The prognostic significance of additional localized treatment to primary lesion in patients undergoing hormone therapy for metastatic hormone-sensitive prostate cancer: A systematic review and meta-analysis

by Yuta Yamada, Fumihiko Urabe, Shoji Kimura, Kosuke Iwatani, Naoki Kimura, Jun Miki, Takahiro Kimura, Haruki Kume

Background

We aimed to compare the prognostic values of ‘localized treatment to the primary lesion (LT) plus hormone therapy (HT)’ versus ‘HT alone’ in metastatic hormone-sensitive prostate cancer (mHSPC).

Methods

We conducted a systematic search through the databases of PubMed®, Web of Science®, and Cochrane library® in April 2023 based on the PRISMA (Preferred Reporting Items for Systemic Reviews and Meta-Analyses) statement. A pooled meta-analysis was performed to assess the prognostic differences between LT + HT and HT alone according to randomized and non-randomized controlled studies (RCTs and NRCTs, respectively).

Results

The search identified three RCTs and eight NRCTs. In RCTs, LT did not show prognostic benefits regarding biochemical-failure free rate nor overall survival (OS), although in patients with low tumor burdens, the LT + HT group showed better OS (HR: 0.68, 95% CI: 0.54–0.86). In the NRCTs, the LT+HT group showed superior progression-free survival (hazard ratio (HR): 0.42, 95% confidence interval (CI): 0.21–0.87), cancer-specific survival (HR: 0.39, 95% CI: 0.20–0.76), and OS (HR: 0.63, 95% CI: 0.57–0.69) to the HT alone group. In addition, better OS was observed in the LT +HT group regardless of the type of treatment modality for LT; radical prostatectomy (HR: 0.52, 95% CI: 0.39–0.69), radiotherapy (HR: 0.63, 95% CI: 0.56–0.71) in NRCTs.

Conclusions

LT to the primary lesion in metastatic hormone-sensitive prostate cancer may provide prognostic benefits and especially in patients with low tumor burden.