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Adding androgen deprivation therapy to salvage radiotherapy improves progression-free survival in patients with post-prostatectomy biochemical recurrence or positive surgical margins: a systematic review and meta-analysis
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DOI：10.1186/s40001-026-05046-9.png)
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Abstract
En 中文
Recently, several trials have explored the efficacy of salvage radiotherapy (RT) alone or in combination with androgen deprivation therapy (ADT) in patients with localized prostate cancer (PCa) after radical prostatectomy. We conducted this meta-analysis to evaluate the efficacy of the combination regimen by comparison with salvage RT alone. Literature was searched using the PubMed, Embase, Cochrane Library and ClinicalTrials.gov databases. The primary comparative analysis was restricted to head-to-head randomized controlled trials (RCTs) that compared salvage RT+ADT vs. salvage RT alone. A secondary single-arm meta-analysis was conducted to pool the absolute survival rates of the combination regimen, including all eligible studies with an RT+ADT arm. The primary outcome was progression-free survival (PFS), whereas the secondary outcomes included overall survival (OS) and adverse events. Subgroup analyses and meta-regression were conducted to explore the sources of heterogeneity. Survival analysis was performed on the basis of reconstructed individual patient data (IPD) extracted from survival curves. I2 ≤ 50% was considered to indicate low heterogeneity. Publication bias was evaluated using funnel plots and Egger’s test. The data of 3052 patients from 7 studies were synthesized and analyzed. Compared with salvage RT alone, the combination regimen significantly decreased the risk of progression (HR: 0.62, 95% CI 0.53–0.72) (I2 = 0.0%, P = 0.748). Moreover, the addition of ADT to salvage RT showed a favorable trend toward improved overall survival, but the result did not reach conventional statistical significance (HR: 0.85; 95% CI 0.68–1.05) (I2 = 0.0%; P = 0.832). The pooled PFS of the combination group was 0.71 (95% CI 0.62–0.80) (I2 = 93.4%, P < 0.001). In exploratory meta-regression, baseline prostate-specific antigen and positive surgical margin were identified as potential contributors to heterogeneity. Compared with the control group, the combination group had significantly better PFS. Grade 3–4 adverse events were uncommon, reported in 0–6% of patients across the included studies. The most frequently observed grade 1–2 toxicities were hot flashes, fatigue, and gastrointestinal disturbances. No significant evidence of publication bias was detected in the meta-analysis. Based on pooled randomized evidence, the addition of ADT to salvage RT significantly improved progression-free survival in patients with biochemical recurrence after radical prostatectomy. The absolute survival rates of the combination regimen provide a supportive descriptive context.
Keywords:
Prostate cancer
Androgen deprivation therapy
Radiotherapy
Prognosis
Outcome
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