Prostate cancer (early).

INTRODUCTION

Prostate cancer is the sixth most common cancer in the world, and 85% of cases are diagnosed in men over the age of 65 years. In men with well to moderately differentiated prostate cancer that remains within the capsule, clinical progression-free survival is 70% at 5 years, and 40% at 10 years.

METHODS AND OUTCOMES

We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for early prostate cancer? We searched: Medline, Embase, The Cochrane Library and other important databases up to February 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).

RESULTS

We found 25 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.

CONCLUSIONS

In this systematic review we present information relating to the effectiveness and safety of the following interventions: adding hormone therapy to external beam radiation therapy, or to brachytherapy; adding neoadjuvant hormone therapy to surgery alone, or to surgery plus adjuvant hormone therapy; brachytherapy alone; external beam radiation therapy alone; hormone therapy plus standard care; immediate hormone therapy; radical prostatectomy; and watchful waiting.