Comparison of short-term and long-term neoadjuvant hormone therapy prior to radical prostatectomy: a systematic review and meta-analysis
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Comparison of short-term and long-term neoadjuvant hormone therapy prior to radical prostatectomy: a systematic review and meta-analysis. / Katayama, Satoshi; Mori, Keiichiro; Pradere, Benjamin; Mostafaei, Hadi; Schuettfort, Victor M; Quhal, Fahad; Motlagh, Reza Sari; Laukhtina, Ekaterina; Grossmann, Nico C; Rajwa, Pawel; Aydh, Abdulmajeed; König, Frederik; Mathieu, Romain; Nyirady, Peter; Karakiewicz, Pierre I; Nasu, Yasutomo; Shariat, Shahrokh F.
in: SCAND J UROL, Jahrgang 56, Nr. 2, 04.2022, S. 85-93.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Review › Forschung
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T1 - Comparison of short-term and long-term neoadjuvant hormone therapy prior to radical prostatectomy: a systematic review and meta-analysis
AU - Katayama, Satoshi
AU - Mori, Keiichiro
AU - Pradere, Benjamin
AU - Mostafaei, Hadi
AU - Schuettfort, Victor M
AU - Quhal, Fahad
AU - Motlagh, Reza Sari
AU - Laukhtina, Ekaterina
AU - Grossmann, Nico C
AU - Rajwa, Pawel
AU - Aydh, Abdulmajeed
AU - König, Frederik
AU - Mathieu, Romain
AU - Nyirady, Peter
AU - Karakiewicz, Pierre I
AU - Nasu, Yasutomo
AU - Shariat, Shahrokh F
PY - 2022/4
Y1 - 2022/4
N2 - PURPOSE: This study aimed to evaluate the efficacy of long-term neoadjuvant androgen-deprivation therapy (ADT) before radical prostatectomy (RP).METHODS: We conducted meta-analyses and network meta-analyses, which included randomized controlled trials that assessed patients with prostate cancer (PC) who received either short-term (<6 months) or long-term (≥6 months) neoadjuvant ADT before RP.RESULTS: Thirteen articles with 2778 patients were eligible for analysis. Short-term neoadjuvant ADT was neither associated with biochemical recurrence (OR 1.19, 95% CI, 0.93-1.51, p = 0.17), metastasis (OR 0.73, 95% CI, 0.45-1.19, p = 0.21), nor overall mortality (OR 0.72, 95% CI 0.43-1.21, p = 0.22); no study investigated survival outcomes in patients on long-term neoadjuvant ADT. In terms of pathologic outcomes, long-term neoadjuvant ADT was significantly associated with a reduced risk of positive surgical margin (SM) and an increased rate of organ-confined disease (OCD) compared to short-term neoadjuvant ADT (OR 0.56, 95% CI 0.39-0.80, p = 0.001, and OR 1.48, 95% CI 1.10-1.99, p = 0.009, respectively). These findings were confirmed in the network meta-analyses. Meanwhile, only a non-significant trend favoring long-term neoadjuvant ADT was observed for pathologic complete response (OR 1.98, 95% Crl 1.00-3.93).CONCLUSION: Long-term neoadjuvant ADT was associated with more favorable pathologic outcomes, but whether these findings translate into favorable survival outcomes still remains unproven due to very limited evidence. Since there are no reliable survival data, long-term neoadjuvant ADT before RP should not be used in clinical practice until more robust evidence arises from ongoing trials.
AB - PURPOSE: This study aimed to evaluate the efficacy of long-term neoadjuvant androgen-deprivation therapy (ADT) before radical prostatectomy (RP).METHODS: We conducted meta-analyses and network meta-analyses, which included randomized controlled trials that assessed patients with prostate cancer (PC) who received either short-term (<6 months) or long-term (≥6 months) neoadjuvant ADT before RP.RESULTS: Thirteen articles with 2778 patients were eligible for analysis. Short-term neoadjuvant ADT was neither associated with biochemical recurrence (OR 1.19, 95% CI, 0.93-1.51, p = 0.17), metastasis (OR 0.73, 95% CI, 0.45-1.19, p = 0.21), nor overall mortality (OR 0.72, 95% CI 0.43-1.21, p = 0.22); no study investigated survival outcomes in patients on long-term neoadjuvant ADT. In terms of pathologic outcomes, long-term neoadjuvant ADT was significantly associated with a reduced risk of positive surgical margin (SM) and an increased rate of organ-confined disease (OCD) compared to short-term neoadjuvant ADT (OR 0.56, 95% CI 0.39-0.80, p = 0.001, and OR 1.48, 95% CI 1.10-1.99, p = 0.009, respectively). These findings were confirmed in the network meta-analyses. Meanwhile, only a non-significant trend favoring long-term neoadjuvant ADT was observed for pathologic complete response (OR 1.98, 95% Crl 1.00-3.93).CONCLUSION: Long-term neoadjuvant ADT was associated with more favorable pathologic outcomes, but whether these findings translate into favorable survival outcomes still remains unproven due to very limited evidence. Since there are no reliable survival data, long-term neoadjuvant ADT before RP should not be used in clinical practice until more robust evidence arises from ongoing trials.
KW - Androgen Antagonists/therapeutic use
KW - Hormones/therapeutic use
KW - Humans
KW - Male
KW - Neoadjuvant Therapy
KW - Prostatectomy
KW - Prostatic Neoplasms/drug therapy
U2 - 10.1080/21681805.2022.2034941
DO - 10.1080/21681805.2022.2034941
M3 - SCORING: Review article
C2 - 35142251
VL - 56
SP - 85
EP - 93
JO - SCAND J UROL
JF - SCAND J UROL
SN - 2168-1805
IS - 2
ER -
