Department of Urology Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.
Department of Infectious Diseases, The First Affiliated Hospital of China Medical University, Shenyang, China.
Front Endocrinol (Lausanne). 2023 Feb 6;14:1131715. doi: 10.3389/fendo.2023.1131715. eCollection 2023.
Orchiectomy has been replaced by medication represented by luteinizing hormone-releasing hormone (LHRH) agonist as the first-line therapy for androgen deprivation therapy (ADT). After the wide application of LHRH agonist, the side-effects of long-term ADT were noticed. It is time to reconsider the role of medication and surgeries in the treatment of prostate cancer.
Embase, Pubmed, Web of science and Cochrane library were searched for relevant trials. Quality of the studies and risk of bias were assessed by using the Newcastle-Ottawa Scale (NOS). Therapeutic and adverse effects, as well as long-term metabolic adverse effects were extracted from the selected studies. The data synthesized in meta-analyses were performed with R software (4.2.1). Risk ratio (RR) with its 95% confidence interval (CI) was calculated by combining outcome data including complete and partial response rate, progression rate, death rate and adverse effects such as hot flash and increase in pain. Descriptive analysis was performed among the prostate specific antigen (PSA), testosterone and metabolic adverse effects due to a lack of homogeneity of frailty measures.
1,711 participants from 11 studies were included in our systematic review. 1,258 patients from six studies were included in the meta-analysis. Based on the meta-analysis, the therapeutic and adverse outcomes included overall response rate, complete response rate, partial response rate, stable rate, progression rate, death rate and hot flashes. No statistical significance was observed between LHRH agonists and orchiectomy. Compared with surgery, LHRH agonist elevated the risk of the increase in pain. In descriptive analysis, it was shown that the therapeutic effects between PSA and testosterone also showed no significant difference. Both groups had lipid and glucose metabolic disorders, and a few studies reported worse lipid metabolic performance in orchiectomy group and worse insulin resistance in LHRH agonist group.
We found that the therapeutic outcomes were similar between the two options. The results of lipid and glucose metabolic abnormality were controversial in existing studies. The direct comparison studies on metabolic adverse effects should be performed in the future. The therapeutic, metabolic, psychological and economical effects should be considered before applying ADT methods.
https://www.crd.york.ac.uk/prospero/, identifier CRD42022365891.
促黄体激素释放激素（LHRH）激动剂已取代睾丸切除术，成为雄激素剥夺治疗（ADT）的一线治疗方法。LHRH 激动剂广泛应用后，人们注意到长期 ADT 的副作用。现在是重新考虑药物和手术在前列腺癌治疗中的作用的时候了。
在 Embase、Pubmed、Web of science 和 Cochrane 图书馆中搜索相关试验。使用纽卡斯尔-渥太华量表（NOS）评估研究的质量和偏倚风险。从选定的研究中提取治疗和不良反应以及长期代谢不良反应。使用 R 软件（4.2.1）对选择的研究进行荟萃分析。使用合并结局数据（包括完全和部分缓解率、进展率、死亡率以及不良反应如热潮红和疼痛增加）计算风险比（RR）及其 95%置信区间（CI）。由于脆弱性指标的同质性不足，对前列腺特异性抗原（PSA）、睾酮和代谢不良反应进行描述性分析。
我们的系统评价纳入了 11 项研究的 1711 名参与者，6 项研究的 1258 名患者纳入荟萃分析。基于荟萃分析，治疗和不良反应结果包括总缓解率、完全缓解率、部分缓解率、稳定率、进展率、死亡率和热潮红。LHRH 激动剂和睾丸切除术之间没有观察到统计学意义。与手术相比，LHRH 激动剂增加了疼痛增加的风险。在描述性分析中，PSA 和睾酮之间的治疗效果也没有显著差异。两组均存在血脂和糖代谢紊乱，少数研究报告睾丸切除术组血脂代谢表现更差，LHRH 激动剂组胰岛素抵抗更差。
我们发现两种选择的治疗效果相似。现有研究中关于脂质和糖代谢异常的结果存在争议。未来应进行代谢不良反应的直接比较研究。在应用 ADT 方法之前，应考虑治疗、代谢、心理和经济影响。
https://www.crd.york.ac.uk/prospero/，标识符 CRD42022365891。
