Context

What is the best treatment for localised prostate cancer? This simple question, for a common disease now affecting about one in six North American men, does not have a clear answer. This is not a ‘normal’ situation in medicine. For most common diseases, including most primary cancers, there is usually a consensus as to the best therapeutic approach. Not so for localised prostate cancer. Surgery contends with radiation of various types and conservative management, particularly active surveillance, which has made inroads against both of these for favourable risk disease. The lack of consensus reflects many factors, including difficulty in successfully completing randomised comparative trials (RCTs), long timelines to achieve robust endpoints and trade-offs between survival and quality of …