ICER developed a report on Active Surveillance and Radical Prostatectomy for prostate cancer.
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.
The ICER review found that there are no definitive head-to-head studies comparing these options, but that accumulated evidence from multiple studies over the years suggests that overall survival and the rate of cancer recurrence are quite similar among all options, including active surveillance. There are different risks for certain side effects and complications, but no treatment option stands out as superior overall. Because low-risk prostate cancer is typically slow-growing and may not cause any symptoms, active surveillance is a reasonable option, particularly for men 65 and older, approximately half of whom will never have their cancer progress to the point of requiring treatment.
Date of Review: September 2009
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Below you will find the final documents from the assessment review process:
“ICER works hard to create unbiased, fully-informed appraisals of disease management and treatment options so that patients, clinicians, and payers can trust the information produced. The results of the summary report on low-risk prostate cancer are an example of how scientifically-sound comparative effectiveness research can be presented in an actionable way for multiple audiences. Ultimately, this type of research can help improve patient outcomes and overall value in the healthcare system.”