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Review
. 2024 Mar 3;50(3):237-249.
doi: 10.1590/S1677-5538.IBJU.2023.0628. Online ahead of print.

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

Guilherme Miranda Andrade  1   2 , Felipe Giorgi Manente  3 , Pedro José Damato Dias Barroso  3 , Saulo Borborema Teles  1 , Alexandre Dib Partezani  1 , Willy Baccaglini  1 , Rafael Sanchez-Salas  4 , Ruben Olivares  5 , Bruno Nahar  6 , Gustavo Caserta Lemos  1 , Bianca Bianco  1   2 , Arie Carneiro  1
Affiliations
Review

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

Guilherme Miranda Andrade et al. Int Braz J Urol. .

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.

Keywords: Minimally Invasive Surgical Procedures; Prostatic Neoplasms; Radiotherapy.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1. Flow diagram of included studies (PRISMA flow).
Figure 2
Figure 2. Biochemical recurrence in 3 years (A) and 5 years (B).
Figure 3
Figure 3. Continence rate in 12 months (A), and sexual potency in 12 and 36 months (B).
Supplementary Figure 1
Supplementary Figure 1. AMSTAR 2.
Supplementary Figure 2
Supplementary Figure 2. Rob 2.
Supplementary Figure 3
Supplementary Figure 3. Rob-1.
See this image and copyright information in PMC

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