Herlemann A, Cowan JE, Washington SL, et al. - In the present study, the researchers sought to compare long-term survival among men who had radical prostatectomy (RP), brachytherapy (BT), external beam radiation therapy (EBRT), primary androgen deprivation therapy (PADT), or monitoring (AS/WW) for localized prostate cancer (PCa). Within the CaPSURE registry, 12,062 men with localized PCa were analyzed. Using the Stephenson preoperative nomogram and the Cancer of the Prostate Risk Assessment score, PCa risk was assessed. Six thousand three hundred fifty-seven men underwent RP, 1,351 BT, 1,716 EBRT, 1,605 PADT, and 1,033 AS/WW. In a large, prospective cohort of men with localized PCa, the risk of PCSM and ACM after RP was lowest after adjustment for age and comorbidity. Mortality after EBRT and AS/WW was significantly higher, and the highest after PADT. RP should be offered as part of the high-risk disease management paradigm, with AS/WW preferred for most low-risk PCa.