Comparative effectiveness of treatment alternatives for localized prostate cancer

Abstract

A patient newly diagnosed with prostate cancer in 2011 faces a potentially bewildering menu of treatment options. Alternatives endorsed by the American Urological Association (AUA)'s 2007 practice guideline for localized prostate cancer [1], for example, include active surveillance, radical prostatectomy, interstitial radiation (brachytherapy), or external beam radiation therapy (EBRT). However, the detailed list of options becomes longer, including among surgical options open radical retropubic prostatectomy (ORRP), radical perineal prostatectomy (RPP), straight laparoscopic radical prostatectomy (LRP), and robot-assisted radical prostatectomy (RARP), within brachytherapy, permanent (low-dose rate) seed implantation or temporary (high-dose rate [HDR]) via catheters, and within EBRT, conventional 3-D conformal radiation therapy (3DCRT), intensity-modulated radiation therapy (IMRT), or proton beam therapy, possibly combined with brachytherapy and/or with androgen deprivation therapy (ADT). Other options not necessarily endorsed by the guideline but frequently used in practice include primary ADT (PADT) monotherapy and cryotherapy; those traveling outside the United States also have the option of high-intensity focused ultrasound (HIFU).