title: Impact of local treatment on overall survival of patients with metastatic prostate cancer: systematic review and meta-analysis.
abstract: BACKGROUND
  Currently, standard treatment of metastatic prostatic cancer (MPCa) is androgen-deprivation therapy (ADT). Recent studies suggested that local treatment of MPCa is related to increase of survival of those patients, as observed in other tumors.
  
  
  OBJECTIVE
  To evaluate the impact of local treatment on overall survival and cancer specific survival in 3 and 5 years in patients with MPCa.
  
  
  METHODS
  Systematic review and meta-analysis of population studies published at PubMed, Scielo, Lilacs, Cochrane and EMBASE databases until June 2016. Several large cohorts and Post-Roc studies were included, that evaluated patients with MPCa submitted to local treatment (LT) using radiotherapy (RDT), surgery (RP) or brachytherapy (BCT) or not submitted to local treatment (NLT).
  
  
  RESULTS
  34.338 patients were analyzed in six included papers, 31.653 submitted to NLT and 2.685 to LT. Overall survival in three years was significantly higher in patients submitted to LT versus NLT (64.2% vs. 44.5%; RD 0.19, 95% CI, 0.17-0.21; p<0.00001; I²=0%), as well as in five years (51.9% vs. 23.6%; RD 0.30, 95% CI, 0.11-0.49; p<0.00001; I²=97%). Sensitive analysis according to type of local treatment showed that surgery (78.2% and 45.0%; RD 0.31, 95% CI, 0.26-0.35; p<0.00001; I²=50%) and radiotherapy (60.4% and 44.5%; RD 0.17, 95% CI, 0.12-0.22; p<0.00001; I²=67%) presented better outcomes.
  
  
  CONCLUSIONS
  LT using RDT, RP or BCT seems to significantly improve overall survival and cancer-specific survival of patients with metastatic prostatic cancer. Prospective and randomized studies must be performed in order to confirm our results.
authors: Departamento de Urologia, Hospital Israelita Albert Einstein, SP, Brasil.|Departamento de Urologia, Faculdade de Medicina do ABC, SP, Brasil.
authors: Arie
authors: A
authors: Carneiro
authors: Departamento de Urologia, Faculdade de Medicina do ABC, SP, Brasil.
authors: Willy
authors: W
authors: Baccaglini
authors: Faculdade de Ciências Médicas, Universidade Metropolitana de Santos, SP, Brasil.
authors: Felipe P A
authors: FPA
authors: Glina
authors: Departamento de Urologia, Hospital Israelita Albert Einstein, SP, Brasil.
authors: Paulo P
authors: PP
authors: Kayano
authors: Centro Universitário Lusiada, Faculdade de Ciências Médicas de Santos, SP, Brasil.
authors: Victor M
authors: VM
authors: Nunes
authors: Departamento de Oncologia, Hospital Israelita Albert Einstein, São Paulo, Brasil.
authors: Oren
authors: O
authors: Smaletz
authors: Centro Universitário Lusiada, Faculdade de Ciências Médicas de Santos, SP, Brasil.
authors: Wanderley Marques
authors: WM
authors: Bernardo
authors: Departamento de Radioterapia, Hospital Israelita Albert Einstein, São Paulo, Brasil.
authors: Icaro Thiago de
authors: IT
authors: Carvalho
authors: Departamento de Urologia, Hospital Israelita Albert Einstein, SP, Brasil.
authors: Gustavo Caserta
authors: GC
authors: Lemos
mesh_terms: D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D009362:Neoplasm Metastasis; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*
keywords: Prostate; Prostatic Neoplasms; Radiation Oncology; Survival