Local treatment benefits patients with oligometastatic prostate cancer: A systematic review and meta-analysis

Objectives

This study aims to evaluate the efficacy of local treatment (LT), including radiotherapy (RT) and cytoreductive prostatectomy (CRP), in improving outcomes for patients with oligometastatic prostate cancer (OmPCa).

Methods

A systematic review and meta-analysis of articles from PubMed, Embase, and Web of Science published between 2010 and November 2023 were conducted. The study included 11 articles, comprising three randomized controlled trials (RCTs) and eight retrospective analyses. The study assessed overall survival (OS), radiographic progression-free survival (rPFS), prostate-specific antigen (PSA) PFS, cancer-specific survival (CSS), and complication rate (CR).

Results

OS was significantly improved in the LT group, with both RCTs and non-RCTs showing statistical significance [hazard ratios (HR) = 0.64; 95% confidence intervals (95% CIs), 0.51–0.80; p < 0.0001; HR = 0.55; 95% CIs, 0.40–0.77; p = 0.0004]. For rPFS, RCTs did not show statistically significant outcomes (HR = 0.60; 95% CIs, 0.34–1.07; p = 0.09), whereas non-RCTs demonstrated significant results (HR = 0.42; 95% CIs, 0.24–0.72; p = 0.002). Both RCTs and non-RCTs showed a significant improvement in PSA-PFS (HR = 0.44; 95%CI, 0.29–0.67; p = 0.0001; HR = 0.51; 95% CIs, 0.32–0.81; p = 0.004). For CSS, RCTs demonstrated statistical differences (HR = 0.65; 95% CIs, 0.47–0.90; p = 0.009), whereas non-RCTs did not (HR = 0.61; 95% CIs, 0.29–1.27; p = 0.19). Regarding CR, the risk difference was −0.22 (95% CIs, −0.32 to −0.12; p < 0.00001).

Conclusion

LT significantly improved OS and PFS in patients with OmPCa. Further RCTs are necessary to confirm these results.