Fausto Petrelli1, Ivano Vavassori2, Andrea Coinu3, Karen Borgonovo3, Enrico Sarti4, Sandro Barni3. 1. Oncology Department, Medical Oncology Unit, Azienda Ospedaliera Treviglio, Treviglio, Bergamo, Italy. Electronic address: faupe@libero.it. 2. Surgical Department, Urology Unit, Azienda Ospedaliera Treviglio, Treviglio, Bergamo, Italy. 3. Oncology Department, Medical Oncology Unit, Azienda Ospedaliera Treviglio, Treviglio, Bergamo, Italy. 4. Oncology Department, Radiotherapy Unit, Azienda Ospedaliera Treviglio, Treviglio, Bergamo, Italy.
Abstract
BACKGROUND: Radical prostatectomy (RP) is one of the treatment options for localized, high-risk prostate cancer (PC), but it has never been compared with external beam radiotherapy (RT), which is an alternative approach, in a large randomized trial. To compare the outcomes of patients treated with surgery versus RT, we performed a metaanalysis of available studies on this topic. MATERIALS AND METHODS: We performed a search of MEDLINE, EMBASE, Web of Science, SCOPUS, and The Cochrane Central Register of Controlled Trials (CENTRAL) for randomized or observational studies that investigated overall survival (OS) and PC-specific mortality (PCSM) risks in relation to use of surgery or RT in patients with high-risk PC. Fixed- and random-effect models were fitted to estimate the summary odds ratio (OR). Between-study heterogeneity was tested using χ(2) statistics and measured using the I(2) statistic. Publication bias was evaluated using a funnel plot and Egger regression asymmetry test. RESULTS: Seventeen studies were included (1 randomized and 16 retrospective). RP was associated with improved OS (OR, 0.51; 95% confidence interval [CI], 0.38-0.68; P < .00001), PCSM (OR, 0.56; 95% CI, 0.37-0.85; P = .007), and non-PCSM (OR, 0.53; 95% CI, 0.35-0.8; P = .002) compared with RT. Biochemical relapse-free survival rates were similar to those of RT. CONCLUSION: Overall and cancer-specific mortality rates appear to be better with RP compared with RT in localized, high-risk PC. Surgery is also associated with a 50% decreased risk of non-PCSM compared with RT.
BACKGROUND: Radical prostatectomy (RP) is one of the treatment options for localized, high-risk prostate cancer (PC), but it has never been compared with external beam radiotherapy (RT), which is an alternative approach, in a large randomized trial. To compare the outcomes of patients treated with surgery versus RT, we performed a metaanalysis of available studies on this topic. MATERIALS AND METHODS: We performed a search of MEDLINE, EMBASE, Web of Science, SCOPUS, and The Cochrane Central Register of Controlled Trials (CENTRAL) for randomized or observational studies that investigated overall survival (OS) and PC-specific mortality (PCSM) risks in relation to use of surgery or RT in patients with high-risk PC. Fixed- and random-effect models were fitted to estimate the summary odds ratio (OR). Between-study heterogeneity was tested using χ(2) statistics and measured using the I(2) statistic. Publication bias was evaluated using a funnel plot and Egger regression asymmetry test. RESULTS: Seventeen studies were included (1 randomized and 16 retrospective). RP was associated with improved OS (OR, 0.51; 95% confidence interval [CI], 0.38-0.68; P < .00001), PCSM (OR, 0.56; 95% CI, 0.37-0.85; P = .007), and non-PCSM (OR, 0.53; 95% CI, 0.35-0.8; P = .002) compared with RT. Biochemical relapse-free survival rates were similar to those of RT. CONCLUSION: Overall and cancer-specific mortality rates appear to be better with RP compared with RT in localized, high-risk PC. Surgery is also associated with a 50% decreased risk of non-PCSM compared with RT.
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