To systematically evaluate the efficacy and safety of brachytherapy (BT) combined with external beam radiation therapy (EBRT) and EBRT alone for prostate cancer.

Databases including PubMed, Web of Science, Cochrane Library, CNKI, WanFang Data and VIP were searched from the inception to July 2018 to collect the clinical trials which comparatively analyzed the efficacy and safety between EBRT plus BT and EBRT alone for prostate cancer. According to the inclusion and exclusion criteria, data of the included studies were extracted and the methodological quality was evaluated. Then, a meta-analysis was performed using RevMan 5.3.

Ten studies of 23 393 patients were included, in which 6 were randomized controlled trials (RCTs) and the other 4 were non-RCTs.The 3-year biochemical progression-free survival (b-PFS)[OR=2.03(95%CI: 1.11 to 3.73), P=0.02]and the 5-year b-PFS of intermediate-risk patients[OR=2.27(95%CI: 1.49 to 3.45), P<0.01] in the EBRT+ BT group were significantly higher compared with those in the EBRT group. The 3-and 5-year b-PFS, 5-year overall survival and 5-year metastasis-free survival did not differ between two groups. in the incidence of ≥grade 2 acute[OR=1.44(95%CI: 1.11 to 1.38), P<0.01] and chronic genitourinary adverse reactions[OR=3.06(95%CI: 1.37 to 6.80), P<0.01], ≥grade 3 acute[OR=1.75(95%CI: 1.14 to 2.69), P=0.01] and chronic genitourinary adverse reactions[OR=3.41(95%CI: 2.42 to 4.82), P<0.01] in the EBRT group were significantly lower than those in the EBRT+ BT group. The incidence of gastrointestinal adverse reactions did not significantly differ between two groups.

Compared with EBRT alone, EBRT combined with BT can effectively improve the 3-and 5-year b-PFS, whereas increase the incidence of genitourinary adverse reactions for patients with intermediate-risk prostate cancer.

Prostate neoplasm/brachytherapy; Prostate neoplasm/radiotherapy; Treatment outcome; Meta-analysis