A Systematic Review of Clinical Trials Comparing Radiation Therapy Versus Radical Prostatectomy in Prostate Cancer

Area of Science:

• Urology
• Oncology
• Evidence-Based Medicine

Background:

• Localized and regional prostate cancer management involves active surveillance, radiation therapy (RT), and radical prostatectomy (RP).
• Previous population-based studies comparing RP to RT have yielded conflicting results due to methodological limitations.

Purpose of the Study:

• To conduct a systematic review and pooled analysis comparing cause-specific survival (CSS), overall survival (OS), disease-free survival (DFS), and toxicity outcomes between RP and RT for prostate cancer.

Main Methods:

• Systematic literature search of PubMed, Embase, and Cochrane databases up to June 24, 2023, adhering to PRISMA guidelines.
• Inclusion of randomized phase 2 or 3 clinical trials comparing RP to RT in prostate cancer.
• Meta-analysis using the Mantel-Haenszel method for Odds Ratios (OR) and a fixed effects model.

Main Results:

• Seven completed and four ongoing randomized clinical trials were identified; most completed trials focused on low to intermediate-risk patients.
• No significant differences in OS (OR 1.00), CSS (OR 0.99), or DFS (OR 1.26) were observed between RP and RT at 10 years.
• RP was associated with increased urinary symptoms and sexual dysfunction, whereas RT led to more frequent bowel symptoms.

Conclusions:

• RP and RT demonstrate similar oncological outcomes for low to intermediate-risk prostate cancer.
• Treatment decisions should incorporate multidisciplinary approaches, considering individual patient values and preferences.
• Understanding the distinct toxicity profiles of RP (urinary/sexual) and RT (bowel) is crucial for patient counseling and management.