Impact of local treatment on overall survival of patients with metastatic prostate cancer: systematic review and meta-analysis

Abstract Background The most recent overall survival (OS) and adverse event (AE) data have not been compared for the three guideline-recommended high-risk non-metastatic castration-resistant prostate cancer (nmCRPC) treatment alternatives. Methods We performed a systematic review and network meta-analysis focusing on OS and AE according to the most recent apalutamide, enzalutamide, and darolutamide reports. We systematically examined and compared apalutamide vs. enzalutamide vs. darolutamide efficacy and toxicity, relative to ADT according to PRISMA. We relied on PubMed search for most recent reports addressing prospective randomized trials with proven predefined OS benefit, relative to ADT: SPARTAN, PROSPER, and ARAMIS. OS represented the primary outcome and AEs represented secondary outcomes. Results Overall, data originated from 4117 observations made within the three trials that were analyzed. Regarding OS benefit relative to ADT, darolutamide ranked first, followed by enzalutamide and apalutamide, in that order. In the subgroup of PSA-doubling time (PSA-DT) ≤ 6 months patients, enzalutamide ranked first, followed by darolutamide and apalutamide in that order. Conversely, in the subgroup of PSA-DT 6–10 months patients, darolutamide ranked first, followed by apalutamide and enzalutamide, in that order. Regarding grade 3+ AEs, darolutamide was most favorable, followed by enzalutamide and apalutamide, in that order. Conclusion The current network meta-analysis suggests the highest OS efficacy and lowest grade 3+ toxicity for darolutamide. However, in the PSA-DT ≤ 6 months subgroup, the highest efficacy was recorded for enzalutamide. It is noteworthy that study design, study population, and follow-up duration represent some of the potentially critical differences that distinguish between the three studies and remained statistically unaccounted for using the network meta-analysis methodology. Those differences should be strongly considered in the interpretation of the current and any network meta-analyses.

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Cytoreductive radical prostatectomy versus systemic therapy and radiation therapy in metastatic prostate cancer: A systematic review and meta-analysis

Urologia Journal ◽

10.1177/03915603211036631 ◽

2021 ◽

pp. 039156032110366

Author(s):

Hamidreza Shemshaki ◽

Said Abdallah Al-Mamari ◽

Ishfaq Ahmed Geelani ◽

Santosh Kumar

Keyword(s):

Prostate Cancer ◽

Systematic Review ◽

Radiation Therapy ◽

Radical Prostatectomy ◽

Systemic Therapy ◽

Metastatic Prostate Cancer ◽

Meta Analysis ◽

Cochrane Library ◽

Original Research ◽

The Cochrane Library

Cytoreductive prostatectomy had gained a lot of interest in treatment of metastatic prostate cancer (mPCa) but this treatment approach is still in the experimental phase. This systematic review and meta-analysis was conducted to shed light on the merits of cytoreductive radical prostatectomy compared to systemic and radiation therapy in treatment of mPCa. In February 2021, summary data from 12 original research papers covering 100,973 patients is abstracted. PubMed/Medline, Scopus, Google Scholar, EMBASE, and the Cochrane Library were all reviewed and 12 publications were chosen for inclusion. The evaluated outcomes were 1-, 3-, and 5-year Cancer-Specific (CSS) and overall survival (OS) rates. Cytoreductive radical prostatectomy had significantly higher survival rate for 1-year (OR: 3.03; 95% CI: 2.30–3.98; p < 0.001), 3-year (OR: 2.47; 95% CI: 2.14–3.51; p < 0.001), and 5-year CSS rates (OR: 2.90; 95% CI: 2.10–4.01; p < 0.001) than systemic therapy in mPCa. Higher significant rates of 1-year (OR: 2.35; 95% CI: 1.65–3.36; p < 0.001), three-year (OR: 2.25; 95% CI: 1.96–2.60; p < 0.001), and 5-year OS rates (OR: 2.54; 95% CI: 2.10–3.08; p < 0.001) were also detected for cytoreductive radical prostatectomy compared to systemic therapy. There were no significant differences in 1-year (OR: 1.21; 95% CI: 0.88–1.66; p = 0.25), 3-year (OR: 1.21; 95% CI: 0.92–1.59; p = 0.18), and 5-year CSS rates (OR: 0.91; 95% CI: 0.58–1.42; p = 0.67) between cytoreductive radical prostatectomy and radiation in mPCa patients. Also, no significant differences in 1-year (OR: 1.06; 95% CI: 0.77–1.47; p = 0.71), 3-year (OR: 0.83; 95% CI: 0.60–1.14; p = 0.25), and 5-year OS rates (OR: 1.84; 95% CI: 0.76–4.45; p = 0.18) were detected between cytoreductive radical prostatectomy and radiation therapy. Cytoreductive radical prostatectomy had significantly higher 1-, 3-, and 5-year CSS and OS rates compared to systemic therapy. Comparable CSS and OS rates were found between cytoreductive radical prostatectomy and radiation therapy.

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

Frontiers in Surgery ◽

10.3389/fsurg.2021.648676 ◽

2021 ◽

Vol 8 ◽

Author(s):

Zhenghao Wang ◽

DeHong Cao ◽

Wuran Wei

Keyword(s):

Prostate Cancer ◽

Systematic Review ◽

Radiation Therapy ◽

Selection Process ◽

Meta Analysis ◽

Local Treatment ◽

Local Therapy ◽

Cochrane Library ◽

Significant Heterogeneity ◽

Conformal Radiation Therapy

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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