Local Therapy Improves Overall Survival in cN1 Prostate Cancer

Local therapy improves overall survival (OS) in patients with clinically lymph node-positive (cN1) prostate cancer, according to a meta-analysis published in European Urology Oncology.

Researchers found that local therapy — either radiotherapy or radical prostatectomy — improved OS in patients with cN1 prostate cancer.

This meta-analysis included data from 8522 patients in 8 retrospective studies. The cohort included 5717 patients who received local therapy — 1723 who underwent radical prostatectomy and 3994 who received radiotherapy. Patients who did not receive local therapy (n=2805) were treated with androgen deprivation therapy (ADT) or observed.

Patients who received local therapy had significantly longer OS than those who did not receive it. This OS benefit began at 2 years (odds ratio [OR], 1.76; 95% CI, 1.04-2.98; P =.04) and continued through to the last time point evaluated, at 10 years (OR, 1.49; 95% CI, 1.06-2.10; P =.03).

There was a significant improvement in OS with radiotherapy, compared to no local therapy, from 4 years (OR, 1.79; 95% CI, 1.40-2.29; P <.01) up to 8 years (OR, 1.64; 95% CI, 1.07-2.51; P =.03). There was no significant improvement in OS with radiotherapy at 2 years (OR, 1.71; 95% CI, 0.82-3.57; P =.10) or 10 years (OR, 1.69; 95% CI, 0.98-2.19; P =.06).

Data comparing radical prostatectomy to no local therapy were not reported.

The addition of local therapy to ADT was associated with a significant improvement in OS at 4 years (OR, 1.94; 95% CI, 1.45-2.61; P =.01) but not 2 years (OR, 1.44; 95% CI, 0.22-9.65; P =.50). Later time points were not available for this comparison.

There was no significant difference in OS with radiotherapy or radical prostatectomy, with or without ADT, at 2 years (OR, 0.59; 95% CI, 0.14-2.49; P =.26) or at 4 years (OR, 0.76; 95% CI, 0.41-1.40; P =.19). Later time points were not available for this comparison.

“This present systematic review and meta-analysis suggests that the use of LT [local therapy] in PCa [prostate cancer] patients with cN1 disease leads to improved oncological outcomes compared with observation or ADT alone,” the researchers wrote. “Despite the lack of high-level evidence for analysis, it can be suggested that LT should be recommended for cN1 patients, although it would be beneficial for future studies to elucidate specific patient populations that would derive the greatest benefit from LT.”

Reference

Yaow CYL, Lee HJ, Teoh SE, et al. Local therapy on clinically lymph node–positive prostate cancer: A systematic review and meta-analysis. Eur Urol Oncol. Published online September 18, 2023. doi:10.1016/j.euo.2023.09.002

This article originally appeared on Cancer Therapy Advisor