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 effectiveness 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 insufficient. 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 additionally 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 better PCa control cannot be definitively answered now or in the near future. Complications following PCa treatment are relatively common regardless of treatment approach. These include the commonly identified issues of urinary incontinence and erectile dysfunction, and others including hospitalization and invasive procedures to manage complications and secondary malignancies. Population-based outcome studies, rather than clinical trial data, will be necessary for a comprehensive understanding of the relative benefits and risks of each therapeutic approach.

Patient summary

Surgery and radiotherapy are the most common interventions for men diagnosed with prostate cancer. Comparisons of survival after these treatments are limited by various flaws in the relevant studies. Complications are common regardless of the treatment approach.

中文翻译：

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局限性前列腺癌手术和放疗后的生存和并发症：国际合作评论

背景

评估局部前列腺癌（PCa）的治疗方案仍然是比较有效性研究的重中之重。手术和放射疗法（RT）是最常用的两种干预措施。

客观的

提供有关手术和放疗在局部PCa治疗中的相对有效性和危害性证据的重要叙述性回顾。

取证

对文献进行了协作性的批判性叙事评论。

证据综合

明确指导PCa治疗选择的证据仍然不足。随机临床试验不足以用于具有临床意义的终点，并且未证明总体或PCa特异性生存率存在差异。观察性研究一贯证明了接受前列腺癌根治术的男性的绝对生存获益，但受到选择偏倚和残留混杂误差的限制。在三项随机试验中，手术和放疗与治疗后可比的健康相关生活质量相关。关于尿，勃起和肠功能的随机数据显示，长期差异（> 5岁）几乎没有，尽管手术后短期尿失禁和勃起功能较差，而在RT后短期尿不便和肠功能较差。最近已经认识到其他并发症，这些并发症可能会严重影响接受PCa治疗的患者的生活轨迹。其中，在接受RT治疗的男性中，住院治疗，泌尿外科，直肠手术和其他主要外科手术的需要以及继发性癌症更为常见。经常与放疗同时使用的雄激素剥夺疗法可能还会增加与治疗相关的发病率。手术和放疗中的技术创新已显示出不一致的肿瘤学和功能优势。可能还会增加与治疗相关的发病率。手术和放疗中的技术创新已显示出不一致的肿瘤学和功能优势。可能还会增加与治疗相关的发病率。手术和放疗中的技术创新已显示出不一致的肿瘤学和功能优势。

结论

由于动力不足的随机对照研究以及观察性研究固有的选择偏倚，目前或不久的将来无法确切回答哪种治疗方法能更好地控制PCa的问题。无论采用何种治疗方法，PCa治疗后的并发症相对普遍。这些包括尿失禁和勃起功能障碍的常见问题，其他包括住院和处理并发症和继发性恶性肿瘤的侵入性程序。为了全面了解每种治疗方法的相对益处和风险，有必要进行基于人群的结局研究，而不是临床试验数据。

病人总结

对于诊断为前列腺癌的男性，手术和放疗是最常见的干预措施。这些治疗后的生存期比较受到相关研究中各种缺陷的限制。无论采用何种治疗方法，并发症都很常见。