Outcomes of ablative therapy and radical treatment for prostate cancer: a systematic review and meta-analysis.

IF 3.1 3区 医学 Q1 UROLOGY & NEPHROLOGY International Braz J Urol Pub Date : 2024-03-03 DOI:10.1590/S1677-5538.IBJU.2023.0628
Guilherme Miranda Andrade, Felipe Giorgi Manente, Pedro José Damato Dias Barroso, Saulo Borborema Teles, Alexandre Dib Partezani, Willy Baccaglini, Rafael Sanchez-Salas, Ruben Olivares, Bruno Nahar, Gustavo Caserta Lemos, Bianca Bianco, Arie Carneiro
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Abstract

Purpose: To compare biochemical recurrence, sexual potency and urinary continence outcomes of ablative therapy and radical treatment (radical prostatectomy or radiotherapy with androgen deprivation therapy).

Material and methods: A systematic review and meta-analysis followed the PRISMA guidelines were performed. We searched MEDLINE/PubMed. Biochemical recurrence at three and five years; incontinence rate (patients who used one pad or more) and erectile dysfunction rate at 12 and 36 months (patients who did not have sufficient erection to achieve sexual intercourse) were evaluated. The Mantel-Haenszel method was applied to estimate the pooled risk difference (RD) in the individual studies for categorical variables. All results were presented as 95% confidence intervals (95%CI). Random effects models were used regardless of the level of heterogeneity (I²). (PROSPERO CRD42022296998).

Results: Eight studies comprising 2,677 men with prostate cancer were included. There was no difference in biochemical recurrence between ablative and radical treatments. We observed the same biochemical recurrence between ablative therapy and radical treatment within five years (19.3% vs. 16.8%, respectively; RD 0.07; 95%CI=-0.05, 0.19; I2=68.2%; P=0.08) and continence rate at 12 months (9.2% vs. 31.8%, respectively; RD -0.13; 95%CI, -0.27, 0.01; I2=89%; P=0.32). When focal treatment was analyzed alone, two studies with 582 patients found higher erectile function at 12 months in the ablative therapy group than in the radical treatment (88.9% vs. 30.8%, respectively; RD -0.45; 95%CI -0.84, -0.05; I2=93%; P=0.03).

Conclusion: Biochemical recurrence and urinary continence outcomes of ablative therapy and radical treatment were similar. Ablative therapy appears to have a high rate of sexual potency.

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前列腺癌消融治疗和根治治疗的结果:系统回顾和荟萃分析。
目的:比较消融治疗和根治治疗(根治性前列腺切除术或放射治疗加雄激素剥夺治疗)的生化复发、性功能和排尿功能:按照 PRISMA 指南进行了系统综述和荟萃分析。我们检索了 MEDLINE/PubMed。评估了3年和5年的生化复发率、尿失禁率(使用一个或多个尿垫的患者)以及12个月和36个月的勃起功能障碍率(勃起功能不足以实现性交的患者)。对于分类变量,采用曼特尔-海恩泽尔法估算各研究的汇总风险差异(RD)。所有结果均以 95% 置信区间 (95%CI) 表示。无论异质性水平(I²)如何,均采用随机效应模型。(PROSPERO CRD42022296998).Results:结果:共纳入八项研究,包括 2,677 名前列腺癌男性患者。消融治疗和根治治疗的生化复发率没有差异。我们观察到,消融治疗与根治治疗在五年内的生化复发率(分别为19.3% vs. 16.8%;RD 0.07;95%CI=-0.05,0.19;I2=68.2%;P=0.08)和12个月时的尿失禁率(分别为9.2% vs. 31.8%;RD -0.13;95%CI,-0.27,0.01;I2=89%;P=0.32)相同。当单独分析病灶治疗时,两项共 582 例患者的研究发现,消融治疗组患者在 12 个月后的勃起功能高于根治治疗组(分别为 88.9% 对 30.8%;RD -0.45;95%CI -0.84,-0.05;I2=93%;P=0.03):结论:消融治疗和根治治疗的生化复发和尿失禁结果相似。烧蚀疗法似乎具有较高的性功能恢复率。
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来源期刊
International Braz J Urol
International Braz J Urol UROLOGY & NEPHROLOGY-
CiteScore
4.60
自引率
21.60%
发文量
246
审稿时长
6-12 weeks
期刊介绍: Information not localized
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