title: Radical prostatectomy or radiotherapy in high-risk prostate cancer: a systematic review and metaanalysis.
abstract: BACKGROUND
  Radical prostatectomy (RP) is one of the treatment options for localized, high-risk prostate cancer (PC), but it has never been compared with external beam radiotherapy (RT), which is an alternative approach, in a large randomized trial. To compare the outcomes of patients treated with surgery versus RT, we performed a metaanalysis of available studies on this topic.
  
  
  METHODS
  We performed a search of MEDLINE, EMBASE, Web of Science, SCOPUS, and The Cochrane Central Register of Controlled Trials (CENTRAL) for randomized or observational studies that investigated overall survival (OS) and PC-specific mortality (PCSM) risks in relation to use of surgery or RT in patients with high-risk PC. Fixed- and random-effect models were fitted to estimate the summary odds ratio (OR). Between-study heterogeneity was tested using χ(2) statistics and measured using the I(2) statistic. Publication bias was evaluated using a funnel plot and Egger regression asymmetry test.
  
  
  RESULTS
  Seventeen studies were included (1 randomized and 16 retrospective). RP was associated with improved OS (OR, 0.51; 95% confidence interval [CI], 0.38-0.68; P < .00001), PCSM (OR, 0.56; 95% CI, 0.37-0.85; P = .007), and non-PCSM (OR, 0.53; 95% CI, 0.35-0.8; P = .002) compared with RT. Biochemical relapse-free survival rates were similar to those of RT.
  
  
  CONCLUSIONS
  Overall and cancer-specific mortality rates appear to be better with RP compared with RT in localized, high-risk PC. Surgery is also associated with a 50% decreased risk of non-PCSM compared with RT.
authors.affiliation: Oncology Department, Medical Oncology Unit, Azienda Ospedaliera Treviglio, Treviglio, Bergamo, Italy. Electronic address: faupe@libero.it.
authors.forename: Fausto
authors.initials: F
authors.lastname: Petrelli
authors.affiliation: Surgical Department, Urology Unit, Azienda Ospedaliera Treviglio, Treviglio, Bergamo, Italy.
authors.forename: Ivano
authors.initials: I
authors.lastname: Vavassori
authors.affiliation: Oncology Department, Medical Oncology Unit, Azienda Ospedaliera Treviglio, Treviglio, Bergamo, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Coinu
authors.affiliation: Oncology Department, Medical Oncology Unit, Azienda Ospedaliera Treviglio, Treviglio, Bergamo, Italy.
authors.forename: Karen
authors.initials: K
authors.lastname: Borgonovo
authors.affiliation: Oncology Department, Radiotherapy Unit, Azienda Ospedaliera Treviglio, Treviglio, Bergamo, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Sarti
authors.affiliation: Oncology Department, Medical Oncology Unit, Azienda Ospedaliera Treviglio, Treviglio, Bergamo, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Barni
mesh_terms: D006801:Humans; D008297:Male; D011379:Prognosis; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D011878:Radiotherapy; D012307:Risk Factors
keywords: Cancer mortality; Overall survival; Prostate carcinoma; Radiation therapy; Surgery