Comparing Radiotherapy to Prostatectomy for High-Risk Prostate Cancer: A Narrative Review of Mortality and Quality-of-Life Outcomes

Cancer J. 2020 Jan/Feb;26(1):29-37. doi: 10.1097/PPO.0000000000000420.


There is currently a lack of level 1 evidence regarding the relative efficacy of radical prostatectomy compared with radiotherapy combined with androgen deprivation therapy for high-risk prostate cancer. There has recently been an improved optimization of treatment, achieving superior biochemical outcomes and cancer-specific mortality through the use of combined modality therapy strategies. Combined modality therapies have also increasingly incorporated brachytherapy boost. Although available observational data must be interpreted with caution because of the effects of potential residual confounding, we present here a narrative review of recent advances in understanding the relative efficacy of the principal combined modality approaches for treating high-risk prostate cancer. As the trend has demonstrated approaching equivalence between well-selected combined modality therapies, an increasing emphasis should be placed on selecting therapy tailored toward a patient's goals regarding quality of life. We present here an outline of efforts to date to understand the implications of treatment on functional outcomes and quality-of-life endpoints.

Publication types

  • Comparative Study
  • Review

MeSH terms

  • Androgen Antagonists / administration & dosage
  • Androgen Antagonists / adverse effects*
  • Brachytherapy / adverse effects
  • Brachytherapy / methods
  • Chemoradiotherapy / adverse effects*
  • Chemoradiotherapy / methods
  • Disease Progression
  • Disease-Free Survival
  • Humans
  • Male
  • Meta-Analysis as Topic
  • Observational Studies as Topic
  • Patient Reported Outcome Measures
  • Prostate / drug effects
  • Prostate / radiation effects
  • Prostate / surgery
  • Prostatectomy / adverse effects*
  • Prostatic Neoplasms / complications
  • Prostatic Neoplasms / mortality
  • Prostatic Neoplasms / therapy*
  • Quality of Life*
  • Randomized Controlled Trials as Topic


  • Androgen Antagonists