Boyle Peter, Koechlin Alice, Bota Maria, d'Onofrio Alberto, Zaridze David G, Perrin Paul, Fitzpatrick John, Burnett Arthur L, Boniol Mathieu
Strathclyde Institute of Global Public Health at iPRI, Ecully Lyon Ouest, France.
International Prevention Research Institute, Lyon, France.
BJU Int. 2016 Nov;118(5):731-741. doi: 10.1111/bju.13417. Epub 2016 Feb 24.
To review and quantify the association between endogenous and exogenous testosterone and prostate-specific antigen (PSA) and prostate cancer.
Literature searches were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Prospective cohort studies that reported data on the associations between endogenous testosterone and prostate cancer, and placebo-controlled randomized trials of testosterone replacement therapy (TRT) that reported data on PSA and/or prostate cancer cases were retained. Meta-analyses were performed using random-effects models, with tests for publication bias and heterogeneity.
Twenty estimates were included in a meta-analysis, which produced a summary relative risk (SRR) of prostate cancer for an increase of 5 nmol/L of testosterone of 0.99 (95% confidence interval [CI] 0.96, 1.02) without heterogeneity (I² = 0%). Based on 26 trials, the overall difference in PSA levels after onset of use of TRT was 0.10 ng/mL (-0.28, 0.48). Results were similar when conducting heterogeneity analyses by mode of administration, region, age at baseline, baseline testosterone, trial duration, type of patients and type of TRT. The SRR of prostate cancer as an adverse effect from 11 TRT trials was 0.87 (95% CI 0.30; 2.50). Results were consistent across studies.
Prostate cancer appears to be unrelated to endogenous testosterone levels. TRT for symptomatic hypogonadism does not appear to increase PSA levels nor the risk of prostate cancer development. The current data are reassuring, although some caution is essential until multiple studies with longer follow-up are available.
回顾并量化内源性和外源性睾酮与前列腺特异性抗原（PSA）及前列腺癌之间的关联。
根据系统评价和Meta分析的首选报告项目（PRISMA）指南进行文献检索。保留报告了内源性睾酮与前列腺癌之间关联数据的前瞻性队列研究，以及报告了PSA和/或前列腺癌病例数据的睾酮替代疗法（TRT）安慰剂对照随机试验。使用随机效应模型进行Meta分析，并进行发表偏倚和异质性检验。
一项Meta分析纳入了20项估计值，睾酮水平每增加5 nmol/L，前列腺癌的汇总相对风险（SRR）为0.99（95%置信区间[CI] 0.96，1.02），无异质性（I² = 0%）。基于26项试验，TRT开始使用后PSA水平的总体差异为0.10 ng/mL（-0.28，0.48）。按给药方式、地区、基线年龄、基线睾酮水平、试验持续时间、患者类型和TRT类型进行异质性分析时，结果相似。11项TRT试验中前列腺癌作为不良反应的SRR为0.87（95% CI 0.30；2.50）。各研究结果一致。
前列腺癌似乎与内源性睾酮水平无关。有症状性腺功能减退的TRT似乎不会增加PSA水平或前列腺癌发生风险。目前的数据令人安心，不过在有更多长期随访的研究可用之前，仍需保持一定谨慎。
