TY - JOUR
T1 - Delayed radical prostatectomy for localised prostate cancer – A systematic review and meta-analysis for the COVID-19 Pandemic
AU - Chan, Vinson Wai-Shun
AU - Tan, Wei Shen
AU - Asif, Aqua
AU - Ng, Alexander
AU - Gbolahan, Olayinka
AU - Dinneen, Eion
AU - To, Wilson
AU - Kadhim, Hassan
AU - Premchand, Melissa
AU - Burton, Oliver
AU - Koe, Jasmine Sze-Ern
AU - Wang, Nicole
AU - Leow, Jeffrey
AU - Giannarini, Gianluca
AU - Vasdev, Nikhil
AU - Shariat, S. F.
AU - Enikeev, Dmitry
AU - Ng, Chi Fai
AU - Teoh, Jeremy
N1 - © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons
Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
PY - 2021/6/30
Y1 - 2021/6/30
N2 - 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.
AB - 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.
U2 - 10.3390/cancers13133274
DO - 10.3390/cancers13133274
M3 - Article
SN - 2072-6694
VL - 13
JO - Cancers
JF - Cancers
IS - 13
M1 - 3274
ER -