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Does surgery benefit patients with oligometastatic or metastatic prostate cancer? – A retrospective cohort study and meta‐analysis
Author(s) -
Si Shubin,
Zheng Bin,
Wang Zhenlin,
Niu Zhihong
Publication year - 2021
Publication title -
the prostate
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.295
H-Index - 123
eISSN - 1097-0045
pISSN - 0270-4137
DOI - 10.1002/pros.24170
Subject(s) - medicine , prostate cancer , androgen deprivation therapy , interquartile range , hazard ratio , prostatectomy , oncology , proportional hazards model , confidence interval , biochemical recurrence , univariate analysis , prostate specific antigen , retrospective cohort study , survival analysis , urology , statistical significance , cohort , multivariate analysis , cancer
Background To evaluate long‐term oncological outcomes of radical prostatectomy (RP) plus androgen deprivation therapy (ADT) in oligometastatic prostate cancer (PCa) patients. Methods Our study included oligometastatic PCa patients hospitalized between January 1, 2010 and December 31, 2015, who received ADT with or without RP. We evaluated survival by employing Kaplan–Meier methods, with log‐rank tests and univariate and multivariate Cox regression analyses. A meta‐analysis of previously published studies was additionally performed. Results The median follow‐up times of both groups were 68.4 months (interquartile range = 56.5–85.0). In this cohort study, significant statistical difference in preoperative total prostate‐specific antigen (tPSA; p = .121), clinical T stage ( p = .115), and N stage ( p = .394) were not found between the two groups. Meanwhile, the difference in overall survival (OS) between the two groups did not reach statistical significance ( p = .649). A significant difference was not observed in castration‐resistant prostate cancer (CRPC)‐free survival between two groups as well ( p = .183). Numbers of metastases might be an independent prognosis factor ( p = .05) for OS, and postoperative tPSA is a risk predictor for CRPC‐free survival ( p = .032). A meta‐analysis of four relevant studies demonstrated significant statistical difference in clinical improvement with RP plus ADT over ADT alone in OS survival ( p < .001; hazard ratio [HR] = 0.51; 95% confidence interval [CI] = 0.38–0.69) instead of CRPC‐free survival ( p = .42; HR = 0.86; 95% CI = 0.59–1.24). Conclusion The addition of RP to ADT for the treatment of oligometastatic PCa was associated with an improved OS instead of CRPC‐free survival.