저위험도 전립선암 환자의 치료 편집하기 (부분)

== 근거표 ==
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!KQ3
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!Reference
|1. MB Gretzer, BJ Trock, Han M, et al. A critical analysis of the interpretation of biochemical failure in surgically treated patients using the American Society for Therapeutic Radiation and Oncology criteria. J Urol 2002;168:1419-22.
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!Study type
|Retrospective study
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!Patients
|2,691 men who underwent anatomical radical prostatectomy for localized disease
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!Purpose of Study
|To evaluate how the American Society for Therapeutic Radiation and Oncology (ASTRO) criteria affect the interpretation of failure when applied to radical prostatectomy.
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!Study Results
|Using actuarial analysis of the data defining failure as the first PSA 0.2 ng/ml or greater, biochemical freedom from failure at 5, 10 and 15 years was 85%, 77% and 68%, respectively. In contrast, when backdating was used in this series, almost all failures occurred early with rare late failures (freedom from failure 82%, 80% and 80% at 5, 10 and 15 years, respectively). The difference in failure became even more pronounced when ASTRO criteria were applied requiring 3 consecutive increases, and backdating failure to the midpoint between nadir and first PSA (freedom from failure 90%, 90% and 90% at 5, 10 and 15 years, respectively).
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!Level of Study
|3
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!Reference
|2. S Nilsson, BJ Norlen, A Widmark: A systematic overview of radiation therapy effects in prostate cancer. Acta Oncol 2004;43:316-81.
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!Study type
|Meta-analysis
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!Patients
|152,614
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!Purpose of Study
|To randomize studies that compare the outcome of surgery (radical prostatectomy) with either external beam radiotherapy or brachytherapy for patients with clinically localized low-risk prostate cancer
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!Study Results
|There are no randomized studies that compare the outcome of surgery (radical prostatectomy) with either external beam radiotherapy or brachytherapy for patients with clinically localized low-risk prostate cancer. However, with the advent of widely accepted prognostic markers for prostate cancer (pre-treatment PSA, Gleason score, and T-stage), such comparisons have been made possible. There is substantial documentation from large single-institutional and multi-institutional series on patients with this disease category (PSA <10, GS < or=6, < or=T2b) showing that the outcome of external beam radiotherapy and brachytherapy is similar to those of surgery. *There is fairly strong evidence that patients with localized, intermediate risk, and high risk (pre-treatment PSA > or=10 and/or GS > or=7 and/or > T2) disease, i.e. patients normally not suited for surgery, benefit from higher than conventional total dose. No overall survival benefit has yet been shown.
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!Level of Study
|1
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!Reference
|3. ND Arvold, Chen MH, JW Moul, et al. Risk of death from prostate cancer after radical prostatectomy or brachytherapy in men with low or intermediate risk disease. J Urol 2011;186:91-6.
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!Study type
|Prospective study
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!Patients
|5,760 men with low risk prostate cancer (prostate specific antigen 10 ng/ml or less, clinical category T1c or 2a and Gleason score 6 or less), and 3,079 with intermediate risk prostate cancer (prostate specific antigen 10 to 20 ng/ml, clinical category T2b or T2c, or Gleason score 7).
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!Purpose of Study
|To estimated the risk of prostate cancer specific mortality following radical prostatectomy or brachytherapy in men with low or intermediate risk prostate cancer using prospectively collected data.
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!Study Results
|After a median follow up of 4.2 years (IQR 2.0-7.4) for low risk and 4.8 years (IQR 2.2- 8.1) for intermediate risk men, there was no significant difference in the risk of prostate cancer specific mortality among low risk (adjusted hazard ratio 1.62, 95% CI 0.59-4.45, p=0.35) or intermediate risk men (AHR 2.30, 95% CI 0.95-5.58, p=0.07) treated with brachytherapy compared with radical prostatectomy. The only factor associated with an increased risk of prostate cancer specific mortality (AHR 1.05, 95% CI 1.01-1.10, p=0.03) was increasing age at treatment in intermediate risk men.
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!Level of Study
|2
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!Reference
|4. Hamdy FC, Donovan JL, Lane JA, et al. 10-year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer. N Engl J Med 2016;375:1415-24.
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!Study type
|Retrospective study
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!Patients
|82,429
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!Purpose of Study
|The primary outcome was prostate-cancer mortality at a median of 10 years of follow-up. Secondary outcomes included the rates of disease progression, metastases, and all-cause deaths.
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!Study Results
|There were 17 prostate-cancer-specific deaths overall: 8 in the active-monitoring group (1.5 deaths per 1000 person-years; 95% confidence interval [CI], 0.7 to 3.0), 5 in the surgery group (0.9 per 1000 person-years; 95% CI, 0.4 to 2.2), and 4 in the radiotherapy group (0.7 per 1000 person-years; 95% CI, 0.3 to 2.0); the difference among the groups was not significant (P=0.48 for the overall comparison). In addition, no significant difference was seen among the groups in the number of deaths from any cause (169 deaths overall; P=0.87 for the comparison among the three groups). Metastases developed in more men in the active-monitoring group (33 men; 6.3 events per 1000 person-years; 95% CI, 4.5 to 8.8) than in the surgery group (13 men; 2.4 per 1000 person-years; 95% CI, 1.4 to 4.2) or the radiotherapy group (16 men; 3.0 per 1000 person-years; 95% CI, 1.9 to 4.9) (P=0.004 for the overall comparison). Higher rates of disease progression were seen in the activemonitoring group (112 men; 22.9 events per 1000 person-years; 95% CI, 19.0 to 27.5) than in the surgery group (46 men; 8.9 events per 1000 person-years; 95% CI, 6.7 to 11.9) or the radiotherapy group (46 men; 9.0 events per 1000 person-years; 95% CI, 6.7 to 12.0) (P<0.001 for the overall comparison).
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!Level of Study
|2
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!Reference
|5. Hayes JH, Ollendorf DA, Pearson SD, et al. Active surveillance compared with initial treatment for men with low-risk prostate cancer: a decision analysis. JAMA 2010;304(21):2373-80.
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!Study type
|Similar meta analysis
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!Patients
|309 article
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!Purpose of Study
|To examine the quality-of-life benefits and risks of active surveillance compared with initial treatment for men with low-risk, clinically localized prostate cancer.
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!Study Results
|Active surveillance was associated with the greatest QALE (11.07 quality-adjusted life-years [QALYs]), followed by brachytherapy (10.57 QALYs), IMRT (10.51 QALYs), and radical prostatectomy (10.23 QALYs). Active surveillance remained associated with the highest QALE even if the relative risk of prostate cancer-specific death for initial treatment vs active surveillance was as low as 0.6. However, the QALE gains and the optimal strategy were highly dependent on individual preferences for living under active surveillance and for having been treated.
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!Level of Study
|1
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!Reference
|6. Jayadevappa R, Chhatre S, Wong YN, et al. Comparative effectiveness of prostate cancer treatments for patient-centered outcomes: A systematic review and meta-analysis (PRISMA Compliant. Medicine (Baltimore) 2017;96(18):e6790.
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!Study type
|Meta analysis
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!Patients
|58 article
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!Purpose of Study
|To analyzed the comparative effectiveness of PCa treatments through systematic review and meta-analysis with a focus on outcomes that matter most to newly diagnosed localized PCa patients.
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!Study Results
|Our search strategy yielded 58 articles, of which 29 were RCTs, 6 were prospective studies, and 23 were retrospective studies. The studies provided moderate data for the patientcentered outcome of mortality. Radical prostatectomy demonstrated mortality benefit compared to watchful waiting (all-cause HR=0.63 CI=0.45, 0.87; disease-specific HR=0.48 CI=0.40, 0.58), and radiation therapy (all-cause HR=0.65 CI=0.57, 0.74; disease-specific HR=0.51 CI=0.40, 0.65). However, we had minimal comparative information about tradeoffs between and within treatment for other patient-centered outcomes in the short and long-term.
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!Level of Study
|1
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