Radical Prostatectomy or Radiotherapy in High-Risk Prostate Cancer


Clin Genitourin Cancer. 2014 Feb 6. pii: S1558-7673(14)00018-4. doi: 10.1016/j.clgc.2014.01.010. [Epub ahead of print]

Radical Prostatectomy or Radiotherapy in High-Risk Prostate Cancer: A Systematic Review and Metaanalysis.

Petrelli F1, Vavassori I2, Coinu A3, Borgonovo K3, Sarti E4, Barni S3.

English: Micrograph of prostatic adenocarcinom...

English: Micrograph of prostatic adenocarcinoma, conventional (acinar) type, the most common form of prostate cancer. Prostate biopsy. H&E stain. (Photo credit: Wikipedia)

Author information

  • 1Oncology Department, Medical Oncology Unit, Azienda Ospedaliera Treviglio, Treviglio, Bergamo, Italy. Electronic address: faupe@libero.it.
  • 2Surgical Department, Urology Unit, Azienda Ospedaliera Treviglio, Treviglio, Bergamo, Italy.
  • 3Oncology Department, Medical Oncology Unit, Azienda Ospedaliera Treviglio, Treviglio, Bergamo, Italy.
  • 4Oncology Department, Radiotherapy Unit, Azienda Ospedaliera Treviglio, Treviglio, Bergamo, Italy.

Abstract

BACKGROUND:

Radical prostatectomy (RP) is one of the treatment options for localized, high-risk prostate cancer (PC), but it has never been compared with external beam radiotherapy (RT), which is an alternative approach, in a large randomized trial. To compare the outcomes of patients treated with surgery versus RT, we performed a metaanalysis of available studies on this topic.

MATERIALS AND METHODS:

We performed a search of MEDLINE, EMBASE, Web of Science, SCOPUS, and The Cochrane Central Register of Controlled Trials (CENTRAL) for randomized or observational studies that investigated overall survival (OS) and PC-specific mortality (PCSM) risks in relation to use of surgery or RT in patients with high-risk PC. Fixed- and random-effect models were fitted to estimate the summary odds ratio (OR). Between-study heterogeneity was tested using χ2 statistics and measured using the I2 statistic. Publication bias was evaluated using a funnel plot and Egger regression asymmetry test.

RESULTS:

Seventeen studies were included (1 randomized and 16 retrospective). RP was associated with improved OS (OR, 0.51; 95% confidence interval [CI], 0.38-0.68; P < .00001), PCSM (OR, 0.56; 95% CI, 0.37-0.85; P = .007), and non-PCSM (OR, 0.53; 95% CI, 0.35-0.8; P = .002) compared with RT. Biochemical relapse-free survival rates were similar to those of RT.

CONCLUSION:

Overall and cancer-specific mortality rates appear to be better with RP compared with RT in localized, high-risk PC. Surgery is also associated with a 50% decreased risk of non-PCSM compared with RT.Cancer mortality; Overall survival; Prostate carcinoma; Radiation therapy; Surgery

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