Patient-Reported Outcomes after Treatment for Clinically Localized Prostate Cancer: A Systematic Review and Meta-analysis.

Publication date: Available online 3 April 2018
Source:Cancer Treatment Reviews
Author(s): Mónica Ávila, Laila Patel, Silvia López, Laura Cortés-Sanabria, Olatz Garin, Àngels Pont, Ferran Ferrer, Ana Boladeras, Victor Zamora, Sophie Fosså, Anne H. Storås, Martin Sanda, Vicky Serra-Sutton, Montse Ferrer
BACKGROUNDThe aim of this systematic review is to assess the impact of primary treatments with curative intention in patients with localized prostate cancer, measured with Patient-Reported Outcomes (PROs), and to examine differences among modalities within treatments.METHODSWe conducted a systematic literature search for January 2005-March 2017 following PRISMA guidelines, including longitudinal studies measuring disease-specific PROs in localized prostate cancer patients with a follow-up from pre- to post-treatment (≥1 year). Two reviewers independently extracted data and assessed risk of bias. The study is registered in PROSPERO: CRD42015019747.RESULTSOf 148 identified studies, 60 were included in the meta-analyses. At the 1^st year, radical prostatectomy patients showed small urinary irritative-obstructive improvement (0.37SD 95%CI 0.30, 0.45), but large deterioration for sexual function and incontinence with high heterogeneity (I²=77% and 93%). Moderate worsening in external radiotherapy patients for sexual function (-0.46SD 95%CI -0.55, -0.36), small urinary incontinence (-0.16SD 95%CI -0.23, -0.09) and bowel impairment (-0.31SD 95%CI -0.39, -0.23). Brachytherapy patients presented small deterioration in urinary incontinence (-0.29SD 95%CI -0.39, -0.19), irritative obstructive symptoms (-0.35SD 95%CI -0.47, -0.23), sexual function (-0.12SD 95%CI -0.24, -0.002), and bowel bother (-0.27SD 95%CI -0.42, -0.11). These patterns persisted up to the 5^th year. High-intensity focused ultrasound and active surveillance only have results at 1^st year, showing no statistically significant worsening.CONCLUSIONSNo remarkable differences in PRO appeared between modalities within each treatment. Nowadays, available evidence supports brachytherapy as possible alternative to radical prostatectomy for patients seeking an attempted curative treatment limiting the risk for urinary incontinence and sexual dysfunction.



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