ORIGINAL RESEARCH article
Front. Oncol.
Sec. Genitourinary Oncology
This article is part of the Research TopicAdvances in Combined Modality Treatments for Prostate CancerView all 9 articles
Prostatectomy versus Definitive Radiation for Localized Prostate Cancer: Revisiting the Debate at a Tertiary Cancer Center
Provisionally accepted
Ramiz AbuHijlih1
Abdulla Alzibdeh1
Haneen Abaza1Rami Ghanem1Abdel-Hamid Khairy1Zaid Al-Kilani1
Mohammed Shahait2Samer Salah3
Fawzi Abuhijla1
Issa Mohamad1
Ayat Taqash1Hadeel Abdel Khaleq1
Hikmat Abdel-Razeq1
Amal Al Omari1*- 1King Hussein Cancer Center, Amman, Jordan
- 2University of Sharjah, Sharjah, United Arab Emirates
- 3King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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Background: Surgery and radiotherapy are the main treatments for localized prostate cancer. Although many retrospective studies have compared their efficacy, evidence from the Middle East and North Africa (MENA) region is limited. This study reports real-world outcomes of patients treated with radical prostatectomy versus definitive radiotherapy at a tertiary cancer center in Jordan. Methods: We conducted a retrospective cohort study of patients treated between June 2006 and June 2019. Patient demographics, disease characteristics, and treatment details were extracted from electronic medical records. Primary endpoints were cancer-specific survival (CSS) and overall survival (OS); secondary endpoints included metastasis-free survival (MFS) and biochemical relapse-free survival (BRFS). Survival outcomes and group differences were evaluated with the log-rank test. Results: Among 317 patients, median age was 68 years and median PSA 12.98 ng/mL. High-risk disease predominated (62.5%), followed by intermediate (32.8%) and low-risk (4.7%). Eighty-nine patients underwent radical prostatectomy and 228 received radiotherapy with androgen deprivation therapy (ADT). Five-year CSS and OS were excellent and similar between surgery and radiotherapy (CSS: 98.7% vs. 96.7%; OS: 90% vs. 89.6%). MFS was comparable (94.9% vs. 94.2%), while BRFS was lower in the surgical group (59.8% vs. 90.5%, p < 0.001). Recurrence occurred in 44.9% of surgical versus 14% of radiotherapy patients, and prostate cancer–specific deaths were 4.4% and 4.3%, respectively. Conclusion: This study shows that surgery and radiotherapy achieve excellent long-term survival for localized prostate cancer. Radiotherapy with ADT provides superior biochemical control, emphasizing the importance of individualized, multidisciplinary treatment planning.
Keywords: Jordan, localized prostate cancer, Prostatectomy, Radiotherapy, Recurrence
Received: 28 Nov 2025; Accepted: 05 Feb 2026.
Copyright: © 2026 AbuHijlih, Alzibdeh, Abaza, Ghanem, Khairy, Al-Kilani, Shahait, Salah, Abuhijla, Mohamad, Taqash, Abdel Khaleq, Abdel-Razeq and Al Omari. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Amal Al Omari
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