Effects of Delayed Radical Prostatectomy and Active Surveillance on Localised Prostate Cancer—A Systematic Review and Meta-Analysis

Cancers

Nikhil Vasdev¹  Hassan Kadhim²  Shahrokh F. Shariat³  Melissa Premchand⁴  Wilson To⁵  Olayinka Gbolahan⁵  Jeffrey J. Leow⁶  Wei Shen Tan⁷  Aqua Asif⁷  Eoin Dinneen⁷  Dmitry Enikeev⁸  Chi Fai Ng⁹  Jeremy Yuen-Chun Teoh⁹  Vinson Wai-Shun Chan^1,10  Jasmine Sze-Ern Koe^1,10  Nicole Wang^1,11  Alexander Ng^1,11  Gianluca Giannarini^1,12  Oliver Burton^1,13 

[1] Department of Urology, Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital Stevenage, School of Medicine and Life Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK;Department of Urology, Ipswich Hospital, Ipswich IP4 5PD, UK;Department of Urology, Medical University of Vienna, 1090 Vienna, Austria;Department of Urology, Northwick Park Hospital, London HA1 3UJ, UK;Department of Urology, Royal Free Hospital, London NW3 2QG, UK;Department of Urology, Tan Tock Seng Hospital, Singapore 308433, Singapore;Division of Surgery and Interventional Science, University College London, London W1W 7TS, UK;Institute for Urology and Reproductive Health, Sechenov University, 119991 Moscow, Russia;S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China;School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK;UCL Medical School, University College London, London WC1E 6DE, UK;Urology Unit, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy;Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK;

关键词: COVID-19;    prostate cancer;    radical prostatectomy;    treatment delay;    surgical waiting time;    active surveillance;   

DOI  :  10.3390/cancers13133274

来源: DOAJ

【 摘 要 】

External factors, such as the coronavirus disease 2019 (COVID-19), can lead to cancellations and backlogs of cancer surgeries. The effects of these delays are unclear. This study summarised the evidence surrounding expectant management, delay radical prostatectomy (RP), and neoadjuvant hormone therapy (NHT) compared to immediate RP. MEDLINE and EMBASE was searched for randomised controlled trials (RCTs) and non-randomised controlled studies pertaining to the review question. Risks of biases (RoB) were evaluated using the RoB 2.0 tool and the Newcastle–Ottawa Scale. A total of 57 studies were included. Meta-analysis of four RCTs found overall survival and cancer-specific survival were significantly worsened amongst intermediate-risk patients undergoing active monitoring, observation, or watchful waiting but not in low- and high-risk patients. Evidence from 33 observational studies comparing delayed RP and immediate RP is contradictory. However, conservative estimates of delays over 5 months, 4 months, and 30 days for low-risk, intermediate-risk, and high-risk patients, respectively, have been associated with significantly worse pathological and oncological outcomes in individual studies. In 11 RCTs, a 3-month course of NHT has been shown to improve pathological outcomes in most patients, but its effect on oncological outcomes is apparently limited.

【 授权许可】

Unknown