The prognosis benefits of adjuvant versus salvage radiotherapy for patients after radical prostatectomy with adverse pathological features: a systematic review and meta-analysis

Abstract

BackgroundThe appropriate timing of radiotherapy (RT) for patients after radical prostatectomy (RP) with adverse pathological features (APFs) remains controversial. This systematic review was conducted to compare the efficacy of adjuvant radiotherapy (ART) and salvage radiotherapy (SRT).MethodsPubMed, EMBASE, Web of Science and the Cochrane Library electronic databases were searched to retrieve the required. The hazard ratio (HR) and corresponding 95% confidence interval (CI) of overall survival (OS), biochemical recurrence-free survival (BRFS) and distant metastases-free survival (DMFS) were extracted. The survival benefits of ART with SRT (including early salvage radiotherapy (ESRT)) were analyzed. The process of the meta-analysis was performed with RevMan version 5.3.ResultsA total of fifteen retrospective studies were finally included in the final analysis including 5586 patients. The pooled analysis indicated that ART could achieve better control of prostate cancer and improve OS (p = 0.0006), BRFS (p < 0.0001) and DMFS (p < 0.0001), when compared to SRT. The subgroup analysis of the 5-year OS rate demonstrated that the ART group still had survival advantages compared to the SRT group (p = 0.0006). However, ART and SRT were comparable in 10-year OS rate (p = 0.07). ART had advantages over SRT in both 5-year (p = 0.0003) and 10-year BRFS (p = 0.0003). The subgroup analysis with different follow-up starting points from RP or RT was essentially consistent with the above results. The pooled analysis also showed that ART was superior to ESRT on OS (p = 0.008) and DMFS (p = 0.03), and comparable to ESRT on BRFS (p = 0.1).ConclusionsAccording to this meta-analysis, ART could be served as a preferential treatment for patients with APFs after RP to improve prognosis. Certainly, high-quality, multicenter randomized controlled trials (RCTs) are expecting to confirm the outcomes of our meta-analysis in the future.

Generation of Phenothiazine with Potent Anti-TLK1 Activity for Prostate Cancer Therapy

“…Prostate cancer (PCa) is a leading cause of morbidity and mortality of men in the western world. The standard of care for advanced PCa after failure of localized treatments is androgen deprivation therapy (ADT) and anti-androgens ( Karantanos et al., 2013 ; Tao et al., 2019 ), which provides respite from disease progression, but ultimately fails resulting in the incurable phase of the disease: mCRPC. Treatments that can suppress the conversion to mCRPC have the best potential to improve outcome and be rapidly implemented in the clinics, and this requires a clear understanding of the process of PCa cells' mechanisms of adaptation to ADT.…”

A meta-analysis on the use of radiotherapy after prostatectomy: adjuvant versus early salvage radiation

“…ART has been proven to increase biochemical recurrence-free survival. 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 ART had an increased biochemical recurrence-free survival mean for almost all years after prostatectomy. When comparing the population of patients that participated in BRFS studies for ART and ESRT/SRT, results were clinically significant, but did not reach statistical significance ( p = 0.08).…”

“…In multiple peer review articles, MFS had better results when a patient received ART. 2 , 3 , 7 , 9 , 10 , 12 One study supported ESRT to improve MFS. 13 Some articles were incapable of demonstrating a difference in either radiotherapy when it came to MFS rates, showing that either method was effective.…”

“…Certain studies have claimed ART superiority since it can obtain better control of prostate cancer. 2 , 3 , 7 , 9 , 10 , 12 Despite the fact that ART was seen as the preferable treatment in many of the peer review articles, a great deal of studies supported either method by demonstrating that ART and ESRT/SRT shared no statistically significant differences relating to OS. 14 , 15 , 16 , 17 , 18 To further provide evidence for this point, this review discovered that even when comparing data with other studies, OS rates in ART and ESRT/SRT were almost equivalent.…”

“…A few peer review articles concluded that ART was the preferred method since it yielded significantly better outcomes. 2 , 7 , 9 , 10 , 11 , 13 Meanwhile ESRT was noted as the better treatment option in 8 articles since it reduces the risk of overtreatment. 15 , 20 , 21 , 22 , 24 , 25 , 26 , 27 Lastly, there were some articles that discovered ART and ESRT were just as effective as the other, and the radiation treatment a patient receives really depends on each patient's risk-benefit ratio.…”