EURURO Vol. 73 No. 1

Platinum Priority – Review – Prostate Cancer

Editorial by Alison Tree and David Dearnaley on pp. 21–22 of this issue

Survival and Complications Following Surgery and Radiation for

Localized Prostate Cancer: An International Collaborative Review

Christopher J.D. Wallis

a , b ,

Adam Glaser

c ,

Jim C. Hu

d ,

Hartwig Huland

e ,

Nathan Lawrentschuk

f , g , h ,

Daniel Moon

h , i , j ,

Declan G. Murphy

h , j ,

Paul L. Nguyen

k ,

Matthew J. Resnick

l , m

, Robert K. Nam

a , b , *

Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada;

Institute of Health Policy,

Management, & Evaluation, University of Toronto, Toronto, ON, Canada;

Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK;

Department of Urology, Weill Cornell Medicine, New York, NY, USA;

Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf,

Hamburg, Germany;

Department of Surgery, University of Melbourne, Austin Health, Melbourne, Australia;

Olivia Newton-John Cancer Research Institute,

Austin Health, Melbourne, Australia;

Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia;

Central Clinical School, Monash

University, Clayton, Australia;

The Epworth Prostate Centre, Epworth Hospital, Richmond, Australia;

Department of Radiation Oncology, Dana-Farber/

Brigham and Women’s Cancer Center, Harvard Medical School, Boston, MA, USA;

Department of Urologic Surgery, Vanderbilt University Medical Center,

Nashville, TN, USA;

Geriatric Research, Education, and Clinical Center, Tennessee Valley VA Health Care System, Nashville, TN, USA

E U R O P E A N U R O L O G Y 7 3 ( 2 0 1 8 ) 1 1 – 2 0

ava ilable at

www.sciencedirect.com

journal homepage:

www.eu ropeanurology.com

Article info

Article history:

Accepted May 30, 2017

Associate Editor:

Giacomo Novara

Keywords:

Prostatic neoplasms

Mortality

Radiotherapy

Adverse effects

Prostatectomy

Comparative effectiveness

research

Brachytherapy

Quality of life

Abstract

Background:

Evaluation of treatment options for localized prostate cancer (PCa)

remains among the highest priorities for comparative effectiveness research. Surgery

and radiotherapy (RT) are the two interventions most commonly used.

Objective:

To provide a critical narrative review of evidence of the comparative effec-

tiveness and harms of surgery and RT in the treatment of localized PCa.

Evidence acquisition:

A collaborative critical narrative review of the literature was

conducted.

Evidence synthesis:

Evidence to clearly guide treatment choice in PCa remains insuffi-

cient. Randomized trials are underpowered for clinically meaningful endpoints and have

demonstrated no difference in overall or PCa-specific survival. Observational studies

have consistently demonstrated an absolute survival benefit for men treated with

radical prostatectomy, but are limited by selection bias and residual confounding errors.

Surgery and RT are associated with comparable health-related quality of life following

treatment in three randomized trials. Randomized data regarding urinary, erectile, and

bowel function show few long-term (

5 yr) differences, although short-term continence

and erectile function were worse following surgery and short-term urinary bother and

bowel function were worse following RT. There has been recent recognition of other

complications that may significantly affect the life trajectory of those undergoing PCa

treatment. Of these, hospitalization, the need for urologic, rectoanal, and other major

surgical procedures, and secondary cancers are more common among men treated with

RT. Androgen deprivation therapy, frequently co-administered with RT, may addition-

ally contribute to treatment-related morbidity. Technological innovations in surgery

and RT have shown inconsistent oncologic and functional benefits.

Conclusions:

Owing to underpowered randomized control studies and the selection

biases inherent in observational studies, the question of which treatment provides

* Corresponding author. Division of Urology, Department of Surgery, Sunnybrook Health Sciences

Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.

Tel. +1 416 4805075; Fax: +1 416 4806934.

E-mail address:

robert.nam@utoronto.ca

(R.K. Nam).

http://dx.doi.org/10.1016/j.eururo.2017.05.055

0302-2838/