Cytoreductive radical prostatectomy or radiation therapy for metastases prostate cancer: Evidence from meta-analysis

Abstract

Background: Cytoreductive radical prostatectomy (RP), transurethral resection of the prostate, and radiation therapy were the main local treatments for oligometastatic prostate cancer (PCa). An optimal local treatment for metastases PCa was not consensus. The purpose of this study was to evaluate the effect on these local treatments for patients with metastases PCa.Methods: All relevant studies were systematically searched through PubMed, Web of Science through November 1, 2021. Studies were screened by inclusion and exclusion criteria. Progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS) were evaluated by this meta-analysis.Results: Eleven studies were identified that met the inclusion criteria. 644 patients received cytoreductive surgery, 8556 patients received no surgery or radiation therapy (RT), and 461 patients received RP + androgen deprivation therapy compared with 746 patients who received RT. Pooled data indicated that cytoreductive surgery significantly prolonged the PFS (OR = 0.65, 95% CI 0.53-0.80, P < .0001), CSS and OS (OR = 0.49, 95% CI 0.43-0.56, P < .00001; and OR = 0.80, 95% CI 0.72-0.88, P < .00001; respectively). Comparing cytoreductive surgery with RT, CSS, and OS were similar (OR = 0.82, 95% CI 0.67-1.01, P = .06; and OR = 0.93, 95% CI 0.79-1.09, P = .39; respectively).Conclusions: Cytoreductive radical prostatectomy significantly prolonged the PFS for metastatic PCa. Although OS was considered a-not-so significant difference between cytoreductive surgery and non-local therapy, non-local treatment was not recommended.Abbreviations: ADT = androgen deprivation therapy, CSS = cancer-specific survival, mHSPC = metastatic hormone-sensitive prostate cancer, OR = odds ratio, OS = overall survival, PCa = prostate cancer, PFS = progression-free survival, RP = radical prostatectomy, SEER = Surveillance Epidemiology and End Results, TURP = transurethral resection of the prostate.

Cytoreductive radical prostatectomy: who benefits from the surgical approach?

“…The feasibility of cytoreductive prostatectomy could have been demonstrated in retrospective and small prospective trials [3–15]. Meanwhile, there are meta-analysis and comparative data between cytoreductive prostatectomy and radiotherapy available highlighting that surgical interventions have comparable oncologic control [16 ▪▪ ,17,18]. Knipper et al [16 ▪▪ ] compared 78 patients with low-volume initially metastatic prostate cancer undergoing cytoreductive prostatectomy and compared their retrospective cohort to 410 patients from the Stampede-H-arm.…”