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J BUON. 2019 Jan-Feb;24(1):239-248.

Comparison of radical prostatectomy versus conservative treatment in localized prostate cancer: systematic review and meta-analysis.

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Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing, China.



To evaluate the effects of radical prostatectomy (RP) and conservative treatment (CT) on the survival of localized prostate cancer by conducting a systematic review and meta-analysis.


We searched for all studies about RP and CT for localized prostate cancer in PubMed and Web of Science up to December 2017. A systematic review and meta-analysis was performed.


There were 4 randomized clinical trials (RCTs) and 12 cohort studies including 69871 patients treated with RP and 65765 patients treated with CT. There was a significantly reduced all-cause mortality (HR:0.575;95%CI:0.487 to 0.678;p<0.001) along with a reduced risk of prostate cancer mortality in patients treated with RP compared to those treated with CT (HR:0.408;95%CI:0.313 to 0.533;p<0.001). RP was effective with a lower all-cause mortality and prostate cancer mortality for patients with intermediate risk disease (HR:0.774;95%CI:0.664 to 0.902,p=0.001; HR:0.428;95%CI:0.286 to 0.641, p=0.001, respectively). However, for low risk (HR:0.774;95%CI:0.505 to 1.187, p=0.241; HR:0.603;95%CI:0.332 to 1.097, p=0.098, respectively) and high risk (HR:0.662;95%CI:0.376 to 1.164, p=0.152; HR:0.584;95%CI:0.315 to 1.084, p=0.089, respectively) prostate cancer patients, there was no significant difference between RP and CT. In the subgroup analysis according to the age and follow-up time, the results favored the RP and there was no specific factor affecting the outcomes.


RP offers a better survival rate than CT in patients with localized prostate cancer. For some patients with localized prostate cancer, treatment should be chosen very carefully.

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