Dilemmas in treating early prostate cancer: the evidence and a questionnaire survey of consultant urologists in the United Kingdom

Editorial by Emberton Evidence based medicine suggests that evidence of effectiveness should accumulate, preferably from randomised controlled trials, before treatments for any condition become widely used. The case of localised prostate cancer shows how difficult this can be in practice. The suitability of population screening for localised prostate cancer has been debated, 1 2 with particular concerns about the comparative effectiveness of the main treatments for the disease: radical prostatectomy, radical radiotherapy, and conservative management (also known as watchful waiting or surveillance). 3 4 Systematic reviews show that published evidence is limited to two seriously flawed randomised controlled trials and a range of observational studies with biases relating to patient selection, variable treatment techniques, outcome assessments, and methods of data analysis.3 These studies show that 10 year survival is good and overlaps for the three treatments, being 85-90% for radical prostatectomy, 65-90% for radical radiotherapy, and 70-90% for conservative management.3 Although some studies indicate a survival advantage of radical treatments in some patients, this advantage is small and uncertain given the particular study designs. Furthermore, …