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Medicine (Baltimore). 2017 May;96(18):e6790. doi: 10.1097/MD.0000000000006790.

Comparative effectiveness of prostate cancer treatments for patient-centered outcomes: A systematic review and meta-analysis (PRISMA Compliant).

Author information

1
aDepartment of Medicine bUrology Division, Department of Surgery, Perelman School of Medicine, University of Pennsylvania cCorporal Michael J. Crescenz VAMC dLeonard Davis Institute of Health Economics eAbramson Cancer Center fDepartment of Psychiatry, Perelman School of Medicine, University of Pennsylvania gFox Chase Cancer Center, Temple University, Philadelphia, PA hDepartment of Psychiatry, University of Rochester Medical Center, NY iDepartment of Biostatistics and Epidemiology, Perelman School of Medicine jDepartment of Radiation Oncology kHealth Care Management Department, Wharton School of Business, University of Pennsylvania, Philadelphia, PA lGeneral Internal Medicine, Johns Hopkins University School of Medicine, and Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.

Abstract

BACKGROUND:

In the context of prostate cancer (PCa) characterized by the multiple alternative treatment strategies, comparative effectiveness analysis is essential for informed decision-making. We analyzed the comparative effectiveness of PCa treatments through systematic review and meta-analysis with a focus on outcomes that matter most to newly diagnosed localized PCa patients.

METHODS:

We performed a systematic review of literature published in English from 1995 to October 2016. A search strategy was employed using terms "prostate cancer," "localized," "outcomes," "mortality," "health related quality of life," and "complications" to identify relevant randomized controlled trials (RCTs), prospective, and retrospective studies. For observational studies, only those adjusting for selection bias using propensity-score or instrumental-variables approaches were included. Multivariable adjusted hazard ratio was used to assess all-cause and disease-specific mortality. Funnel plots were used to assess the level of bias.

RESULTS:

Our search strategy yielded 58 articles, of which 29 were RCTs, 6 were prospective studies, and 23 were retrospective studies. The studies provided moderate data for the patient-centered outcome of mortality. Radical prostatectomy demonstrated mortality benefit compared to watchful waiting (all-cause HR = 0.63 CI = 0.45, 0.87; disease-specific HR = 0.48 CI = 0.40, 0.58), and radiation therapy (all-cause HR = 0.65 CI = 0.57, 0.74; disease-specific HR = 0.51 CI = 0.40, 0.65). However, we had minimal comparative information about tradeoffs between and within treatment for other patient-centered outcomes in the short and long-term.

CONCLUSION:

Lack of patient-centered outcomes in comparative effectiveness research in localized PCa 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.

PMID:
28471976
PMCID:
PMC5419922
DOI:
10.1097/MD.0000000000006790
[Indexed for MEDLINE]
Free PMC Article

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