Comparative Effectiveness Review: Treatments for Localized Prostate Cancer

Over the last 20 years, there has been widespread adoption of prostate cancer screening programs for middle-aged and older men. This has led to a marked increase in the detection of prostate cancer. As a result, most newly diagnosed cases have been small tumors that have not yet shown signs of spreading beyond the prostate.

While several types of treatment are available, they all cause unpleasant side effects, such as erectile dysfunction or problems urinating. However, some prostate cancers that grow at a slower rate may not lead to death or serious complications if left untreated. Men with localized prostate cancer thereby face a difficult decision to choose among treatments with known harms or to choose to pursue no initial treatment. This clinical challenge is the type of problem for which Comparative Effectiveness Reviews (CERs) can provide valuable insight to guide decision-making.

The EHC Program commissioned the Evidence-based Practice Center at the University of Minnesota to prepare a CER on treatments for localized prostate cancer, and the CER was released in February 2008. As has been customary with the CERs released by the EHC Program over the last 2 years, a companion article was published by Annals of Internal Medicine that is available on that journal’s Web site.

The CER found that no single treatment approach provides superior outcomes for all men. For those with a new diagnosis of localized prostate cancer, individualized decision-making should be based on the person’s overall health and preferences about the risks of the treatment options. For men who choose complete surgical removal of the prostate (known as radical prostatectomy), the CER found that men who have an operation performed by an experienced surgeon in a hospital that frequently performs the operation are are less likely to experience urinary incontinence or other complications.

Further information about the CER, including both an Executive Summary and the complete report, is available here.