Surgery or radiotherapy for prostate cancer?

Prostate cancer is the commonest malignancy in males in the Western world, accounting for over a quarter of all cancer diagnoses in men in the United Kingdom; more than 90% of new diagnoses of prostate cancer are of localised disease.1 Surprisingly, we do not objectively yet know the best form of treatment for this prevalent disease. In a linked paper, Sooriakumaran and colleagues (doi:10.1136/bmj.g1502) present some of the best quality evidence so far by comparing radical prostatectomy and radiotherapy, the two most widely used treatments.2 Although previous investigators have evaluated the comparative effectiveness of treatments, most such reports were arguably flawed by lack of complete and accurate data on certain key variables that would help predict mortality. Indeed, guidelines from England’s National Institute for Health and Care Excellence, updated just last month, make no suggestion as to which treatment is preferred and simply encourage decision making to be based on differences in adverse event profiles.3

The only two …