title: Systematic review and meta-analysis of the survival outcomes of first-line treatment options in high-risk prostate cancer.
abstract: Prostate cancer (PCa) is the most common non-dermatologic cancer in the western countries in western countries. High-risk PCa accounts for 15% of the diagnosed cases. In this study, we compare the long-term survival outcomes of radical prostatectomy (RP), radiation therapy (RT), brachytherapy (BT), androgen- deprivation therapy (ADT), and watchful waiting (WW) in high-risk prostate cancer (PCa). Overall, RP/(RT plus ADT) gave the best survival outcome in patients with high-risk PCa, whereas ADT/WW had the worst outcome. The overall priority for treatment strategy could be ranked as follows: RP/(RT plus ADT), RT, and ADT/WW. RP had significant better overall survival (OS) than RT or BT, and RP had significant lower cancer-specific mortality (CSM) than RT (0.51 [95% CI 0.30-0.73], P<0.001). ADT improved the cancer-specific survival (CSS) of RP based on a case-controlled study; added ADT to RT failed to challenge the position of RP but could improve the outcome of RT. In conclusions,RP/(RT plus adjuvant ADT) could both be used for the first-line therapy of high-risk PCa. When encountering an individual patient, urologists should consider various factors like tumors themselves, preferences of individuals, and so on.
authors.affiliation: Department of Urology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Jun H
authors.initials: JH
authors.lastname: Lei
authors.affiliation: Department of Urology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Liang R
authors.initials: LR
authors.lastname: Liu
authors.affiliation: Department of Urology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Wei
authors.affiliation: Department of Urology, Dujiangyan Medical Center/ the affiliated hospital of Chengdu University, Dujianyan, China.
authors.forename: Shi B
authors.initials: SB
authors.lastname: Yan
authors.affiliation: Department of Urology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Tu R
authors.initials: TR
authors.lastname: Song
authors.affiliation: Department of Urology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Fu S
authors.initials: FS
authors.lastname: Lin
authors.affiliation: Department of Urology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Lu
authors.initials: L
authors.lastname: Yang
authors.affiliation: Department of Urology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: De H
authors.initials: DH
authors.lastname: Cao
authors.affiliation: Department of Urology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Hai C
authors.initials: HC
authors.lastname: Yuan
authors.affiliation: Department of Urology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Wen B
authors.initials: WB
authors.lastname: Xue
authors.affiliation: Department of Urology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Xiao
authors.initials: X
authors.lastname: Lv
authors.affiliation: Department of Urology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Ying C
authors.initials: YC
authors.lastname: Cai
authors.affiliation: Department of Urology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Zeng
authors.affiliation: Department of Urology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Han
mesh_terms: D003131:Combined Modality Therapy; D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D057832:Watchful Waiting