The efficacy and safety of radical prostatectomy and radiotherapy in high-risk prostate cancer: a systematic review and meta-analysis
Abstract Background The optimal treatment for patients with high-risk prostate cancer (PCa) remains a debate and selection of patients to receive proper therapy is still an unsettled question. This systematic review was conducted to compare the effectiveness of prostatectomy (RP) and radiotherapy (R...
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2020-02-01
|
| Series: | World Journal of Surgical Oncology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12957-020-01824-9 |
| _version_ | 1819204635507818496 |
|---|---|
| author | Zhipeng Wang Yuchao Ni Junru Chen Guangxi Sun Xingming Zhang Jinge Zhao Xudong Zhu Haoran Zhang Sha Zhu Jindong Dai Pengfei Shen Hao Zeng |
| author_facet | Zhipeng Wang Yuchao Ni Junru Chen Guangxi Sun Xingming Zhang Jinge Zhao Xudong Zhu Haoran Zhang Sha Zhu Jindong Dai Pengfei Shen Hao Zeng |
| author_sort | Zhipeng Wang |
| collection | DOAJ |
| description | Abstract Background The optimal treatment for patients with high-risk prostate cancer (PCa) remains a debate and selection of patients to receive proper therapy is still an unsettled question. This systematic review was conducted to compare the effectiveness of prostatectomy (RP) and radiotherapy (RT) in patients with high-risk PCa and to select candidates for optimal treatment. Methods PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were searched for eligible studies. We extracted hazard ratios (HRs) and 95% confidence interval (CI) of all included studies. The primary outcomes were overall survival (OS) and cancer-specific survival (CSS); the secondary outcomes were biochemical recurrence-free survival (BRFS), metastasis-free survival (MFS) and clinical recurrence-free survival (CRFS). The meta-analysis was performed using Review Manager 5.3. Subgroup analyses were conducted according to Gleason score (GS), T stage and RT types. Quality of life (QoL) was compared with these two treatments. Results A total of 25 studies were included in this meta-analysis. Overall, RP showed more survival benefits than RT on CSS (P = 0.003) and OS (P = 0.002); while RT was associated with better BRFS (P = 0.002) and MFS (P = 0.004). Subgroup analyses showed RT was associated with similar or even better survival outcomes compared to RP in patients with high GS, high T stage or received external beam radiotherapy plus brachytherapy (EBRT + BT). As for QoL, RP was associated with poorer urinary and sexual function but better performance in the bowel domain. Conclusion RP could prolong the survival time of patients with high-risk PCa; however, RT could delay the disease progression, and combined RT (EBRT + BT) even brought preferable CSS and similar OS compared to RP. RT might be the prior choice for patients with high T stage or high GS. RP could lead to poorer urinary and sexual function, while bringing better performance in the bowel domain. |
| first_indexed | 2024-12-23T04:38:57Z |
| format | Article |
| id | doaj.art-7fe811c740a1458f98c38456d9c6ef3c |
| institution | Directory Open Access Journal |
| issn | 1477-7819 |
| language | English |
| last_indexed | 2024-12-23T04:38:57Z |
| publishDate | 2020-02-01 |
| publisher | BMC |
| record_format | Article |
| series | World Journal of Surgical Oncology |
| spelling | doaj.art-7fe811c740a1458f98c38456d9c6ef3c2022-12-21T17:59:49ZengBMCWorld Journal of Surgical Oncology1477-78192020-02-0118111310.1186/s12957-020-01824-9The efficacy and safety of radical prostatectomy and radiotherapy in high-risk prostate cancer: a systematic review and meta-analysisZhipeng Wang0Yuchao Ni1Junru Chen2Guangxi Sun3Xingming Zhang4Jinge Zhao5Xudong Zhu6Haoran Zhang7Sha Zhu8Jindong Dai9Pengfei Shen10Hao Zeng11Department of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan UniversityDepartment of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan UniversityDepartment of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan UniversityDepartment of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan UniversityDepartment of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan UniversityDepartment of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan UniversityDepartment of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan UniversityDepartment of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan UniversityDepartment of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan UniversityDepartment of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan UniversityDepartment of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan UniversityDepartment of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan UniversityAbstract Background The optimal treatment for patients with high-risk prostate cancer (PCa) remains a debate and selection of patients to receive proper therapy is still an unsettled question. This systematic review was conducted to compare the effectiveness of prostatectomy (RP) and radiotherapy (RT) in patients with high-risk PCa and to select candidates for optimal treatment. Methods PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were searched for eligible studies. We extracted hazard ratios (HRs) and 95% confidence interval (CI) of all included studies. The primary outcomes were overall survival (OS) and cancer-specific survival (CSS); the secondary outcomes were biochemical recurrence-free survival (BRFS), metastasis-free survival (MFS) and clinical recurrence-free survival (CRFS). The meta-analysis was performed using Review Manager 5.3. Subgroup analyses were conducted according to Gleason score (GS), T stage and RT types. Quality of life (QoL) was compared with these two treatments. Results A total of 25 studies were included in this meta-analysis. Overall, RP showed more survival benefits than RT on CSS (P = 0.003) and OS (P = 0.002); while RT was associated with better BRFS (P = 0.002) and MFS (P = 0.004). Subgroup analyses showed RT was associated with similar or even better survival outcomes compared to RP in patients with high GS, high T stage or received external beam radiotherapy plus brachytherapy (EBRT + BT). As for QoL, RP was associated with poorer urinary and sexual function but better performance in the bowel domain. Conclusion RP could prolong the survival time of patients with high-risk PCa; however, RT could delay the disease progression, and combined RT (EBRT + BT) even brought preferable CSS and similar OS compared to RP. RT might be the prior choice for patients with high T stage or high GS. RP could lead to poorer urinary and sexual function, while bringing better performance in the bowel domain.http://link.springer.com/article/10.1186/s12957-020-01824-9High-risk prostate cancerRadical prostatectomyRadiotherapy |
| spellingShingle | Zhipeng Wang Yuchao Ni Junru Chen Guangxi Sun Xingming Zhang Jinge Zhao Xudong Zhu Haoran Zhang Sha Zhu Jindong Dai Pengfei Shen Hao Zeng The efficacy and safety of radical prostatectomy and radiotherapy in high-risk prostate cancer: a systematic review and meta-analysis World Journal of Surgical Oncology High-risk prostate cancer Radical prostatectomy Radiotherapy |
| title | The efficacy and safety of radical prostatectomy and radiotherapy in high-risk prostate cancer: a systematic review and meta-analysis |
| title_full | The efficacy and safety of radical prostatectomy and radiotherapy in high-risk prostate cancer: a systematic review and meta-analysis |
| title_fullStr | The efficacy and safety of radical prostatectomy and radiotherapy in high-risk prostate cancer: a systematic review and meta-analysis |
| title_full_unstemmed | The efficacy and safety of radical prostatectomy and radiotherapy in high-risk prostate cancer: a systematic review and meta-analysis |
| title_short | The efficacy and safety of radical prostatectomy and radiotherapy in high-risk prostate cancer: a systematic review and meta-analysis |
| title_sort | efficacy and safety of radical prostatectomy and radiotherapy in high risk prostate cancer a systematic review and meta analysis |
| topic | High-risk prostate cancer Radical prostatectomy Radiotherapy |
| url | http://link.springer.com/article/10.1186/s12957-020-01824-9 |
| work_keys_str_mv | AT zhipengwang theefficacyandsafetyofradicalprostatectomyandradiotherapyinhighriskprostatecancerasystematicreviewandmetaanalysis AT yuchaoni theefficacyandsafetyofradicalprostatectomyandradiotherapyinhighriskprostatecancerasystematicreviewandmetaanalysis AT junruchen theefficacyandsafetyofradicalprostatectomyandradiotherapyinhighriskprostatecancerasystematicreviewandmetaanalysis AT guangxisun theefficacyandsafetyofradicalprostatectomyandradiotherapyinhighriskprostatecancerasystematicreviewandmetaanalysis AT xingmingzhang theefficacyandsafetyofradicalprostatectomyandradiotherapyinhighriskprostatecancerasystematicreviewandmetaanalysis AT jingezhao theefficacyandsafetyofradicalprostatectomyandradiotherapyinhighriskprostatecancerasystematicreviewandmetaanalysis AT xudongzhu theefficacyandsafetyofradicalprostatectomyandradiotherapyinhighriskprostatecancerasystematicreviewandmetaanalysis AT haoranzhang theefficacyandsafetyofradicalprostatectomyandradiotherapyinhighriskprostatecancerasystematicreviewandmetaanalysis AT shazhu theefficacyandsafetyofradicalprostatectomyandradiotherapyinhighriskprostatecancerasystematicreviewandmetaanalysis AT jindongdai theefficacyandsafetyofradicalprostatectomyandradiotherapyinhighriskprostatecancerasystematicreviewandmetaanalysis AT pengfeishen theefficacyandsafetyofradicalprostatectomyandradiotherapyinhighriskprostatecancerasystematicreviewandmetaanalysis AT haozeng theefficacyandsafetyofradicalprostatectomyandradiotherapyinhighriskprostatecancerasystematicreviewandmetaanalysis AT zhipengwang efficacyandsafetyofradicalprostatectomyandradiotherapyinhighriskprostatecancerasystematicreviewandmetaanalysis AT yuchaoni efficacyandsafetyofradicalprostatectomyandradiotherapyinhighriskprostatecancerasystematicreviewandmetaanalysis AT junruchen efficacyandsafetyofradicalprostatectomyandradiotherapyinhighriskprostatecancerasystematicreviewandmetaanalysis AT guangxisun efficacyandsafetyofradicalprostatectomyandradiotherapyinhighriskprostatecancerasystematicreviewandmetaanalysis AT xingmingzhang efficacyandsafetyofradicalprostatectomyandradiotherapyinhighriskprostatecancerasystematicreviewandmetaanalysis AT jingezhao efficacyandsafetyofradicalprostatectomyandradiotherapyinhighriskprostatecancerasystematicreviewandmetaanalysis AT xudongzhu efficacyandsafetyofradicalprostatectomyandradiotherapyinhighriskprostatecancerasystematicreviewandmetaanalysis AT haoranzhang efficacyandsafetyofradicalprostatectomyandradiotherapyinhighriskprostatecancerasystematicreviewandmetaanalysis AT shazhu efficacyandsafetyofradicalprostatectomyandradiotherapyinhighriskprostatecancerasystematicreviewandmetaanalysis AT jindongdai efficacyandsafetyofradicalprostatectomyandradiotherapyinhighriskprostatecancerasystematicreviewandmetaanalysis AT pengfeishen efficacyandsafetyofradicalprostatectomyandradiotherapyinhighriskprostatecancerasystematicreviewandmetaanalysis AT haozeng efficacyandsafetyofradicalprostatectomyandradiotherapyinhighriskprostatecancerasystematicreviewandmetaanalysis |