Drug treatment options of high-risk biochemically recurrent prostate cancer based on efficacy and safety: a systematic review and Bayesian network analysis
Abstract Background Emerging evidence has revealed the potential efficacy of Novel Hormonal Agent (NHA) or chemotherapy in high-risk patients with biochemical recurrence (BCR). However, the optimal drug-based treatment strategy remains unknown. Methods We conducted a comprehensive search of the PubM...
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BMC
2025-06-01
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| Series: | European Journal of Medical Research |
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| Online Access: | https://doi.org/10.1186/s40001-025-02643-y |
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| author | Qian Wang Qiyu Zhu Haoyang Liu Ke Huang Xingming Zhang Jinge Zhao Hong Zeng Jindong Dai Yifu Shi Hao Zeng Pengfei Shen |
| author_facet | Qian Wang Qiyu Zhu Haoyang Liu Ke Huang Xingming Zhang Jinge Zhao Hong Zeng Jindong Dai Yifu Shi Hao Zeng Pengfei Shen |
| author_sort | Qian Wang |
| collection | DOAJ |
| description | Abstract Background Emerging evidence has revealed the potential efficacy of Novel Hormonal Agent (NHA) or chemotherapy in high-risk patients with biochemical recurrence (BCR). However, the optimal drug-based treatment strategy remains unknown. Methods We conducted a comprehensive search of the PubMed, Cochrane, and Embase databases up to February 18, 2024 to identify relevant studies. Our analysis focused on outcome measures, including prostate-specific antigen progression-free survival (PSA-PFS), overall survival (OS) and the incidence of adverse events (AEs). A Bayesian network meta-analysis was utilized to indirectly compare the efficacy and safety of various treatment modalities. Results Four randomized controlled trials with 2074 participants were selected for data extraction and analysis. Treatment combining Androgen Deprivation Therapy (ADT) with Enzalutamide (ENZA) significantly enhanced PSA-PFS as compared to ADT monotherapy (Hazard Ratio (HR) = 0.07, 95% Confidence Interval (CI) 0.01–0.97). The surface under the cumulative ranking curve (SUCRA) indicated ADT + ENZA as the most effective strategy for improving PSA-PFS. In terms of OS improvement, the treatments were ranked as follows: ADT + Docetaxel (DOC), ADT + ENZA, ENZA, and ADT. In terms of adverse event incidence, ADT exhibited the lowest incidence of adverse events, followed by ADT + ENZA. In the meta-analysis, ADT + NHA combined therapy achieved superior efficacy in PSA-PFS and OS than ADT. Conclusion This study suggests that ADT + NHA, particularly ADT + ENZA, may provide a significant survival benefit and an acceptable safety profile for prostate cancer patients at high-risk BCR. The findings could potentially inform the selection of medications for these patients, although further confirmation through large-scale clinical trials is imperative. |
| format | Article |
| id | doaj-art-9e25de9200f741d382fa848a0a73e635 |
| institution | OA Journals |
| issn | 2047-783X |
| language | English |
| publishDate | 2025-06-01 |
| publisher | BMC |
| record_format | Article |
| series | European Journal of Medical Research |
| spelling | doaj-art-9e25de9200f741d382fa848a0a73e6352025-08-20T02:30:45ZengBMCEuropean Journal of Medical Research2047-783X2025-06-013011910.1186/s40001-025-02643-yDrug treatment options of high-risk biochemically recurrent prostate cancer based on efficacy and safety: a systematic review and Bayesian network analysisQian Wang0Qiyu Zhu1Haoyang Liu2Ke Huang3Xingming Zhang4Jinge Zhao5Hong Zeng6Jindong Dai7Yifu Shi8Hao Zeng9Pengfei Shen10Department of Urology, Institute of Urology, West China Hospital, Sichuan UniversityDepartment of Urology, Institute of Urology, West China Hospital, Sichuan UniversityDepartment of Urology, Institute of Urology, West China Hospital, Sichuan UniversityDepartment of Urology, Institute of Urology, West China Hospital, Sichuan UniversityDepartment of Urology, Institute of Urology, West China Hospital, Sichuan UniversityDepartment of Urology, Institute of Urology, West China Hospital, Sichuan UniversityDepartment of Urology, Institute of Urology, West China Hospital, Sichuan UniversityDepartment of Urology, Institute of Urology, West China Hospital, Sichuan UniversityDepartment of Urology, Institute of Urology, West China Hospital, Sichuan UniversityDepartment of Urology, Institute of Urology, West China Hospital, Sichuan UniversityDepartment of Urology, Institute of Urology, West China Hospital, Sichuan UniversityAbstract Background Emerging evidence has revealed the potential efficacy of Novel Hormonal Agent (NHA) or chemotherapy in high-risk patients with biochemical recurrence (BCR). However, the optimal drug-based treatment strategy remains unknown. Methods We conducted a comprehensive search of the PubMed, Cochrane, and Embase databases up to February 18, 2024 to identify relevant studies. Our analysis focused on outcome measures, including prostate-specific antigen progression-free survival (PSA-PFS), overall survival (OS) and the incidence of adverse events (AEs). A Bayesian network meta-analysis was utilized to indirectly compare the efficacy and safety of various treatment modalities. Results Four randomized controlled trials with 2074 participants were selected for data extraction and analysis. Treatment combining Androgen Deprivation Therapy (ADT) with Enzalutamide (ENZA) significantly enhanced PSA-PFS as compared to ADT monotherapy (Hazard Ratio (HR) = 0.07, 95% Confidence Interval (CI) 0.01–0.97). The surface under the cumulative ranking curve (SUCRA) indicated ADT + ENZA as the most effective strategy for improving PSA-PFS. In terms of OS improvement, the treatments were ranked as follows: ADT + Docetaxel (DOC), ADT + ENZA, ENZA, and ADT. In terms of adverse event incidence, ADT exhibited the lowest incidence of adverse events, followed by ADT + ENZA. In the meta-analysis, ADT + NHA combined therapy achieved superior efficacy in PSA-PFS and OS than ADT. Conclusion This study suggests that ADT + NHA, particularly ADT + ENZA, may provide a significant survival benefit and an acceptable safety profile for prostate cancer patients at high-risk BCR. The findings could potentially inform the selection of medications for these patients, although further confirmation through large-scale clinical trials is imperative.https://doi.org/10.1186/s40001-025-02643-yBCREfficacyHigh riskProstate cancerSafety |
| spellingShingle | Qian Wang Qiyu Zhu Haoyang Liu Ke Huang Xingming Zhang Jinge Zhao Hong Zeng Jindong Dai Yifu Shi Hao Zeng Pengfei Shen Drug treatment options of high-risk biochemically recurrent prostate cancer based on efficacy and safety: a systematic review and Bayesian network analysis European Journal of Medical Research BCR Efficacy High risk Prostate cancer Safety |
| title | Drug treatment options of high-risk biochemically recurrent prostate cancer based on efficacy and safety: a systematic review and Bayesian network analysis |
| title_full | Drug treatment options of high-risk biochemically recurrent prostate cancer based on efficacy and safety: a systematic review and Bayesian network analysis |
| title_fullStr | Drug treatment options of high-risk biochemically recurrent prostate cancer based on efficacy and safety: a systematic review and Bayesian network analysis |
| title_full_unstemmed | Drug treatment options of high-risk biochemically recurrent prostate cancer based on efficacy and safety: a systematic review and Bayesian network analysis |
| title_short | Drug treatment options of high-risk biochemically recurrent prostate cancer based on efficacy and safety: a systematic review and Bayesian network analysis |
| title_sort | drug treatment options of high risk biochemically recurrent prostate cancer based on efficacy and safety a systematic review and bayesian network analysis |
| topic | BCR Efficacy High risk Prostate cancer Safety |
| url | https://doi.org/10.1186/s40001-025-02643-y |
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