an almost equivalent second choice, depending on the patient's concerns about preserving potency. For patients over age 70, radiation therapy is preferred, and the approach used may vary among medical centers. For the hypothetical 70-year-old patient described in this article, the optimal treatment is controversial. Considerations include the expertise of the physicians involved and the patient's willingness to tolerate unpleasant side effects, Fortunately, long-term control is highly likely with any of the available treatments.