around 65 years and most (78%) had a Gleason sum score of 7. All trials were assessed as having low risk of bias.Based on 270 EFS events, the meta-analysis showed no evidence that EFS was improved with ART compared to a policy of SRT (HR=0.95, 95% CI=0.75-1.21, p=0.70), with only a 1% change in 5-year EFS (89% vs. 88%). Results were consistent across trials (heterogeneity p=0.18; I 2 =42%). Although power is limited, we did not see any strong evidence of a difference in the treatment effect according to any of the patient or disease characteristics assessed. InterpretationThis collaborative, and prospectively-designed systematic review and meta-analysis suggests that ART does not improve EFS in men with localised or locally advanced prostate cancer. Until data on long-term outcomes are available, early salvage treatment would seem the preferable treatment policy as it offers the opportunity to spare many men from RT and its associated side-effects.

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