Abstract
This network meta-analysis was conducted to compare the efficacy and adverse effects of several treatments for advanced/metastatic prostate cancer (PC). The PubMed and Cochrane Library databases were searched for randomized controlled trials of treatments for advanced/metastatic PC. Eighteen studies covering 6,340 patients were included in this analysis. The calculated were odds ratios, 95% confidence intervals, and the surface under the cumulative ranking (SUCRA) curve. Pairwise meta-analysis showed that overall survival rates achieved with radiotherapy or endocrine therapy were lower than obtained with radiotherapy + endocrine therapy. The endocrine therapy includes estrogen therapy, luteinizing hormone-releasing hormone agonist (LHRH-A), anti-androgen therapy (ADT), ADT + LHRH-A and estrogen therapy + LHRH-A, and its SUCRA values indicated that for overall response rate, estrogen therapy + LHRH-A ranked the highest (92.6%); for overall survival rate, ADT ranked the highest (75.2%); for anemia, estrogen therapy ranked the highest (88.2%); and for diarrhea and hot flushes, ADT ranked the highest (diarrhea, 87.4%; hot flushes, 89.3%). Cluster analysis on the endocrine therapy showed that ADT + LHRH-A achieved the highest overall survival and overall response rates in the treatment of advanced/metastatic PC. Estrogen therapy and ADT had the lowest incidences of diarrhea and anemia. Thus, combined radiotherapy + endocrine therapy had higher overall survival rate, and among the endocrine therapy, in terms of overall response rate and overall survival rate, ADT + LHRH-A may be a better regimen in the treatment of advanced or metastatic PC.
Highlights
In 2008, prostate cancer (PC) is the second most common cause of cancer and the sixth leading cause of cancer death among men worldwide [1]
This study shows that compared to radiotherapy and endocrine therapy, alone, radiotherapy + endocrine therapy was most efficacious in the treatment of advanced/metastatic PC
Salvage radiotherapy is often necessary in men who have undergone radical prostatectomy but show evidence of PC recurrence signaled by persistently or recurrently elevated prostate-specific antigen (PSA) levels [15]
Summary
In 2008, prostate cancer (PC) is the second most common cause of cancer and the sixth leading cause of cancer death among men worldwide [1]. Often patients present with locally advanced PC, which is a serious condition. In the UK, for example, > 27% of new PC presentations are in locally advanced stage [2]. PC include watchful waiting, radiotherapy, and hormone monotherapy or radiation therapy combined with androgen deprivation. Radiotherapy is most commonly used in conjunction with neo-adjuvant, concomitant and/or adjuvant hormone treatment [2]. We took treatments for advanced/metastatic PC classified as radiotherapy, endocrine therapy and radiotherapy + endocrine therapy. Endocrine regimens were searched including estrogen therapy, luteinizing hormone-releasing hormone agonist (LHRH-A), anti-androgen therapy (ADT), ADT + LHRH-A and estrogen therapy + LHRH-A
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