cancer, prostate
DISEASE INTERVENTION COMPARISON RESULTS
J Clin Oncol. 2007 Aug 20;25(24):3582-8 Decision Model
IN cancer, prostate The Use of
a nomogram including age, ethnicity, family history, urinary symptoms, prostatic specific antigen (PSA), free:total PSA ratio, and digital rectal examination
As Diagnostic Tool
Is better Than
PSA alone
To detect patients with prostate cancer. 24% of patients with PSA < 4 ng/mL had prostate cancer.
J Clin Oncol. 2005 Jul 1;23(19):4322-9. Epub 2005 Mar 21 Decision Model
IN cancer, prostate The Use of
PSA>1.55 ng/mL or >0.165 ng/mL/cc(prostate volume), hypoechoic lesion, age>55y, prostate volume<44cc
As Diagnostic Tool
Is better Than
increase PSA alone
To select patients for prostatic biopsy in search of prostatic cancer: 31% sensibility and 96,6% specificity for prostatic cancer
N Engl J Med. 2005 May 12;352(19):1977-84 Randomized Controlled Trial, Multicenter Study
IN cancer, prostate, early non-metastatic The Use of
radical prostatectomy
As Treatment, Acute
Is better Than
watchful waiting
To decrease - at 8 years - metatasis development, local progression, death due to prostate cancer (8.6% with surgery VS 14.4% waiting) and total mortality (24% with surgery VS 30.5% waiting)
Ann Intern Med. 2008 Mar 18;148(6):435-48 Systematic Review
IN cancer, prostate, early non-metastatic The Use of
radical prostatectomy
As Treatment, Acute
Is better Than
watchful waiting or external-beam radiation
To reduced at 10 years all-cause mortality (24% prostatectomy vs. 30% wacthful) or reduce at 5 years cancer recurrence
N Engl J Med. 2016 Oct 13;375(15):1425-1437 Randomized Controlled Trial, Multicenter Study
IN cancer, prostate, early non-metastatic The Use of
active monitoring
As Treatment, Chronic
Is better Than
radical prostatectomy, or external-beam radiotherapy
To preserve sexual, urinary and bowel functions: sexual and urinary function declined gradually. Prostatectomy was the worst on sexual function and urinary continence. Radiotherapy reduced sexual and bowel functions but did not impact continency
N Engl J Med. 2016 Oct 13;375(15):1415-1424 Randomized Controlled Trial, Multicenter Study
IN cancer, prostate, early non-metastatic The Use of
active monitoring only
As Treatment, Chronic
Is equal Than
radical prostatectomy, or external-beam radiotherapy
To change overral mortality and prostate-cancer-specific deaths at 10 years follow-up: 1.5/1000 persons-year active monitoring VS 1/1000 prostatectomy VS 0.7/1000 radiotherapy. More disease progression and metastases in monitoring only
N Engl J Med. 2003 Jul 17;349(3):215-24 Randomized Controlled Trial, Multicenter Study
IN cancer, prostate, primary prevention in healthy men The Use of
finasteride
As Prevention, Primary
Is better Than
placebo
To prevent development of prostate cancer (2,63%/year in intv VS 3,48%/year), benign prostatic hyperplasia (5,2% VS 8,7%) and have less urinary symptoms. But intv group had more sexual dysfunction and prostatic cancers were high grade more freq(6,4% vs 5,1%)
N Engl J Med. 2009 Mar 26;360(13):1310-9 Randomized Controlled Trial, Multicenter Study
IN cancer, prostate, screening in healthy men The Use of
screeing using annual PSA testing and digital rectal examination for 6 years
As Diagnostic Tool
Is equal Than
usual care, not routine screening
To modify mortality by prostatic cancer (2/10,000 person-years screening VS 1.7/10,000 controls) despite detecting more prostatic cancers (116/10,000 person-years screening VS 95/10,000 controls)