Effectiveness, harms of prostate Ca treatments: Data are limited

Assessing the comparative effectiveness and harms of various treatments for localized prostate cancer treatments is difficult because of limitations in evidence, according to a study to be published in the March 18, 2008, edition of the Annals of Internal Medicine.

Timothy Wilt, MD, of the University of Minnesota School of Medicine, Minneapolis, and colleagues, analyzed 18 randomized, controlled trials and 473 observational studies and discovered the following:

• One randomized, controlled study enrolled mostly men without PSA-detected disease and reported that, compared with watchful waiting, radical prostatectomy reduced all-cause mortality (24% vs. 30%; p=.04) and prostate cancer–specific mortality (5% vs. 10%; p=.01) at 10 years (p=.04). Effectiveness was limited to men younger than age 65 years, but was not associated with Gleason score or baseline PSA level.

• In an older, smaller study, no significant overall survival difference was seen between radical prostatectomy and watchful waiting (risk difference, 0% [95% CI, –19% to 18%]).

• Radical prostatectomy reduced disease recurrence at 5 years compared with external-beam radiation therapy in one small, older trial (14% vs. 39%; p=.04).

• No external-beam radiation regimen was superior to another in reducing mortality.

• No randomized trials evaluated primary androgen deprivation.

• Androgen deprivation used adjuvant to radical prostatectomy did not improve biochemical progression compared with radical prostatectomy alone.

• No randomized trial evaluated brachytherapy, cryotherapy, robotic radical prostatectomy, photon-beam, or intensity-modulated radiation therapy.

• Observational studies showed wide and overlapping effectiveness estimates within and between treatments.

• The Prostate Cancer Outcomes Study reported that urinary leakage was more common with radical prostatectomy than with radiation therapy or androgen deprivation.

• Erectile dysfunction occurred frequently after all treatments.

• A higher risk score incorporating histologic grade, PSA level, and tumor stage was associated with increased risk for disease progression or recurrence regardless of treatment.