Long-Term Clinical Outcomes of Radical Prostatectomy versus Watchful Waiting in Localized Prostate Cancer Patients: A Systematic Review and Meta-Analysis
Abstract
Background: The present study aimed to compare the long-term clinical and functional outcomes of patients with clinically localized prostate cancer treated with radical prostatectomy compared to the watchful waiting.
Methods: PubMed, Cochrane Central Register of Controlled Trials and reference lists of relevant marker studies were scrutinized from inception to Jan 2018. Two reviewers conducted data abstraction and quality assessment of included trials independently. Quality of included studies were assessed by using Cochrane checklist. Inverse-variance and Mantel-Haenszel estimates under random effects model were used to pool results as relative risks with 95% confidence interval. Heterogeneity was assessed by using I2.
Results: Three randomized controlled trials with 1568 participants were included. Compared to watchful waiting, radical prostatectomy had no significant effect on all-cause mortality at 12-year follow-up. However, radical prostatectomy had significant effect on reducing prostate-cause mortality at 12-year follow-up. We found significant lower prostate-cause mortality in patients with PSA>10 and GS≥7 scores who had undergone radical prostatectomy compared with patients in watchful waiting group. In addition, younger patients undergoing surgery developed lower distant metastases rate compared to another approach. Watchful waiting had a significant effect on erectile and urinary incontinence during 2 years.
Conclusion: There was no significant difference between radical prostatectomy and watchful waiting on all-cause mortality. However, the radical prostatectomy was associated with statistically lower prostate-cause mortality and metastases rates. Compared with older men, younger men experienced better clinical outcomes. Moreover, watchful waiting had better effect on reducing erectile dysfunction and urinary incontinence among patients during 2 years compared to radical prostatectomy.
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10. Kopp RP, Marshall LM, Wang PY et al (2013). The Burden of Urinary Incontinence and Urinary Bother Among Elderly Prostate Cancer Survivors. Eur Urol. 64:672-9.
11. Batura D, Gopal Rao G (2013). The national burden of infections after prostate biopsy in England and Wales: a wake-up call for better prevention. J Antimicrob Chemother, 68:247-9.
12. Pockett RD, Castellano D, McEwan P et al (2010). The hospital burden of disease associated with bone metastases and skeletal-related events in patients with breast cancer, lung cancer, or prostate cancer in Spain. Eur J Cancer Care (Engl), 19:755-60.
13. Soerjomataram I, Lortet-Tieulent J, Ferlay J et al (2012). Estimating and validating disability-adjusted life years at the global level: a methodological framework for cancer. BMC Med Res Methodol, 12:125.
14. Snyder CF, Frick KD, Blackford AL et al (2010). How does initial treatment choice affect short-term and long-term costs for clinically localized prostate cancer? Cancer, 116:5391-9.
15. Fourcade RO, Benedict A, Black LK et al (2010). Treatment costs of prostate cancer in the first year after diagnosis: a short-term cost of illness study for France, Germany, Italy, Spain and the UK. BJU Int, 105:49-56.
16. Xia J, Gulati R, Au M et al (2013). Effects of screening on radical prostatectomy efficacy: the prostate cancer intervention versus observation trial. J Natl Cancer Inst, 105:546-50.
17. Perlroth DJ, Bhattacharya J, Goldman DP, Garber AM (2012). An economic analysis of conservative management versus active treatment for men with localized prostate cancer. J Natl Cancer Inst Monogr, 2012:250-7.
18. Budaus L, Huland H, Graefen M (2012). Controversies in the management of localized prostate cancer: radical prostatectomy still the standard of care. Crit Rev Oncol Hematol, 84 Suppl 1:e24-9.
19. Kirby R (2005). Management of clinically localized prostate cancer by radical prostatectomy followed by watchful waiting. Nat Clin Pract Urol, 2:298-303.
20. Gacci M, Simonato A, Masieri L et al (2009). Urinary and sexual outcomes in long-term (5+ years) prostate cancer disease free survivors after radical prostatectomy. Health Qual Life Outcomes, 7:94.
21. Hegarty J, Beirne PV, Walsh E et al (2010). Radical prostatectomy versus watchful waiting for prostate cancer. Cochrane Database Syst Rev, (11):CD006590.
22. Higgins J, S Green (2008). Cochrane handbook for systematic reviews of interventions. Version 5.0.0.
23. Byar DP, Corle DK (1981). VACURG randomised trial of radical prostatectomy for stages I and II prostatic cancer. Veterans Administration Cooperative Urological Research Group. Urology, 17(4 Suppl):7-11.
24. Madsen PO, Graversen PH, Gasser TC, Corle DK (1988). Treatment of localized prostatic cancer. Radical prostatectomy versus placebo. A 15-year follow-up. Scand J Urol Nephrol Suppl, 110:95-100.
25. Graversen PH, Nielsen KT, Gasser TC et al (1990). Radical prostatectomy versus expectant primary treatment in stages I and II prostatic cancer. A fifteen-year follow-up. Urology, 36:493-8.
26. Iversen P, Madsen PO, Corle DK (1995). Radical prostatectomy versus expectant treatment for early carcinoma of the prostate. Twenty-three year follow-up of a prospective randomized study. Scand J Urol Nephrol Suppl, 172:65-72.
27. Wilt TJ, Brawer MK, Jones KM et al (2012). Radical prostatectomy versus observation for localized prostate cancer. N Engl J Med, 367:203-13.
28. Bill-Axelson A, Holmberg L, Ruutu M et al (2011). Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med, 364:1708-17.
29. Bill-Axelson A, Holmberg L, Filen F et al (2008). Radical prostatectomy versus watchful waiting in localized prostate cancer: the Scandinavian prostate cancer group-4 randomized trial. J Natl Cancer Inst, 100:1144-54.
30. Bill-Axelson A, Holmberg L, Ruutu M et al (2005). Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med, 352:1977-84.
31. Steineck G, Helgesen F, Adolfsson J et al (2002). Quality of life after radical prostatectomy or watchful waiting. N Engl J Med, 347:790-6.
32. Holmberg L, Bill-Axelson A, Helgesen F et al (2002). A randomized trial comparing radical prostatectomy with watchful waiting in early prostate cancer. N Engl J Med, 347:781-9.
33. Holmberg L, Bill-Axelson A, Garmo H et al (2006). Prognostic markers under watchful waiting and radical prostatectomy. Hematol Oncol Clin North Am, 20:845-55.
34. Johansson E, Bill-Axelson A, Holmberg L et al (2009). Time, symptom burden, androgen deprivation, and self-assessed quality of life after radical prostatectomy or watchful waiting: the Randomized Scandinavian Prostate Cancer Group Study Number 4 (SPCG-4) clinical trial. Eur Urol, 55:422-30.
35. Johansson E, Steineck G, Holmberg L et al (2011). Long-term quality-of-life outcomes after radical prostatectomy or watchful waiting: the Scandinavian Prostate Cancer Group-4 randomised trial. Lancet Oncol, 12:891-9.
36. Wilt TJ, Brawer MK, Barry MJ et al (2009). The Prostate cancer Intervention Versus Observation Trial:VA/NCI/AHRQ Cooperative Studies Program #407 (PIVOT): design and baseline results of a randomized controlled trial comparing radical prostatectomy to watchful waiting for men with clinically localized prostate cancer. Contemp Clin Trials, 30:81-7.
37. Cohen JH, Schoenbach VJ, Kaufman JS et al (2006). Racial differences in clinical progression among Medicare recipients after treatment for localized prostate cancer (United States). Cancer Causes Control, 17:803-11.
38. Godley PA, Schenck AP, Amamoo MA et al (2003). Racial differences in mortality among Medicare recipients after treatment for localized prostate cancer. J Natl Cancer Inst, 95:1702-10.
39. Singh GK, Williams SD, Siahpush M, Mulhollen A (2011). Socioeconomic, Rural-Urban, and Racial Inequalities in US Cancer Mortality: Part I-All Cancers and Lung Cancer and Part II-Colorectal, Prostate, Breast, and Cervical Cancers. J Cancer Epidemiol, 2011:107497.
40. Telesca D, Etzioni R, Gulati R (2008). Estimating lead time and overdiagnosis associated with PSA screening from prostate cancer incidence trends. Biometrics, 64:10-9.
41. Tornblom M, Eriksson H, Franzen S et al (2004). Lead time associated with screening for prostate cancer. Int J Cancer, 108:122-9.
42. Schroder FH, Hugosson J, Roobol MJ et al (2009). Screening and prostate-cancer mortality in a randomized European study. N Engl J Med, 360:1320-8.
2. Bian SX, Hoffman KE (2013). Management of prostate cancer in elderly men. Semin Radiat Oncol, 23:198-205.
3. Li J, Djenaba JA, Soman A et al (2012). Recent trends in prostate cancer incidence by age, cancer stage, and grade, the United States, 2001-2007. Prostate Cancer, 2012:691380.
4. Howrey BT, Kuo YF, Lin YL, Goodwin JS (2013). The impact of PSA screening on prostate cancer mortality and overdiagnosis of prostate cancer in the United States. J Gerontol A Biol Sci Med Sci, 68:56-61.
5. Etzioni R, Tsodikov A, Mariotto A et al (2008). Quantifying the role of PSA screening in the US prostate cancer mortality decline. Cancer Causes Control, 19:175-81.
6. Ciezki JP, Reddy CA, Kupelian PA, Klein EA (2012). Effect of prostate-specific antigen screening on metastatic disease burden 10 years after diagnosis. Urology, 80:367-72.
7. Albertsen PC (2010). The unintended burden of increased prostate cancer detection associated with prostate cancer screening and diagnosis. Urology, 75:399-405.
8. Popiolek M, Rider JR, Andren O et al (2013). Natural history of early, localized prostate cancer: a final report from three decades of follow-up. Eur Urol, 63:428-35.
9. Melia J (2005). Part 1: The burden of prostate cancer, its natural history, information on the outcome of screening and estimates of ad hoc screening with particular reference to England and Wales. BJU Int, 95 Suppl 3:4-15.
10. Kopp RP, Marshall LM, Wang PY et al (2013). The Burden of Urinary Incontinence and Urinary Bother Among Elderly Prostate Cancer Survivors. Eur Urol. 64:672-9.
11. Batura D, Gopal Rao G (2013). The national burden of infections after prostate biopsy in England and Wales: a wake-up call for better prevention. J Antimicrob Chemother, 68:247-9.
12. Pockett RD, Castellano D, McEwan P et al (2010). The hospital burden of disease associated with bone metastases and skeletal-related events in patients with breast cancer, lung cancer, or prostate cancer in Spain. Eur J Cancer Care (Engl), 19:755-60.
13. Soerjomataram I, Lortet-Tieulent J, Ferlay J et al (2012). Estimating and validating disability-adjusted life years at the global level: a methodological framework for cancer. BMC Med Res Methodol, 12:125.
14. Snyder CF, Frick KD, Blackford AL et al (2010). How does initial treatment choice affect short-term and long-term costs for clinically localized prostate cancer? Cancer, 116:5391-9.
15. Fourcade RO, Benedict A, Black LK et al (2010). Treatment costs of prostate cancer in the first year after diagnosis: a short-term cost of illness study for France, Germany, Italy, Spain and the UK. BJU Int, 105:49-56.
16. Xia J, Gulati R, Au M et al (2013). Effects of screening on radical prostatectomy efficacy: the prostate cancer intervention versus observation trial. J Natl Cancer Inst, 105:546-50.
17. Perlroth DJ, Bhattacharya J, Goldman DP, Garber AM (2012). An economic analysis of conservative management versus active treatment for men with localized prostate cancer. J Natl Cancer Inst Monogr, 2012:250-7.
18. Budaus L, Huland H, Graefen M (2012). Controversies in the management of localized prostate cancer: radical prostatectomy still the standard of care. Crit Rev Oncol Hematol, 84 Suppl 1:e24-9.
19. Kirby R (2005). Management of clinically localized prostate cancer by radical prostatectomy followed by watchful waiting. Nat Clin Pract Urol, 2:298-303.
20. Gacci M, Simonato A, Masieri L et al (2009). Urinary and sexual outcomes in long-term (5+ years) prostate cancer disease free survivors after radical prostatectomy. Health Qual Life Outcomes, 7:94.
21. Hegarty J, Beirne PV, Walsh E et al (2010). Radical prostatectomy versus watchful waiting for prostate cancer. Cochrane Database Syst Rev, (11):CD006590.
22. Higgins J, S Green (2008). Cochrane handbook for systematic reviews of interventions. Version 5.0.0.
23. Byar DP, Corle DK (1981). VACURG randomised trial of radical prostatectomy for stages I and II prostatic cancer. Veterans Administration Cooperative Urological Research Group. Urology, 17(4 Suppl):7-11.
24. Madsen PO, Graversen PH, Gasser TC, Corle DK (1988). Treatment of localized prostatic cancer. Radical prostatectomy versus placebo. A 15-year follow-up. Scand J Urol Nephrol Suppl, 110:95-100.
25. Graversen PH, Nielsen KT, Gasser TC et al (1990). Radical prostatectomy versus expectant primary treatment in stages I and II prostatic cancer. A fifteen-year follow-up. Urology, 36:493-8.
26. Iversen P, Madsen PO, Corle DK (1995). Radical prostatectomy versus expectant treatment for early carcinoma of the prostate. Twenty-three year follow-up of a prospective randomized study. Scand J Urol Nephrol Suppl, 172:65-72.
27. Wilt TJ, Brawer MK, Jones KM et al (2012). Radical prostatectomy versus observation for localized prostate cancer. N Engl J Med, 367:203-13.
28. Bill-Axelson A, Holmberg L, Ruutu M et al (2011). Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med, 364:1708-17.
29. Bill-Axelson A, Holmberg L, Filen F et al (2008). Radical prostatectomy versus watchful waiting in localized prostate cancer: the Scandinavian prostate cancer group-4 randomized trial. J Natl Cancer Inst, 100:1144-54.
30. Bill-Axelson A, Holmberg L, Ruutu M et al (2005). Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med, 352:1977-84.
31. Steineck G, Helgesen F, Adolfsson J et al (2002). Quality of life after radical prostatectomy or watchful waiting. N Engl J Med, 347:790-6.
32. Holmberg L, Bill-Axelson A, Helgesen F et al (2002). A randomized trial comparing radical prostatectomy with watchful waiting in early prostate cancer. N Engl J Med, 347:781-9.
33. Holmberg L, Bill-Axelson A, Garmo H et al (2006). Prognostic markers under watchful waiting and radical prostatectomy. Hematol Oncol Clin North Am, 20:845-55.
34. Johansson E, Bill-Axelson A, Holmberg L et al (2009). Time, symptom burden, androgen deprivation, and self-assessed quality of life after radical prostatectomy or watchful waiting: the Randomized Scandinavian Prostate Cancer Group Study Number 4 (SPCG-4) clinical trial. Eur Urol, 55:422-30.
35. Johansson E, Steineck G, Holmberg L et al (2011). Long-term quality-of-life outcomes after radical prostatectomy or watchful waiting: the Scandinavian Prostate Cancer Group-4 randomised trial. Lancet Oncol, 12:891-9.
36. Wilt TJ, Brawer MK, Barry MJ et al (2009). The Prostate cancer Intervention Versus Observation Trial:VA/NCI/AHRQ Cooperative Studies Program #407 (PIVOT): design and baseline results of a randomized controlled trial comparing radical prostatectomy to watchful waiting for men with clinically localized prostate cancer. Contemp Clin Trials, 30:81-7.
37. Cohen JH, Schoenbach VJ, Kaufman JS et al (2006). Racial differences in clinical progression among Medicare recipients after treatment for localized prostate cancer (United States). Cancer Causes Control, 17:803-11.
38. Godley PA, Schenck AP, Amamoo MA et al (2003). Racial differences in mortality among Medicare recipients after treatment for localized prostate cancer. J Natl Cancer Inst, 95:1702-10.
39. Singh GK, Williams SD, Siahpush M, Mulhollen A (2011). Socioeconomic, Rural-Urban, and Racial Inequalities in US Cancer Mortality: Part I-All Cancers and Lung Cancer and Part II-Colorectal, Prostate, Breast, and Cervical Cancers. J Cancer Epidemiol, 2011:107497.
40. Telesca D, Etzioni R, Gulati R (2008). Estimating lead time and overdiagnosis associated with PSA screening from prostate cancer incidence trends. Biometrics, 64:10-9.
41. Tornblom M, Eriksson H, Franzen S et al (2004). Lead time associated with screening for prostate cancer. Int J Cancer, 108:122-9.
42. Schroder FH, Hugosson J, Roobol MJ et al (2009). Screening and prostate-cancer mortality in a randomized European study. N Engl J Med, 360:1320-8.
| Files | ||
| Issue | Vol 48 No 4 (2019) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v48i4.978 | |
| Keywords | ||
| Clinical outcomes Radical prostatectomy Prostate cancer Systematic review | ||
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How to Cite
1.
NOUHI M, MOUSAVI SM, OLYAEEMANESH A, SHAKSISALIM N, AKBARI SARI A. Long-Term Clinical Outcomes of Radical Prostatectomy versus Watchful Waiting in Localized Prostate Cancer Patients: A Systematic Review and Meta-Analysis. Iran J Public Health. 2019;48(4):566-578.
