Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Shariati Hospital, Tehran University of Medical Sciences, Teheran, Iran.
Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan.
Urol Oncol. 2019 Oct;37(10):637-646. doi: 10.1016/j.urolonc.2019.06.007. Epub 2019 Jul 8.
To evaluate the association between testosterone replacement therapy (TRT) in prostate cancer (CaP) patients who underwent definitive local therapy with curative intent with biochemical recurrence (BCR).
A literature search using PubMed, Scopus, Web of Science, and Cochrane Library was conducted on November 2018 to identify relevant studies according to the Preferred Reporting Items for Systematic Review and Meta Analysis guidelines. The pooled BCR rate in CaP men treated with TRT after definitive local therapy with curative intent was calculated using a random effects model.
Twenty-one studies were eligible. The overall pooled BCR rate was 0.01 (95%CI 0.00-0.02) suggesting a lack of association between TRT and BCR; there was no heterogeneity among included studies (I = 24.34%, P = 0.15). In subgroup analyses, pooled BCR rates were 0.00 (95%CI 0.00-0.02) in patients treated with radical prostatectomy and 0.02 (95%CI 0.00-0.04) in patients treated with external beam radiation therapy, brachytherapy, cryotherapy, or high intensity focused ultrasound; there was no heterogeneity in the subgroup analyses (I = 19.88%, P = 0.18).
In this systematic review and meta-analysis, we did not observe higher rate of BCR after TRT for nonmetastatic CaP patients after definitive local therapy. Based on these data, others and we have outlined a phase I/II trial assessing the safety and benefits of TRT in select men with secondary symptomatic hypogonadism who have no active disease after definitive local CaP therapy with curative intent.
评估接受根治性局部治疗的前列腺癌（CaP）患者中睾丸激素替代疗法（TRT）与生化复发（BCR）之间的关系。
根据系统评价和荟萃分析的首选报告项目，于 2018 年 11 月在 PubMed、Scopus、Web of Science 和 Cochrane Library 上进行了文献检索，以确定相关研究。使用随机效应模型计算接受根治性局部治疗后接受 TRT 的 CaP 男性的总体 BCR 率。
21 项研究符合条件。总体 BCR 率为 0.01（95%CI 0.00-0.02），表明 TRT 与 BCR 之间缺乏关联；纳入研究之间没有异质性（I=24.34%，P=0.15）。在亚组分析中，接受根治性前列腺切除术治疗的患者的 BCR 率为 0.00（95%CI 0.00-0.02），接受外照射放疗、近距离放射治疗、冷冻治疗或高强度聚焦超声治疗的患者的 BCR 率为 0.02（95%CI 0.00-0.04）；亚组分析中没有异质性（I=19.88%，P=0.18）。
在这项系统评价和荟萃分析中，我们没有观察到接受根治性局部治疗的非转移性 CaP 患者在接受 TRT 后 BCR 率升高。基于这些数据，我们和其他人已经制定了一项 I/II 期试验，评估在根治性局部 CaP 治疗后无活动性疾病且具有继发性症状性性腺功能减退的男性中选择性使用 TRT 的安全性和益处。
