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[Comment] Innovation and surgical clinical trials

Most intermediate-risk and high-risk, but organ-confined, prostate cancer is treated by radical prostatectomy or external beam radiotherapy. Over time both have evolved with advances in technology and we have seen the diffusion of innovation proceed largely uninterrupted, without a robust evidence base comparing old with new. This uninterrupted diffusion has become particularly important for financially constrained health-care systems, when the technology is potentially high impact but also high cost.