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Related Experiment Video

Updated: Nov 24, 2025

A New Technique for Treating Low-risk Prostate Cancer—Super Active Surveillance
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Therapies for Clinically Localized Prostate Cancer: A Comparative Effectiveness Review.

Timothy J Wilt1, Kristen E Ullman1, Eric J Linskens1

  • 1Minneapolis VA Healthcare System, Minneapolis, Minnesota.

The Journal of Urology
|December 22, 2020
PubMed
Summary

For clinically detected localized prostate cancer, radical prostatectomy lowers mortality compared to watchful waiting but increases harms. Active monitoring shows similar mortality to radical prostatectomy or radiation therapy, with fewer side effects.

Keywords:
androgen antagonistsbrachytherapymaleprostate-specific antigenprostatic neoplasms

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Area of Science:

  • Oncology
  • Urology
  • Clinical Therapeutics

Background:

  • Localized prostate cancer treatment decisions involve balancing efficacy and patient-reported outcomes.
  • Existing evidence on long-term outcomes for various localized prostate cancer therapies is evolving.

Purpose of the Study:

  • To identify and evaluate new information on treatments for clinically localized prostate cancer.
  • To compare mortality, metastasis, and harm outcomes across different therapeutic strategies.

Main Methods:

  • Systematic search of bibliographic databases (2013-2020), ClinicalTrials.gov, and systematic reviews.
  • Inclusion of controlled studies with follow-up durations of at least 5 years for mortality/metastases and 1 year for harms.
  • Analysis focused on therapies for clinically localized prostate cancer.

Main Results:

  • Radical prostatectomy may reduce mortality versus watchful waiting in clinically detected disease, but with increased urinary and erectile dysfunction.
  • Active monitoring shows little to no mortality difference compared to radical prostatectomy or radiation plus androgen deprivation, with potentially fewer harms.
  • Certain combination therapies, like 3-Dimensional conformal radiation plus androgen deprivation and brachytherapy, showed minor mortality benefits but no significant difference in metastases.

Conclusions:

  • Radical prostatectomy offers mortality benefits over watchful waiting for clinically detected localized prostate cancer, particularly in younger, intermediate-risk men, but at the cost of increased morbidity.
  • Active monitoring presents a viable alternative with comparable survival outcomes to more aggressive treatments and a better safety profile.
  • Limited new data exist for other localized prostate cancer treatment modalities.