Cancer treatment reviews · 2025
Primary tumor and metastasis-directed treatment for oligometastatic prostate cancer: An umbrella review of meta-analyses.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод в очереди
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Petrelli Fausto, Trevisan Francesca, Bruschieri Lorenza, Riboldi Valentina, Vavassori Ivano, Seghezzi Silvia, Esposito Andrea, Dottorini Lorenzo, Stefani Agostina De
Аннотация
BACKGROUND: The management of metastatic prostate cancer (mPC) has shifted from a purely systemic approach to an integrated paradigm incorporating local and metastasis-directed therapies. Advances in imaging and improved characterization of the oligometastatic state have stimulated renewed interest in aggressive multimodal treatment strategies.
OBJECTIVE: To systematically evaluate and grade the evidence from published meta-analyses investigating the efficacy, safety, and credibility of local and metastasis-directed treatments in metastatic or oligometastatic prostate cancer.
DESIGN, SETTING, AND PARTICIPANTS: This umbrella review followed PRISMA 2020 recommendations and Ioannidis umbrella-review methodology. PubMed, Embase, Web of Science, and Cochrane Library were searched through June 2025. Eligible studies were systematic reviews or meta-analyses with quantitative pooling of outcomes for local treatment (LT; prostate radiotherapy [RT] or radical prostatectomy [RP]), cytoreductive radical prostatectomy (CRP), or metastasis-directed therapy (MDT) using stereotactic body radiotherapy (SBRT). Twenty-one meta-analyses published between 2018 and 2025, enrolling > 160 000 patients, were included.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Primary endpoints were overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS). Secondary endpoints included local control, toxicity, and prevention of symptomatic pelvic events. When multiple meta-analyses assessed the same association, second-level pooling was performed. Evidence credibility was graded as strong, highly suggestive, suggestive, or weak.
RESULTS AND LIMITATIONS: Prostate RT improved OS in low-volume metastatic hormone-sensitive disease (pooled HR ≈ 0.64-0.73) with minimal grade ≥ 3 toxicity (∼5%) and low heterogeneity (I2 ≈ 0 %). CRP demonstrated suggestive OS and CSS advantages (HR/OR ≈ 0.6-0.8; CSS ≈ 0.5) versus systemic therapy alone but no superiority over RT. MDT/SBRT significantly prolonged PFS (HR ≈ 0.48) and showed emerging OS benefit (HR ≈ 0.60) across randomized trials, with very low rates of serious toxicity (<2%). Local therapy halved the risk of symptomatic pelvic complications (RR 0.50). Limitations include residual heterogeneity in imaging, disease definitions, and non-randomized data for surgical outcomes.
CONCLUSIONS: Across 21 meta-analyses, prostate RT provides highly suggestive evidence of survival benefit in low-volume mHSPC, CRP offers suggestive survival improvement in selected patients, and MDT/SBRT achieves highly suggestive evidence for progression control with emerging OS benefit. These strategies represent validated, evidence-based components of modern multimodal mPC management.
OBJECTIVE: To systematically evaluate and grade the evidence from published meta-analyses investigating the efficacy, safety, and credibility of local and metastasis-directed treatments in metastatic or oligometastatic prostate cancer.
DESIGN, SETTING, AND PARTICIPANTS: This umbrella review followed PRISMA 2020 recommendations and Ioannidis umbrella-review methodology. PubMed, Embase, Web of Science, and Cochrane Library were searched through June 2025. Eligible studies were systematic reviews or meta-analyses with quantitative pooling of outcomes for local treatment (LT; prostate radiotherapy [RT] or radical prostatectomy [RP]), cytoreductive radical prostatectomy (CRP), or metastasis-directed therapy (MDT) using stereotactic body radiotherapy (SBRT). Twenty-one meta-analyses published between 2018 and 2025, enrolling > 160 000 patients, were included.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Primary endpoints were overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS). Secondary endpoints included local control, toxicity, and prevention of symptomatic pelvic events. When multiple meta-analyses assessed the same association, second-level pooling was performed. Evidence credibility was graded as strong, highly suggestive, suggestive, or weak.
RESULTS AND LIMITATIONS: Prostate RT improved OS in low-volume metastatic hormone-sensitive disease (pooled HR ≈ 0.64-0.73) with minimal grade ≥ 3 toxicity (∼5%) and low heterogeneity (I2 ≈ 0 %). CRP demonstrated suggestive OS and CSS advantages (HR/OR ≈ 0.6-0.8; CSS ≈ 0.5) versus systemic therapy alone but no superiority over RT. MDT/SBRT significantly prolonged PFS (HR ≈ 0.48) and showed emerging OS benefit (HR ≈ 0.60) across randomized trials, with very low rates of serious toxicity (<2%). Local therapy halved the risk of symptomatic pelvic complications (RR 0.50). Limitations include residual heterogeneity in imaging, disease definitions, and non-randomized data for surgical outcomes.
CONCLUSIONS: Across 21 meta-analyses, prostate RT provides highly suggestive evidence of survival benefit in low-volume mHSPC, CRP offers suggestive survival improvement in selected patients, and MDT/SBRT achieves highly suggestive evidence for progression control with emerging OS benefit. These strategies represent validated, evidence-based components of modern multimodal mPC management.