Prostatectomy Versus Observation for Localized Prostate Cancer: A Meta-Analysis

Background and Aims: Controversy exists regarding whether prostatectomy benefits localized prostate cancer patients; the aim of our study was to evaluate the role of prostatectomy in localized prostate cancer patients. Materials and Methods: A systematic search was conducted using PubMed and Web of Science through March 22, 2019, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines to identify randomized studies reporting on prostatectomy for localized prostate cancer patients. Results: Of a total of 1827 studies, six were considered for evidence synthesis. A total of 2524 patients in 3 studies were included for survival analysis, where 1256 patients received prostatectomy and 1268 patients received no treatment but were regularly followed up. Three other studies were included for adverse effects analysis. Prostatectomy displayed a significantly decreased risk of death of 9% compared with that of observation for patients with localized prostate cancer (risk ratio = 0.91; 95% confidence interval, 0.85-0.97; p = 0.007). Pooled data indicated that prostatectomy reduced the risk of disease progression by 43% (risk ratio = 0.57; 95% confidence interval, 0.47-0.70; p < 0.00001). Anxiety, depressed mood, well-being, and sense of meaningfulness for patients were not different between the prostatectomy and observation groups. However, prostatectomy increased the risk of erectile dysfunction by 2.10-fold (risk ratio = 2.10; 95% confidence interval, 1.36-3.26; p = 0.0009) and the risk of urinary function problems by 2.02-fold (risk ratio = 2.02; 95% confidence interval, 1.15-3.54; p = 0.01). Conclusion: Prostatectomy prolonged survival and deferred disease progression compared to observation for patients with localized prostate cancer. Symptoms between the two groups were not significantly different except for erectile and urinary function. Patients should decide on prostatectomy after balancing the survival benefit and risk of erectile dysfunction.