Department of Urology, Beijing Tian-Tan Hospital, Capital Medical University, No. 6 Tiantan Xi Li, Dongcheng District, Beijing, 100050, China.
Int Urol Nephrol. 2013 Aug;45(4):979-87. doi: 10.1007/s11255-013-0477-0. Epub 2013 Jun 1.
Androgen replacement therapy is a widely accepted form of treatment worldwide for aging men with late-onset hypogonadism (LOH) syndrome. Urologists have been concerned with the use of androgen supplements due to the possibility of enhancing prostate growth. We performed a systematic review and meta-analysis to assess the effect of 5α-reductase inhibitors on prostate growth in men receiving testosterone replacement therapy.
A literature review was performed to identify all published randomized placebo-controlled trials (RCT) that used exogenous testosterone combined with 5α-reductase inhibitor therapy for the treatment of hypogonadism. The search included the following databases: MEDLINE, EMBASE, and the Cochrane Controlled Trials Register. The reference lists of the retrieved studies were also investigated, and a systematic review and meta-analysis were conducted.
Five publications involving a total of 250 patients were used in the analysis, including 4 RCTs that were short-term (≤6 mo) comparisons of testosterone plus a 5α-reductase inhibitor with testosterone plus placebo and 3 RCTs that were long-term (18-36 mo) comparisons of testosterone plus a 5α-reductase inhibitor with testosterone plus placebo. In our meta-analysis, we found that testosterone plus a 5α-reductase inhibitor may slow the progression of prostate growth. For the comparison of short-term testosterone plus 5α-reductase inhibitor treatment with testosterone plus placebo therapy, the prostate-specific antigen (PSA) level (the standardized mean difference (SMD) = -0.24, 95 % confidence interval (CI) = -0.45 to 0.04, p = 0.02)) and the prostate volume (SMD = -1.66, 95 % CI = -4.54 to 1.22, p = 0.26) indicated that, compared with testosterone plus placebo therapy, the testosterone plus 5α-reductase inhibitor may decrease the PSA level. For the comparison of long-term testosterone plus 5α-reductase inhibitor with testosterone plus placebo, the PSA level (SMD = -0.53, 95 % CI = -0.84 to 0.21, p = 0.001) and the prostate volume (SMD = -8.53, 95 % CI = -15.51 to 1.54, p = 0.02) showed that, compared with testosterone plus placebo therapy, the testosterone plus 5α-reductase inhibitor treatment may slow the progression of prostate growth.
Our meta-analysis indicates that the treatment of LOH patients with short-term testosterone plus 5α-reductase inhibitor therapy does not lead to prostate growth; however, this treatment could effectively decrease the PSA level. Additionally, long-term testosterone plus 5α-reductase inhibitor therapy could slow the progression of prostate growth.
雄激素替代疗法是一种被广泛接受的治疗方法，用于治疗全球范围内出现迟发性性腺功能减退（LOH）综合征的老年男性。泌尿科医生一直关注雄激素补充剂的使用，因为它有可能促进前列腺生长。我们进行了系统评价和荟萃分析，以评估 5α-还原酶抑制剂对接受睾酮替代治疗的男性前列腺生长的影响。
进行文献综述，以确定所有已发表的随机安慰剂对照试验（RCT），这些试验使用外源性睾酮联合 5α-还原酶抑制剂治疗性腺功能减退症。搜索包括以下数据库：MEDLINE、EMBASE 和 Cochrane 对照试验登记处。还调查了检索研究的参考文献列表，并进行了系统评价和荟萃分析。
共有 250 名患者的 5 项研究纳入分析，包括 4 项短期（≤6 个月）比较睾酮加 5α-还原酶抑制剂与睾酮加安慰剂的 RCT，以及 3 项长期（18-36 个月）比较睾酮加 5α-还原酶抑制剂与睾酮加安慰剂的 RCT。在我们的荟萃分析中，我们发现睾酮加 5α-还原酶抑制剂可能会减缓前列腺生长的进展。对于短期睾酮加 5α-还原酶抑制剂治疗与睾酮加安慰剂治疗的比较，前列腺特异性抗原（PSA）水平（标准化均数差（SMD）=-0.24，95%置信区间（CI）=-0.45 至 0.04，p=0.02）和前列腺体积（SMD=-1.66，95%CI=-4.54 至 1.22，p=0.26）表明，与睾酮加安慰剂治疗相比，睾酮加 5α-还原酶抑制剂可能会降低 PSA 水平。对于长期睾酮加 5α-还原酶抑制剂与睾酮加安慰剂的比较，PSA 水平（SMD=-0.53，95%CI=-0.84 至 0.21，p=0.001）和前列腺体积（SMD=-8.53，95%CI=-15.51 至 1.54，p=0.02）表明，与睾酮加安慰剂治疗相比，睾酮加 5α-还原酶抑制剂治疗可能会减缓前列腺生长的进展。
我们的荟萃分析表明，短期睾酮加 5α-还原酶抑制剂治疗 LOH 患者不会导致前列腺生长；然而，这种治疗方法可以有效地降低 PSA 水平。此外，长期睾酮加 5α-还原酶抑制剂治疗可能会减缓前列腺生长的进展。
