Characterizing Surgical and Radiotherapy Outcomes in Non-metastatic High-Risk Prostate Cancer: A Systematic Review and Meta-Analysis

Abstract

Background Identifying the optimal management of high-risk non-metastatic prostate cancer (PCa) is an important public health concern, given the large burden of this disease. We performed a meta-analysis of studies comparing PCa-specific mortality (CSM) among men diagnosed with high-risk non-metastatic PCa who were treated with primary radiotherapy (RT) and radical prostatectomy (RP). Methods Medline and Embase were searched for articles between January 1, 2005, and February 11, 2020. After title and abstract screening, two authors independently reviewed full-text articles for inclusion. Data were abstracted, and a modified version of the Newcastle-Ottawa Scale, involving a comprehensive list of confounding variables, was used to assess the risk of bias. Results Fifteen studies involving 131,392 patients were included. No difference in adjusted CSM in RT relative to RP was shown (hazard ratio, 1.02 [95% confidence interval: 0.84, 1.25]). Increased CSM was found in a subgroup analysis comparing external beam radiation therapy (EBRT) with RP (1.35 [1.10, 1.68]), whereas EBRT combined with brachytherapy (BT) versus RP showed lower CSM (0.68 [0.48, 0.95]). All studies demonstrated a high risk of bias as none fully adjusted for all confounding variables. Conclusion We found no difference in CSM between men diagnosed with non-metastatic high-risk PCa and treated with RP or RT; however, this is likely explained by increased CSM in men treated with EBRT and decreased CSM in men treated with EBRT + BT studies relative to RP. High risk of bias in all studies identifies the need for better data collection and confounding control in the PCa research.

Clinically Localized Prostate Cancer: AUA/ASTRO Guideline, Part I: Introduction, Risk Assessment, Staging, and Risk-Based Management

“…46,47 The optimal treatment for these patients remains a topic of active study, and prior published meta-analyses have reported relatively disparate findings as to comparative survival following each of these treatment approaches. 48,49 The Panel supports offering patients with unfavorable intermediate-and high-risk disease either radical prostatectomy or radiation with ADT (see Principles of Surgery and Principles of Radiation in Parts II and II, respectively, of this series). For patients with sufficiently high-risk disease (clinically node positive, or with 2 of 3 of the following criteria: clinical stage T3 or T4, PSA 40 ng/mL, or Gleason 8), treatment with radiation and ADT can include two years of concurrent abiraterone acetate plus prednisone as well.…”

Our Experience with Radical Prostatectomy and Extended Pelvic Lymph Node Dissection in the Treatment of Clinical Stage T3 Prostate Cancer and Its Possible Advantages

“…Although the proportion of patients with prostate cancer diagnosed at stage cT3 is decreasing, the course of the disease may be aggressive at this stage and require complicated treatments [9,10]. Traditionally, urologists preferred EBRT and ADT in the cT3 stage, but in recent years, it has been shown that the option of RP plays an important role in this stage [11]. It has been understood that RP can be used safely with oncological and functional results in patients with stage cT3, as shown in our study in parallel with the literature.…”