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The role of radical prostatectomy and radiotherapy in treatment of locally advanced prostate cancer: a systematic review and meta-analysis

Background: The role of radical prostatectomy (RP) is still controversial for locally advanced prostate cancer (PC). Radiotherapy (RT) and hormonal therapy (HT) are usually used as a primary treatment. Material and Methods: A systematic online search was conducted according to Preferred Reporting...

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Main Authors: Fahmy, Omar, Khairul-Asri, Mohd Ghani, Hadi, Syed H.S.M., Gakis, Georgios, Stenzl, Arnulf
Format: Article
Language:English
Published: Karger AG Basel 2017
Online Access:http://psasir.upm.edu.my/id/eprint/63523/1/The%20role%20of%20radical%20prostatectomy%20and%20radiotherapy%20in%20treatment%20of%20locally%20advanced%20prostate%20cancer.pdf
http://psasir.upm.edu.my/id/eprint/63523/
https://www.karger.com/Article/Abstract/478789
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spelling my.upm.eprints.635232018-11-05T01:10:37Z http://psasir.upm.edu.my/id/eprint/63523/ The role of radical prostatectomy and radiotherapy in treatment of locally advanced prostate cancer: a systematic review and meta-analysis Fahmy, Omar Khairul-Asri, Mohd Ghani Hadi, Syed H.S.M. Gakis, Georgios Stenzl, Arnulf Background: The role of radical prostatectomy (RP) is still controversial for locally advanced prostate cancer (PC). Radiotherapy (RT) and hormonal therapy (HT) are usually used as a primary treatment. Material and Methods: A systematic online search was conducted according to Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Eligible publications reporting the overall survival (OS) and/or disease-specific survival (DSS) were included. A total of 14 studies, including 17,869 patients, were considered for analysis. The impact of therapeutic modalities on survival was assessed, with a risk of bias assessment according to the Newcastle Ottawa Scale. Results: For RP, RT, and HT, the mean 10-year OS was 70.7% (95% CI 61.3-80.2), 65.8% (95% CI 48.1-83.3), and 22.6% (95% CI 4.9-40.3; p = 0.001), respectively. The corresponding 10-year DSS was 84.1% (95% CI 75.1-93.2), 89.4% (95% CI 70.1-108.6), and 50.4% (95% CI 31.2-69.6; p = 0.0127), respectively. Among all treatment combinations, RP displayed significant improvement in OS when included in the treatment (Z = 4.01; p < 0.001). Adjuvant RT significantly improved DSS (Z = 2.7; p = 0.007). Combination of RT and HT favored better OS in comparison to monotherapy with RT or HT (Z = 3.61; p < 0.001). Conclusion: Improved outcomes in advanced PC were detected for RP plus adjuvant RT vs. RP alone and RT plus adjuvant HT vs. RT alone with comparable survival results between both regimens. RP with adjuvant RT may present the modality of choice when HT is contraindicated. Karger AG Basel 2017 Article PeerReviewed text en http://psasir.upm.edu.my/id/eprint/63523/1/The%20role%20of%20radical%20prostatectomy%20and%20radiotherapy%20in%20treatment%20of%20locally%20advanced%20prostate%20cancer.pdf Fahmy, Omar and Khairul-Asri, Mohd Ghani and Hadi, Syed H.S.M. and Gakis, Georgios and Stenzl, Arnulf (2017) The role of radical prostatectomy and radiotherapy in treatment of locally advanced prostate cancer: a systematic review and meta-analysis. Urologia Internationalis, 99 (3). 249 - 256. ISSN 0042-1138; ESSN: 1423-0399 https://www.karger.com/Article/Abstract/478789 10.1159/000478789
institution Universiti Putra Malaysia
building UPM Library
collection Institutional Repository
continent Asia
country Malaysia
content_provider Universiti Putra Malaysia
content_source UPM Institutional Repository
url_provider http://psasir.upm.edu.my/
language English
description Background: The role of radical prostatectomy (RP) is still controversial for locally advanced prostate cancer (PC). Radiotherapy (RT) and hormonal therapy (HT) are usually used as a primary treatment. Material and Methods: A systematic online search was conducted according to Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Eligible publications reporting the overall survival (OS) and/or disease-specific survival (DSS) were included. A total of 14 studies, including 17,869 patients, were considered for analysis. The impact of therapeutic modalities on survival was assessed, with a risk of bias assessment according to the Newcastle Ottawa Scale. Results: For RP, RT, and HT, the mean 10-year OS was 70.7% (95% CI 61.3-80.2), 65.8% (95% CI 48.1-83.3), and 22.6% (95% CI 4.9-40.3; p = 0.001), respectively. The corresponding 10-year DSS was 84.1% (95% CI 75.1-93.2), 89.4% (95% CI 70.1-108.6), and 50.4% (95% CI 31.2-69.6; p = 0.0127), respectively. Among all treatment combinations, RP displayed significant improvement in OS when included in the treatment (Z = 4.01; p < 0.001). Adjuvant RT significantly improved DSS (Z = 2.7; p = 0.007). Combination of RT and HT favored better OS in comparison to monotherapy with RT or HT (Z = 3.61; p < 0.001). Conclusion: Improved outcomes in advanced PC were detected for RP plus adjuvant RT vs. RP alone and RT plus adjuvant HT vs. RT alone with comparable survival results between both regimens. RP with adjuvant RT may present the modality of choice when HT is contraindicated.
format Article
author Fahmy, Omar
Khairul-Asri, Mohd Ghani
Hadi, Syed H.S.M.
Gakis, Georgios
Stenzl, Arnulf
spellingShingle Fahmy, Omar
Khairul-Asri, Mohd Ghani
Hadi, Syed H.S.M.
Gakis, Georgios
Stenzl, Arnulf
The role of radical prostatectomy and radiotherapy in treatment of locally advanced prostate cancer: a systematic review and meta-analysis
author_facet Fahmy, Omar
Khairul-Asri, Mohd Ghani
Hadi, Syed H.S.M.
Gakis, Georgios
Stenzl, Arnulf
author_sort Fahmy, Omar
title The role of radical prostatectomy and radiotherapy in treatment of locally advanced prostate cancer: a systematic review and meta-analysis
title_short The role of radical prostatectomy and radiotherapy in treatment of locally advanced prostate cancer: a systematic review and meta-analysis
title_full The role of radical prostatectomy and radiotherapy in treatment of locally advanced prostate cancer: a systematic review and meta-analysis
title_fullStr The role of radical prostatectomy and radiotherapy in treatment of locally advanced prostate cancer: a systematic review and meta-analysis
title_full_unstemmed The role of radical prostatectomy and radiotherapy in treatment of locally advanced prostate cancer: a systematic review and meta-analysis
title_sort role of radical prostatectomy and radiotherapy in treatment of locally advanced prostate cancer: a systematic review and meta-analysis
publisher Karger AG Basel
publishDate 2017
url http://psasir.upm.edu.my/id/eprint/63523/1/The%20role%20of%20radical%20prostatectomy%20and%20radiotherapy%20in%20treatment%20of%20locally%20advanced%20prostate%20cancer.pdf
http://psasir.upm.edu.my/id/eprint/63523/
https://www.karger.com/Article/Abstract/478789
_version_ 1643837821745627136
score 13.211869

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