Comparative effectiveness of prostate cancer treatments for patient-centered outcomes: A systematic review and meta-analysis

In Medicine, Jayadevappa, Schwartz, and colleagues analyzed the comparative effectiveness of localized prostate cancer treatments (active surveillance, radical prostatectomy, and radiation therapy) through systematic review and meta-analysis. They focused on outcomes that matter most to newly diagnosed patients: mortality; cancer recurrence; disease and treatment complications; side effects; and patient-reported outcomes such as health-related quality of life, satisfaction with care, and decision regrets. The systematic review included 58 articles published from 1995-2016, (29 randomized controlled trials, six prospective studies, and 23 retrospective studies). The studies showed that radical prostatectomy had a mortality benefit compared to watchful waiting and radiation therapy. However, there was minimal comparative information about tradeoffs between and within treatments for other patient-centered outcomes, such as symptomology, functionality, and quality of life, in the short and long-term. Lack of patient-centered outcomes in comparative effectiveness research in localized prostate cancer is a major hurdle to informed and shared decision-making. More rigorous studies that can integrate patient-centered and intermediate outcomes in addition to mortality are needed.