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	Institution: STANFORD Univ Med Center  | My Account | E-mail Alerts | Access Rights | Sign In Vol. 2 No. 5, May 1993   Archives  •  Online Features Original Contributions  This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal A Structured Literature Review of Treatment for Localized Prostate Cancer John H. Wasson, MD; Cynthia C. Cushman, MD; Reginald C. Bruskewitz, MD; Benjamin Littenberg, MD; Albert G. Mulley, Jr, MD, MPP; John E. Wennberg, MD, MPH Arch Fam Med. 1993;2(5):487-493. Abstract Objective We performed a structured literature review to define the clinical course of localized prostate cancer, the effectiveness of radical surgery and radiation therapy, and treatment complications. Article Selection We identified more than 1600 Englishlanguage, MEDLINE referenced articles for 1966 through 1991. All but 144 were excluded because they lacked primary data, involved fewer than 15 patients, or described neither the course of the disease nor treatment complications. Data Synthesis In these 144 articles, persistent genitourinary complications were more common after radical surgery than after external-beam radiation. Radiation resulted in a higher incidence of bowel problems. The median annual risks for the development of distant metastases and cancer-related death were 2.6% and 1.0%, respectively. Because tumor grade was correlated with metastases (Spearman correlation r=.56) and cancer mortality (r=.31), controlling for grade was necessary before we could compare the effectiveness of treatments for these outcomes. However, stratification by grade of malignancy was available in only nine of the patient series describing metastatic rates and in seven describing cancerrelated mortality. Furthermore, in the patient series that described prostate cancer—related metastatic rates, 48% neglected to identify patients unavailable for follow-up, 92% did not stratify patients by age, and only 48% stratified patients by the extent of disease at treatment. Conclusions Although we were able to compare complications of treatments, we were unable to determine treatment effectiveness for localized prostate cancer because of methodologic inadequacies in the literature we reviewed. Until better scientific evidence is available, patients and their physicians cannot make informed choices based on knowledge of the benefits of radical prostatectomy, radiation, or watchful waiting. Author Affiliations Prostate Disease Patient Outcome Research Team From the Center for the Evaluative Clinical Sciences, Department of Community and Family Medicine, Dartmouth Medical School, Hanover, NH (Drs Wasson and Wennberg), the Department of Pediatrics (Dr Cushman) and the Technology Assessment Program (Dr Littenberg), Dartmouth Hitchcock Medical Center, Lebanon, NH; the General Internal Medicine Unit of the Medical Services, Massachusetts General Hospital, Boston (Dr Mulley); and the Clinical Science Center, University of Wisconsin Medical School, Madison (Dr Bruskewitz). Dr Littenberg is an American College of Physicians George Morris Piersol teaching and research scholar. THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES Helping Men Decide About Scheduling a Prostate Cancer Screening Exam Liberatore et al. Interfaces 2009;39:209-217. ABSTRACT   Time Course and Predictors of Symptoms After Primary Prostate Cancer Therapy Talcott et al. JCO 2003;21:3979-3986. ABSTRACT | FULL TEXT   Patients' Perceptions of Quality of Life After Treatment for Early Prostate Cancer Clark et al. JCO 2003;21:3777-3784. ABSTRACT | FULL TEXT   Do Older Men Benefit From Curative Therapy of Localized Prostate Cancer? Alibhai et al. JCO 2003;21:3318-3327. ABSTRACT | FULL TEXT   Trends in prostate cancer incidence and mortality: an analysis of mortality change by screening intensity Coldman et al. CMAJ 2003;168:31-35. ABSTRACT | FULL TEXT   Understanding and Appreciating Overdiagnosis in the PSA Era Yao and Lu-Yao JNCI J Natl Cancer Inst 2002;94:958-960. FULL TEXT   Factors Associated With Initial Therapy for Clinically Localized Prostate Cancer: Prostate Cancer Outcomes Study Harlan et al. JNCI J Natl Cancer Inst 2001;93:1864-1871. ABSTRACT | FULL TEXT   Screening for prostate cancer in the UK Donovan et al. BMJ 2001;323:763-764. FULL TEXT   Prostate Cancer Staging: Should MR Imaging Be Used?-A Decision Analytic Approach Jager et al. Radiology 2000;215:445-451. ABSTRACT | FULL TEXT   Prostate Cancer Practice Patterns and Quality of Life: the Prostate Cancer Outcomes Study Potosky et al. JNCI J Natl Cancer Inst 1999;91:1719-1724. FULL TEXT   Prostate Cancer Tumor Grade Differentiation with Dynamic Contrast-enhanced MR Imaging in the Rat: Comparison of Macromolecular and Small-Molecular Contrast Media-Preliminary Experience Gossmann et al. Radiology 1999;213:265-272. ABSTRACT | FULL TEXT   Improving Appropriate Selection of Radical Prostatectomy for Prostate Cancer Lewis and Rising Eval Health Prof 1998;21:429-441. ABSTRACT   Acute effects of therapeutic irradiation for prostatic carcinoma on anorectal function Yeoh et al. Gut 1998;43:123-127. ABSTRACT | FULL TEXT   Medical Malpractice Implications of PSA Testing for Early Detection of Prostate Cancer Collins et al. J Law Med Ethics 1997;25:234-242.   Fifteen-Year Survival in Prostate Cancer: A Prospective, Population-Based Study in Sweden Johansson et al. JAMA 1997;277:467-471. ABSTRACT   Preferences of Husbands and Wives for Prostate Cancer Screening Volk et al. Arch Fam Med 1997;6:72-76. ABSTRACT   Controversies in Prostate Cancer Screening: Analogies to the Early Lung Cancer Screening Debate Collins and Barry JAMA 1996;276:1976-1979. ABSTRACT   Results of Radical Prostatectomy in Men With Clinically Localized Prostate Cancer: Multi-institutional Pooled Analysis Gerber et al. JAMA 1996;276:615-619. ABSTRACT   Screening for Prostate Cancer with Prostate-Specific Antigen -- An Examination of the Evidence Woolf NEJM 1995;333:1401-1405. FULL TEXT   Long-term Survival Among Men With Conservatively Treated Localized Prostate Cancer Albertsen et al. JAMA 1995;274:626-631. ABSTRACT   Medicine--Molecular, Monetary, or More Than Both? Eisenberg JAMA 1995;274:331-334. ABSTRACT   A 72-Year-Old Man With Localized Prostate Cancer Albertsen JAMA 1995;274:69-74. ABSTRACT   The Role of Increasing Detection in the Rising Incidence of Prostate Cancer Potosky et al. JAMA 1995;273:548-552. ABSTRACT   Urology Chodak JAMA 1994;271:1717-1718. ABSTRACT   Results of Conservative Management of Clinically Localized Prostate Cancer Chodak et al. NEJM 1994;330:242-248. ABSTRACT | FULL TEXT   Men's Health Issues Konen Arch Fam Med 1993;2:917-919. ABSTRACT   An Assessment of Radical Prostatectomy: Time Trends, Geographic Variation, and Outcomes Lu-Yao et al. JAMA 1993;269:2633-2636. ABSTRACT   A Decision Analysis of Alternative Treatment Strategies for Clinically Localized Prostate Cancer Fleming et al. JAMA 1993;269:2650-2658. ABSTRACT   Management of Clinically Localized Prostatic Cancer: An Unresolved Problem Whitmore JAMA 1993;269:2676-2677. ABSTRACT   HOME | CURRENT ISSUE | PAST ISSUES | TOPIC COLLECTIONS | CME | PHYSICIAN JOBS | HELP CONDITIONS OF USE | PRIVACY POLICY | CONTACT US | SITE MAP   © 1993 American Medical Association. All Rights Reserved.