Appraisal of current therapies for prostate cancer

All aspects of the treatment of prostate cancer remain controversial. Even the simplest question--is early detection of prostate cancer beneficial?--remains the subject of heated debate. While it would appear intuitive that early detection should increase the survival of patients with prostate cancer, no high quality evidence actually supports this assumption. Indeed decision-analysis models have suggested that early detection and treatment may impair quality-adjusted survival. More practical issues such as the effectiveness and side effects of traditional treatments for prostate cancer, such as radical therapy for localised disease and androgen ablation therapy, are now under great scrutiny. There are proponents and opponents of all treatments brandishing widely divergent analyses designed to support their views. In an era of cost containment these various treatments are all being subjected to outcome analyses which will determine their true benefit. Nonetheless, the judicious selection of patients most likely to benefit from each individual therapy will assure the best possible outcome.