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

Abdulmajeed Aydh, Reza Sari Motlagh, Mohammad Abufaraj, Keiichiro Mori, Satoshi Katayama, Nico Grossmann, Pawel Rajawa, Hadi Mostafai, Ekaterina Laukhtina, Benjamin Pradere, Fahad Quhal, Victor M. Schuettfort, Alberto Briganti, Pierre I. Karakiewicz, Haron Fajkovic, Shahrokh F. Shariat

Research output: Contribution to journalReview articlepeer-review

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 I2 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.

Original languageEnglish
Pages (from-to)71-80
Number of pages10
JournalArab Journal of Urology
Volume20
Issue number2
DOIs
Publication statusPublished - 2022

Keywords

  • androgen-deprivation therapy
  • Brachytherapy
  • external beam radiation therapy
  • high-risk prostate cancer
  • radiation therapy
  • radical prostatectomy

ASJC Scopus subject areas

  • Urology

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