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Conservative management and radical treatment in localised prostate cancer: A systematic review with meta-analysis and trial sequential analysis
Background: Several randomised control trials comparing conservative management (watchful waiting/observation/active monitoring) and radical treatments (radical prostatectomy/radiotherapy) for localised prostate cancer with at least more than 10 years of follow-up (median) have been published with c...
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Published in: | Journal of clinical urology 2019-05, Vol.12 (3), p.228-238 |
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Main Authors: | , , |
Format: | Article |
Language: | English |
Citations: | Items that this one cites |
Online Access: | Get full text |
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Summary: | Background:
Several randomised control trials comparing conservative management (watchful waiting/observation/active monitoring) and radical treatments (radical prostatectomy/radiotherapy) for localised prostate cancer with at least more than 10 years of follow-up (median) have been published with conflicting findings. The primary aim of this study was to determine all-cause mortality and prostate cancer-related mortality between conservative management and radical treatment for localised prostate cancer.
Methods:
All randomised clinical trials were searched in MEDLINE, EMBASE, PubMed and CENTRAL from their inception until September 2018.
Results:
Four trials were eligible (n = 3211) for inclusion in the data synthesis. In patients who had radical treatment, the incidence of all-cause mortality and prostate cancer-related mortality (three trials, 3069 patients) were reduced (with odds ratio, i.e. 95% confidence interval (CI)), of 1.37 (1.14–1.64), ρ < 0.001, low quality of evidence and odd ratio (95% CI) of 1.74 (1.31–2.30), ρ < 0.001, low quality of evidence, respectively). The radical treatment group was associated with reduced incidence of distant metastases, the odds ratio (95% CI) being 1.87 (1.48–2.36), ρ < 0.001, low quality of evidence. However, patients who were randomised to radical treatment had a significantly higher incidence of erectile dysfunction (the odds ratio (95% CI) being 0.62 (0.39–0.98), ρ = 0.04, very low quality of evidence) and urinary incontinence (odds ratio (95% CI) of 0.42 (0.21–0.86), ρ = 0.02, very low quality of evidence).
Conclusions:
In summary, radical treatments reduce all-cause mortality, and prostate cancer-related and distant metastases, at the expense of higher incidence of erectile dysfunction and urinary incontinence. The general quality of evidence ranged from very low to low.
Level of evidence: 1a
PROSPERO Registration Number: CRD42017072687 |
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ISSN: | 2051-4158 2051-4158 2051-4166 |
DOI: | 10.1177/2051415818812316 |