“…In contrast to most cohort studies that assessed EBRT (i.e. without a concomitant BT) vs RP for high-risk disease, we found a significantly worse OS and CSS [ 9 , 11 , 18 , 22 ]. Finally, until well-designed RCTs assess survival outcomes between MaxRT and MaxRP, a multidisciplinary approach should be considered in treating patients with high-risk PCa beyond the results of survival outcomes of cohort studies.…”
Section: Discussioncontrasting
confidence: 99%
“…The funnel plot was slightly asymmetrical (Figure1S-F in supplemental data). Table 3 [ 9 , 10 , 12–14 , 16 , 17 , 19 , 29 ] shows the reported data regarding RT and RP components among studies included in this systematic review. Figure 4.…”
Section: Resultsmentioning
confidence: 99%
“…Today, RT as adjuvant or salvage strategy is supported as a part of a multimodal therapy after RP by major guidelines for patients with high-risk PCa based on data recruiting from several RCTs [ 38–40 ]. However, more studies that compared EBRT plus BT to RP have not reported postoperative RT usage, therefore making fair comparisons impossible [ 9 , 10 , 12 , 14 , 16 ]. Limitations for optionally combining BT with EBRT include dose distribution and prostate size, reflecting a selection bias that may reflect the local tumour burden.…”
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
I
2
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
“…In contrast to most cohort studies that assessed EBRT (i.e. without a concomitant BT) vs RP for high-risk disease, we found a significantly worse OS and CSS [ 9 , 11 , 18 , 22 ]. Finally, until well-designed RCTs assess survival outcomes between MaxRT and MaxRP, a multidisciplinary approach should be considered in treating patients with high-risk PCa beyond the results of survival outcomes of cohort studies.…”
Section: Discussioncontrasting
confidence: 99%
“…The funnel plot was slightly asymmetrical (Figure1S-F in supplemental data). Table 3 [ 9 , 10 , 12–14 , 16 , 17 , 19 , 29 ] shows the reported data regarding RT and RP components among studies included in this systematic review. Figure 4.…”
Section: Resultsmentioning
confidence: 99%
“…Today, RT as adjuvant or salvage strategy is supported as a part of a multimodal therapy after RP by major guidelines for patients with high-risk PCa based on data recruiting from several RCTs [ 38–40 ]. However, more studies that compared EBRT plus BT to RP have not reported postoperative RT usage, therefore making fair comparisons impossible [ 9 , 10 , 12 , 14 , 16 ]. Limitations for optionally combining BT with EBRT include dose distribution and prostate size, reflecting a selection bias that may reflect the local tumour burden.…”
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
I
2
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
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