Adjuvant Chemotherapy in High-Risk Prostate Cancer Patients after Primary Local Therapy: Recurrence, Metastasis, and Survival – A Meta-Analysis

Abstract

<b><i>Context:</i></b> Several randomized clinical trials (RCTs) have recently tested adjuvant chemotherapy to high-risk prostate cancer patients (PCA) after primary local therapy. <b><i>Objective:</i></b> The aim of the study was to perform a systematic review and meta-analysis of RCTs evaluating the adjuvant chemotherapy in high-risk prostate cancer patients after primary local therapy. The primary endpoint was overall survival (OS). The secondary endpoint was disease-free survival (DFS) and biochemical recurrence-free survival (BRFS). <b><i>Methods:</i></b> A systematic review of PubMed/Medline, Embase, and Cochrane databases was performed to identify relevant studies published in English up to March 2020. Six trials were selected for inclusion. <b><i>Results:</i></b> There were 7 studies included in the present study. The meta-analysis did not show a significant OS benefit from adjuvant chemotherapy in patients with high-risk prostate cancer after primary local therapy (hazard ratio [HR]: 0.87; 95% confidence interval [CI], 0.72–1.05; <i>p =</i> 0.15). But docetaxel in patients with high-risk prostate cancer after primary local therapy was associated with a slightly OS improvement (HR: 0.79; 95% CI, 0.63–0.98; <i>p</i> = 0.03). It also did not show a significant benefit in DFS and BRFS in patients with high-risk prostate cancer (HR: 0.89, 95% CI, 0.75–1.06, <i>p</i> = 0.18; HR: 0.85, 95% CI, 0.69–1.06, <i>p</i> = 0.16). <b><i>Conclusions:</i></b> This meta-analysis shows a slightly OS benefit from docetaxel in patients with high-risk prostate cancer after primary local therapy. It did not show a significant benefit in DFS and BRFS from adjuvant chemotherapy in patients with high-risk prostate cancer.