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A new comparative effectiveness study has concluded that the various approaches, including active surveillance, surgery, and radiation therapy result in similar overall survival and tumor recurrence rates.

Compared with the immediate treatment options, active surveillance yields both a comparable net health benefit and more quality-adjusted life years for men age 65 and older, according to the economic model used in this study.

Researchers at the Institute for Clinical and Economic Review, which is based at the Massachusetts General Hospital’s Institute for Technology Assessment, examined the published evidence on different approaches being used to manage low-risk prostate cancer and the results of a simulation model that can project the long-term effects of each approach for large populations. Their review also included a comparison of the relative economic cost of each approach. The literature review and analysis were aided by an evidence review group of nearly 50 members that included top prostate cancer specialists from across the country, patient advocates, and representatives from medical device, pharmaceutical, and health insurance companies.

Their task was complicated, the reviewers acknowledged, by a lack of published trials that compared the different options head-to-head, as well as other factors. In addition to traditional open surgery (or radical prostatectomy), they assessed the clinical and cost effectiveness of robotic and traditional laparoscopic prostatectomy, as well as of brachytherapy and intensity-modulated radiation therapy. Because of the limited published data on proton beam radiation therapy, a treatment for localized prostate cancer that has gained popularity, the reviewers called it “premature” to offer any “judgments about its relative benefit or inferiority to other options.”

Source: National Cancer Institute

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