(ChemotherapyAdvisor) – For patients with low-risk prostate cancer, survival rates are largely equivalent for different treatment modalities, but for intermediate- and high-risk prostate cancer, surgery—and possibly, external-beam radiotherapy plus brachytherapy—appear to be more effective compared to other treatments; however, radiotherapy methods were consistently more expensive according to the authors of a comprehensive systematic review recently published in the British Journal of Urology International (BJU International).

“Our analysis found small differences in outcomes and substantial differences in payer and patient costs across treatment alternatives,” reported lead author Matthew R. Cooperberg, MD, of the University of California San Francisco’s Helen Diller Family Comprehensive Cancer Center, in San Francisco, CA, and coauthors. “There were no statistically significant (survival) differences among surgical methods, which tended to be more effective than radiotherapy methods, with the exception of combined external beam radiotherapy (EBRT) plus brachytherapy for high-risk disease. Radiotherapy methods were consistently more expensive than surgical methods.”

There exists no consensus for managing localized prostate cancer, and “patterns of management vary tremendously,” the authors commented. Clinical trial findings comparing surgery and radiotherapy outcomes are not expected to be available for several years, they wrote.

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Their analysis of data from 232 published papers found “statistically significant but relatively modest differences” between treatments in quality-adjusted survival. “In general, surgery was preferred over radiotherapy for lower-risk men, whereas combined EBRT plus brachytherapy compared favorably for high-risk men,” the authors reported. “However, across the risk spectrum, radiotherapy was consistently more expensive.”

Costs, however, varied markedly between treatments, they reported.

Intensity-modulated radiotherapy (IMRT) for low- and intermediate-risk prostate cancer was “substantially more expensive” than surgery or brachytherapy, without offering improved survival times compared to those treatments, the authors noted. Robot-assisted prostatectomy for low-risk prostate cancer costs approximately $19,901, the authors noted, whereas combined radiotherapy for high-risk prostate can cost as much as $50,276.

“Our findings support a greater role for surgery for high-risk disease than we have generally seen it used in most practice settings,” Dr. Cooperberg concluded.

Active surveillance (“watchful waiting”) and proton therapy were not assessed in the analysis. The study was “the most comprehensive” cost-effectiveness analysis reported to date for localized prostate cancer, the authors reported.