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Prostate Cancer Treatment and Research / Prostate Cancer Diagnosis and Treatment / Advanced Radiotherapy Techniques · Review
Frontiers in Urology · August 17, 2026
Well-designed and adequately powered for the question it asks.
This meta-analysis of 13 studies demonstrates that combined SRT+ADT significantly improves biochemical progression-free survival and metastasis-free survival compared to SRT alone in men with biochemical recurrence after radical prostatectomy. Overall survival benefit remains uncertain, and toxicity (endocrine, sexual, gynecomastia, erectile dysfunction) is substantially attributable to hormonal blockade, necessitating individualized risk stratification.
Systematic review with meta-analysis. Men with biochemical recurrence of prostate cancer after radical prostatectomy receiving either salvage radiotherapy alone or salvage radiotherapy combined with androgen deprivation therapy. Intervention: Salvage radiotherapy combined with androgen deprivation therapy (SRT+ADT). Compared with: Salvage radiotherapy alone (SRT).
Combined SRT+ADT associated with improved b-PFS: HR 0.51 (95% CI 0.45–0.57, I²=0%) Combined SRT+ADT associated with improved MFS: HR 0.71 (95% CI 0.60–0.84, I²=39%) No consistent benefit or limited heterogeneity observed for overall survival
Most frequent adverse events were endocrine and sexual toxicity, gynecomastia, and erectile dysfunction
Clinicians should consider adding ADT to SRT in biochemical recurrence, particularly in higher-risk patients, to improve biochemical disease control and reduce metastatic progression. However, individual risk stratification is essential to balance oncologic benefit against substantial endocrine and sexual toxicity, and the overall survival advantage requires further confirmation.
Rigorous systematic review and meta-analysis of 13 studies showing SRT+ADT improves biochemical progression-free survival and metastasis-free survival with low heterogeneity, though overall survival benefit remains uncertain.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians should consider adding ADT to SRT in biochemical recurrence, particularly in higher-risk patients, to improve biochemical disease control and reduce metastatic progression. However, individual risk stratification is essential to balance oncologic benefit against substantial endocrine and sexual toxicity, and the overall survival advantage requires further confirmation.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Introduction Salvage radiotherapy (SRT) is one of the treatment options after progression following surgical management, with effectiveness varying according to patient risk and clinical-pathological characteristics. Objective To compare the effectiveness of SRT alone versus SRT combined with androgen deprivation therapy (ADT) in men with biochemical recurrence. Methods We conducted a systematic review with advanced searches in MEDLINE (PubMed), EMBASE, SCOPUS, Cochrane CENTRAL, and LILACS for the period 1990–2024. Two independent reviewers performed study selection (titles/abstracts and full text) and data extraction. Risk of bias was assessed with ROBINS-I and RoB 2.0. A random-effects meta-analysis was used to pool effect estimates. PROSPERO registration: CRD42025640604. Results Thirteen studies were included. Nine reported overall survival (OS) and biochemical progression-free survival (b-PFS) respectively, four clinical progression-free survival (c-PFS), and eight metastasis-free survival (MFS). Combined SRT+ADT was associated with improved b-PFS (HR 0.51; 95% CI 0.45-0.57; I²=0%) and MFS (HR 0.71; 95% CI 0.60-0.84; I²=39%), whereas the remaining meta-analyzed outcomes showed no consistent benefit or were limited by heterogeneity. Regarding toxicity, the most frequent adverse events were endocrine and sexual, related to hormonal blockade, gynecomastia and erectile dysfunction. Conclusions Combined SRT + ADT improves biochemical disease control and may reduce the risk of metastasis in selected patients with biochemical recurrence after radical postatectomy, whereas the effect on overall survival remains uncertain. Individualized management requires risk stratification when deciding on the addition and duration of ADT to optimize oncologic outcomes. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/, identifier CRD42025640604.
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