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A Systematic Review and Meta-Analysis of the Impact of Local Therapies on Local Event Suppression in Metastatic Hormone-Sensitive Prostate Cancer Publisher Pubmed



Tsuboi I1, 4, 6, 8, 10, 12, 14, 16, 18, 20, 23, 27 ; Matsukawa A1, 4, 6, 8, 10, 12, 14, 16, 18, 20, 23, 27 ; Kardoust Parizi M1, 4, 6, 8, 10, 12, 14, 16, 18, 20, 23, 27 ; Klemm J1, 4, 6, 8, 10, 12, 14, 16, 18, 20, 23, 27 ; Mancon S1, 4, 6, 8, 10, 12, 14, 16, 18, 20, 23, 27 ; Chiujdea S1, 4, 6, 8, 10, 12, 14, 16, 18, 20, 23, 27 ; Fazekas T1, 4, 6, 8, 10, 12, 14, 16, 18, 20, 23, 27 ; Miszczyk M1, 4, 6, 8, 10, 12, 14, 16, 18, 20, 23, 27 ; Laukhtina E1, 4, 6, 8, 10, 12, 14, 16, 18, 20, 23, 27 ; Kawada T1, 4, 6, 8, 10, 12, 14, 16, 18, 20, 23, 27 ; Katayama S1, 4, 6, 8, 10, 12, 14, 16, 18, 20, 23, 27 ; Iwata T1, 4, 6, 8, 10, 12, 14, 16, 18, 20, 23, 27 ; Bekku K1, 4, 6, 8, 10, 12, 14, 16, 18, 20, 23, 27 ; Karakiewicz P22 Show All Authors
Authors
  1. Tsuboi I1, 4, 6, 8, 10, 12, 14, 16, 18, 20, 23, 27
  2. Matsukawa A1, 4, 6, 8, 10, 12, 14, 16, 18, 20, 23, 27
  3. Kardoust Parizi M1, 4, 6, 8, 10, 12, 14, 16, 18, 20, 23, 27
  4. Klemm J1, 4, 6, 8, 10, 12, 14, 16, 18, 20, 23, 27
  5. Mancon S1, 4, 6, 8, 10, 12, 14, 16, 18, 20, 23, 27
  6. Chiujdea S1, 4, 6, 8, 10, 12, 14, 16, 18, 20, 23, 27
  7. Fazekas T1, 4, 6, 8, 10, 12, 14, 16, 18, 20, 23, 27
  8. Miszczyk M1, 4, 6, 8, 10, 12, 14, 16, 18, 20, 23, 27
  9. Laukhtina E1, 4, 6, 8, 10, 12, 14, 16, 18, 20, 23, 27
  10. Kawada T1, 4, 6, 8, 10, 12, 14, 16, 18, 20, 23, 27
  11. Katayama S1, 4, 6, 8, 10, 12, 14, 16, 18, 20, 23, 27
  12. Iwata T1, 4, 6, 8, 10, 12, 14, 16, 18, 20, 23, 27
  13. Bekku K1, 4, 6, 8, 10, 12, 14, 16, 18, 20, 23, 27
  14. Karakiewicz P22
  15. Wada K1, 4, 6, 8, 10, 12, 14, 16, 18, 20, 23, 27
  16. Roupret M25
  17. Araki M3, 21, 26
  18. Shariat SF1, 4, 6, 8, 10, 12, 14, 16, 18, 20, 23, 27
Show Affiliations
Authors Affiliations
  1. 1. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
  2. 2. Department of Urology, Shimane University Faculty of Medicine, Shimane, Japan
  3. 3. Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
  4. 4. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
  5. 5. Department of Urology, Jikei University School of Medicine, Tokyo, Japan
  6. 6. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
  7. 7. Department of Urology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
  8. 8. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
  9. 9. Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  10. 10. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
  11. 11. Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy
  12. 12. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
  13. 13. Department of Urology, Spitalul Clinic Judetean Murures, University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Mures, Romania
  14. 14. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
  15. 15. Department of Urology, Semmelweis University, Budapest, Hungary
  16. 16. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
  17. 17. Collegium Medicum - Faculty of Medicine, WSB University, Dabrowa Gornicza, Poland
  18. 18. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
  19. 19. Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
  20. 20. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
  21. 21. Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
  22. 22. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada
  23. 23. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
  24. 24. Department of Urology, Shimane University Faculty of Medicine, Shimane, Japan
  25. 25. AP-HP, Urology, Pitie-Salpetriere Hospital, Sorbonne University, Paris, France
  26. 26. Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
  27. 27. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
  28. 28. Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
  29. 29. Department of Urology, University of Texas Southwestern, Dallas, TX, USA
  30. 30. Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
  31. 31. Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
  32. 32. Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
  33. 33. Research center of Evidence Medicine, Urology department Tabriz University of Medical Sciences, Tabriz, Iran
  34. 34. Department of Urology, Weill Cornell Medical College, New York, NY, USA

Source: European urology oncology Published:2024


Abstract

CONTEXT: It remains unclear to what extent the therapy of the primary local tumor, such as radical prostatectomy (RP) and radiation therapy (RT), improves overall survival in patients with low-volume metastatic hormone-sensitive prostate cancer (mHSPC). However, data suggest a benefit of these therapies in preventing local events secondary to local tumor progression. OBJECTIVE: To evaluate the efficacy of adding local therapy (RP or RT) to systemic therapies, including androgen deprivation therapy, docetaxel, and/or androgen receptor axis-targeted agents, in preventing local events in mHSPC patients compared with systemic therapy alone (ie, without RT of the prostate or RP). EVIDENCE ACQUISITION: Three databases and meeting abstracts were queried in November 2023 for studies analyzing mHSPC patients treated with local therapy. The primary outcome of interest was the prevention of overall local events (urinary tract infection, urinary tract obstruction, and gross hematuria) due to local disease progression. Subgroup analyses were conducted to assess the differential outcomes according to the type of local therapy (RP or RT). EVIDENCE SYNTHESIS: Overall, six studies, comprising two randomized controlled trials, were included for a systematic review and meta-analysis. The overall incidence of local events was significantly lower in the local treatment plus systemic therapy group than in the systemic therapy only groups (relative risk [RR]: 0.50, 95% confidence interval [CI]: 0.28-0.88, p = 0.016). RP significantly reduced the incidence of overall local events (RR: 0.24, 95% CI: 0.11-0.52) and that of local events requiring surgical intervention (RR: 0.08, 95% CI: 0.03-0.25). Although there was no statistically significant difference between the RT plus systemic therapy and systemic therapy only groups in terms of overall local events, the incidence of local events requiring surgical intervention was significantly lower in the RT plus systemic therapy group (RR: 0.70, 95% CI: 0.49-0.99); local events requiring surgical intervention of the upper urinary tract was significantly lower in local treatment groups (RR: 0.60, 95% CI: 0.37-0.98, p = 0.04). However, a subgroup analysis revealed that neither RP nor RT significantly impacted the prevention of local events requiring surgical intervention of the upper urinary tract. CONCLUSIONS: In some patients with mHSPC, RP or RT of primary tumor seems to reduce the incidence of local progression and events requiring surgical intervention. Identifying which patients are most likely to benefit from local therapy, and at what time point (eg, after response of metastases), will be necessary to set up a study assessing the risk, benefits, and alternatives to therapy of the primary tumor in the mHSPC setting. PATIENT SUMMARY: Our study suggests that local therapy of the prostate, such as radical prostatectomy or radiotherapy, in patients with metastatic hormone-sensitive prostate cancer can prevent local events, such as urinary obstruction and gross hematuria. Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.