Radiation therapy compared to radical prostatectomy as first-line definitive therapy for patients with high-risk localised prostate cancer: An updated systematic review and meta-analysis

Abstract

Objective To present an update of the available literature on external beam radiation therapy (EBRT) with or without brachytherapy (BT) compared to radical prostatectomy (RP) for patients with high-risk localised prostate cancer (PCa). Methods We conducted a systematic review and meta-analysis of the literature assessing the survival outcomes in patients with high-risk PCa who received EBRT with or without BT compared to RP as the first-line therapy with curative intent. We queried PubMed and Web of Science database in January 2021. Moreover, we used random or fixed-effects meta-analytical models in the presence or absence of heterogeneity per the I 2 statistic, respectively. We performed six meta-analyses for overall survival (OS) and cancer-specific survival (CSS). Results A total of 27 studies were selected with 23 studies being eligible for both OS and CSS. EBRT alone had a significantly worse OS and CSS compared to RP (hazard ratio [HR] 1.38, 95% confidence interval [CI] 1.16–1.65; and HR 1.55, 95% CI 1.25–1.93). However, there was no difference in OS (HR 1.1, 95% CI 0.76–1.34) and CSS (HR 0.69, 95% CI 0.45–1.06) between EBRT plus BT compared to RP. Conclusion While cancer control affected by EBRT alone seems inferior to RP in patients with high-risk PCa, BT additive to EBRT was not different from RP. These data support the need for BT in addition to EBRT as part of multimodal RT for high-risk PCa. Abbreviations: ADT: androgen-deprivation therapy; BT: brachytherapy; CSS: cancer-specific survival; HR: hazard ratio; MFS, metastatic-free survival; MOOSE: Meta-analyses of Observational Studies in Epidemiology; OR: odds ratio; OS: overall survival; PCa: prostate cancer; RR: relative risk; RP: radical prostatectomy; RCT: randomised controlled trials; (EB)RT: (external beam) radiation therapy

Assessing the Efficacy and Long-Term Outcomes of Surgical Intervention Versus Radiotherapy: A Comprehensive Systematic Review and Meta-Analysis of Prostate Cancer Treatment Modalities

“…Our results support some of the findings of previous reviews and meta-analyses on this topic. For instance, in a study conducted by Abdulmajeed Aydh in 2021, EBRT alone had a significantly worse OS than RP [ 42 ]. The results were also in agreement with a study conducted in 2017 by Omar Fahmy, who also reported a significant improvement in OS in RP-treated patients [ 43 ].…”

“…The overall HR was found to be HR=0. 42 For radiation therapy: Forest plots for five of the 19 studies were plotted for PCSM in patients treated with RT. Data for the current intervention were extracted from the same studies to ensure an effective comparison between the interventions due to coherence in population demographics.…”

The diagnostic accuracy of 68Ga‐PSMA‐PET/CT in primary staging of patients with high‐risk nonmetastatic prostate cancer treated with radical prostatectomy: A single‐center cohort analysis

“…High‐risk PCa, depending on its definition, is currently detected in 20%–30% of men with clinically localized PCa 3 . While there is still no consensus on the best therapy for these patients, radical prostatectomy (RP) results in durable disease control and excellent survival 2,4–7 . Notably, patients with high‐risk PCa who are diagnosed with lymph node metastases at RP are at an increased risk of PSA failure, metastasis, and death from PCa 2,8 .…”

“…3 While there is still no consensus on the best therapy for these patients, radical prostatectomy (RP) results in durable disease control and excellent survival. 2,[4][5][6][7] Notably, patients with high-risk PCa who are diagnosed with lymph node metastases at RP are at an increased risk of PSA failure, metastasis, and death from PCa. 2,8 Identification of the true lymph node status would be helpful to guide the template of lymphadenectomy and/or change the original treatment strategy in a shared decisionmaking process.…”