Spinal Unit, San Raffaele Sulmona Institute, Sulmona 67039, Italy.
Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila 67100, Italy.
Asian J Androl. 2018 Nov-Dec;20(6):555-560. doi: 10.4103/aja.aja_31_18.
A lower risk of prostate cancer has been reported in men with spinal cord injury (SCI) as compared to that observed in able-bodied subjects. As injury-related consequences can have opposite effects on prostate pathophysiology, this meta-analysis aimed to (1) establish the existence/quantify the extent of decreased prostate cancer risk following SCI and (2) find out if there is any statistically significant difference in prostate-specific antigen (PSA) levels between SCI and able-bodied subjects. MEDLINE, Cochrane Library, Scopus, CINAHL, and ScienceDirect databases were used. Only studies reporting a prostate cancer diagnosis and/or PSA levels following SCI and in able-bodied controls were included. Five studies provided information about prostate cancer on 35 293 subjects with SCI and 158 140 controls. Six studies were included in PSA analysis which reported information on 391 men with SCI and 1921 controls. Pooled estimates indicated that SCI reduced the prostate cancer risk by approximately 50% as compared to controls, whereas differences in PSA levels were not statistically significant. Funnel plots suggested the presence of publication bias only in PSA analysis. Between-study heterogeneity was established and when, according to meta-regression models, analysis was restricted to studies including men with mean age over 55 years, prostate cancer risk in SCI decreased up to 65.0% than that in controls with no heterogeneity (P = 0.33, I = 9%). In conclusion, in men over 55 years old, SCI decreases the prostate cancer risk up to 65.0% than that in controls. The large between-study heterogeneity on PSA confirms its poor reliability as a screening tool for prostate cancer in SCI.
与身体健全的受试者相比，脊髓损伤 (SCI) 男性患前列腺癌的风险较低。由于与损伤相关的后果可能对前列腺病理生理学产生相反的影响，因此本荟萃分析旨在：(1) 确定 SCI 后前列腺癌风险降低的存在/量化程度；(2) 确定 SCI 和身体健全的受试者之间 PSA 水平是否存在任何统计学差异。使用了 MEDLINE、Cochrane 图书馆、Scopus、CINAHL 和 ScienceDirect 数据库。仅纳入了报告 SCI 后前列腺癌诊断和/或 PSA 水平以及身体健全对照组的研究。五项研究提供了关于 35293 名 SCI 患者和 158140 名对照组患者前列腺癌的信息。六项研究纳入了 PSA 分析，其中报告了 391 名 SCI 男性和 1921 名对照组的信息。汇总估计表明，与对照组相比，SCI 使前列腺癌风险降低了约 50%，而 PSA 水平的差异没有统计学意义。漏斗图表明仅在 PSA 分析中存在发表偏倚。建立了研究间异质性，当根据荟萃回归模型将分析仅限于包括平均年龄超过 55 岁的男性的研究时，SCI 中的前列腺癌风险比对照组降低了高达 65.0%，且无异质性（P=0.33，I=9%）。总之，在 55 岁以上的男性中，SCI 使前列腺癌风险降低了高达 65.0%。PSA 的研究间异质性很大，证实其作为 SCI 前列腺癌筛查工具的可靠性较差。
