There have been some advances in local control, but little impact on survival

Prostate cancer is now the commonest male cancer and the second commonest cause of male cancer deaths. Death rates have doubled over the past 20 years, and mortality is predicted to exceed that for lung cancer in 15 years' time. This increased incidence of prostate cancer has led to considerable efforts to improve on local treatments and boost survival. In the United Kingdom 60% of patients with prostate cancer are diagnosed with metastatic disease. Screening for prostate specific antigen (PSA) in North America has led to increased detection of the disease at an earlier stage, but not yet to increased survival.1 Screening has, however, meant that more patients have become candidates for radical local treatments. What evidence do we have that we are doing any better for localised prostate cancer?

Localised prostate cancer may be treated surgically or with radiotherapy or managed by “watchful waiting,” with treatment only when disease progresses. Surgery has been suggested as offering the best chance of cure for patients with poorly differentiated tumours, with survival figures of 70-80% compared with 15% for radiotherapy.2 The survival figures for patients with well and moderately differentiated tumours are identical whether they are managed by radiotherapy or by watchful waiting.3^–5 …