Therapies for Clinically Localized Prostate Cancer: A Comparative Effectiveness Review.

Identify new information evaluating clinically localized prostate cancer (CLPC) therapies.

Bibliographic databases (2013-January 2020); ClinicalTrials.gov; and systematic reviews were searched for controlled studies of CLPC treatments; duration ≥5 years for mortality and metastases and ≥1 year for harms.

We identified 67 eligible references. Among clinically, rather than prostate-specific antigen (PSA) detected CLPC, Watchful Waiting (WW) may increase mortality and metastases but decreases urinary and erectile dysfunction versus Radical Prostatectomy (RP). Comparative mortality effect may vary by tumor risk and age but not by race, health status, comorbidities or PSA. Active Monitoring (AM) probably results in little to no mortality difference in PSA detected CLPC versus RP or External Beam Radiation (EBR) plus Androgen Deprivation (AD) regardless of tumor risk. Metastases were slightly higher with AM. Harms were greater with RP than AM and mixed between EBR plus AD versus AM. 3D-Conformal Radiation (3D-CR) and AD plus low-dose-rate brachytherapy (BT) provided small mortality reductions versus 3D-CR and AD but little to no difference on metastases. EBR plus AD versus EBR alone may result in small mortality and metastases reductions in higher risk disease but may increase sexual harms. Little new data exist on other treatments.

RP reduces mortality versus WW in clinically detected CLPC but causes more harms. Effectiveness may be limited to younger men and those with intermediate risk disease. AM results in little to no mortality difference versus RP or EBR plus AD. Little new data exist on other treatments.

The Journal of urology. 2020 Dec 22 [Epub ahead of print]

Timothy J Wilt, Kristen E Ullman, Eric J Linskens, Roderick MacDonald, Michelle Brasure, Elizabeth Ester, Victoria A Nelson, Jayati Saha, Shahnaz Sultan, Philipp Dahm

Minneapolis VA Healthcare System, Minneapolis, Minnesota.