Photodynamic therapy for prostate cancer: a systematic review and meta-analysis

PURPOSE: Photodynamic therapy (PDT) is an emerging focal treatment modality for prostate cancer. However, the efficacy, safety, and functional outcomes of PDT are not clear. We performed a meta-analysis of available single-arm studies and control trials which used PDT for prostate cancer. MATERIALS AND METHODS: We searched Pubmed, Embase, Ovid and the Cochrane library (until March,2018) for studies about PDT in patients with prostate cancer. The negative biopsy rate after PDT, PSA decreasing rate, pooled rate of functional outcome (IPSS or IIEF-5), and adverse events were analyzed. RESULTS: 14 studies containing 654 patients were included. Nine of the 14 included studies had evaluated a negative biopsy rate after PDT. The pooled rate was 55.0% (95.0% CI: 0.44–0.66, I(2) = 85.7%). Twelve of the 14 included studies which evaluated PSA decreasing rate with the pooled rate of 35.0% (95.0% CI: 0.24–0.47, I(2) = 88.7%). Six of the included studies evaluated IPSS with decreasing rate of 29.1% (95.0 % CI: 2.7%–55.5%, I(2) = 96.9%). Five of the included studies evaluated IIEF-5 with decreasing rate of 14.9% (95.0% CI: 6.8%–23.0%, I(2) = 44.2%). The most common adverse events were haematuria (28.1%, 95.0% CI: 17.1%–39.2%, I(2) = 79.8%), erectile dysfunction (23.1%, 95.0% CI: 9.7%–36.5%, I(2) = 87.7%), and dysuria (18.6%, 95.0% CI: 12.1%–25.0 %, I(2) = 53.4 %). CONCLUSIONS: The meta-analysis results shows that PDT for patients with prostate cancer can be considered as effective based on single-arm clinical trials. Meanwhile, this study reveals that there are not only low levels of side effect rates but also insignificant effect on both urinary and erectile function. However, more high-quality RCTs are needed to evaluate the comparative efficacy, safety, and functional outcomes of PDT for patients with prostate cancer.