Following the analysis of 232 published papers on the subject of prostate cancer treatments, researchers at the University of California, San Francisco (UCSF) have come to some conclusions regarding which procedures are the most successful and cost-effective when treating the condition.
For patients with low-risk prostate cancer, analysts confirmed that the differing types of treatment available did not vary significantly in terms of survival, but there were some steep disparities regarding expense — radiation therapy being more burdensome on the grounds of cost than surgery.
High-risk prostate cancer patients were found to benefit in both the cost and survival realms from surgery, although the union of external-beam radiation and brachytherapy did prove effective on the grounds of quality of life-adjusted survival.
"Our findings support a greater role for surgery for high-risk disease than we have generally seen it used in most practice settings," said urologist Matthew Cooperberg, MD, MPH, assistant professor of urology and epidemiology and biostatistics in the UCSF Helen Diller Family Comprehensive Cancer Center, in a news release.
Brands of treatment investigated by the study’s cohort included:
- Surgery: open, laparoscopic or robot-assisted
- Radiation therapy: dose-escalated three-dimensional conformal radiation therapy, intensity-modulated radiation therapy and brachytherapy
- Hormone therapies
- Combination therapies
Active surveillance and proton therapy were not explored by Cooperberg and his team. “Differences across treatments in quality-adjusted life years across methods were modest, ranging from 10.3 to 11.3 for low-risk patients, 9.6–10.5 for intermediate-risk patients and 7.8–9.3 for high-risk patients,” the study authors wrote.
Even though "there is very little solid evidence that one [approach] is better than another," regarding outcomes for different patients with different disease severity, price tags were a different story, Cooperberg noted. Costs for the above alleviants ranged from $19,901 to undergo a robot-assisted prostatectomy, to $50,276 for combined radiation therapy.
The study was published in the latest edition of the British Journal of Urology International.