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Comparison of short-term and long-term neoadjuvant hormone therapy prior to radical prostatectomy: a systematic review and meta-analysis
S. Katayama, K. Mori, B. Pradere, H. Mostafaei, VM. Schuettfort, F. Quhal, RS. Motlagh, E. Laukhtina, NC. Grossmann, P. Rajwa, A. Aydh, F. König, R. Mathieu, P. Nyirady, PI. Karakiewicz, Y. Nasu, SF. Shariat
Language English Country Great Britain
Document type Journal Article, Meta-Analysis, Review, Systematic Review
- MeSH
- Androgen Antagonists * therapeutic use MeSH
- Hormones therapeutic use MeSH
- Humans MeSH
- Prostatic Neoplasms * drug therapy pathology surgery MeSH
- Neoadjuvant Therapy MeSH
- Prostatectomy MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Publication type
- Journal Article MeSH
- Meta-Analysis MeSH
- Review MeSH
- Systematic Review MeSH
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.
Department of Urology 2nd Faculty of Medicine Charles University Prague Czechia
Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna Austria
Department of Urology King Fahad Specialist Hospital Dammam Saudi Arabia
Department of Urology King Faisal Medical City Abha Saudi Arabia
Department of Urology Medical University of Silesia Zabrze Poland
Department of Urology Rennes University Hospital Rennes France
Department of Urology Semmelweis University Budapest Hungary
Department of Urology The Jikei University School of Medicine Tokyo Japan
Department of Urology University Hospital Zurich Zurich Switzerland
Department of Urology University Medical Center Hamburg Eppendorf Hamburg Germany
Department of Urology University of Texas Southwestern Dallas TX USA
Department of Urology Weill Cornell Medical College New York NY USA
Institute for Urology and Reproductive Health Sechenov University Moscow Russia
Karl Landsteiner Institute of Urology and Andrology Vienna Austria
Research Center for Evidence Based Medicine Tabriz University of Medical Sciences Tabriz Iran
References provided by Crossref.org
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- $a Katayama, Satoshi $u Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria $u Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan $1 https://orcid.org/0000000283772457
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