Survival benefit of local vs. no local treatment for metastatic prostate cancer - impact of baseline PSA and metastatic substages

Pompe, Raisa S.; Tilki, Derya; Preißer, Felix; Leyh-Bannurah, Sami-Ramzi; Bandini, Marco; Marchioni, M.; Gierok, Philipp; Tian, Zhe; Fossati, Nicola; Cindolo, L.; Shariat, Shahrokh F.; Davis-Bondarenko, Helen; Smith, Ariane; Huland, Hartwig; Briganti, Alberto; Graefen, Markus; Karakiewicz, Pierre I.

doi:10.1016/s1569-9056(18)32272-3

Cited by 2 publications

(4 citation statements)

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“…We tested whether LT (RP or BT) still conferred a survival benefit compared with NLT, even when adjusted for bPSA, and further analyzed whether the effect of LT might be modulated according to bPSA and M1 substages. 7 In M1b patients, lower bPSA values resulted in higher survival benefit, when LT was compared with NLT, up to a threshold of 60 ng/mL. No survival benefit was observed in M1b patients above the 60 ng/mL PSA threshold and in M1c patients, regardless of bPSA.…”

Section: Studies Reporting Oncological Outcomesmentioning

confidence: 80%

“…7 We complemented the results of Leyh-Bannurah et al by using the latest SEER database release, which provides validated bPSA values from 2004 onwards that were previously unavailable. The SEER database lacks important variables that are indispensable to control for selection bias.…”

Section: Studies Reporting Oncological Outcomesmentioning

confidence: 99%

“…The limitation of the lack of sufficient bPSA data has most recently been addressed by our group. 7 We complemented the results of Leyh-Bannurah et al by using the latest SEER database release, which provides validated bPSA values from 2004 onwards that were previously unavailable. We tested whether LT (RP or BT) still conferred a survival benefit compared with NLT, even when adjusted for bPSA, and further analyzed whether the effect of LT might be modulated according to bPSA and M1 substages.…”

Section: Studies Reporting Oncological Outcomesmentioning

confidence: 99%

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Local treatment for metastatic prostate cancer: A systematic review

et al. 2018

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The potential oncological benefit for radical treatment in the setting of oligometastatic prostate cancer has been under investigation and is frequently discussed. We carried out a systematic review of English language articles using the Medline database (January 2000 to May 2017) to identify studies reporting local treatment in men with metastatic prostate cancer at diagnosis. Primary end-points were oncological outcomes, such as cancer-specific and overall mortality. Secondary end-points were non-oncological outcomes, such as complications, operating room time, blood loss or length of hospital stay. Two independent authors reviewed and extracted all search results. Overall, 18 studies reporting on local treatment in metastatic prostate cancer patients were identified (14 original articles, three brief correspondences and one letter to the editor). All of them were retrospective; one partly included prospective data. All studies addressed oncological outcomes, 16 compared local treatment with no-local treatment and 14 adjusted for confounders using multivariable regression models. All but one study concluded a survival benefit for local treatment in the metastatic setting. Due to heterogeneity of available data, a representative meta-analysis could not be carried out. Five studies reported non-oncological outcomes. Although local treatment in metastatic prostate cancer appears to be feasible, its oncological effect remains unclear due to high susceptibility of available studies to significant selection bias.

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Section: Studies Reporting Oncological Outcomesmentioning

confidence: 80%

Section: Studies Reporting Oncological Outcomesmentioning

confidence: 99%

Section: Studies Reporting Oncological Outcomesmentioning

confidence: 99%

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Local treatment for metastatic prostate cancer: A systematic review

et al. 2018

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“…After the exclusion of 1,073 duplicate articles, 8,538 records were excluded based on the titles or abstracts for various reasons (reviews, letters, case reports, or unrelated to mPCa or unrelated to RT). After reading the remaining 20 articles in full text, 13 articles were excluded because 2 studies focused on the effect of prior LT on mPCa [15,16], 2 studies focused on the effect of LT on mPCa [7,8], 4 studies of repeated research [17][18][19][20], 3 repeated data studies [21][22][23], and 2 papers did not provide adequate data [24,25]. Finally, 7 studies [26][27][28][29][30][31][32] contributed to the systematic review and meta-analysis (Fig.…”

Section: Resultsmentioning

confidence: 99%

Impact of Radiotherapy on Prognosis in Patients Diagnosed with Metastatic Prostate Cancer: A Systematic Review and Meta-Analysis

et al. 2020

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Background: It has been reported that compared with no local therapy (NLT), patients treated with local therapy (LT) using radiotherapy (RT) possess higher survival rate in metastatic prostate cancer (mPCa). The aim of this meta-analysis was to evaluate the impact of RT on prognosis in patients with mPCa. Methods: We retrieved the literature in PubMed, Embase, and Cochrane Library databases until June 2019 using structured search terms. Several studies were included, which evaluated patients with mPCa who received RT versus NLT. Results: A total of 14,542 patients were analyzed in 7 included papers (2 randomized controlled trials [RCTs] and 5 cohort retrospective studies [CRS]), and 2,232 mPCa patients were treated with RT and 12,310 with NLT. The data of RCTs and CRS were analyzed separately. In RCTs, RT was associated with no significant difference in overall survival (OS) (pooled hazard ratio [HR] = 0.96; 95% confidence interval [CI]: 0.85–1.09; p = 0.55; I2 = 42%) relative to NLT, while survival benefit was observed in the low-metastatic burden group (pooled HR = 0.68; 95% CI: 0.54–0.86; p = 0.001; I2 = 0%), and no survival benefit was observed in the high-metastatic burden group (pooled HR = 1.07; 95% CI: 0.92–1.24; p = 0.39; I2 = 0%). In CRS, RT results in lower cancer-specific mortality (CSM) (pooled HR = 0.49; 95% CI: 0.34–0.75; p < 0.00001; I2 = 0%) and higher OS (pooled HR = 0.61; 95% CI: 0.55–0.68; p < 0.00001; I2 = 0%) relative to NLT. Subsequent analysis demonstrated that high level of M-stage or N-stage was associated with increased CSM (pooled HR = 2.08; 95% CI: 1.69–2.55; p < 0.00001; I2 = 0% and pooled HR = 1.16; 95% CI: 1.03–1.30; p < 0.00001; I2 = 0%; respectively). Conclusions: Our observations in aggregate indicated that RT at least does not appear to be harmful and may be beneficial for low-metastatic burden patients and better condition patients. More prospective and randomized studies evaluating RT for mPCa are warranted.

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Survival benefit of local vs. no local treatment for metastatic prostate cancer - impact of baseline PSA and metastatic substages

Cited by 2 publications

References 0 publications

Local treatment for metastatic prostate cancer: A systematic review

Local treatment for metastatic prostate cancer: A systematic review

Impact of Radiotherapy on Prognosis in Patients Diagnosed with Metastatic Prostate Cancer: A Systematic Review and Meta-Analysis

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