A comparison of effectiveness is indeterminate.
In 2007 approximately 219,000 men in the United States were diagnosed with prostate cancer and 27,050 died. The number of diagnosed cases has doubled since the advent of prostate specific antigen (PSA) blood testing in the late 1980s, yet the disease's mortality rate has remained at approximately 3%. Concern has arisen about false-positive PSA test results causing "overdetection" and clinically localized cases that are unlikely to cause morbidity, leading to unnecessary treatment.
After a diagnosis of prostate cancer, a patient, his family, and his health care practitioner must choose a course of treatment based primarily on the physician's recommendation, the risk of metastasis without treatment, the potential for both disease eradication and adverse effects with treatment, and the convenience and cost of treatment. Patient characteristics such as age and race or ethnicity and comorbidities are also considered when assessing the potential for death and the likelihood that treatment will cause urinary, bowel, or sexual dysfunction.
To compare the various options for treating clinically localized prostate cancer, the Agency for Healthcare Research and Quality reviewed approximately 500 published articles concerning complete surgical removal of the prostate (radical prostatectomy), including the minimally invasive laparoscopic procedure; external radiation; radioactive implant placement; destruction of cancerous cells by repeated rapid freezing and thawing; androgen deprivation (surgical removal of the testicles or hormone therapy); high-intensity ultrasonography; or no treatment ("watchful waiting").
The authors conclude that limitations in the available evidence make it difficult to compare the various treatments for localized prostate cancer. All the treatments reviewed have adverse effects (primarily on urinary, bowel, and sexual function), although their severity and frequency appear to vary.
The crux of the matter. Insufficient evidence makes it difficult to determine the best treatment for localized prostate cancer.