Metastasis-free survival in patients with localized and locally advancedprostate cancer after prostatectomy vs. radiotherapy: Systematic reviewand meta-analysis

Abstract

Introduction: Both Radical Prostatectomy (RP) and radiotherapeutic modalities are suitable therapeutic options for localized Prostate Cancer (PC). For this reason, Metastasis-Free Survival (MFS) is a surrogate to compare both approaches. Objective: To compare RP and External Beam Radiotherapy (EBRT) in localized PC using the MFS
endpoint. Material and Methods: A systematic review of four electronic databases of retrospective cohort studies
comparing these therapeutic options was performed. The primary endpoint was MFS using the Hazard Ratio (HR). The quality of the included studies was assessed using the “Newcastle-Ottawa Score (NOS)”, which is suitable for observational cohort studies. Results: Of 42,286 articles, 8 were included, comprising a total of 10,062 patients.
Radiotherapy was administered with hormonal therapy (Androgen Deprivation Therapy) in all studies. Survival rates
for RP ranged from 66.7% to 93% at 5 years, while rates for EBRT ranged from 58.2% to 81% during the same period. When performing the meta-analysis, patients who received RP as primary treatment were found to have a 21% lower risk of developing distant metastases than those who received EBRT, although this difference was not statistically significant (CI 0.5-1.24; I2=90.34%; T2=0.31). Conclusions: This review suggests a non-significantly increased risk of
distant metastases for patients treated with radiotherapy, particularly EBRT, compared with surgery. When choosing a therapeutic modality, factors other than clinical endpoints should be considered.