TY - JOUR
T1 - Outcomes and Toxicities After Treatment for Men Diagnosed With Localized Prostate Cancer in Low- and Middle-Income Countries
T2 - A Systematic Review and Meta-Analysis
AU - Kitson-Mills, Doris
AU - Donkor, Andrew
AU - Amoako, Yaw Ampem
AU - Kyei, Kofi Adesi
AU - Bonsu, Ernest Barwuah Osei
AU - Vanderpuye, Verna
AU - Wiafe, Yaw Amo
N1 - Publisher Copyright:
© 2024 The Author(s)
PY - 2025/1
Y1 - 2025/1
N2 - Purpose: Current management for clinically localized prostate cancer in low- and middle-income countries (LMICs) includes surgery, external beam radiation therapy (EBRT), and brachytherapy either alone or in combination, with plus or minus hormone therapy. The toxicity profiles and oncological outcomes of these treatment modalities vary. This systematic review and meta-analysis aimed to determine the prevalence of treatment-related outcomes and toxicities for men diagnosed with localized prostate cancer in LMICs. Methods and Materials: The review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Cochrane Library, Embase, and Medline were searched for eligible articles. Meta-analysis was performed with Review Manager version 5.4.1 using a random effects model at a 95% confidence interval. Results: A total of 2,820 patients were analyzed from 24 articles that met the inclusion criteria. Following 3-dimensional conformal radiation therapy (3D-CRT), the most common clinician-reported toxicities were acute skin grade 1, acute genitourinary grade 1, acute gastrointestinal grade 1, and late gastrointestinal grade 1, with 46%, 29%, 24%, and 18%, respectively. Acute and late genitourinary grade 3 and gastrointestinal grade 3 toxicities were below 3% with no grade 4 toxicities reported after 3D-CRT. In the brachytherapy group, the prevalence of acute genitourinary grade 1 toxicity was 19%. Perioperative rectal injury was the least prevalent (2%) after retropubic radical prostatectomy. Following 3D-CRT, the 5-year overall survival rate was 87%, and for the combined brachytherapy and EBRT group, it increased to 96%. The prevalence of 5-year biochemical failure following EBRT and brachytherapy was 18% and 30%, respectively. The 4- and 3-year biochemical failure after radical prostatectomy and combined EBRT with brachytherapy were 22% and 2%, respectively. Conclusions: This systematic review and meta-analysis indicate that in LMICs, EBRT, brachytherapy, and radical prostatectomy, either alone or in combination has an excellent potential for localized prostate cancer control with low toxicities and good oncological outcomes. Results of treatment-related toxicities and outcomes can support policymakers, patients, and clinicians on informed decision-making to strengthen prostate cancer care in the region. However, efforts are required to improve early detection, treatment accessibility, regular post-treatment follow-up care, consistent quality assurance practices, and staff continues development to help minimize treatment toxicities and improve outcomes of localized prostate cancer in LMICs.
AB - Purpose: Current management for clinically localized prostate cancer in low- and middle-income countries (LMICs) includes surgery, external beam radiation therapy (EBRT), and brachytherapy either alone or in combination, with plus or minus hormone therapy. The toxicity profiles and oncological outcomes of these treatment modalities vary. This systematic review and meta-analysis aimed to determine the prevalence of treatment-related outcomes and toxicities for men diagnosed with localized prostate cancer in LMICs. Methods and Materials: The review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Cochrane Library, Embase, and Medline were searched for eligible articles. Meta-analysis was performed with Review Manager version 5.4.1 using a random effects model at a 95% confidence interval. Results: A total of 2,820 patients were analyzed from 24 articles that met the inclusion criteria. Following 3-dimensional conformal radiation therapy (3D-CRT), the most common clinician-reported toxicities were acute skin grade 1, acute genitourinary grade 1, acute gastrointestinal grade 1, and late gastrointestinal grade 1, with 46%, 29%, 24%, and 18%, respectively. Acute and late genitourinary grade 3 and gastrointestinal grade 3 toxicities were below 3% with no grade 4 toxicities reported after 3D-CRT. In the brachytherapy group, the prevalence of acute genitourinary grade 1 toxicity was 19%. Perioperative rectal injury was the least prevalent (2%) after retropubic radical prostatectomy. Following 3D-CRT, the 5-year overall survival rate was 87%, and for the combined brachytherapy and EBRT group, it increased to 96%. The prevalence of 5-year biochemical failure following EBRT and brachytherapy was 18% and 30%, respectively. The 4- and 3-year biochemical failure after radical prostatectomy and combined EBRT with brachytherapy were 22% and 2%, respectively. Conclusions: This systematic review and meta-analysis indicate that in LMICs, EBRT, brachytherapy, and radical prostatectomy, either alone or in combination has an excellent potential for localized prostate cancer control with low toxicities and good oncological outcomes. Results of treatment-related toxicities and outcomes can support policymakers, patients, and clinicians on informed decision-making to strengthen prostate cancer care in the region. However, efforts are required to improve early detection, treatment accessibility, regular post-treatment follow-up care, consistent quality assurance practices, and staff continues development to help minimize treatment toxicities and improve outcomes of localized prostate cancer in LMICs.
UR - http://www.scopus.com/inward/record.url?scp=85211980920&partnerID=8YFLogxK
U2 - 10.1016/j.adro.2024.101670
DO - 10.1016/j.adro.2024.101670
M3 - Review article
AN - SCOPUS:85211980920
SN - 2452-1094
VL - 10
JO - Advances in Radiation Oncology
JF - Advances in Radiation Oncology
IS - 1
M1 - 101670
ER -