Comparative Evaluation of Radiation Treatments for Clinically Localized Prostate Cancer: An Updated Systematic Review.  Bannuru R, Dvorak T et al.  Annals of Internal Medicine 2011, published online on 6th June.

Localised prostate cancer

Many men are diagnosed with clinically localised prostate cancer (T1-T2N0) every year.  There is a broad range of treatment options, including:

• Active Surveillance or Watchful Waiting
• Radiotherapy
• Surgery
• Hormone therapy
• Other treatments, such as High Intensity Focused Ultrasound (HIFU) and cryotherapy.

There remains considerable uncertainty as to the best treatment.  This is because of limitations of the available research evidence and the need to balance potential benefits against the likely adverse effects of treatments.

The systematic review

Systematic reviews, when performed well, can provide us with the best evidence from research.  It is important that they are updated regularly so that they can keep pace with new research.

The US Agency for Healthcare Research and Quality is currently engaged in updating its review of the research evidence in the treatment of localised prostate cancer.  This review represents their analysis of radiotherapy.

The review addressed two questions:

1. What are the benefits and harms of radiation therapy for clinically localized prostate cancer compared with no treatment or no initial treatment (watchful waiting, active surveillance, or observation)?
2. What are the benefits and harms of different forms of radiation therapy for clinically localized prostate cancer?

Findings

Although they found 75 studies, they did not find any randomised trials that addressed the first question.  The reviewers reported a lot of inconsistency in how studies defined and reported their outcomes.  This makes it harder to combine their results.

Their conclusion was that there is inadequate evidence to be able to say whether or not radiotherapy improves overall survival compared with no initial treatment in localised prostate cancer.  Download a summary of their results.

Find out more

• Read the full text of the review
  
• Find out more about localised prostate cancer and radiotherapy and other treatments