Effects of Delayed Radical Prostatectomy and Active Surveillance on Localised Prostate Cancer—A Systematic Review and Meta-Analysis
| Autor: | Chi-Fai Ng, Aqua Asif, Oliver Burton, Shahrokh F. Shariat, Olayinka Gbolahan, Jasmine Sze Ern Koe, Melissa Premchand, G. Giannarini, Nicole Wang, Jeffrey J. Leow, Vinson Wai-Shun Chan, Wilson To, Dmitry Enikeev, Wei Shen Tan, Nikhil Vasdev, Eoin Dinneen, Hassan Kadhim, Jeremy Yuen-Chun Teoh, Alexander Ng |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Cancer Research
medicine.medical_specialty medicine.medical_treatment 030232 urology & nephrology MEDLINE 03 medical and health sciences Prostate cancer 0302 clinical medicine Internal medicine treatment delay medicine RC254-282 business.industry Prostatectomy active surveillance Cancer COVID-19 Neoplasms. Tumors. Oncology. Including cancer and carcinogens surgical waiting time medicine.disease prostate cancer radical prostatectomy Oncology 030220 oncology & carcinogenesis Meta-analysis Observational study Hormone therapy Systematic Review business Watchful waiting |
| Zdroj: | Cancers, Vol 13, Iss 3274, p 3274 (2021) Cancers |
| ISSN: | 2072-6694 |
| Popis: | Simple Summary We reviewed the evidence available for postponing or delaying cancer surgery for localised prostate cancer. Watchful waiting is an acceptable option in low-risk patients. Evidence is uncertain in postponing surgery, but conservative estimates suggest delays of over 5 months, 4 months, and 30 days for low-, intermediate-, and high-risk patients, respectively, can lead to worse survival outcomes. Neoadjuvant therapy can shrink the tumours prior to surgery and can be a useful adjunct in delaying surgery for, at the most, 3 months. Abstract 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. |
| Databáze: | OpenAIRE |
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