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

Petrelli, Fausto; Vavassori, Ivano; Coinu, Andrea; Borgonovo, Karen; Sarti, Enrico; Barni, Sandro

doi:10.1016/j.clgc.2014.01.010

Cited by 90 publications

(49 citation statements)

References 35 publications

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“…Table 2 lists the 14 studies in chronologic order, the RS assigned to each, and the scoring of each individual component. The median and average RS for all studies was 12 (range, [5][6][7][8][9][10][11][12][13][14][15][16][17][18], and the overall median difference in OS and CSS favoring RP over RT was 10% (average difference 11%; 95% confidence interval [CI]: 7%-16%) and 4% (average difference 5%; 95% CI: 2%-8%) at 10 years, respectively. For most studies (80%), OS was statistically significant, but CSS was not (46%).…”

Section: Resultsmentioning

confidence: 99%

“…To address this issue, several studies led by investigators from the urologic community have been reported, with some concluding that RP renders a better chance of OS and CSS than RT (4). However, most of these studies did not compare RP with treatment that was consistent with standard of care (eg, in accordance with National Comprehensive Cancer Center [NCCN] guidelines) (5,6). There is clear level I evidence derived from phase 3 trials demonstrating that the inclusion of short-term androgen deprivation therapy (ADT) substantially improves OS in patients with intermediate-risk disease (1).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Radical Prostatectomy Versus Radiation and Androgen Deprivation Therapy for Clinically Localized Prostate Cancer: How Good Is the Evidence?

Roach

Lizarraga

Lazar

2015

International Journal of Radiation Oncology*Biology*Physics

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Radical Prostatectomy Versus Radiation and Androgen Deprivation Therapy for Clinically Localized Prostate Cancer: How Good Is the Evidence?

Roach

Lizarraga

Lazar

2015

International Journal of Radiation Oncology*Biology*Physics

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“…A recent meta-analysis of available studies on this topic was conducted by Petrelli et al [24] (Table 3). A total of 17 studies reporting the outcomes of either surgery or RT for high-risk PCa were selected, among which one was randomized trial.…”

Section: Radical Prostatectomy Versus Radiotherapy In Highrisk Pcamentioning

confidence: 98%

The role for surgeryin high-risk prostate cancer

Lanchon

Shariat

Rouprêt

2015

Wien Med Wochenschr

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High-risk prostate cancer (PCa) refers to a very heterogeneous subgroup of disease. Recent series have shown very promising results of radical prostatectomy (RP)-alone or part as a multimodality approach-in patients with high-risk PCa, with satisfactory survival curves even though biochemical recurrence rate was high. Adjuvant treatment (radiotherapy (RT) alone or combined with androgen deprivation) was necessary in 20 to 54 % of patients, notably in cases with positive surgical margins. As for functional outcomes, urinary continence was preserved in about 92 % of cases and overall potency in 60 %. When comparing RP versus RT as primary treatment for high-risk PCa, a recent meta-analysis found surgery to be associated with an improved cancer-specific mortality compared with RT. In selected high-risk PCa young patients, surgery appears to be a valid option. Patients should however be informed of the possibility of adjuvant treatment, as part of a multimodal approach.

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“…[25] Likewise, a meta-analysis with all published trials, which compared the outcomes of PCa patients, treated with RP or RT showed that RP have better outcomes than RT in terms of overall survival (49%) and cancer-specific mortality (44%). [26] The cohort study made by Nam et al [27] , with 15870 RP and 16595 RT patients found that patients who had undergone RT had higher incidence of secondary malignancies, and complications requiring hospital admissions, open surgical procedures, anorectal procedures. Furthermore, a recent multi-centered study made by Sooriakumaran et al [28] concluded that RP for patients with resectable distant metastasis appears safe in expert hands for meticulously selected patients.…”

Section: Discussionmentioning

confidence: 99%

Robot-assisted radical prostatectomy in low- and high-risk prostate cancer patients

Boylu¹,

Bindayı²,

Küçük³

et al. 2017

Turkish Journal of Urology

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Objective: To evaluate the benefit of robot-assisted radical prostatectomy (RARP) in the low-risk prostate cancer (PCa) patients suitable for active surveillance and in the high-risk PCa patients who would be considered for alternative treatments such as radiotherapy (RT) and androgen deprivation therapy (ADT) instead of radical prostatectomy. Material and methods:Of 548 patients, who underwent RARP, 298 PCa patients (258 low-risk and 40 high-risk) with a mean of 3.6 years follow-up, were included into this study. Oncological outcomes were compared separately in low-and high-risk PCa patients. Results:The pathologic Gleason scores were ≥7 in 73 (28%), and 68 (26%) patients had a pathologic stage of T3, 29 (11%) patients had a positive surgical margin (PSM), and 20 (7%) patients had biochemical recurrence (BCR) in the first year follow-up in the low-risk group. Of 258 low-risk PCa patients, a total of 93 (36%) patients had not either BCR, pathologic Gleason score ≥7, or ≥pT3 disease with PSM. In the high-risk group, the pathologic stage was pT2 in 14 (35%) patients and 29 (72%) patients had no biochemical recurrence in the follow-up of these high-risk PCa patients. Of 40 high-risk PCa patients, in a total of 25 (62.5%) patients ≥pT3b disease, BCR, pT3a disease with PSM were not detected. Conclusion:Approximately two thirds of high-risk PCa patients benefit from RARP without additional RT or ADT. Besides, more than one third of low-risk PCa patients who fit active surveillance criteria would have unfavorable results.

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

Cited by 90 publications

References 35 publications

Radical Prostatectomy Versus Radiation and Androgen Deprivation Therapy for Clinically Localized Prostate Cancer: How Good Is the Evidence?

Radical Prostatectomy Versus Radiation and Androgen Deprivation Therapy for Clinically Localized Prostate Cancer: How Good Is the Evidence?

The role for surgeryin high-risk prostate cancer

Robot-assisted radical prostatectomy in low- and high-risk prostate cancer patients

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