The role of radical prostatectomy for the treatment of metastatic prostate cancer: a systematic review and meta-analysis

Wang, Yi; Qin, Zhiqiang; Wang, Yamin; Chen, Chen; Wang, Yichun; Meng, Xuhui; Song, Ninghong

doi:10.1042/bsr20171379

Cited by 24 publications

(22 citation statements)

References 35 publications

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“…Whether these theories apply to all or only specific solid tumors remain still to be determined. As pointed out by the results of our study, cytoreductive prostatectomy could have the potential to enhance mCRPC disease control 43,44 , but the lack of randomized controlled trials and the low level of evidence in the current literature preclude any firms conclusion on the benefit of cytoreductive strategy in mCRPC and to clearly identify the patients who would most benefit from their primary PCa ablation. Further, ongoing phase II and future phase III studies are mandatory to gain better insight in this regard.…”

Section: Role Of Primary Tumor Cytoreduction In Mcrpcmentioning

confidence: 83%

Primary Radical Prostatectomy or Ablative Radiotherapy as Protective Factors for Patients With mCRPC Treated With Radium-223 Dichloride: An Italian Multicenter Study

Frantellizzi

Costa

Mascia

et al. 2020

Clinical Genitourinary Cancer

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MicroabstractThis study investigates the impact on the overall survival of previous radical primary treatment in mCRPC patients treated with 223-Ra. In this multicenter retrospective study, we enrolled 275 consecutive patients. Results obtained showed a clear advantage for patients subjected to radical primary treatment in respect of those without, with an estimated median survival of 18 months and 11, respectively. AbstractBackground. We provide an analysis aiming to investigate, in a real-life setting, the prognostic relevance of previous primary treatment (radical prostatectomy (RP) or external beam radiotherapy (EBRT)) in terms of overall survival, in mCRPC patients treated with 223-Ra. Materials and methodsIn this multicenter retrospective study we enrolled 275 consecutive patients. Demographics and clinical data, as well as mCRPC characteristics, have been obtained and evaluated at baseline and the end of the treatment or progression. 223-Ra has been administered according to the current label authorization until disease progression or unacceptable toxicity. We divided the whole cohort into 2 groups: men previously treated with primary radical prostatectomy or ablative radiotherapy (RP/EBRT) and patient with no prior primary treatment available (NO). Results128 out of 275 patients (46.5%) are alive and currently on follow-up; 103 patients (37.4%) dropped treatment out for disease progression or onset of comorbidities, and 147 patients died during the follow-up (53.5%). 93 patients underwent RP, 76 patients performed ablative EBRT. 132 patients enrolled in the RP/EBRT group (48%), 143 patients in the NO group (52%).Data showed a clear advantage for patients subjected to RP or EBRT in respect of those without primary treatment performed, with an estimated median survival of 18 months and 11 respectively (p<0.001). The multivariate analysis corroborated this trending results, returning in an HR of 0.7 (p-value= 0.0443), confirming the best outcome of the RP/EBRT group. 3 Conclusions Previous radical treatment plays a protective role in mCRPC patients who underwent 223-Ra treatment.

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Section: Role Of Primary Tumor Cytoreduction In Mcrpcmentioning

confidence: 83%

Primary Radical Prostatectomy or Ablative Radiotherapy as Protective Factors for Patients With mCRPC Treated With Radium-223 Dichloride: An Italian Multicenter Study

Frantellizzi

Costa

Mascia

et al. 2020

Clinical Genitourinary Cancer

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“…However, for prolong survival for patients, many complements like new agents (including abiraterone, cabazitaxel, enzalutamide, and sipuleucel-T), local RT for oligo-metastatic disease, directed RT to metastases and RP for local tumor has emerged. Owing to improvement in surgical techniques, surgery as an intervention has changed from the treatment of choice in low risk to more advanced and even in high-risk PCa (26). Though present metaanalyses showed that LT significantly improved OS and CMS of patients with metastatic prostatic cancer (12,27), however, these meta-analyses lack a subgroup analysis of M1 substagespecific which often combine with highest risk and mortality.…”

Section: Discussionmentioning

confidence: 65%

“…Furthermore, a multivariable competing risk regression analyses tested CSM after propensity score matching in SEER database and the results showed that in comparison to RT, RP demonstrated important and statistically significant survival benefit in CSM in every stage of metastatic Pca (15). Additionally, Wang et al reported that a relatively low level of Gleason score, Mstage or N-stage could be a better prognosis for patients with metastatic Pca undergoing RP (26). Loppenberg et al.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Local Therapy on M1c Prostate Cancer Patients: A Systematic Review and Meta-Analysis

2021

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Background: A systematic review and meta-analysis was conducted to explore the effect of local treatment (LT) on overall survival (OS) and cancer-specific mortality (CSM) for patients diagnosed with M1c prostate cancer (PCa).Methods: PubMed, Web of Science, Embase, EBSCO, and Cochrane library databases (updated November 2020) were searched for studies assessing the effect of LT on patients with M1c Pca. The search strategy and study selection process was managed according to the PRISMA statement.Results: Four cohort respective studies were identified for satisfying the inclusion criteria. Our results indicated that LT significantly improved CSM (HR = 0.36, 95% CI = 0.22–0.60; P < 0.0001) and OS (HR = 0.42, 95% CI = 0.24–0.77; P = 0.004). Subgroup analysis showed that radical prostatectomy (RP) and radiation therapy (RT) including brachytherapy (BT), conformal radiation therapy (CRT), and intensity modulated radiation (IMRT) had a significant benefit on cutting down the CSM of M1c PCa patients (HR = 0.27, 95% CI = 0.13–0.56; P = 0.0005 and HR = 0.42, 95% CI = 0.20–0.89; P = 0.02). In addition, RP had improved the OS for patients (HR = 0.33, 95% CI = 0.15–0.73; P = 0.008). There was no difference of OS in patients that underwent RT (HR = 0.58, 95% CI = 0.24–1.40; P = 0.23). No significant heterogeneity was among the results, indicating consistency in the study.Conclusions: Present meta-analysis indicates that LT for M1c PCa correlated with decreased CSM and enhanced OS. The survival benefit of RP was successfully confirmed and the advantage of RT seemed to be associated with the tumor burden and method of RT.

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“…Although, we had successfully demonstrated the feasibility and survival benefit of LT for mPCa in improving OS or decreasing CSM, ACM, not all patients were suitable for it. Previous studies by Fossati et al and Wang et al revealed that patients with a relatively lower level of tumors and better general health seemed to benefit the most (35,36). Moreover, in a short period of time, no survival benefits have been observed for patients treated with RP compared with patients treated with androgen deprivation treatment (29).…”

Section: Discussionmentioning

confidence: 95%

Might definitive local therapy of the primary tumor improve the survival benefits of metastatic prostate cancer? —evidence from a meta-analysis

et al. 2020

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Background: With the successful application of local therapy (LT) of the primary tumor in other metastatic disease and the demonstration of their better survival benefits, the traditionally seldom involved role of LT for metastatic prostate cancer (mPCa) had gained a lot of interest. Hence, this meta-analysis was conducted to clarify its efficacy in mPCa.Methods: A comprehensive search of major databases (PubMed, EMBASE and Web of Science) was conducted for eligible studies, up to May 2019. The pooled hazard ratio (HR) with 95% confidence interval (CI) was utilized to evaluate the efficacy of LT for mPCa.Results: A total of 12 eligible studies with 78,864 participants, containing 28 different comparisons were ultimately enrolled in this article. Our results showed that LT involving radical prostatectomy (RP) or radiation therapy (RT) for mPCa was related to enhanced overall survival (OS) (pooled HR =0.53, 95% CI: 0.47 to 0.61, I 2 =59.7%, P=0.015), decreased cancer-specific mortality (CSM) (pooled HR =0.42, 95% CI: 0.34 to 0.51, I 2 =63.1%, P=0.004) and lower all-cause mortality (ACM) (pooled HR =0.37, 95% CI: 0.31 to 0.45, I 2 =49.4%, P=0.115), compared with no local therapy (NLT). In subsequent stratified analysis, RP or RT was respectively linked to longer OS (pooled HR =0.49, 95% CI: 0.44 to 0.54, I 2 =0.0%, P=0.741; pooled HR =0.64, 95% CI: 0.56 to 0.72, I 2 =15.4%, P=0.306), lower CSM (pooled HR =0.37, 95% CI: 0.29 to 0.46, I 2 =35.2%, P=0.187; pooled HR =0.51, 95% CI: 0.42 to 0.63, I 2 =27.0%, P=0.250) and decreased ACM (pooled HR =0.31, 95% CI: 0.23 to 0.40, I 2 =56.4%, P=0.130; pooled HR =0.44, 95% CI: 0.34 to 0.56, I 2 =0.0%, P=0.856), compared with NLT. In terms of RP vs. RT, RP was linked to a decreased CSM (pooled HR =0.59, 95% CI: 0.53 to 0.66, I 2 =0.0%, P=0.653).Conclusions: In summary, our results shed light on the positive role of LT (RP or RT) for mPCa and meanwhile its feasibility and survival benefits had been demonstrated. Moreover, when compared with RT, RP showed its superiority in CSM. Upcoming prospective randomized controlled trials should be taken to validate our findings.

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The role of radical prostatectomy for the treatment of metastatic prostate cancer: a systematic review and meta-analysis

Cited by 24 publications

References 35 publications

Primary Radical Prostatectomy or Ablative Radiotherapy as Protective Factors for Patients With mCRPC Treated With Radium-223 Dichloride: An Italian Multicenter Study

Primary Radical Prostatectomy or Ablative Radiotherapy as Protective Factors for Patients With mCRPC Treated With Radium-223 Dichloride: An Italian Multicenter Study

The Effect of Local Therapy on M1c Prostate Cancer Patients: A Systematic Review and Meta-Analysis

Might definitive local therapy of the primary tumor improve the survival benefits of metastatic prostate cancer? —evidence from a meta-analysis

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