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

Abstract

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.

Positive Association between Preoperative Total Testosterone Levels and Risk of Positive Surgical Margins by Prostate Cancer: Results in 476 Consecutive Patients Treated Only by Radical Prostatectomy

“…Indeed, patients elected to RP should be sharply informed about the risk of unfavorable pathologic findings such as multifocal PSMs, which associate with cancer invading the capsule or seminal vesicles. These patients should be informed about the increased probability of radiotherapy and androgen deprivation therapy or radiotherapy alone if androgen deprivation therapy is contraindicated [6,14,28,29]. Our model gives a tool to evaluate the risk of PSMs according to preoperative TT levels as well as to the D'Amico clinical risk classes.…”

Local staging with multiparametric MRI in daily clinical practice: diagnostic accuracy and evaluation of a radiologic learning curve

“…Nerve-sparing surgery is generally restricted to patients with organ-confined disease. Extension of PCa outside the prostatic capsule requires dissection of the neurovascular bundle, for nerve-sparing surgery would increase the risk of positive surgical margins [ 3 , 4 , 6 ]. The assessment of the local tumor stage is similarly important when radiotherapy is chosen as treatment and guides decisions on radiation dose, radiation template, and adjuvant therapies [ 3 , 7 ].…”

Prostatectomy Provides Better Symptom-Free Survival Than Radiotherapy Among Patients With High-Risk or Locally Advanced Prostate Cancer After Neoadjuvant Hormonal Therapy

“…In addition, a systematic review of adjuvant HT plus NHT with RP or RT for high risk or locally advanced PC revealed that NHT before RP did not significantly improve OS (odds ratio, 1.11; p=0.69). 27 Nevertheless, it did provide significant im- In our study, the RT group showed better 5-year OS rate than the RP group. The authors presume that the reason for this is due to the fact that the number of RP group was higher and the FU duration was longer than RT group.…”