When a decision has been taken to treat localised prostate cancer, there is no formal evidence to support the superiority of either radical prostatectomy or localised external radiotherapy, or to justify the use of one form of treatment rather than another. Patients need to have a life expectancy of at least 10 years to gain any benefit from either of these two forms of treatment. If life expectancy is lower, watchful waiting appears to be preferable.
The uncertainties and possible risks of the various forms of treatment mean that a patient should be given adequate information about the advantages and disadvantages of each of the alternatives, and be included in the treatment decision. The gold standard treatments for localised prostate cancer are open retropubic radical prostatectomy and conventional external radiotherapy. Studies of dose escalation in conformational radiotherapy have not yet contributed any proof of benefit from this form of treatment compared with conventional radiotherapy. Brachytherapy for prostate cancer is still too new for conclusions to be drawn regarding its efficacy and safety compared with conventional forms of treatment. There is not yet sufficient evidence on laparoscopic surgery to allow it to be offered to patients as equivalent to gold standard surgery. Other new approaches such as cryosurgery or high intensity focused ultrasound are also still experimental.