The place of radical prostatectomy in the treatment of early localized prostate cancer

Today a number of treatment options exist for men diagnosed with early loca lized prostate carcinoma, of which the most important are radical prostatec tomy, external beam radiotherapy and brachytherapy. New advances in brachyt herapy using the implantation of iodine-125 and palladium-103 seeds have si gnificantly altered its place in the treatment of localized disease and pro vided an alternative to external beam radiotherapy and potentially radical prostatectomy. Drawing on recently published data and our own experiences o f retropubic radical prostatectomy in 100 consecutive men with localized di sease, we review the place of radical prostatectomy in the treatment of ear ly prostate cancer today. For many urologists radical prostatectomy remains the treatment of choice for men aged 70 years or less, with localized dise ase, a life expectancy of over 10 years and no co-morbidity. However, this has to be balanced against recent advances in brachytherapy, which now prov ides a minimally invasive alternative therapy for some patients with organ- confined disease and for those in whom surgery is contraindicated. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.