What is it about?
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.
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Why is it important?
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).
Perspectives
In young patients with localised prostate cancer, they may benefit more from radical treatment as it reduces mortality and disease mets as shown in the review paper. However, patients would need to aware of the complications of radical treatments, namely urinary incontinence and erectile dysfunction. There is no one size fits for all. The management plan needs to be tailored with individual's wishes and decisions.
Dr Ka Ting Ng
University of Malaya
Read the Original
This page is a summary of: Conservative management and radical treatment in localised prostate cancer: A systematic review with meta-analysis and trial sequential analysis, Journal of Clinical Urology, November 2018, SAGE Publications,
DOI: 10.1177/2051415818812316.
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