Systemic treatment of metastatic castration-sensitive prostate cancer: A meta-analysis of efficacy and safety

Within the last 10 years, multiple clinical randomized controlled trials in metastatic castration-sensitive prostate cancer patients (mCSPC) have demonstrated that androgen deprivation therapy (ADT) combination therapy is significantly superior to ADT alone. However, there are no guidelines that recommend the best clinical decisions with regard to multi-selective systemic therapy for mCSPC.

Two independent researchers have conducted a systematic literature search of the Cochrane Central, Web of Science, Clinical Trials. gov and EU Clinical Trial Register databases with a search deadline of July 5, 2022. Hazard Ratio (HR) and 95% confidence intervals were analyzed and extracted for overall and progression-free survival and their subgroups, as well as the number of adverse events. Trial quality was assessed through the Risk of Bias Form and the Newcastle-Ottawa Scale, and systematic reviews and meta-analyses were carried out in strict accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) project.

8704 patients from 7 studies participated in trials comparing the effectiveness of 4 ADT combination treatments (including ADT + docetaxel, ADT + abiraterone acetate, ADT + enzalutamide, ADT + apalutamide) and ADT alone (ADT + placebo/no-treatment). The results suggested that ADT combination therapy was significantly better than ADT alone. Furthermore, based on the patient's initial clinical characteristics and expected prognosis, we tentatively provided relevant optimal treatment options.

ADT + ARAT outperformed ADT ± docetaxel in OS/PFS for mCSPC, with strategies tailored to patient profiles. Future work will leverage advanced analytics and standardized reporting; direct combination trials are critical for precise guidance.