临床隐匿性前列腺癌病例可能会扭曲睾酮替代疗法对前列腺癌风险的影响。
Clinically occult prostate cancer cases may distort the effect of testosterone replacement therapy on risk of PCa.
机构信息
Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, MS 1266, 212 Adriance Lab Road, College Station, TX, 77843-1266, USA.
Department of Statistics, Texas A&M University, College Station, USA.
出版信息
World J Urol. 2019 Oct;37(10):2091-2097. doi: 10.1007/s00345-018-02621-6. Epub 2019 Jan 18.
BACKGROUND
Although prostate cancer (PCa) screening is conducted before testosterone replacement therapy (TRT), clinically occult PCa cases may exist.
METHODS
To evaluate whether the possible inclusion of occult PCa cases distorts the effect of TRT on risk of PCa, we followed 776 hypogonadal males (TRT = 400, non-TRT = 376) from a urology center in Germany from 2004 to 2016, with a mean follow-up period of 7 years. We assumed occult cases might take 1-2 years (latency period) to become clinically detectable after receiving TRT. We selected several latency periods (12/18/24 months) and compared the risk of PCa in the TRT and non-TRT group over the latency period, from the end of latency period till the end of follow-up, and over the whole follow-up time.
RESULTS
Overall, 26 PCa cases occurred in the non-TRT group vs 9 cases in the TRT group. Within 18 months of follow-up, 9 cases occurred in the TRT group vs 0 cases in the non-TRT group; from the end of 18 months till the end of follow-up, 26 cases occurred in the non-TRT group vs 0 cases in the TRT group. The adjusted table showed seemingly adverse effects of TRT on PCa development within 18 months (p = 0.0301) and beneficial effects from the end of 18 months till the end of follow-up (p = 0.0069). Similar patterns were observed for 12 or 24 months as the latency period.
CONCLUSIONS
TRT may make occult PCa cases detectable within early phase of treatment and present a beneficial effect in the long run. Future longitudinal studies are needed to confirm findings from our exploratory analyses.
背景
尽管在进行睾丸激素替代疗法（TRT）之前会进行前列腺癌（PCa）筛查，但临床上可能存在隐匿性 PCa 病例。
方法
为了评估隐匿性 PCa 病例的可能纳入是否会扭曲 TRT 对 PCa 风险的影响，我们从 2004 年至 2016 年在德国的一家泌尿科中心随访了 776 名低睾酮男性（TRT=400，非 TRT=376），平均随访时间为 7 年。我们假设隐匿性病例在接受 TRT 后可能需要 1-2 年（潜伏期）才能变为临床可检测。我们选择了几个潜伏期（12/18/24 个月），并比较了 TRT 和非 TRT 组在潜伏期内、潜伏期结束后至随访结束时以及整个随访期间的 PCa 风险。
结果
总体而言，非 TRT 组发生 26 例 PCa 病例，TRT 组发生 9 例。在 18 个月的随访期内，TRT 组发生 9 例，非 TRT 组无病例发生；从 18 个月随访结束到随访结束，非 TRT 组发生 26 例，TRT 组无病例发生。调整后的表格显示，TRT 在 18 个月内对 PCa 发展似乎有不利影响（p=0.0301），从 18 个月结束到随访结束时有有益影响（p=0.0069）。对于 12 个月或 24 个月作为潜伏期，也观察到类似的模式。
结论
TRT 可能使隐匿性 PCa 病例在治疗早期变得可检测，并从长远来看呈现有益的效果。需要进行未来的纵向研究来证实我们的探索性分析结果。
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