Investig Clin Urol.
2023 May;64(3):242-254. 10.4111/icu.20230058.
Cytoreductive prostatectomy may improve oncological outcomes in patients with oligometastatic prostate cancer: An updated systematic review and meta-analysis
- Affiliations
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- 1Department of Urology, Inha University College of Medicine, Incheon, Korea
- 2Department of Urology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
- 3Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
- 4Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
- 5Department of Urology, Prostate Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- 6Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University, Seoul, Korea
- KMID: 2542247
- DOI: http://doi.org/10.4111/icu.20230058
Abstract
- The oncologic outcomes of cytoreductive prostatectomy (CRP) in oligometastatic prostate cancer (OmPCa) are still controversial. Therefore, we conducted a systematic review and meta-analysis on the oncologic outcome of CRP in OmPCa. OVID-Medline, OVID-Embase, and Cochrane Library databases were searched to identify eligible studies published before January 2023. A total of 11 studies (929 patients), 1 randomized controlled trial (RCT) and 10 non-RCT studies, were included in the final analysis. RCT and non-RCT were further analyzed separately. End points were progression-free-survival (PFS), time to castration-resistant prostate cancer (CRPCa), cancer-specific-survival (CSS) and overall-survival (OS). It was analyzed using hazard ratio (HR) and 95% confidence intervals (CIs). In PFS, in RCT, HR=0.43 (CIs=0.27–0.69) was shown statistically significant, but in non-RCTs, HR=0.50 (CIs=0.20–1.25), there was no statistical difference. And, in time to CRPCa was statistically significant in the CRP group in all analyses (RCT; HR=0.44; CIs=0.29–0.67) (non-RCTs; HR=0.64; CIs=0.47–0.88). Next, CSS was not statistically different between the two groups (HR=0.63; CIs=0.37–1.05). Finally, OS showed better results in the CRP group in all analyses (RCT; HR=0.44; CIs=0.26–0.76) (non-RCTs; HR=0.59; CIs=0.37–0.93). Patients who received CRP in OmPCa showed better oncologic outcomes compared to controls. Notably, time to CRPC and OS showed significantly improved compared with control. We recommend that experienced urologists who are capable of managing complications consider CRP as a strategy to achieve good oncological outcomes in OmPCa. However, since most of the included studies are non-RCT studies, caution should be exercised in interpreting the results.
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