Efficacy of transurethral resection of prostate plus endocrine therapy for bladder outlet obstruction in advanced prostate cancer: A systematic review

Objective To systematically review the efficacy of transurethral resection of prostate (TURP) plus endocrine therapy (ET) for bladder outlet obstruction (BOO) in advanced prostate cancer (PCa). Methods Randomized controlled trials (RCTs) and non-randomized clinical controlled trials (CCTs) about TURP plus ET vs. ET for BOO in PCa patients were retrieved in Pubmed, Cochrane library, Sciverse, CNKI, VIP and Wanfang Database up to July, 2016. According to the inclusion and exclusion criteria, two reviewers independently screened the trials, extracted the data, conducted the Meta-analysis with Revman 5.3. Results Four RCTs and three CCTs were included. The results of meta-analysis based on RCT showed that, maximum urinary flow rate was higher [MD=3.11, 95%CI (1.13, 5.09), P=0.002] and IPSS was lower [MD=-6.76, 95%CI (-12.61, -0.91), P=0.02] in TURP plus ET group than those in ET group. However, there was no difference in residual urine volume in the two groups [MD=-27.81, 95%CI (-63.91, 8.29), P=0.13]. The results of meta-analysis based on CCT showed that, maximum urinary flow rate was higher [MD=5.49, 95%CI (4.23, 6.74), P<0.001], IPSS was lower [MD=-7.69, 95%CI (-11.69, -3.69), P=0.0002] and residual urine volume was lower [MD=-33.21, 95%CI (-59.82, -6.61), P=0.01] in TURP plus ET group than those in ET group. Meanwhile, no significant difference was observed in survival rate between the two groups [RR=1.06, 95%CI (0.95,1.17), P=0.29]. Descriptive analysis showed that PSA level did not increase in TURP plus ET. Conclusion TURP plus ET could relieve dysuresia symptoms, improve quality of life and did not influence the over survival rate for BOO in PCa patients Key words: Prostate caner; Resection of prostate; Endocrine therapy (ET); Systematic review