Meta-analysis of treatment effects for localized prostate cancer: a comparative study of seed implant brachytherapy and external beam radiotherapy

To systematically summarize the effects of seed implantation brachytherapy (BT) and external beam radiation therapy (EBRT) in treating localized prostate cancer patients and conduct a meta-analysis. All relevant research reports on the effects of radioactive seed implantation BT and EBRT on the clinical efficacy of localized prostate cancer were searched. The search related databases were English databases, involving Pubmed, EMbase, Web of Science, Cochrane Library, Clinical Trials, etc. After literature screening, 10 articles were finally obtained. The Newcastle-Ottawa Scale (NOS) scores were all ≥7 points, and all were high-quality articles. The forest plot showed that compared with EBRT, the 5-year overall survival rate of localized prostate cancer patients treated by radioactive seed implantation BT was higher [RR = 1.15, 95 %CI (1.12; 1.18), P < 0.05]. Compared with EBRT alone, the biochemical progression-free survival rate of localized prostate cancer patients treated by radioactive seed implantation BT combined with EBRT was higher [RR = 1.23, 95 %CI (1.19; 1.28), P < 0.05]. Compared with EBRT alone, the occurrence of gastrointestinal toxicity in localized prostate cancer patients treated by radioactive seed implantation BT was lower [RR = 0.73, 95 %CI (0.61; 0.89), P < 0.05]. The funnel plot showed that the scatter distribution of the subjects was symmetrical as a whole, indicating that there may be a small risk of publication bias. The effect of BT seed implantation in treating localized prostate cancer is better than that of EBRT. The 5-year overall survival rate of patients is higher, and the gastrointestinal toxicity is significantly reduced. The limitation of this review is that our findings predominantly reflect historical EBRT techniques, and the differences in toxicity between BT and EBRT may have been reduced by IGRT use. Caution is warranted when generalizing these results to modern radiotherapy protocols.