The debate about the best treatment for prostate surgery has as much to do with the intense beliefs and economic competition between urologic surgeons and radiation therapists as it does with scientific fact.

Tension between the two medical specialities -- each with its own approach for treating the same patients -- has helped perpetuate the debate, several physicians said last week.

Dr. Mario A. Eisenberger, a medical oncologist from the University of Maryland Cancer Center in Baltimore, put the dispute into perspective with a joke: Three doctors died and went to heaven -- a urologic surgeon, a radiation therapist and a medical oncologist. And the Lord came to each and said, "You lived a good life on Earth. I will grant you each one wish."

The urologic surgeon said, "Lord, make all the radiation therapists disappear."

And the radiation therapist said, "Lord, make all the urologic surgeons disappear."

Then it was the medical oncologist's turn. "Lord, don't do anything for me," he said. "Just grant their wishes."

The audience at the National Institute of Health's consensus conference on prostate cancer laughed in appreciation and agreement.

When it comes to choosing how they would want to be treated if they had prostate cancer, both surgeons and radiation therapists tend to go with what they know best.

A survey of physicians by researchers at the Ontario Cancer Institute in Toronto found that 80 percent of the American urologists would have their prostate surgically removed, while 92 percent of the radiation therapists would prefer treatment with radiation.

Medical oncologists, however, who are trained to use drugs to kill cancers, were split: 42 percent for surgery, 46 percent radiation therapy. --