883 1030
two previous reviews, which concluded that there was a
paucity of clinically important information from high-
quality RCTs on this topic
[41,42] .In another review by
Chou et al
[43] ,which included not only HRQoL outcomes,
the authors reported that RP was associated with increased
risk for urinary incontinence and erectile dysfunction, while
EBRT was associated with increased risk for erectile and
bowel dysfunction when compared with WW. Our
systematic review differs from others with regard to
the methodology, strict inclusion and exclusion criteria,
and robust methods used to synthesise the evidence and
analyse the data. These are the principal strengths of our
study.
4.
Conclusions
Based on currently available evidence, choice of primary
treatments for clinically localised PCa have a distinct impact
on cancer-specific QoL, for a period of up to 6 yr following
treatment. Men managed with AS have good overall QoL
scores, which are comparable with or better than those of
patients undergoing radical treatments. Surgery has a more
pronounced negative impact on urinary and sexual function
when compared with AS and EBRT, while EBRT has a more
pronounced negative impact on bowel function when
compared with AS and RP. Data from one small RCT
including patients with low-risk disease reported that BT
has a negative impact on urinary function at 1 yr, but there
are no significant differences in cancer-specific QoL 5 yr
after treatment. The review findings support the assertion
that AS provides a good alternative to radical treatments in
patients in whom it is desirable to prioritise QoL outcomes.
The findings provide a basis for informing patients and
clinicians regarding the impact of radical treatments on
QoL.
Appendix A
Database: AMED (Allied and Complementary Medicine)
<1985 to March 2017>, Embase <1974 to 2017 April 05>,
OVID Medline Epub Ahead of Print, In-Process & Other Non-
Indexed Citations, Ovid MEDLINE(R) Daily and Ovid
MEDLINE(R) 1946 to Present, PsycINFO <1987 to March
Week 4 2017>, EBM Reviews - Cochrane Central Register of
Controlled Trials <February 2017>, EBM Reviews - Cochrane
Database of Systematic Reviews <2005 to April 4, 2017>
Search Strategy:
1
exp Prostatic Neoplasms/ or exp prostate cancer/ (320773)
2
((prostate or prostatic) adj3 (cancer* or carcinoma* or malignan*
or tumor* or tumour* or neoplas* or adenocarcinoma* or
adenoma*)).tw,kw. (305713)
3
1 or 2 (374942)
4
Neoplasm Metastasis/ (238795)
5
metastasis/ (408688)
Appendix A (
Continued
)
6
(((advanced or inoperable or unopera* or unresectable or
nonresect* or non resect* or invasive) adj2 (cancer* or carcinoma*
or malignan* or tumor* or tumour* or neoplas* or
adenocarcinoma* or adenoma*)) not (without or ‘‘non’’ or ‘‘not’’ or
exclud* or other than or localized or localised or ‘‘T1-2c N0
M0’’)).tw,kw. (158157)
7
((metastatic or metastasis or metastases) not (without or ‘‘non’’ or
‘‘not’’ or exclud* or other than or localized or localised or ‘‘T1-2c N0
M0’’)).tw,kw. (492924)
8
or/4-7 (860374)
9
3 not 8 (316054)
10 exp prostatectomy/ (77504)
11 (prostat* adj3 (resect* or prostatectom* or surgery or
operat*)).tw,kw. (83251)
12 exp radiotherapy/ or exp cancer radiotherapy/ (631742)
13 exp Radiotherapy, Adjuvant/ (21980)
14 (brachytherap* or radiation or radiotherap* or irradiat* or
chemoradio* or radiochemo*).tw,kw. (1324674)
15 exp disease surveillance/ (21061)
16 (surveillance or observed or observation*).tw,kw. (7080940)
17 or/10-16 (8418235)
18 9 and 17 (133294)
19 exp ‘‘Quality of Life’’/ (622447)
20 ((life adj2 (quality or qualities)) or QoL or HRQOL or well-being or
‘‘SWB’’ or QALY or Quality Adjusted Life Year*).tw,kw. (950415)
21 (‘‘EORTC QLQ-C30’’ or ‘‘QLQ-PR25’’ or ‘‘FACT-G’’ or ‘‘FACT-P’’ or
‘‘FAPSI-8’’ or ‘‘PCTO-Q’’ or ‘‘UCLA-PCI’’ or ‘‘EPIC’’ or ‘‘PORPUS’’).tw.
(18472)
22 exp ‘‘Surveys and Questionnaires’’/ (1449823)
23 (index or scales or survey* or questionnaire* or functional
assessment or prostate specific module*).tw. (4050397)
24 or/19-23 (5359415)
25 18 and 24 (23126)
26 limit 25 to yr=‘‘2000 -Current’’ (21236)
27 conference abstract.pt. or Congresses as Topic/ (2618958)
28 ((child/ or Pediatrics/ or Adolescent/ or Infant/ or adolescence/ or
newborn/) not adult/) or ((child or children or pediatric* or
paediatric* or peadiatric* or infant* or new born or adolescent or
preschool or pre-school or youth* or student*) not (aged or adult*
or senior or men or women)).ti. (4754536)
29 ((exp animals/ or exp animal/ or exp nonhuman/ or exp animal
experiment/ or animal model/ or animal tissue/ or non human/)
not (humans/ or human/)) or ((rats or mice or mouse or cats or
dogs or animal* or cell lines) not (human* or men or women)).ti.
(11109264)
30 case report/ or case reports/ or (case report or case series).ti.
(4210591)
31 note/ or editorial/ or letter/ or Comment/ or news/ (3894066)
32 or/27-31 (24222706)
33 26 not 32 (16076)
34 randomized controlled trial.pt. (881440)
35 random*.mp,af. (3776078)
36 placebo.ab. (629267)
37 double-blind:.mp. or blind:.tw. (976542)
38 or/34-37 (4202650)
39 (Systematic review or meta-analysis).tw,kw. (405084)
40 Meta analysis/ or ‘‘systematic review’’/ (334793)
41 (Medline or Pubmed Embase or Cochrane or literature search or
literature review).ab. (404518)
42 controlled clinical trial.pt. (183066)
43 clinical trial:.mp. or clinical trial.pt. (2948310)
44 comparative study/ or (comparative or comparison or compared or
controlled).tw. (11843392)
45 (prospective* not retrospective*).tw. (1442681)
46 (trial or groups).ab. (5537688)
47 exp cohort analysis/ or exp Cohort Studies/ (2121229)
48 (cohort or cohorts).tw. (1163083)
49 ((evaluat* or multicenter) adj3 (studies or study)).tw. (1109193)
50 ((population or hospital) adj based).tw. (309218)
51 or/39-50 (18281147)
52 38 or 51 (19292744)
53 33 and 52 (12420)
E U R O P E A N U R O L O G Y 7 2 ( 2 0 1 7 ) 8 6 9 – 8 8 5
883