Prostatectomía radical citorreductora comparado a no realizar tratamiento local en pacientes con cáncer de próstata metastásico

Resúmenes Epistemonikos

Published on 25 de mayo de 2023 | http://doi.org/10.5867/medwave.2023.04.2661

Prostatectomía radical citorreductora comparado a no realizar tratamiento local en pacientes con cáncer de próstata metastásico

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About the body of evidence for this question.

What is the evidence See the evidence matrix in Epistemonikos later	Twelve systematic reviews [3,10–20] were found, including seven primary studies [21–27], none of which were trials. Two were case-control reports [22,27], and five corresponded to cohort studies [21,23–26]. One study was not used in the analyses presented below [25] because it analyzes the same database as another included study [24], where the latter uses a more updated version of the database, and the data were supplemented with other sources.
What types of patients were included*	All selected studies included men with metastatic prostate adenocarcinoma at diagnosis.Three studies excluded patients with visceral metastases [23,27], and one also excluded lymph node metastases [22]. One study included men with bone, visceral, and lymph node metastases [26], and two did not report information on this matter [21,24].The average age of the patients was reported only in five studies, ranging from 61 to 78 years old.
What types of interventions were included*	All primary studies aimed to evaluate the effect of local treatment in patients with metastatic prostate cancer compared to no local treatment. The interventions included in the local treatment group varied across studies, but all included radical prostatectomy or cytoreductive prostatectomy. Two studies included other interventions [24,26], termed: conformal radiation therapy, intensity-modulated radiation therapy, and radiotherapy, but only outcomes related to surgery of the primary tumor were reported in this summary. Neoadjuvant and adjuvant treatment with androgen deprivation therapy was allowed in this group.The comparator, no local treatment, was defined as androgen deprivation therapy with or without chemotherapy.
What types of outcomes were measured	The studies evaluated multiple outcomes, which were grouped by the systematic reviews as follows: All-cause mortality Cancer-specific mortality Disease progression Development of castration resistance Complications grade (Clavien-Dindo classification) Severe local complications Outcomes only reported for the group with local treatment: Operating room time Blood loss Blood transfusions Length of hospital stay Catheterization time Biochemical relapse Urinary continence Outcomes reported only for the group without local treatment: Urinary tract complications for patients without local treatment Surgical or percutaneous interventions for patients without local treatment The median follow-up of the studies ranged from 20 to 82.2 months.