Stopsack Konrad H, Greenberg Alexandra J, Mucci Lorelei A
Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Department of Neurology, Mayo Clinic, Rochester, MN, USA.
World J Urol. 2017 Jun;35(6):875-882. doi: 10.1007/s00345-016-1912-5. Epub 2016 Aug 4.
Most prostate cancer patients also have comorbidities that are treated with both prescription and nonprescription medications; furthermore, many use dietary supplements. We assess their association with prognosis after prostate cancer diagnosis, and we discuss methodological challenges and clinical implications.
We reviewed high-quality observational studies investigating the association of commonly used medications and supplements with prostate cancer-specific mortality.
There is preliminary evidence that statins and metformin use may be associated with lower risk of cancer-specific mortality after prostate cancer diagnosis; conversely, high calcium and multivitamin supplementation may be associated with increased risk. Evidence is inconclusive for nonsteroidal anti-inflammatory drugs, acetylsalicylic acid (aspirin), insulin, antihypertensives such as angiotensin-converting enzyme inhibitors and beta-blockers, digoxin, and warfarin. Common limitations of the internal validity of studies examined include unmeasured confounding and confounding by indication, competing risks, and time-related biases such as immortal time bias. The majority of studies focused on Caucasian men with specific comorbidities, while heterogeneity among patients and tumors was mostly not assessed.
Commonly prescribed medications and over-the-counter supplements may influence prognosis among prostate cancer patients. Further well-designed pharmacoepidemiologic studies and randomized controlled trials of selected medications in appropriate patient groups are necessary before these drugs can bear new indications for prostate cancer treatment. We discuss considerations when deciding about use of these drugs in clinical practice at the present time.
大多数前列腺癌患者还患有合并症，需要使用处方药和非处方药进行治疗；此外，许多患者还使用膳食补充剂。我们评估它们与前列腺癌诊断后预后的关联，并讨论方法学挑战和临床意义。
我们回顾了高质量的观察性研究，这些研究调查了常用药物和补充剂与前列腺癌特异性死亡率之间的关联。
有初步证据表明，使用他汀类药物和二甲双胍可能与前列腺癌诊断后癌症特异性死亡风险降低有关；相反，高钙和多种维生素补充剂可能与风险增加有关。对于非甾体抗炎药、乙酰水杨酸（阿司匹林）、胰岛素、抗高血压药如血管紧张素转换酶抑制剂和β受体阻滞剂、地高辛和华法林，证据尚无定论。所审查研究的内部有效性的常见局限性包括未测量的混杂因素、因适应症导致的混杂、竞争风险以及与时间相关的偏倚，如不朽时间偏倚。大多数研究集中在患有特定合并症的白人男性身上，而患者和肿瘤之间的异质性大多未被评估。
常用的处方药和非处方补充剂可能会影响前列腺癌患者的预后。在这些药物能够承担前列腺癌治疗的新适应症之前，有必要在适当的患者群体中进行进一步精心设计的药物流行病学研究和选定药物的随机对照试验。我们讨论了目前在临床实践中决定使用这些药物时的注意事项。
