Chaos and clinical controversy rages at hospitals worldwide over the best way to treat prostate cancer.

Doctors are unsure whether to treat, and those that do take positive action are uncertain about the type of treatment.

This mass uncertainty, based on inadequate trials, came to light in a survey of 270 British urologists. The research team was so concerned by its findings that it is calling for established standards of practice to be decided upon, but this is hard to implement without proper research.

"For the foreseeable future, recommendations for managing prostate cancer will rely more on dogma than data," says Albert Mulley from Harvard Medical School in an accompanying comment.

Urologists who favour early intervention are divided over what form it should take. Of the urologists who participated in the survey, most recommended radiation for men under the age of 70 with early prostate cancer, some preferred radical prostatectomy and a sizeable minority opted for hormone treatment. For men over 70, 30 per cent of urologists favoured active treatment, usually radiation.

Although 90 per cent of urologists favoured active treatment among younger men, few of them thought that early detection had any benefits.

This indecision may be fuelled by the understanding that any benefit is only likely to be realised long after treatment, while the patient still had to contend with the immediate side effects of incontinence and impotence among the few aspects of treatment that have been well researched (Br J Urol 1997; 79: 749-55; BMJ 1998; 316: 1919-20).

Impotence was suffered by 98 of 112 men after surgery for prostate cancer, an Australian study has discovered. Impotence was the most reported worry, well ahead of fears about cancer and incontinent. Unsatisfactory golf club toilets was a more unexpected item on the list (Med J of Australia 1998; 168: 483-6).