Men with prostate cancer and their healthcare professionals are faced with several options for treating the primary tumour at the time of diagnosis and any recurrence. Newer treatments such as cryotherapy and high intensity focused ultrasound are available in some centres in the United Kingdom and have enthusiastic advocates.

In 2005, the National Institute for Health and Clinical Excellence (NICE) issued guidance on cryotherapy and ultrasound treatment saying that “the current evidence on efficacy and safety” seemed “adequate to support their use” in patients with prostate cancer.1 2 But in 2008, NICE published clinical guidelines on prostate cancer which stated that these treatments “are not recommended for men with localised prostate cancer other than in the context of controlled clinical trials comparing their use with established interventions.”3 This apparent change of heart caused concern among urologists and even reached the national press.4 However, the advice was not really inconsistent—NICE deemed these techniques safe and efficacious enough to be used but thought that the evidence on their clinical effectiveness compared with alternatives was insufficient to recommend their routine use in the NHS.

Cryotherapy is increasingly …