Urologic oncology: extraordinary opportunities for discovery: New initiatives in radiation oncology

The discussion and debate over the “best” treatment for clinically localized prostate cancer will be an iterative process based on a combination of opinions and data. Success is a measure of both cancer control and quality of life such that in a disease with a long natural history, one must be very cautious about over-interpreting short- or medium-term results. As with many treatment approaches in the rapidly evolving world of medicine, outcomes improve over time so that retrospective studies are useful but of limited value due to changes in patient selection and therapeutic technique. Overly aggressive multimodality approaches will produce excellent short-term results such as PSA biochemical NED (bNED), yet these may be more costly in terms of toxicity and expense than necessary compared to uni-modality therapy.