Localized prostate cancer presents a therapeutic challenge with various treatment options, including radical prostatectomy (RP) and radiation therapy (RT). Understanding the comparative effectiveness of these interventions is crucial for informed decision-making. A systematic review was conducted following PRISMA guidelines to identify studies comparing outcomes between RP and RT for localized prostate cancer. PubMed, Embase, and Cochrane Library were searched for relevant articles published up to date. Eligible studies included comparative trials reporting outcomes such as urinary incontinence, sexual function, bowel function, hormonal function, general quality of life, and biochemical failure (BF). Quality assessment and data synthesis were performed using established tools. Sixteen studies met the inclusion criteria, encompassing diverse study designs, patient populations, and follow-up durations. RP was associated with worse urinary incontinence outcomes as compared to RT in several studies, while sexual function outcomes favored RT. Bowel function outcomes varied across studies, with some favoring RP and others RT. Hormonal function outcomes were mixed, with some studies indicating worse outcomes with RT plus androgen deprivation therapy. The BF rates were lower with RT plus adjuvant therapy as compared to RP in some studies. The choice between RP and RT for localized prostate cancer should consider patient-specific factors and preferences. RP might offer advantages in terms of urinary continence, while RT might be preferred for preserving sexual function. Bowel function and hormonal outcomes varied, highlighting the need for individualized treatment decisions. Further research is needed to elucidate long-term outcomes and optimize treatment strategies for localized prostate cancer.
Key words: Quality-of-life, outcomes, radical prostatectomy, radiation therapy, prostate cancer
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