Oncological control in high-risk prostate cancer after radical prostatectomy and salvage radiotherapy compared to radiotherapy plus primary hormone therapy

Velasco, J.; Amo, F. Herránz; Pujol, L. Polanco; Castro, J. Mayor de; Chamizo, J. Aragón; Garcı́a, Eulogio; Bernardos, G. Barbas; Ríos, D. Subirá; Gallego, J.; Fernández, C. Hernández

doi:10.1016/s1569-9056(19)34611-1

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“…Interestingly, four studies used in both analyses indicated perfect comparability between RT and RP groups by Wallis et al, yet some of these studies did not control for study center [ 37 - 39 ], year of diagnosis [ 35 , 37 , 38 ], or demographic characteristics [ 38 ]. Since patients undergoing RT are more likely to be older, have poorer prognostic characteristics, and have sociodemographic characteristics that are associated with poorer CSM and ACM [ 11 , 20 , 29 ], we anticipate the influence of these unaccounted-for biases to overestimate CSM and ACM in the RT group relative to the RP group. However, the discrepancy in such baseline characteristics appears more prominent among those undergoing EBRT ± ADT rather than EBRT + BT ± ADT wherein patients are more similar to those undergoing RP [ 11 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

Characterizing Surgical and Radiotherapy Outcomes in Non-metastatic High-Risk Prostate Cancer: A Systematic Review and Meta-Analysis

Guy¹,

Chen²,

Boldt³

et al. 2021

Cureus

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Background Identifying the optimal management of high-risk non-metastatic prostate cancer (PCa) is an important public health concern, given the large burden of this disease. We performed a meta-analysis of studies comparing PCa-specific mortality (CSM) among men diagnosed with high-risk non-metastatic PCa who were treated with primary radiotherapy (RT) and radical prostatectomy (RP). Methods Medline and Embase were searched for articles between January 1, 2005, and February 11, 2020. After title and abstract screening, two authors independently reviewed full-text articles for inclusion. Data were abstracted, and a modified version of the Newcastle-Ottawa Scale, involving a comprehensive list of confounding variables, was used to assess the risk of bias. Results Fifteen studies involving 131,392 patients were included. No difference in adjusted CSM in RT relative to RP was shown (hazard ratio, 1.02 [95% confidence interval: 0.84, 1.25]). Increased CSM was found in a subgroup analysis comparing external beam radiation therapy (EBRT) with RP (1.35 [1.10, 1.68]), whereas EBRT combined with brachytherapy (BT) versus RP showed lower CSM (0.68 [0.48, 0.95]). All studies demonstrated a high risk of bias as none fully adjusted for all confounding variables. Conclusion We found no difference in CSM between men diagnosed with non-metastatic high-risk PCa and treated with RP or RT; however, this is likely explained by increased CSM in men treated with EBRT and decreased CSM in men treated with EBRT + BT studies relative to RP. High risk of bias in all studies identifies the need for better data collection and confounding control in the PCa research.

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