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Title: Survival and Complications Following Surgery and Radiation for Localized Prostate Cancer: An International Collaborative Review.
Austin Authors: Wallis, Christopher J D;Glaser, Adam;Hu, Jim C;Huland, Hartwig;Lawrentschuk, Nathan;Moon, Daniel;Murphy, Declan G;Nguyen, Paul L;Resnick, Matthew J;Nam, Robert K
Affiliation: Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
Institute of Health Policy, Management, & Evaluation, University of Toronto, Toronto, ON, Canada
Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
Department of Urology, Weill Cornell Medicine, New York, NY, USA
Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
Department of Surgery, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia
Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia .
Central Clinical School, Monash University, Clayton, Australia
The Epworth Prostate Centre, Epworth Hospital, Richmond, Australia
Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA, USA
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
Geriatric Research, Education, and Clinical Center, Tennessee Valley VA Health Care System, Nashville, TN, USA
Issue Date: Jan-2018
Date: 2017-06-11
Publication information: European urology 2018; 73(1): 11-20
Abstract: Evaluation of treatment options for localized prostate cancer (PCa) remains among the highest priorities for comparative effectiveness research. Surgery and radiotherapy (RT) are the two interventions most commonly used. To provide a critical narrative review of evidence of the comparative effectiveness and harms of surgery and RT in the treatment of localized PCa. A collaborative critical narrative review of the literature was conducted. Evidence to clearly guide treatment choice in PCa remains insufficient. Randomized trials are underpowered for clinically meaningful endpoints and have demonstrated no difference in overall or PCa-specific survival. Observational studies have consistently demonstrated an absolute survival benefit for men treated with radical prostatectomy, but are limited by selection bias and residual confounding errors. Surgery and RT are associated with comparable health-related quality of life following treatment in three randomized trials. Randomized data regarding urinary, erectile, and bowel function show few long-term (>5 yr) differences, although short-term continence and erectile function were worse following surgery and short-term urinary bother and bowel function were worse following RT. There has been recent recognition of other complications that may significantly affect the life trajectory of those undergoing PCa treatment. Of these, hospitalization, the need for urologic, rectoanal, and other major surgical procedures, and secondary cancers are more common among men treated with RT. Androgen deprivation therapy, frequently co-administered with RT, may additionally contribute to treatment-related morbidity. Technological innovations in surgery and RT have shown inconsistent oncologic and functional benefits. Owing to underpowered randomized control studies and the selection biases inherent in observational studies, the question of which treatment provides better PCa control cannot be definitively answered now or in the near future. Complications following PCa treatment are relatively common regardless of treatment approach. These include the commonly identified issues of urinary incontinence and erectile dysfunction, and others including hospitalization and invasive procedures to manage complications and secondary malignancies. Population-based outcome studies, rather than clinical trial data, will be necessary for a comprehensive understanding of the relative benefits and risks of each therapeutic approach. Surgery and radiotherapy are the most common interventions for men diagnosed with prostate cancer. Comparisons of survival after these treatments are limited by various flaws in the relevant studies. Complications are common regardless of the treatment approach.
DOI: 10.1016/j.eururo.2017.05.055
ORCID: 0000-0001-8553-5618
Journal: European Urology
PubMed URL: 28610779
Type: Journal Article
Subjects: Adverse effects
Comparative effectiveness research
Prostatic neoplasms
Quality of life
Appears in Collections:Journal articles

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