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Short-term versus long-term hormone therapy plus radiotherapy or prostatectomy for prostate cancer: a systematic review and meta-analysis

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Abstract

Purpose

To compare the efficacy and safety of short-term versus long-term hormonotherapy (HT) plus radiotherapy (RT) or prostatectomy (RP) for prostate cancer.

Methods

Literatures were searched from Embase, PubMed, Web of science and Cochrane Library up to October, 2012. Quality of the study was evaluated according to the Cochrane’s risk of bias of randomized controlled trial (RCT); the Grading of Recommendations Assessment, Development and Evaluation System was used to rate the level of evidence. RevMan 5.1 was used for statistical analysis. Two comparisons were of interest: RT plus short-term HT versus RT plus long-term HT and RP plus short-term HT versus RP plus long-term HT. Pooled risk ratio or standardized mean differences were calculated; HT adverse reactions were descriptively evaluated.

Results

Nine RCTs (total 4,743 patients) were included, 7 RCTs compared RT plus short-term HT with RT plus long-term HT, 2 RCTs compared RP plus short-term HT with RP plus long-term HT. Meta-analysis showed there was no significant difference in overall survival, disease-free survival and PSA level before RP; long-term was superior to short-term hormonotherapy in biochemical failure rate, clinical progression rate, prostate cancer-specific mortality, positive surgical margin rate and prostate volume before RP. Systematic review demonstrated adverse events caused by the increased length of HT were more common.

Conclusions

Long-term HT plus RT showed a trend toward improved overall survival; long-term HT plus RP declined positive surgical margin rate and prostate volume before RP. So, long-term HT may benefit more, but it did not significantly improve the patients’ overall survival, and the adverse reactions are inevitable.

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Acknowledgments

The authors thank Bo Li, Digestive System Department, Xiyuan Hospital, China Academy of Traditional Chinese Medicine, for valuable discussions. Supported by NSFC (Natural Science Foundation of China) (81160285) and Guangxi Natural Science Foundation (2010gxnsfa013240).

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Radiation Oncology, Cancer Hospital of Guangxi Medical University, Cancer Institute of Guangxi Zhuang Autonomous Region, No.71, Hedi Road, Nanning, 530021, People’s Republic of China

    Zhi-Rui Zhou, Xiao-Dong Zhu, Song Qu & Zhong-Guo Liang

  2. Cochrane Schizophrenia Group, The University of Nottingham, Nottingham, NG72TU, UK

    Jun Xia

  3. Department of Neurology of Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China

    Zhang-Yu Zou

  4. Department of Stomatology, Taihe Hospital, Hubei University of Medicine, Shiyan, 442000, People’s Republic of China

    Xian-Tao Zeng

  5. Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People’s Republic of China

    Zhi Mao

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  1. Zhi-Rui Zhou
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  2. Xiao-Dong Zhu
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  3. Jun Xia
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Correspondence to Xiao-Dong Zhu.

Appendix

Appendix

EMBASE Search terms

  1. 1.

    ‘prostate cancer’:ab,ti OR ‘prostate carcinoma’:ab,ti OR ‘prostate neoplasm’:ab,ti OR ‘prostate neoplasms’:ab,ti OR ‘prostatic cancer’:ab,ti OR ‘prostatic carcinoma’:ab,ti OR ‘prostatic neoplasm’:ab,ti OR ‘prostatic neoplasms’:ab,ti OR ‘prostate cancer’/exp

  2. 2.

    ‘hormone therapy’:ab,ti OR ‘hormonal therapy’:ab,ti OR ‘hormonotherapy’:ab,ti OR ‘adjuvant hormonal therapy’:ab,ti OR ‘neoadjuvant hormonal therapy’:ab,ti OR ‘androgen deprivation’:ab,ti OR ‘androgen antagonists’:ab,ti OR ‘androgen suppression’:ab,ti OR ‘endocrine therapy’:ab,ti OR ‘cancer hormone therapy’/exp OR ‘hormonal therapy’/exp

  3. 3.

    ‘radiotherapy’:ab,ti OR ‘radiation therapy’:ab,ti OR ‘external radiation therapy’:ab,ti OR ‘radiotherapy’/exp OR ‘prostatectomy’:ab,ti OR ‘prostate surgery’:ab,ti OR ‘ prostatectomy ‘/exp

  4. 4.

    random*:ab,ti OR ‘randomized controlled trial’:ab,ti OR ‘randomized controlled trial’/exp OR ‘randomized controlled trial (topic)’/exp

  5. 5.

    AND #1 AND #2 AND #3 AND #4.

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Zhou, ZR., Zhu, XD., Xia, J. et al. Short-term versus long-term hormone therapy plus radiotherapy or prostatectomy for prostate cancer: a systematic review and meta-analysis. J Cancer Res Clin Oncol 139, 783–796 (2013). https://doi.org/10.1007/s00432-013-1383-7

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