Pd57-08 Radiation Therapy vs. Surgery for Prostate Cancer: An Updated Systematic Review of Clinical Trials

You have accessJournal of UrologyProstate Cancer: Localized: Radiation Therapy (PD57)1 May 2024PD57-08 RADIATION THERAPY VS. SURGERY FOR PROSTATE CANCER: AN UPDATED SYSTEMATIC REVIEW OF CLINICAL TRIALS Lauren Marie Hekman, Athena Barrett, Dylan Ross, Eli Palaganas, Prashanth Giridhar, Thiraviyam Elumalai, Pragathee V, Alec Block, James Welsh, Sashank Saini, Soumyajit Roy, BhanuPrasad Venkatesulu, and Abhishek Solanki Lauren Marie HekmanLauren Marie Hekman , Athena BarrettAthena Barrett , Dylan RossDylan Ross , Eli PalaganasEli Palaganas , Prashanth GiridharPrashanth Giridhar , Thiraviyam ElumalaiThiraviyam Elumalai , Pragathee VPragathee V , Alec BlockAlec Block , James WelshJames Welsh , Sashank SainiSashank Saini , Soumyajit RoySoumyajit Roy , BhanuPrasad VenkatesuluBhanuPrasad Venkatesulu , and Abhishek SolankiAbhishek Solanki View All Author Informationhttps://doi.org/10.1097/01.JU.0001008808.16085.aa.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Localized prostate cancer can be effectively treated with surgery, radiation therapy, or active surveillance. However, the optimal treatment approach remains controversial. Prior population-based studies comparing surgery and radiation have shown conflicting results. This systematic review aimed to compare overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and side effect profiles between surgery and radiation therapy for prostate cancer. METHODS: The systematic review search included PubMed, Embase and Cochrane libraries according to the PRIMSA statement with the inception of each database up to June 24, 2023. Randomized phase 2 or 3 clinical trials that compared surgery to radiation in prostate cancer were included. The forest plot for the Odds ratio (OR) was plotted using the Mantel-Haenszel method, and the Z test was used to assess significance. The fixed effects model was used for meta-analysis using the Review Manager software. RESULTS: The search yielded 7 completed randomized clinical trials (RCTs) and 4 ongoing trials. The 7 RCTs reviewed enrolled 1748 patients, with 872 patients randomized to the surgery arm and 876 patients randomized to the radiation arm. In the surgery arm, 650 patients had a GS of 6, 120 patients had a GS of 7, 10 patients had GS 8-10, meanwhile in the RT arm 661 patients with GS 6, 108 patients had GS 7, 14 patients had GS 8-10, suggesting that the vast majority of the patients included in these trials were low risk, followed by intermediate risk, and a small number were high-risk prostate cancer patients. OR for OS was 1.00 with 95% CI 0.71-1.41 (p-value: 0.98), CSS OR was 0.99 with 95% CI 0.45-2.18 (p-value 0.11), OR for DFS was 1.26 with 95% CI 0.89-1.78 (p-value 0.19). The rate of distant metastatic disease was 2.3% in the surgery arm vs. 2.9% in the radiation arm at 10 years. The rate of second malignant neoplasms was 4.5% in the surgery arm compared to 4.2% in the radiation arm at 10 years. Surgery caused more urinary symptoms, with a predominance of the need for urinary pads, a higher incidence of sexual dysfunction, and radiation caused a higher incidence of bowel symptoms. CONCLUSIONS: This systematic review of RCTs provides high-quality evidence that surgery and radiation therapy result in comparable treatment-related outcomes for patients with low to intermediate risk prostate cancer. Given the similarity in survival, disease control, and adverse events, an individualized approach that considers each patient's preferences and values should be the cornerstone for determining the ideal treatment option. Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1211 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Lauren Marie Hekman More articles by this author Athena Barrett More articles by this author Dylan Ross More articles by this author Eli Palaganas More articles by this author Prashanth Giridhar More articles by this author Thiraviyam Elumalai More articles by this author Pragathee V More articles by this author Alec Block More articles by this author James Welsh More articles by this author Sashank Saini More articles by this author Soumyajit Roy More articles by this author BhanuPrasad Venkatesulu More articles by this author Abhishek Solanki More articles by this author Expand All Advertisement PDF downloadLoading ...