In an article published in N Eng J Med (2012) Wilt et al investigated radical prostatectomy as a treatment for localised prostate cancer and report results from this research known as the PIVOT trial. Radical prostatectomy did not significantly reduce mortality compared to active surveillance during 10 years of follow-up (171/364 (47%) v 183/367 (49.9%) and made no significant difference to risk of death from prostate cancer or its treatment. The men had localised disease (half the tumours were impalpable) and a median prostate specific antigen concentration of 7.8 μg/L. Four fifths of the men who had surgery were unable to have erections afterwards (231/285 (81%)), and one in six was incontinent (49/287 (17%)). This article suggests that active surveillance is a good treatment for low risk prostate cancer. However, radical prostatectomy improved all cause mortality in patients with a PSA greater than 10ng/ml (p=0.04) and probably in those with intermediate/high risk disease (p=0.07).