PMID- 32093688 OWN - NLM STAT- MEDLINE DCOM- 20201124 LR - 20211122 IS - 1477-7819 (Electronic) IS - 1477-7819 (Linking) VI - 18 IP - 1 DP - 2020 Feb 24 TI - The efficacy and safety of radical prostatectomy and radiotherapy in high-risk prostate cancer: a systematic review and meta-analysis. PG - 42 LID - 10.1186/s12957-020-01824-9 [doi] LID - 42 AB - BACKGROUND: The optimal treatment for patients with high-risk prostate cancer (PCa) remains a debate and selection of patients to receive proper therapy is still an unsettled question. This systematic review was conducted to compare the effectiveness of prostatectomy (RP) and radiotherapy (RT) in patients with high-risk PCa and to select candidates for optimal treatment. METHODS: PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were searched for eligible studies. We extracted hazard ratios (HRs) and 95% confidence interval (CI) of all included studies. The primary outcomes were overall survival (OS) and cancer-specific survival (CSS); the secondary outcomes were biochemical recurrence-free survival (BRFS), metastasis-free survival (MFS) and clinical recurrence-free survival (CRFS). The meta-analysis was performed using Review Manager 5.3. Subgroup analyses were conducted according to Gleason score (GS), T stage and RT types. Quality of life (QoL) was compared with these two treatments. RESULTS: A total of 25 studies were included in this meta-analysis. Overall, RP showed more survival benefits than RT on CSS (P = 0.003) and OS (P = 0.002); while RT was associated with better BRFS (P = 0.002) and MFS (P = 0.004). Subgroup analyses showed RT was associated with similar or even better survival outcomes compared to RP in patients with high GS, high T stage or received external beam radiotherapy plus brachytherapy (EBRT + BT). As for QoL, RP was associated with poorer urinary and sexual function but better performance in the bowel domain. CONCLUSION: RP could prolong the survival time of patients with high-risk PCa; however, RT could delay the disease progression, and combined RT (EBRT + BT) even brought preferable CSS and similar OS compared to RP. RT might be the prior choice for patients with high T stage or high GS. RP could lead to poorer urinary and sexual function, while bringing better performance in the bowel domain. FAU - Wang, Zhipeng AU - Wang Z AD - Department of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China. FAU - Ni, Yuchao AU - Ni Y AD - Department of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China. FAU - Chen, Junru AU - Chen J AD - Department of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China. FAU - Sun, Guangxi AU - Sun G AD - Department of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China. FAU - Zhang, Xingming AU - Zhang X AD - Department of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China. FAU - Zhao, Jinge AU - Zhao J AD - Department of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China. FAU - Zhu, Xudong AU - Zhu X AD - Department of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China. FAU - Zhang, Haoran AU - Zhang H AD - Department of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China. FAU - Zhu, Sha AU - Zhu S AD - Department of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China. FAU - Dai, Jindong AU - Dai J AD - Department of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China. FAU - Shen, Pengfei AU - Shen P AD - Department of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China. cdhx510@foxmail.com. FAU - Zeng, Hao AU - Zeng H AD - Department of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China. kucaizeng@163.com. LA - eng GR - 81974398/National Natural Science Foundation of China (CN)/ GR - 81672547/National Natural Science Foundation of China/ GR - Z2018A01/National Center of Excellence for Clinical Trial and Research (TW)/ PT - Journal Article PT - Meta-Analysis PT - Systematic Review DEP - 20200224 PL - England TA - World J Surg Oncol JT - World journal of surgical oncology JID - 101170544 RN - EC 3.4.21.- (KLK3 protein, human) RN - EC 3.4.21.- (Kallikreins) RN - EC 3.4.21.77 (Prostate-Specific Antigen) SB - IM MH - Brachytherapy/adverse effects/*methods MH - Clinical Decision-Making MH - Combined Modality Therapy/adverse effects/methods MH - Disease Progression MH - Disease-Free Survival MH - Humans MH - Kallikreins/blood MH - Male MH - Neoplasm Grading MH - Neoplasm Staging MH - *Patient Selection MH - Prostate/pathology/radiation effects/surgery MH - Prostate-Specific Antigen/blood MH - Prostatectomy/adverse effects/*methods MH - Prostatic Neoplasms/blood/*mortality/pathology/therapy PMC - PMC7041271 OTO - NOTNLM OT - High-risk prostate cancer OT - Radical prostatectomy OT - Radiotherapy COIS- The authors declare that they have no competing interests. EDAT- 2020/02/26 06:00 MHDA- 2020/11/25 06:00 PMCR- 2020/02/24 CRDT- 2020/02/26 06:00 PHST- 2020/01/09 00:00 [received] PHST- 2020/02/18 00:00 [accepted] PHST- 2020/02/26 06:00 [entrez] PHST- 2020/02/26 06:00 [pubmed] PHST- 2020/11/25 06:00 [medline] PHST- 2020/02/24 00:00 [pmc-release] AID - 10.1186/s12957-020-01824-9 [pii] AID - 1824 [pii] AID - 10.1186/s12957-020-01824-9 [doi] PST - epublish SO - World J Surg Oncol. 2020 Feb 24;18(1):42. doi: 10.1186/s12957-020-01824-9.