Is increased life expectancy worth the potential adverse effects for those undergoing radical prostatectomy for localised prostate cancer?

Men with clinically localised prostate cancer are at relatively low risk for disease‐related morbidity and mortality. The results of this review demonstrate substantial benefit of RP over WW with regard to oncological outcomes. The mortality rate from any cause at 22.1 years follow-up was 733/1000 men in the WW group versus 648/1000 men in the RP group. The mortality rate from prostate cancer at 19.5 years follow-up was 114/1000 men in the WW group versus 67/1000 men in the RP group. However, such benefit is realised only by men with an expected life expectancy of well over 10 years.

Given that all men undergoing RP are at increased risk for urinary incontinence (risk ratio 3.97; 95% confidence interval 2.34–6.74), erectile dysfunction (RR 2.67; 95% CI 1.63–4.38) and resulting diminished quality of life, careful patient selection based on disease characteristics, medical comorbidities and patient expectations appears critical. Ultimately, the decision of RP versus deferred treatment will depend on the values and preferences of each individual patient and the importance they place on the potential for prolonging progression‐free life versus the increased risk for adverse events, including erectile dysfunction and urinary incontinence.