Cytoreductive prostatectomy improves survival outcomes in patients with oligometastases: a systematic meta-analysis

Abstract

Background: Whether cytoreductive prostatectomy (CRP) should be performed in patients with oligometastatic prostate cancer (OPC) remains controversial. The goal of this systematic meta-analysis was to assess the efficacy of CRP as a treatment for OPC.

Methods: This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Data sources included publications in the PubMed, Embase, the Cochrane Library, EBSCO, and Web of Science (SCI) databases as of May 2022. Eligible articles included prospective studies comparing the efficacy of CRP to a lack of CRP in patients with OPC.

Results: In total, 10 publications incorporating 888 patients were analyzed. Tumor-reducing prostatectomy was found to have no significant effect on long-term or short-term OS [OR = 2.26, 95% CI (0.97, 5.28), P = 0.06] and [OR = 1.73, 95% CI (0.83, 3.58), P = 0.14], but it significantly improved patient long-term or short-term CSS [OR = 1.77, 95% CI (1.01, 310), P = 0.04] and [OR = 2.71, 95% CI (1.72, 4.29), P < 0.0001] and PFS [OR = 1.93, 95% CI (1.25, 2.97), P = 0.003].

Conclusion: These results suggest that cytoreductive prostatectomy can confer survival benefits to OPC patients.

Trial registration: INPLASY protocol 202260017 https://doi.org/10.37766/inplasy2022.6.0017 .

Keywords: Cancer-specific survival; Cytoreductive prostatectomy; Oligometastases; Overall survival; Progression-free survival.

Fig. 1

Search strategy flow diagram

Fig. 2

Forest plot corresponding to patient overall survival at 3 years (A) and 5 years (B) in the cytoreductive prostatectomy group and the androgen deprivation therapy group. No significant difference in OS was observed at 3 years (A) [OR = 1.73, 95% CI (0.83, 3.58), P = 0.14 > 0.05] or 5 years (B) [OR = 2.26, 95% CI (0.97, 5.28), P = 0.06 > 0.05]

Fig. 3

Forest plot corresponding to patient CSS at 3 years (A) and 5 years (B) in the cytoreductive prostatectomy group and the androgen deprivation therapy group. Patients in the group that underwent surgery exhibited significantly higher CSS at 3 years (A) [OR = 1.77, 95% CI (1.01, 3.10), P = 0.04 < 0.05] but not at 5 years (B) [OR = 2.71, 95% CI (0.98, 4.63), P = 0.06 > 0.05]

Fig. 4

Forest plot corresponding to patient PFS at 5 years in the cytoreductive prostatectomy group and the androgen deprivation therapy group. A significant difference in 5-year PFS was observed between the surgery and non-surgery groups, with survival being significantly longer for patients that underwent surgery [OR = 1.93, 95% CI (1.25, 2.97), P = 0.003 < 0.05]