BACKGROUND Approximately 30%of patients with localized prostate cancer(PCa)who undergo radical prostatectomy will develop biochemical recurrence.In these patients,the only potentially curative treatment is postoperati...BACKGROUND Approximately 30%of patients with localized prostate cancer(PCa)who undergo radical prostatectomy will develop biochemical recurrence.In these patients,the only potentially curative treatment is postoperative radiotherapy(PORT)with or without hormone therapy.However,the optimal radiotherapy dose is unknown due to the limited data available.AIM To determine whether the postoperative radiotherapy dose influences biochemical failure-free survival(BFFS)in patients with PCa.METHODS Retrospective analysis of patients who underwent radical prostatectomy for PCa followed by PORT-either adjuvant radiotherapy(ART)or salvage radiotherapy(SRT)-between April 2002 and July 2015.From 2002 to 2010,the prescribed radiation dose to the surgical bed was 66-70 Gy in fractions of 2 Gy;from 2010 until July 2015,the prescribed dose was 70-72 Gy.Patients were grouped into three categories according to the total dose administered:66-68 Gy,70 Gy,and 72 Gy.The primary endpoint was BFFS,defined as the post-radiotherapy prostatespecific antigen(PSA)nadir+0.2 ng/mL.Secondary endpoints were overall survival(OS),cancer-specific survival(CSS),and metastasis-free survival(MFS;based on conventional imaging tests).Treatment-related genitourinary(GU)and gastrointestinal(GI)toxicity was evaluated according to Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria.Finally,we aimed to identify potential prognostic factors.BFFS,OS,CSS,and MFS were calculated with the Kaplan-Meier method and the log-rank test.Univariate and multivariate Cox regression models were performed to explore between-group differences in survival outcome measures.RESULTS A total of 301 consecutive patients were included.Of these,93(33.6%)received ART and 186(66.4%)SRT;22 patients were excluded due to residual macroscopic disease or local recurrence in the surgical bed.In this subgroup(n=93),43 patients(46.2%)were Gleason score(GS)≤6,44(47.3%)GS 7,and 6(6.5%)GS≥8;clinical stage was cT1 in 51(54.8%),cT2 in 35(39.3%),and cT3 in one patient(1.1%);PSA was<10 ng/mL in 58(63%)patients,10-20 ng/mL in 28(30.6%),and≥20 ng/mL in 6(6.4%)patients.No differences were found in BFFS in this patient subset versus the entire cohort of patients(P=0.66).At a median follow-up of 113 months(range,4-233),5-and 10-year BFFS rates were 78.8%and 73.7%,respectively,with OS rates of 93.3%and 81.4%.The 5-year BFFS rates in three groups were as follows:69.6%(66-68 Gy),80.5%(70 Gy)and 82.6%(72 Gy)(P=0.12):the corresponding 10-year rates were 63.9%,72.9%,and 82.6%(P=0.12),respectively.No significant between-group differences were observed in MFS,CSS,or OS.On the univariate analysis,the following variables were significantly associated with BFFS:PSA at diagnosis;clinical stage(cT1 vs cT2);GS at diagnosis;treatment indication(ART vs SRT);pre-RT PSA levels;and RT dose 66-68 Gy vs.72 Gy(HR:2.05;95%CI:1.02-4.02,P=0.04).On the multivariate analysis,the following variables remained significant:biopsy GS(HR:2.85;95%CI:1.83-4.43,P<0.001);clinical stage(HR:2.31;95%CI:1.47-4.43,P=0.01);and treatment indication(HR:4.11;95%CI:2.06-8.17,P<0.001).Acute grade(G)1 GU toxicity was observed in 11(20.4%),17(19.8%),and 3(8.3%)patients in each group(66-68 Gy,70 Gy and 72 Gy),respectively(P=0.295).Acute G2 toxicity was observed in 2(3.7%),4(4.7%)and 2(5.6%)patients,respectively(P=0.949).Acute G1 GI toxicity was observed in 16(29.6%),23(26.7%)and 2(5.6%)patients in each group,respectively(P=0.011).Acute G2 GI toxicity was observed in 2(3.7%),6(6.9%)and 1(2.8%)patients,respectively(P=0.278).No cases of acute G3 GI toxicity were observed.CONCLUSION The findings of this retrospective study suggest that postoperative radiotherapy dose intensification in PCa is not superior to conventional radiotherapy treatment.展开更多
AIM: To evaluate the long-term outcomes of patients receiving adjuvant and salvage radiotherapy following prostatectomy with adverse pathologic features and an undetectable prostate specific antigen(PSA).METHODS: A re...AIM: To evaluate the long-term outcomes of patients receiving adjuvant and salvage radiotherapy following prostatectomy with adverse pathologic features and an undetectable prostate specific antigen(PSA).METHODS: A retrospective review was performed of patients who received post-prostatectomy radiation at Loyola University Medical Center between 1992 and 2013. Adverse pathologic features(Gleason score ≥ 8, seminal vesicle invasion, extracapsular extension, pathologic T4 disease, and/or positive surgical margins) and an undetectable PSA following prostatectomy were required for inclusion. Adjuvant patients received therapy with an undetectable PSA, salvage patients following biochemical recurrence(BCR). Post-radiation BCR, overall survival, bone metastases, and initiation of hormonal therapy were assessed. Kaplan-Meier time-to-event analyses and stepwise Cox proportional hazards regression(HR) were performed. RESULTS: Post-prostatectomy patients(n = 134) received either adjuvant(n = 47) or salvage(n = 87) radiation. Median age at radiotherapy(RT) was 63 years, and median follow-up was 53 mo. Five-year post-radiation BCR-free survival was 78% for adjuvant vs 50% salvage radiotherapy(SRT)(Logrank P = 0.001). Patients with radiation administered following a detectable PSA had an increased risk of BCR compared to undetectable: PSA > 0.0-0.2: HR = 4.1(95%CI: 1.5-11.2; P = 0.005); PSA > 0.2-1.0: HR = 4.4(95%CI: 1.6-11.9; P = 0.003); and PSA > 1.0: HR = 52(95%CI: 12.9-210; P < 0.001). There was no demonstrable difference in rates of overall survival, bone metastases or utilization of hormonal therapy between adjuvant and SRT patients. CONCLUSION: Adjuvant RT improves BCR-free survival compared to SRT in patients with adverse pathologic features and an undetectable post-prostatectomy PSA.展开更多
AIM:To investigate the role of neoadjuvant chemoradiotherapy in prognosis and surgery for esophageal carcinoma by a meta-analysis.METHODS:PubMed and manual searches were done to identify all published randomized contr...AIM:To investigate the role of neoadjuvant chemoradiotherapy in prognosis and surgery for esophageal carcinoma by a meta-analysis.METHODS:PubMed and manual searches were done to identify all published randomized controlled trials(RCTs) that compared neoadjuvant chemoradiotherapy plus surgery(CRTS) with surgery alone(S) for esophageal cancer.According to the test of heterogeneity,a fi xed-effect model or a random effect model was used and the odds ratio(OR) was the principal measure of effects.RESULTS:Fourteen RCTs that included 1737 patients were selected with quality assessment ranging from A to C(Cochrane Reviewers' Handbook 4.2.2).OR(95% CI,P value),expressed as CRTS vs S(values>1 favor CRTS arm),was 1.19(0.94-1.48,P=0.28) for 1-year survival,1.33(1.07-1.65,P=0.69) for 2-year survival,1.76(1.42-2.19,P=0.11) for 3-year survival,1.41(1.06-1.87,P=0.11) for 4-year survival,1.64(1.28-2.12,P=0.40) for 5-year survival,0.82(0.39-1.73,P<0.0001) for rate of resection,1.53(1.33-2.84,P=0.007) for rate of complete resection,1.78(1.14-2.78,P=0.79) for operative mortality,1.12(0.89-2.48,P=0.503) for all treatment mortality,1.33(0.94-1.88,P=0.04) for the rate of adverse treatment,1.38(1.23-1.63,P=0.0002) for local-regional cancer recurrence,1.28(0.85-1.58,P=0.60) for distant cancer recurrence,and 1.27(0.86-1.65,P=0.19) for all cancer recurrence.A complete pathological response to chemoradiotherapy occurred in 10%-45.5% of patients.The 5-year survival benefi t was most pronounced when chemotherapy and radiotherapy were given concurrently(OR:1.45,95% CI:1.26-1.79,P=0.015) instead of sequentially(OR:0.85,95% CI:0.64-1.35,P=0.26).CONCLUSION:Compared with surgery alone,neoadjuvant chemoradiotherapy can improve the long-term survival and reduce local-regional cancer recurrence.Concurrent administration of neoadjuvant chemoradiotherapy was superior to sequential chemoradiotherapy.展开更多
Background and Objective: In computed tomography (CT)-based radiotherapy planning for prostate cancer, it is difficult to precisely delineate the prostatic apex because of its relationship with the urogenital diaphrag...Background and Objective: In computed tomography (CT)-based radiotherapy planning for prostate cancer, it is difficult to precisely delineate the prostatic apex because of its relationship with the urogenital diaphragm and bulbospongiosus musculature. In this retrospective study, we analyzed the magnetic resonance imaging (MRI) and CT scans of the patients with prostate cancer to investigate the relationship between the prostatic apex and the anatomic structure visible on CT, and to provide evidence for localizing the prostatic apex in radiotherapy planning. Methods: MRI and CT scans of 108 patients with prostate cancer were analyzed to measure the distances between the prostatic apex and the bottom of ischial tuberosities, the bottom of obturator foramen, the bottom of pubic symphysis, and the bulb of the penis. The volume of the prostate was measured to analyze its relationship with the localization of the prostatic apex. Results: The prostatic apex was located (13.1 ± 3.3) mm above the bulb of the penis, (11.0 ± 5.4) mm above the bottom of the obturator foramen, (31.3 ± 5.5) mm above the ischial tuberosities, and (7.1 ± 4.7) mm above the bottom of the symphysis pubis. There was no correlation between the size of the prostate and the localization of the prostatic apex. Conclusions: The variance of the distance between the prostatic apex and the bulb of the penis is smaller than that of the distance between the apex and bony anatomy. Delineating the target to 6 mm above the bulb of the penis can cover the prostatic apex in 95% of the patients with prostate cancer, delineating to the bottom of obturator foramen can cover the prostatic apex in 100% of the patients.展开更多
目的观察针刺对喉癌术后放疗后吞咽障碍患者吞咽功能、营养状态及生活质量的影响。方法将58例喉癌术后放疗后吞咽障碍患者随机分为试验组和对照组,每组29例。对照组采用康复治疗,试验组在对照组基础上采用针刺治疗。治疗前后采用吞咽造...目的观察针刺对喉癌术后放疗后吞咽障碍患者吞咽功能、营养状态及生活质量的影响。方法将58例喉癌术后放疗后吞咽障碍患者随机分为试验组和对照组,每组29例。对照组采用康复治疗,试验组在对照组基础上采用针刺治疗。治疗前后采用吞咽造影检查(videofluoroscopic swallowing examination,VFSE)评价吞咽功能,患者参与的主观全面评定(patient-generated subjective global assessment,PG-SGA)评价营养状态,生活质量调查表(quality of life questionnaire-core 30,QLQ-C30)评价生活质量。结果治疗后,试验组VFSE、PG-SGA和QLQ-C30评分较治疗前改善(P<0.05);对照组VFSE和QLQ-C30评分均较治疗前改善(P<0.05);试验组VFSE、PG-SGA和QLQ-C30评分优于对照组(P<0.05)。试验组治疗前后VFSE、PG-SGA和QLQ-C30评分差值优于对照组(P<0.05)。结论在康复治疗的基础上,针刺可有效改善喉癌术后放疗后吞咽障碍患者的吞咽功能和营养状态,提高患者的生活质量。展开更多
The first-line treatment options for high-risk prostate cancer(PCa)are definitive external beam radiotherapy(EBRT)with or without androgen deprivation therapy(ADT)and radical prostatectomy(RP)with or without adjuvant ...The first-line treatment options for high-risk prostate cancer(PCa)are definitive external beam radiotherapy(EBRT)with or without androgen deprivation therapy(ADT)and radical prostatectomy(RP)with or without adjuvant therapies.However,few randomized trials have compared the survival outcomes of these two treatments.To systematically evaluate the survival outcomes of high-risk PCa patients treated with EBRT-or RP-based therapy,a comprehensive and up-to-date meta-analysis was performed.A systematic online search was conducted for randomized or observational studies that investigated biochemical relapse-free survival(bRFS),cancer-specific survival(CSS),and/or overall survival(OS),in relation to the use of RP or EBRT in patients with high-risk PCa.The summary hazard ratios(HRs)were estimated under the random effects models.We identified heterogeneity between studies using Q tests and measured it using I2 statistics.We evaluated publication bias using funnel plots and Egger's regression asymmetry tests.Seventeen studies(including one randomized controlled trial[RCT])of low risk of bias were selected and up to 9504 patients were pooled.When comparing EBRT-based treatment with RP-based treatment,the pooled HRs for bRFS,CSS,and OS were 0.40(95%confidence interval[CI]:0.24–0.67),1.36(95%CI:0.94–1.97),and 1.39(95%CI:1.18–1.62),respectively.Better OS for RP-based treatment and better bRFS for EBRT-based treatment have been identified,and there was no significant difference in CSS between the two treatments.RP-based treatment is recommended for high-risk PCa patients who value long-term survival,and EBRT-based treatment might be a promising alternative for elderly patients.展开更多
文摘BACKGROUND Approximately 30%of patients with localized prostate cancer(PCa)who undergo radical prostatectomy will develop biochemical recurrence.In these patients,the only potentially curative treatment is postoperative radiotherapy(PORT)with or without hormone therapy.However,the optimal radiotherapy dose is unknown due to the limited data available.AIM To determine whether the postoperative radiotherapy dose influences biochemical failure-free survival(BFFS)in patients with PCa.METHODS Retrospective analysis of patients who underwent radical prostatectomy for PCa followed by PORT-either adjuvant radiotherapy(ART)or salvage radiotherapy(SRT)-between April 2002 and July 2015.From 2002 to 2010,the prescribed radiation dose to the surgical bed was 66-70 Gy in fractions of 2 Gy;from 2010 until July 2015,the prescribed dose was 70-72 Gy.Patients were grouped into three categories according to the total dose administered:66-68 Gy,70 Gy,and 72 Gy.The primary endpoint was BFFS,defined as the post-radiotherapy prostatespecific antigen(PSA)nadir+0.2 ng/mL.Secondary endpoints were overall survival(OS),cancer-specific survival(CSS),and metastasis-free survival(MFS;based on conventional imaging tests).Treatment-related genitourinary(GU)and gastrointestinal(GI)toxicity was evaluated according to Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria.Finally,we aimed to identify potential prognostic factors.BFFS,OS,CSS,and MFS were calculated with the Kaplan-Meier method and the log-rank test.Univariate and multivariate Cox regression models were performed to explore between-group differences in survival outcome measures.RESULTS A total of 301 consecutive patients were included.Of these,93(33.6%)received ART and 186(66.4%)SRT;22 patients were excluded due to residual macroscopic disease or local recurrence in the surgical bed.In this subgroup(n=93),43 patients(46.2%)were Gleason score(GS)≤6,44(47.3%)GS 7,and 6(6.5%)GS≥8;clinical stage was cT1 in 51(54.8%),cT2 in 35(39.3%),and cT3 in one patient(1.1%);PSA was<10 ng/mL in 58(63%)patients,10-20 ng/mL in 28(30.6%),and≥20 ng/mL in 6(6.4%)patients.No differences were found in BFFS in this patient subset versus the entire cohort of patients(P=0.66).At a median follow-up of 113 months(range,4-233),5-and 10-year BFFS rates were 78.8%and 73.7%,respectively,with OS rates of 93.3%and 81.4%.The 5-year BFFS rates in three groups were as follows:69.6%(66-68 Gy),80.5%(70 Gy)and 82.6%(72 Gy)(P=0.12):the corresponding 10-year rates were 63.9%,72.9%,and 82.6%(P=0.12),respectively.No significant between-group differences were observed in MFS,CSS,or OS.On the univariate analysis,the following variables were significantly associated with BFFS:PSA at diagnosis;clinical stage(cT1 vs cT2);GS at diagnosis;treatment indication(ART vs SRT);pre-RT PSA levels;and RT dose 66-68 Gy vs.72 Gy(HR:2.05;95%CI:1.02-4.02,P=0.04).On the multivariate analysis,the following variables remained significant:biopsy GS(HR:2.85;95%CI:1.83-4.43,P<0.001);clinical stage(HR:2.31;95%CI:1.47-4.43,P=0.01);and treatment indication(HR:4.11;95%CI:2.06-8.17,P<0.001).Acute grade(G)1 GU toxicity was observed in 11(20.4%),17(19.8%),and 3(8.3%)patients in each group(66-68 Gy,70 Gy and 72 Gy),respectively(P=0.295).Acute G2 toxicity was observed in 2(3.7%),4(4.7%)and 2(5.6%)patients,respectively(P=0.949).Acute G1 GI toxicity was observed in 16(29.6%),23(26.7%)and 2(5.6%)patients in each group,respectively(P=0.011).Acute G2 GI toxicity was observed in 2(3.7%),6(6.9%)and 1(2.8%)patients,respectively(P=0.278).No cases of acute G3 GI toxicity were observed.CONCLUSION The findings of this retrospective study suggest that postoperative radiotherapy dose intensification in PCa is not superior to conventional radiotherapy treatment.
文摘AIM: To evaluate the long-term outcomes of patients receiving adjuvant and salvage radiotherapy following prostatectomy with adverse pathologic features and an undetectable prostate specific antigen(PSA).METHODS: A retrospective review was performed of patients who received post-prostatectomy radiation at Loyola University Medical Center between 1992 and 2013. Adverse pathologic features(Gleason score ≥ 8, seminal vesicle invasion, extracapsular extension, pathologic T4 disease, and/or positive surgical margins) and an undetectable PSA following prostatectomy were required for inclusion. Adjuvant patients received therapy with an undetectable PSA, salvage patients following biochemical recurrence(BCR). Post-radiation BCR, overall survival, bone metastases, and initiation of hormonal therapy were assessed. Kaplan-Meier time-to-event analyses and stepwise Cox proportional hazards regression(HR) were performed. RESULTS: Post-prostatectomy patients(n = 134) received either adjuvant(n = 47) or salvage(n = 87) radiation. Median age at radiotherapy(RT) was 63 years, and median follow-up was 53 mo. Five-year post-radiation BCR-free survival was 78% for adjuvant vs 50% salvage radiotherapy(SRT)(Logrank P = 0.001). Patients with radiation administered following a detectable PSA had an increased risk of BCR compared to undetectable: PSA > 0.0-0.2: HR = 4.1(95%CI: 1.5-11.2; P = 0.005); PSA > 0.2-1.0: HR = 4.4(95%CI: 1.6-11.9; P = 0.003); and PSA > 1.0: HR = 52(95%CI: 12.9-210; P < 0.001). There was no demonstrable difference in rates of overall survival, bone metastases or utilization of hormonal therapy between adjuvant and SRT patients. CONCLUSION: Adjuvant RT improves BCR-free survival compared to SRT in patients with adverse pathologic features and an undetectable post-prostatectomy PSA.
文摘AIM:To investigate the role of neoadjuvant chemoradiotherapy in prognosis and surgery for esophageal carcinoma by a meta-analysis.METHODS:PubMed and manual searches were done to identify all published randomized controlled trials(RCTs) that compared neoadjuvant chemoradiotherapy plus surgery(CRTS) with surgery alone(S) for esophageal cancer.According to the test of heterogeneity,a fi xed-effect model or a random effect model was used and the odds ratio(OR) was the principal measure of effects.RESULTS:Fourteen RCTs that included 1737 patients were selected with quality assessment ranging from A to C(Cochrane Reviewers' Handbook 4.2.2).OR(95% CI,P value),expressed as CRTS vs S(values>1 favor CRTS arm),was 1.19(0.94-1.48,P=0.28) for 1-year survival,1.33(1.07-1.65,P=0.69) for 2-year survival,1.76(1.42-2.19,P=0.11) for 3-year survival,1.41(1.06-1.87,P=0.11) for 4-year survival,1.64(1.28-2.12,P=0.40) for 5-year survival,0.82(0.39-1.73,P<0.0001) for rate of resection,1.53(1.33-2.84,P=0.007) for rate of complete resection,1.78(1.14-2.78,P=0.79) for operative mortality,1.12(0.89-2.48,P=0.503) for all treatment mortality,1.33(0.94-1.88,P=0.04) for the rate of adverse treatment,1.38(1.23-1.63,P=0.0002) for local-regional cancer recurrence,1.28(0.85-1.58,P=0.60) for distant cancer recurrence,and 1.27(0.86-1.65,P=0.19) for all cancer recurrence.A complete pathological response to chemoradiotherapy occurred in 10%-45.5% of patients.The 5-year survival benefi t was most pronounced when chemotherapy and radiotherapy were given concurrently(OR:1.45,95% CI:1.26-1.79,P=0.015) instead of sequentially(OR:0.85,95% CI:0.64-1.35,P=0.26).CONCLUSION:Compared with surgery alone,neoadjuvant chemoradiotherapy can improve the long-term survival and reduce local-regional cancer recurrence.Concurrent administration of neoadjuvant chemoradiotherapy was superior to sequential chemoradiotherapy.
文摘Background and Objective: In computed tomography (CT)-based radiotherapy planning for prostate cancer, it is difficult to precisely delineate the prostatic apex because of its relationship with the urogenital diaphragm and bulbospongiosus musculature. In this retrospective study, we analyzed the magnetic resonance imaging (MRI) and CT scans of the patients with prostate cancer to investigate the relationship between the prostatic apex and the anatomic structure visible on CT, and to provide evidence for localizing the prostatic apex in radiotherapy planning. Methods: MRI and CT scans of 108 patients with prostate cancer were analyzed to measure the distances between the prostatic apex and the bottom of ischial tuberosities, the bottom of obturator foramen, the bottom of pubic symphysis, and the bulb of the penis. The volume of the prostate was measured to analyze its relationship with the localization of the prostatic apex. Results: The prostatic apex was located (13.1 ± 3.3) mm above the bulb of the penis, (11.0 ± 5.4) mm above the bottom of the obturator foramen, (31.3 ± 5.5) mm above the ischial tuberosities, and (7.1 ± 4.7) mm above the bottom of the symphysis pubis. There was no correlation between the size of the prostate and the localization of the prostatic apex. Conclusions: The variance of the distance between the prostatic apex and the bulb of the penis is smaller than that of the distance between the apex and bony anatomy. Delineating the target to 6 mm above the bulb of the penis can cover the prostatic apex in 95% of the patients with prostate cancer, delineating to the bottom of obturator foramen can cover the prostatic apex in 100% of the patients.
文摘目的观察针刺对喉癌术后放疗后吞咽障碍患者吞咽功能、营养状态及生活质量的影响。方法将58例喉癌术后放疗后吞咽障碍患者随机分为试验组和对照组,每组29例。对照组采用康复治疗,试验组在对照组基础上采用针刺治疗。治疗前后采用吞咽造影检查(videofluoroscopic swallowing examination,VFSE)评价吞咽功能,患者参与的主观全面评定(patient-generated subjective global assessment,PG-SGA)评价营养状态,生活质量调查表(quality of life questionnaire-core 30,QLQ-C30)评价生活质量。结果治疗后,试验组VFSE、PG-SGA和QLQ-C30评分较治疗前改善(P<0.05);对照组VFSE和QLQ-C30评分均较治疗前改善(P<0.05);试验组VFSE、PG-SGA和QLQ-C30评分优于对照组(P<0.05)。试验组治疗前后VFSE、PG-SGA和QLQ-C30评分差值优于对照组(P<0.05)。结论在康复治疗的基础上,针刺可有效改善喉癌术后放疗后吞咽障碍患者的吞咽功能和营养状态,提高患者的生活质量。
基金This work was supported in part by Phillip Gallo,D epartm ent of Microbiology and Immunology,Albert Einstein College of Medicine,New York,NY,USA.
文摘The first-line treatment options for high-risk prostate cancer(PCa)are definitive external beam radiotherapy(EBRT)with or without androgen deprivation therapy(ADT)and radical prostatectomy(RP)with or without adjuvant therapies.However,few randomized trials have compared the survival outcomes of these two treatments.To systematically evaluate the survival outcomes of high-risk PCa patients treated with EBRT-or RP-based therapy,a comprehensive and up-to-date meta-analysis was performed.A systematic online search was conducted for randomized or observational studies that investigated biochemical relapse-free survival(bRFS),cancer-specific survival(CSS),and/or overall survival(OS),in relation to the use of RP or EBRT in patients with high-risk PCa.The summary hazard ratios(HRs)were estimated under the random effects models.We identified heterogeneity between studies using Q tests and measured it using I2 statistics.We evaluated publication bias using funnel plots and Egger's regression asymmetry tests.Seventeen studies(including one randomized controlled trial[RCT])of low risk of bias were selected and up to 9504 patients were pooled.When comparing EBRT-based treatment with RP-based treatment,the pooled HRs for bRFS,CSS,and OS were 0.40(95%confidence interval[CI]:0.24–0.67),1.36(95%CI:0.94–1.97),and 1.39(95%CI:1.18–1.62),respectively.Better OS for RP-based treatment and better bRFS for EBRT-based treatment have been identified,and there was no significant difference in CSS between the two treatments.RP-based treatment is recommended for high-risk PCa patients who value long-term survival,and EBRT-based treatment might be a promising alternative for elderly patients.