Impact of local treatment on overall survival of patients with metastatic prostate cancer: systematic review and meta-analysis

Carneiro, Ariê; Baccaglini, Willy; Glina, Felipe Placco Araújo; Kayano, Paulo Priante; Nunes, Victor Moisés; Smaletz, Òren; Bernardo, Wanderley Marques; Carvalho, Icaro Thiago de; Lemos, Gustavo Caserta

doi:10.1590/s1677-5538.ibju.2016.0483

Cited by 15 publications

(14 citation statements)

References 38 publications

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“…Radiation therapy is sometimes used in men with stage IV M0 disease with at least 6 months of adjuvant ADT, but also used as part of palliative care to relieve bone pain and improve patient QOL . A recent meta‐analyses reported that men with metastatic disease who received some local treatment (radical prostatectomy, radiation therapy, and brachytherapy) had significantly better survival at 3 and 5 years compared to men receiving no local treatment . However, because patients treated locally tend to be younger, with more favorable clinical characteristics, it is difficult to attribute the improvement in outcome solely to these treatments.…”

Section: Discussionmentioning

confidence: 99%

Racial differences in patterns of treatment among men diagnosed with de novo advanced prostate cancer: A SEER‐Medicare investigation

et al. 2019

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Purpose Approximately 5% of men were initially diagnosed with (also referred to as de novo) advanced stage prostate cancer and experience far poorer survival compared to men diagnosed with local or regionally advanced disease. Given the number of new therapies targeting metastatic and castrate‐resistant disease, we sought to describe recent treatment patterns by race for de novo AJCC stage IV prostate cancer. Methods We used Surveillance, Epidemiology, and End Results (SEER) data linked to Medicare files to identify men aged 66 and older diagnosed in 2004‐2014 with advanced prostate cancer, and examined patterns of treatment among all patients and stratified by race/ethnicity. Results There were 8828 eligible patients identified, and non‐Hispanic black (NHB) patients were more likely to go without treatment (P < 0.001) compared to non‐Hispanic white (NHW) patients, even after accounting for early mortality and TNM stage. The frequency of nearly all forms of treatment was lower among NHB with the exception of orchiectomy, which was significantly higher (10.1% vs 6.1%, P < 0.001), and the use of the progesterone Megace among Medicare Part D enrollees (24.6% vs 15.0%, P < 0.001). Conclusions Results from this study of elderly Medicare patients presenting with advanced stage prostate cancer suggest that NHB men are less likely to pursue aggressive treatment options. With the reduction in screening for prostate cancer, presumably tied to USPSTF recommendations, and the increasing incidence of men diagnosed with de novo metastatic disease, understanding drivers of treatment‐related decisions are critical in reducing racial disparities in advanced prostate cancer outcomes.

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Section: Discussionmentioning

confidence: 99%

Racial differences in patterns of treatment among men diagnosed with de novo advanced prostate cancer: A SEER‐Medicare investigation

et al. 2019

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“…Owing to improvement in surgical techniques, surgery as an intervention has changed from the treatment of choice in low risk to more advanced and even in high-risk PCa (26). Though present metaanalyses showed that LT significantly improved OS and CMS of patients with metastatic prostatic cancer (12,27), however, these meta-analyses lack a subgroup analysis of M1 substagespecific which often combine with highest risk and mortality. Furthermore, Pompe et al concluded that no survival benefit existed in M1c patients for LT, which makes the clinical effect of LT controversial (21).…”

Section: Discussionmentioning

confidence: 67%

“…In recent years, some original articles and meta-analyses have proven that LT potentially prolongs the survival in patients with mPCa (12). However, in HORRAD trial, Boevé et al found that adding radiotherapy did not prolong the survival to patients with bone metastatic PCa (13).…”

Section: Introductionmentioning

confidence: 99%

The Effect of Local Therapy on M1c Prostate Cancer Patients: A Systematic Review and Meta-Analysis

2021

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Background: A systematic review and meta-analysis was conducted to explore the effect of local treatment (LT) on overall survival (OS) and cancer-specific mortality (CSM) for patients diagnosed with M1c prostate cancer (PCa).Methods: PubMed, Web of Science, Embase, EBSCO, and Cochrane library databases (updated November 2020) were searched for studies assessing the effect of LT on patients with M1c Pca. The search strategy and study selection process was managed according to the PRISMA statement.Results: Four cohort respective studies were identified for satisfying the inclusion criteria. Our results indicated that LT significantly improved CSM (HR = 0.36, 95% CI = 0.22–0.60; P < 0.0001) and OS (HR = 0.42, 95% CI = 0.24–0.77; P = 0.004). Subgroup analysis showed that radical prostatectomy (RP) and radiation therapy (RT) including brachytherapy (BT), conformal radiation therapy (CRT), and intensity modulated radiation (IMRT) had a significant benefit on cutting down the CSM of M1c PCa patients (HR = 0.27, 95% CI = 0.13–0.56; P = 0.0005 and HR = 0.42, 95% CI = 0.20–0.89; P = 0.02). In addition, RP had improved the OS for patients (HR = 0.33, 95% CI = 0.15–0.73; P = 0.008). There was no difference of OS in patients that underwent RT (HR = 0.58, 95% CI = 0.24–1.40; P = 0.23). No significant heterogeneity was among the results, indicating consistency in the study.Conclusions: Present meta-analysis indicates that LT for M1c PCa correlated with decreased CSM and enhanced OS. The survival benefit of RP was successfully confirmed and the advantage of RT seemed to be associated with the tumor burden and method of RT.

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“…Furthermore, the results of sensitivity analysis and publication bias indicated the stability of our conclusions. Although several similar (36,38,39), this study was the largest meta-analysis to demonstrate its prognostic role of LT in the treatment of mPCa and the first time to analyze ACM associated with mPCa between RP, RT and NLT.…”

Section: Discussionmentioning

confidence: 99%

Might definitive local therapy of the primary tumor improve the survival benefits of metastatic prostate cancer? —evidence from a meta-analysis

et al. 2020

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Background: With the successful application of local therapy (LT) of the primary tumor in other metastatic disease and the demonstration of their better survival benefits, the traditionally seldom involved role of LT for metastatic prostate cancer (mPCa) had gained a lot of interest. Hence, this meta-analysis was conducted to clarify its efficacy in mPCa.Methods: A comprehensive search of major databases (PubMed, EMBASE and Web of Science) was conducted for eligible studies, up to May 2019. The pooled hazard ratio (HR) with 95% confidence interval (CI) was utilized to evaluate the efficacy of LT for mPCa.Results: A total of 12 eligible studies with 78,864 participants, containing 28 different comparisons were ultimately enrolled in this article. Our results showed that LT involving radical prostatectomy (RP) or radiation therapy (RT) for mPCa was related to enhanced overall survival (OS) (pooled HR =0.53, 95% CI: 0.47 to 0.61, I 2 =59.7%, P=0.015), decreased cancer-specific mortality (CSM) (pooled HR =0.42, 95% CI: 0.34 to 0.51, I 2 =63.1%, P=0.004) and lower all-cause mortality (ACM) (pooled HR =0.37, 95% CI: 0.31 to 0.45, I 2 =49.4%, P=0.115), compared with no local therapy (NLT). In subsequent stratified analysis, RP or RT was respectively linked to longer OS (pooled HR =0.49, 95% CI: 0.44 to 0.54, I 2 =0.0%, P=0.741; pooled HR =0.64, 95% CI: 0.56 to 0.72, I 2 =15.4%, P=0.306), lower CSM (pooled HR =0.37, 95% CI: 0.29 to 0.46, I 2 =35.2%, P=0.187; pooled HR =0.51, 95% CI: 0.42 to 0.63, I 2 =27.0%, P=0.250) and decreased ACM (pooled HR =0.31, 95% CI: 0.23 to 0.40, I 2 =56.4%, P=0.130; pooled HR =0.44, 95% CI: 0.34 to 0.56, I 2 =0.0%, P=0.856), compared with NLT. In terms of RP vs. RT, RP was linked to a decreased CSM (pooled HR =0.59, 95% CI: 0.53 to 0.66, I 2 =0.0%, P=0.653).Conclusions: In summary, our results shed light on the positive role of LT (RP or RT) for mPCa and meanwhile its feasibility and survival benefits had been demonstrated. Moreover, when compared with RT, RP showed its superiority in CSM. Upcoming prospective randomized controlled trials should be taken to validate our findings.

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Impact of local treatment on overall survival of patients with metastatic prostate cancer: systematic review and meta-analysis

Cited by 15 publications

References 38 publications

Racial differences in patterns of treatment among men diagnosed with de novo advanced prostate cancer: A SEER‐Medicare investigation

Racial differences in patterns of treatment among men diagnosed with de novo advanced prostate cancer: A SEER‐Medicare investigation

The Effect of Local Therapy on M1c Prostate Cancer Patients: A Systematic Review and Meta-Analysis

Might definitive local therapy of the primary tumor improve the survival benefits of metastatic prostate cancer? —evidence from a meta-analysis

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