Hormone Therapy With Salvage Radiotherapy After Radical Prostatectomy: A Systematic Review and Meta-Analysis

Salvage radiotherapy (RT) is a standard treatment for non-metastatic prostate cancer recurrence after radical prostatectomy (RP), yet the efficacy of concurrent hormone therapy remains debated. This systematic review and meta-analysis evaluates the impact of adding hormone therapy to adjuvant or salvage RT on key survival outcomes.

We searched PubMed, Scopus, Web of Science, and clinical trial registries for randomized phase 2 or 3 trials comparing RT alone versus RT with hormone therapy (anti-androgens or androgen deprivation therapy) in patients undergoing RP. A random-effects meta-analysis with the inverse variance method was performed for overall survival (OS), metastasis-free survival (MFS), and progression-free survival (PFS) after extracting the corresponding hazard ratios (HR) and 95% confidence intervals (CI).

Four trials with generally low risk of bias were identified. Pooled HRs were 0.85 (95% CI: 0.72-0.99) for OS, 0.82 (95% CI: 0.70-0.96) for MFS, and 0.58 (95% CI: 0.51-0.66) for PFS, favoring hormone therapy. Following a sensitivity analysis that excluded the results of one of the four trials, the significance for OS was no longer observed.

Hormone therapy with post-RP RT significantly improves OS, MFS, and PFS in prostate cancer patients. Although the benefit in OS appears less robust, these findings support the significant role of hormone therapy in delaying disease progression. PROSPERO Registration Number: CRD42024597336.