Surgery Versus Radiotherapy for Clinically-localized Prostate Cancer: A Systematic Review and Meta-analysis

Wallis, Christopher J.D.; Saskin, Refik; Choo, Richard; Herschorn, Sender; Kodama, Ronald; Satkunasivam, Raj; Shah, Prakesh S.; Danjoux, Cyril; Nam, Robert K.

doi:10.1016/j.eururo.2015.11.010

Cited by 244 publications

(197 citation statements)

References 28 publications

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“…Of note, patients who undergo radiotherapy tend to be older and have greater comorbidity. Further, as shown in the present study and supported by others, 8 patients are more likely to receive salvage therapy after radical prostatectomy than radiotherapy and, when offered, salvage therapy after radiotherapy is typically in the form of androgen-deprivation therapy. With high-quality, randomized trials comparing surgery to radiotherapy unlikely to be available in the future, 9,10 interpretation of available observational results, regardless of the endpoints evaluated, must be framed in the context of an individual patient.…”

supporting

confidence: 67%

“…A recent systematic review of observational data compared these endpoints for radical prostatectomy and radiotherapy. 8 Overall and prostate cancer-specific mortality favoured radical prostatectomy, although the most common non-surgical modality was external beam radiotherapy. On subgroup analysis, however, both mortality outcomes favoured surgery over brachytherapy.…”

mentioning

confidence: 99%

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Current prostate cancer treatment: Not what but when?

Massaro

Cagiannos

2016

CUAJ

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supporting

confidence: 67%

mentioning

confidence: 99%

Current prostate cancer treatment: Not what but when?

Massaro

Cagiannos

2016

CUAJ

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“…Unlike localized prostate cancer (PC) for which recent studies have suggested that radical prostatectomy (RP) may provide superior long-term outcomes compared to radiotherapy (RT) [1] , RT is still considered the treatment of choice in locally advanced PC stages [2] .…”

Section: Introductionmentioning

confidence: 99%

The Role of Radical Prostatectomy and Radiotherapy in Treatment of Locally Advanced Prostate Cancer: A Systematic Review and Meta-Analysis

et al. 2017

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Background: The role of radical prostatectomy (RP) is still controversial for locally advanced prostate cancer (PC). Radiotherapy (RT) and hormonal therapy (HT) are usually used as a primary treatment. Material and Methods: A systematic online search was conducted according to Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Eligible publications reporting the overall survival (OS) and/or disease-specific survival (DSS) were included. A total of 14 studies, including 17,869 patients, were considered for analysis. The impact of therapeutic modalities on survival was assessed, with a risk of bias assessment according to the Newcastle Ottawa Scale. Results: For RP, RT, and HT, the mean 10-year OS was 70.7% (95% CI 61.3-80.2), 65.8% (95% CI 48.1-83.3), and 22.6% (95% CI 4.9-40.3; p = 0.001), respectively. The corresponding 10-year DSS was 84.1% (95% CI 75.1-93.2), 89.4% (95% CI 70.1-108.6), and 50.4% (95% CI 31.2-69.6; p = 0.0127), respectively. Among all treatment combinations, RP displayed significant improvement in OS when included in the treatment (Z = 4.01; p < 0.001). Adjuvant RT significantly improved DSS (Z = 2.7; p = 0.007). Combination of RT and HT favored better OS in comparison to monotherapy with RT or HT (Z = 3.61; p < 0.001). Conclusion: Improved outcomes in advanced PC were detected for RP plus adjuvant RT vs. RP alone and RT plus adjuvant HT vs. RT alone with comparable survival results between both regimens. RP with adjuvant RT may present the modality of choice when HT is contraindicated.

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“…Due to insufficient power and small series (89 patients) no conclusion could be drawn about the efficacy. Nonetheless, some observational data suggest that outcomes with RP lead to better overall and cancer-specific survival than RT [108–112]. Wallis and colleagues recently published a meta-analysis comparing RP with EBRT or BT [108].…”

Section: Rt Compared To Surgerymentioning

confidence: 99%

Prostate Cancer Radiation Therapy: What Do Clinicians Have to Know?

Vanneste

Limbergen

Lin

et al. 2016

BioMed Research International

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Radiotherapy (RT) for prostate cancer (PC) has steadily evolved over the last decades, with improving biochemical disease-free survival. Recently population based research also revealed an association between overall survival and doses ≥ 75.6 Gray (Gy) in men with intermediate- and high-risk PC. Examples of improved RT techniques are image-guided RT, intensity-modulated RT, volumetric modulated arc therapy, and stereotactic ablative body RT, which could facilitate further dose escalation. Brachytherapy is an internal form of RT that also developed substantially. New devices such as rectum spacers and balloons have been developed to spare rectal structures. Newer techniques like protons and carbon ions have the intrinsic characteristics maximising the dose on the tumour while minimising the effect on the surrounding healthy tissue, but clinical data are needed for confirmation in randomised phase III trials. Furthermore, it provides an overview of an important discussion issue in PC treatment between urologists and radiation oncologists: the comparison between radical prostatectomy and RT. Current literature reveals that all possible treatment modalities have the same cure rate, but a different toxicity pattern. We recommend proposing the possible different treatment modalities with their own advantages and side-effects to the individual patient. Clinicians and patients should make treatment decisions together (shared decision-making) while using patient decision aids.

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Surgery Versus Radiotherapy for Clinically-localized Prostate Cancer: A Systematic Review and Meta-analysis

Cited by 244 publications

References 28 publications

Current prostate cancer treatment: Not what but when?

Current prostate cancer treatment: Not what but when?

The Role of Radical Prostatectomy and Radiotherapy in Treatment of Locally Advanced Prostate Cancer: A Systematic Review and Meta-Analysis

Prostate Cancer Radiation Therapy: What Do Clinicians Have to Know?

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