Literature Search Strategy
MEDLINE (1966 through February week 2 2005) and EMBASE (1980 through 2005, week 8) databases were searched for relevant papers. MEDLINE was searched using the following medical subject headings: "prostatic neoplasms," "drug therapy," "antineoplastic agents," and "drug therapy, combination," EMBASE was searched using the following Excerpta Medica tree terms: "prostate tumour," "prostate cancer," "drug therapy," "antineoplastic agent," "drug combination," and "combination chemotherapy". In each database those subject headings were combined with the following disease and treatment-specific text words: "prostat: cancer," "prostat: tumo?r," "prostat: carcinoma," and "chemotherapy". Those terms were then combined with search terms for the following publication types and study designs: practice guidelines, systematic reviews, meta-analyses, reviews, randomized controlled trials, and controlled clinical trials.
In addition, the Cochrane Library databases (2004, Issue 4) and the conference proceedings of the American Society of Clinical Oncology (1999 through 2004) were searched for abstracts of relevant trials. The Canadian Medical Association Infobase (http://mdm.ca/cpgsnew/cpgs/index.asp) and the National Guideline Clearinghouse (http://www.guideline.gov) were also searched for existing evidence-based practice guidelines.
Relevant articles and abstracts were selected and reviewed by five reviewers, and the reference lists from those sources were searched for additional trials, as were the reference lists from relevant review articles.
Inclusion Criteria
Articles were selected for inclusion in this systematic review of the evidence if they met the following criteria:
- They were published reports or abstracts of randomized controlled trials (RCTs) or meta-analyses comparing a non-hormonal systemic therapy or combination (i.e., first-line cytotoxic and non-cytotoxic agents excluding bisphosphonates and radiopharmaceuticals) with either placebo or other drug regimens.
- They included patients with hormone-refractory prostate cancer (HRPC) and metastases, where HRPC was defined as clinical progression (either symptomatically, radiologically, or biochemically) in the presence of a castrate testosterone level.
- They included a minimum of 50 patients per trial arm.
- They reported on at least one of the following outcomes: overall survival, disease control (i.e., progression-free survival [PFS], time-to-progression [TTP], time-to-treatment failure [TTF], and objective tumour and prostate-specific antigen [PSA] response), palliative or symptomatic response, quality of life, or toxicity.
or
- They were published reports of systematic reviews or evidence-based guidelines that addressed the guideline question.