title: Comparative evaluation of radiation treatments for clinically localized prostate cancer: an updated systematic review.
abstract: BACKGROUND
  Radiation therapy is one of many treatment options for patients with prostate cancer.
  
  
  OBJECTIVE
  To update findings on the clinical and biochemical outcomes of radiation therapies for localized prostate cancer.
  
  
  METHODS
  MEDLINE (2007 through March 2011) and the Cochrane Central Register of Controlled Trials (2007 through March 2011).
  
  
  METHODS
  Published English-language comparative studies involving adults with localized prostate cancer who either had first-line radiation therapy or received no initial treatment.
  
  
  METHODS
  6 researchers extracted information on study design, potential bias, sample characteristics, interventions, and outcomes and rated the strength of overall evidence. Data for each study were extracted by 1 reviewer and confirmed by another.
  
  
  RESULTS
  75 studies (10 randomized, controlled trials [RCTs] and 65 nonrandomized studies) met the inclusion criteria. No RCTs compared radiation therapy with no treatment or no initial treatment. Among the 10 RCTs, 2 compared combinations of radiation therapies, 7 compared doses and fraction sizes of external-beam radiation therapy (EBRT), and 1 compared forms of low-dose rate radiation therapy. Heterogeneous outcomes were analyzed. Overall, moderate-strength evidence consistently showed that a higher EBRT dose was associated with increased rates of long-term biochemical control compared with lower EBRT dose. The body of evidence was rated as insufficient for all other comparisons.
  
  
  CONCLUSIONS
  Studies inconsistently defined and reported outcomes. Much of the available evidence comes from observational studies with treatment selection biases.
  
  
  CONCLUSIONS
  A lack of high-quality comparative evidence precludes conclusions about the efficacy of radiation treatments compared with no treatments for localized prostate cancer.
  
  
  BACKGROUND
  Agency for Healthcare Research and Quality.
authors.affiliation: Institute of Clinical Research and Health Policy Studies, Tufts University School of Medicine, Tufts Medical Center, and Tufts Clinical and Translational Science Institute, Boston, Massachusetts 02111, USA.
authors.forename: Raveendhara R
authors.initials: RR
authors.lastname: Bannuru
authors.forename: Tomas
authors.initials: T
authors.lastname: Dvorak
authors.forename: Ndidiamaka
authors.initials: N
authors.lastname: Obadan
authors.forename: Winifred W
authors.initials: WW
authors.lastname: Yu
authors.forename: Kamal
authors.initials: K
authors.lastname: Patel
authors.forename: Mei
authors.initials: M
authors.lastname: Chung
authors.forename: Stanley
authors.initials: S
authors.lastname: Ip
mesh_terms: D001918:Brachytherapy / Q000009:adverse effects; D057186:Comparative Effectiveness Research; D006801:Humans; D007410:Intestinal Diseases / Q000209:etiology; D008297:Male; D009364:Neoplasm Recurrence, Local; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D011878:Radiotherapy / Q000009:adverse effects; D011879:Radiotherapy Dosage; D016032:Randomized Controlled Trials as Topic; D012735:Sexual Dysfunction, Physiological / Q000209:etiology; D016019:Survival Analysis; D016896:Treatment Outcome; D014570:Urologic Diseases / Q000209:etiology