Prostate cancer is the second leading cause of cancer deaths and the seventh overall cause of death in men in the United States (Centers for Disease Control and Prevention, 2008). Given that most new cases are diagnosed at an early, localized stage, significant attention has been focused on understanding the risks and benefits of alternative management strategies for patients with low-risk disease. The major options include active surveillance and various forms of radiation therapy and surgery. Most men in the United States choose one of the definitive forms of treatment, but data to compare the long-term risks and benefits of active surveillance and each of the definitive treatment options are limited, placing great emphasis on the need for objective sources of guidance to help clinicians and patients engage in active shared decision-making.
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ICER has previously appraised the comparative clinical effectiveness and value of 4 forms of radiation therapy: intensity-modulated radiation therapy (IMRT), low-dose-rate interstitial brachytherapy, proton beam therapy (PBT), and three-dimensional conformal radiation therapy (3D-CRT). This appraisal focuses on active surveillance as well as the major approaches to radical prostatectomy—namely, the traditional “open” approach, minimally invasive laparoscopic prostatectomy, and robot-assisted laparoscopic prostatectomy. It must be emphasized that this review is relevant only for considerations of the management of localized, low-risk disease; the evidence and clinical tradeoffs involved in the treatment of intermediate- or high-risk prostate cancer would differ substantially.
Below you will find the final documents from the assessment review process: