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        Effects of delayed radical prostatectomy and active surveillance on localised prostate cancer - A systematic review and meta-analysis

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        Author
        Chan, Vinson Wai-Shun
        Tan, Wei Shen
        Asif, Aqua
        Ng, Alexander
        Gbolahan, Olayinka
        Dinneen, Eion
        To, Wilson
        Kadhim, Hassan
        Premchand, Melissa
        Burton, Oliver
        Koe, Jasmine Sze-Ern
        Wang, Nicole
        Leow, Jeffrey
        Giannarini, Gianluca
        Vasdev, Nikhil
        Shariat, Shahrokh F
        Enikeev, Dmitry
        Ng, Chi Fai
        Teoh, Jeremy Yeun-Chun
        Attention
        2299/24880
        Abstract
        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
        Publication date
        2021-06-30
        Published in
        Cancers
        Published version
        https://doi.org/10.3390/cancers13133274
        License
        http://creativecommons.org/licenses/by/4.0/
        Other links
        http://hdl.handle.net/2299/24880
        Relations
        School of Life and Medical Sciences
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