Drug treatment options of high-risk biochemically recurrent prostate cancer based on efficacy and safety: a systematic review and Bayesian network analysis
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Updated: Jun 13, 2025
A Bioluminescent and Fluorescent Orthotopic Syngeneic Murine Model of Androgen-dependent and Castration-resistant Prostate Cancer
Published on: March 6, 2018
Qian Wang1, Qiyu Zhu1, Haoyang Liu1
1Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No.37 Guoxue Alley, Wuhou District, Chengdu City, 610041, Sichuan Province, People's Republic of China.
Background:
Emerging evidence has revealed the potential efficacy of Novel Hormonal Agent (NHA) or chemotherapy in high-risk patients with biochemical recurrence (BCR). However, the optimal drug-based treatment strategy remains unknown.
Methods:
We conducted a comprehensive search of the PubMed, Cochrane, and Embase databases up to February 18, 2024 to identify relevant studies. Our analysis focused on outcome measures, including prostate-specific antigen progression-free survival (PSA-PFS), overall survival (OS) and the incidence of adverse events (AEs). A Bayesian network meta-analysis was utilized to indirectly compare the efficacy and safety of various treatment modalities.
Results:
Four randomized controlled trials with 2074 participants were selected for data extraction and analysis. Treatment combining Androgen Deprivation Therapy (ADT) with Enzalutamide (ENZA) significantly enhanced PSA-PFS as compared to ADT monotherapy (Hazard Ratio (HR) = 0.07, 95% Confidence Interval (CI) 0.01-0.97). The surface under the cumulative ranking curve (SUCRA) indicated ADT + ENZA as the most effective strategy for improving PSA-PFS. In terms of OS improvement, the treatments were ranked as follows: ADT + Docetaxel (DOC), ADT + ENZA, ENZA, and ADT. In terms of adverse event incidence, ADT exhibited the lowest incidence of adverse events, followed by ADT + ENZA. In the meta-analysis, ADT + NHA combined therapy achieved superior efficacy in PSA-PFS and OS than ADT.
Conclusion:
This study suggests that ADT + NHA, particularly ADT + ENZA, may provide a significant survival benefit and an acceptable safety profile for prostate cancer patients at high-risk BCR. The findings could potentially inform the selection of medications for these patients, although further confirmation through large-scale clinical trials is imperative.
Insights
Novel hormonal agents combined with androgen deprivation therapy (ADT) show promise for high-risk prostate cancer patients with biochemical recurrence (BCR). Specifically, ADT plus Enzalutamide (ENZA) improves survival outcomes, offering a potential new treatment strategy.
Area of Science:
- Oncology
- Pharmacology
- Clinical Trials
Background:
- Biochemical recurrence (BCR) in prostate cancer patients necessitates effective treatment strategies.
- Novel hormonal agents (NHA) and chemotherapy show potential for high-risk BCR patients.
- Optimal drug-based treatment for high-risk BCR remains undetermined.
Purpose of the Study:
- To compare the efficacy and safety of various drug-based treatment strategies for high-risk prostate cancer patients with BCR.
- To identify the optimal treatment regimen for improving survival outcomes and managing adverse events.
Main Methods:
- A comprehensive literature search was conducted across PubMed, Cochrane, and Embase databases.
- Bayesian network meta-analysis was employed to compare treatment modalities.
- Key outcome measures included prostate-specific antigen progression-free survival (PSA-PFS), overall survival (OS), and adverse events (AEs).
Main Results:
- Androgen Deprivation Therapy (ADT) combined with Enzalutamide (ENZA) significantly improved PSA-PFS compared to ADT monotherapy.
- ADT + ENZA was identified as the most effective strategy for enhancing PSA-PFS.
- For overall survival, treatment rankings were ADT + Docetaxel (DOC) > ADT + ENZA > ENZA > ADT.
- ADT demonstrated the lowest incidence of AEs, followed by ADT + ENZA.
Conclusions:
- ADT combined with NHA, particularly ADT + ENZA, offers significant survival benefits for high-risk BCR prostate cancer patients.
- This combination therapy presents an acceptable safety profile.
- Findings may guide treatment selection, pending confirmation from large-scale clinical trials.
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