The first-line treatment for localized prostate cancer is surgery (radical prostatectomy) or radiotherapy because these modalities aim for curative intent by removing or eradicating the tumor confined within the prostate. Both treatments have demonstrated effective long-term disease control and survival benefits in appropriately selected patients. Surgery involves complete excision of the prostate gland and seminal vesicles, offering pathological staging and potential cure. Radiotherapy provides a non-invasive alternative with comparable outcomes. Hormonal therapy and chemotherapy are reserved for advanced or metastatic disease. Active surveillance is an option in select low-risk cases but is not considered first-line treatment for those requiring curative intent.

Reference: Bailey & Love’s Short Practice of Surgery, 27th Edition.