ABSTRACT
ABSTRACT
Purpose:
To compare biochemical
recurrence, sexual
potency and urinary continence outcomes of ablative
therapy and radical
treatment (radical
prostatectomy or
radiotherapy with
androgen deprivation
therapy). Material and
methods:
A
systematic review and
meta-analysis followed the PRISMA guidelines were performed. We searched
MEDLINE/
PubMed. Biochemical
recurrence at three and five years; incontinence rate (
patients who used one pad or more) and
erectile dysfunction rate at 12 and 36 months (
patients who did not have sufficient erection to achieve
sexual intercourse) were evaluated. The Mantel-Haenszel
method was applied to estimate the pooled
risk difference (RD) in the individual studies for categorical variables. All results were presented as 95%
confidence intervals (95%CI). Random effects models were used regardless of the level of heterogeneity (I²). (PROSPERO CRD42022296998).
Results:
Eight studies comprising 2,677
men with
prostate cancer were included. There was no difference in biochemical
recurrence between ablative and radical
treatments. We observed the same biochemical
recurrence between ablative
therapy and radical
treatment within five years (19.3% vs. 16.8%, respectively; RD 0.07; 95%CI=-0.05, 0.19; I2=68.2%; P=0.08) and continence rate at 12 months (9.2% vs. 31.8%, respectively; RD −0.13; 95%CI, −0.27, 0.01; I2=89%; P=0.32). When focal
treatment was analyzed alone, two studies with 582
patients found higher erectile function at 12 months in the ablative
therapy group than in the radical
treatment (88.9% vs. 30.8%, respectively; RD −0.45; 95%CI −0.84, −0.05; I2=93%; P=0.03).
Conclusion:
Biochemical
recurrence and urinary continence outcomes of ablative
therapy and radical
treatment were
similar. Ablative
therapy appears to have a high rate of sexual
potency.
