Zhang Pu, Qian Bei, Shi Jiawei, Xiao Yajun
Department of Urology Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
Transl Androl Urol. 2020 Apr;9(2):332-343. doi: 10.21037/tau.2020.02.15.
Prostate cancer (PCa) is a form of malignancy that harms the health status of elderly men worldwide. It is unclear which of radical prostatectomy (RP) or brachytherapy (BT) is the more effective treatment for PCa. This study presents the first highly comprehensive and up-to-date comparative analysis of the overall outcomes of RP versus BT.
We conducted a systematic literature search for studies published on PubMed, EMBASE, and the Cochrane Library on the outcomes of RP versus BT in clinically localized PCa. The cumulative analysis was performed using Review Manager Version 5.3 software, and the Chi-square test was employed to test the statistical heterogeneity. The summary odds ratio (OR) and standard mean difference (SMD) was estimated using random effects models at 95% confidence intervals (CIs).
In total, 2 randomized, 2 prospective, and 21 retrospective comparative studies were included. No significant differences in biochemical recurrence rate (BCR) (OR: 1.24; 95% CI: 0.91, 1.68) and prostate cancer-specific mortality (PCSM) (OR: 1.62; 95% CI: 0.86, 3.04) between RP and BT were noted. With erectile dysfunction and urinary incontinence, BT was more protective than RP in both short-term post-operative reports (OR: 2.06; 95% CI: 1.15, 3.70 and OR: 4.62; 95% CI: 2.33, 9.16) and long-term patient outcome reports (SMD: -5.62; 95% CI: -13.81, 2.57 and SMD: -11.52; 95% CI: -18.32, -4.72).
BT and RP for PCa therapy pose comparable risks of PCSM and BCR, while BT is associated with a lower incidence of erectile dysfunction and urinary incontinence. This study tentatively confirms that BT is an alternative to RP for patients seeking a curative treatment with minimal risks of urinary incontinence and sexual dysfunction.
前列腺癌（PCa）是一种危害全球老年男性健康状况的恶性肿瘤。目前尚不清楚根治性前列腺切除术（RP）和近距离放射治疗（BT）哪种对PCa的治疗更有效。本研究首次对RP与BT的总体疗效进行了高度全面且最新的比较分析。
我们在PubMed、EMBASE和Cochrane图书馆系统检索了关于临床局限性PCa中RP与BT疗效的研究。使用Review Manager 5.3软件进行累积分析，并采用卡方检验来检验统计异质性。汇总比值比（OR）和标准化均数差（SMD）采用随机效应模型在95%置信区间（CI）下进行估计。
总共纳入了2项随机对照研究、2项前瞻性研究和21项回顾性比较研究。RP与BT在生化复发率（BCR）（OR：1.24；95%CI：0.91，1.68）和前列腺癌特异性死亡率（PCSM）（OR：1.62；95%CI：0.86，3.04）方面未发现显著差异。在勃起功能障碍和尿失禁方面，无论是术后短期报告（OR：2.06；95%CI：1.15，3.70和OR：4.62；95%CI：2.33，9.16）还是长期患者结局报告（SMD：-5.62；95%CI：-13.81，2.57和SMD：-11.52；95%CI：-18.32，-4.72）中，BT对这些方面的保护作用均优于RP。
PCa治疗中BT和RP在PCSM和BCR方面的风险相当，而BT与较低的勃起功能障碍和尿失禁发生率相关。本研究初步证实，对于寻求具有最低尿失禁和性功能障碍风险的根治性治疗的患者，BT是RP的一种替代方案。
