Surgery, radiotherapy and endocrine therapy for oligometastatic prostate cancer efficacy: a systematic review and...

In recent years, the treatment approach for metastatic prostate cancer has evolved, with early combination therapies increasingly being favored over androgen-deprivation therapy (ADT) alone. Despite the availability of various treatments, their relative effectiveness and safety trade-offs remain uncertain. Randomized controlled trials have explored a range of treatments for oligometastatic prostate cancer, but clear conclusions regarding their prognostic benefits and patient-centered outcomes have not been established. This network meta-analysis (NMA) aims to quantify the benefits of different treatments by analyzing data from a systematic search of Medline, EMBASE, and Cochrane databases, covering trials up to October 1, 2024. The primary outcomes evaluated in this study include overall survival (OS), progression-free survival (PFS), treatment-related adverse events (TRAEs), and quality of life (QoL). This study is registered with PROSPERO (CRD42022370203). We analyzed individual patient data from 13 eligible trials, involving a total of 2,524 patients. Our analysis revealed that ADT+ radiation therapy (RT) (hazard ratio (HR) = 0.39, 95% confidence interval (CI) [0.27-0.56]) and ADT+stereotactic body radiotherapy (SBRT) (HR = 0.35, 95% CI [0.21-0.58]) significantly improved progression-free survival (PFS) compared to ADT alone, while no treatment showed a significant overall survival (OS) benefit. Safety analysis revealed ADT monotherapy had the lowest risk of grade ≥3 adverse events (TRAEs), whereas ADT+abiraterone increased toxicity (OR = 1.54). Limited quality of life (QoL) data suggested ADT+RT may offer slight improvement (surface under the cumulative ranking curve (SUCRA) 74.3%). Most trials exhibited low bias risk, though heterogeneity and small sample sizes for some comparisons warrant cautious interpretation. These findings support ADT+RT/SBRT for PFS benefit but highlight the need for further research to optimize survival outcomes and treatment tolerability.