Brachytherapy For The Treatment Of Localized Prostate Cancer: A Meta-Analysis

Objective To evaluate the therapeutic effect,complications,health related quality of life(HRQOL) and costs of brachytherapy for localized prostate cancer systemically.Methods We searched and screened published randomized controlled trials(RCTs) or prospective observational controlled studies in English on comparison of brachytherapy(BT) and radical prostatectomy(RP) for the treatment of localized prostate cancer in Pubmed, EMBASE, Ovid and Cochrane library databases under preset including and excluding criterias or by manual retrieving,and evaluated the quality of included RCTs.We extracted the data of 5-year biochemical diseasefree survival rates for the comparison of therapeutic effect,extracted the data of irritation,incontinence,urinary function,bowel function and sexual function scores from Expanded Prostate cancer Index Composite(EPIC) questionnaire for the comparisons of complications and HRQOL,and extracted economic data for the comparison of costs.The Meta-analysis was performed by RevMan 4.2,which was a professional software recommended by the Cochrane Collaboration.Results For the comparison of therapeutic effect,5 RCTs including 4445 patients were eligible to the criterias in total( 2146 in BT group and 2299 in RP group). All the RCTs were of high quality.The pooled odds radio of 5 trials was 1.08, 95%CI 0.70～1.67, P=0.7 2 >0.05,which showed no statistic difference. For the comparison of complications and HRQOL,3 well designed prospective observational controlled studies were eligible to the criterias in total.The analysis suggested that urinary irritation and obstruction occured more frequently and seriously after BT than RP (WMD=- 4.36 ,95%CI - 8.14～- 0.58, P=0.02< 0.05) ,and bowel function after BT was worse(WMD=- 2.73 ,95%CI-4 .31～- 1.15 , P=0.0007 < 0.05 ).However,the urinary incontinence after RP was more serious (WMD=11.1 0 , 95%CI 8.20～14.00 , P < 0.00001 ), and the urinary( WMD=5.31 , 95%CI 2.91～7.71, P< 0.0001) and sexual ( WMD=16.17, 95%CI 12.97～19.36, P< 0.00001) function after BT were much more better than RP.Regrettably,there was no eligible study about costs comparison to the criterias,which stymied us to perform a Meta-analysis of costs comparison.At last,the reliability of this Meta-analysis was demonstrated through publication bias analysis.Conclusion For BT versus RP, these was no significant difference in therapeutic effect for localized prostate cancer.On the other hand,urinary and sexual function after BT was much better,and urinary incontinence after BT was less serious.However,urinary irritation and obstruction occured more frequently and seriously after BT than RP,and bowel function after BT was worse.We suggest more RCTs to be performed for better analysises.