Localised prostate cancer: clinical and cost-effectiveness of new and emerging technologies

In contrast to pharmacological interventions that undergo rigorous clinical testing, recent technological advances in the treatment of prostate cancer (PCa) have particularly been introduced and driven by economic incentives rather than high-quality clinical evidence. In this review we summarise the clinical and cost-effectiveness of new and emerging technologies for localised PCa. We emphasise particularly on robotic prostatectomy, new developments in radiotherapy, novel technologies in focal therapy such as cryosurgery and high-intensity focused ultrasound (HIFU). Robotic-assisted laparoscopic radical prostatectomy (RALRP) has similar oncologic outcomes to open radical retropubic prostatectomy (RRP); however, patients who undergo RALRP are more likely to have improved short-term potency rates. Intensity-modulated radiotherapy (IMRT) and proton-beam therapy (PBT) have similar oncologic outcomes to external-beam radiotherapy (EBRT). IMRT has exhibited an improved gastrointestinal side effect profile compared to EBRT. PBT is not cost-effective compared to other radiotherapy modalities. Early studies of focal therapies in localised PCa have yielded positive results. Treatment decisions should be driven by cancer risk and patient preference rather than by financial incentives or availability of technology.