Prostate Cancer Treatment

The treatment of localised prostate cancer remains controversial since there is no clear evidence of the superiority of any one treatment modality over any other. However, evidence is emerging that, in some patient groups, radical treatment may confer a survival advantage. The issue, therefore, appears to be one of treatment efficacy against complications and effects on quality of life. Compared to watchful waiting, radical prostatectomy remains the only treatment modality where there is published evidence of a survival advantage. Goldstraw and Kirby, therefore, argue that surgery remains the gold standard treatment despite its slightly higher complication rates compared to external beam radiotherapy. Langley, however, demonstrates that brachytherapy now offers effective treatment of prostate cancer with oncological outcomes which are certainly comparable with those of surgery and he describes a lower risk of complications. Whether the complication rates are really more acceptable is perhaps less clear than he suggests since there is a danger in comparing figures from acknowledged centres of excellence with those from units performing much lesser numbers of procedures. In considering new treatment modalities, healthcare systems have now become obliged to consider costs. Hitherto, new technologies including brachytherapy and laparoscopic or robotic techniques have proved expensive compared to traditional surgery. It is perhaps difficult, therefore, to see the NHS wishing to continue funding for procedures where an acceptable, cheaper alternative exists. Krishna K Sethia Consultant Urological Surgeon, Norfolk & Norwich University NHS Trust, Colney, Norwich NR4 7UY, UK ku.shn.hunn@aihtes.anhsirk