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.

中文翻译：

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高危前列腺癌放疗与前列腺切除术的比较：死亡率和生活质量结果的叙事回顾。

目前，与放疗联合雄激素剥夺疗法相比，前列腺癌根治术相对于高危前列腺癌的相对疗效尚缺乏1级证据。最近，通过组合治疗方法的使用，优化了治疗方法，实现了出色的生化结果和特定于癌症的死亡率。联合方式疗法也越来越多地结合了近距离放射疗法。尽管由于潜在的残留混杂因素的影响，必须谨慎解释可用的观察数据，但我们在这里对最近的进展进行了叙述性综述，以了解了解主要联合方式治疗高危前列腺癌的相对疗效。由于这种趋势已经证明，在精心选择的联合治疗方法之间趋于等同，因此应越来越重视选择适合患者生活质量目标的治疗方法。我们在这里提出了迄今为止为了解治疗对功能结局和生活质量终点的影响所做的努力概述。