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androgen-deprivation therapy alone versus combined with radiation therapy or chemotherapy For nonlocalized prostate cancer： a systematic review and meta-analysis

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Asian Journal of Andrology 2016年第1期18卷 102-107页

作者： Jun-Hao Lei Liang-Ren Liu Qiang Wei Tu-Run Song Lu Yang Yang Meng Ping Han Department of Urology West China Hospital Sichuan University Guoxue Xiang #37 Chengdu 610041 Sichuan China

In this paper, we reviewed the long-term survival outcomes, safety, and quality-of-life of androgen-deprivation therapy （ADT） alone versus combined with radiation therapy （RT） or chemotherapy for locally advanced and metastatic prostate cancer （PCa）. A literature search was performed using OvidSP. Randomized controlled trials （RCTs） that met the following criteria were included： including locally advanced or metastatic PCa, comparing ADT alone versus combined with any treatment method and reporting quantitative data of disease control or survival outcomes. Finally, eight RCTs met the inclusion criteria. Among these, three compared ADT versus ADT plus RT （n = 2344） and one compared ADT versus ADT plus docetaxel-estramustine （n = 413） in locally advanced PCa; two compared ADT versus ADT plus docetaxel （n = 1175） and two compared ADT versus ADT plus estramustine （n = 114） in metastatic PCa. For locally advanced PCa, the addition of RT to long-term ADT can improve the outcomes of survival and tumor control with fully acceptable adverse effects. Specially, the pooled odds ratio （OR） of overall survival （OS） was 1.43 （95% confidence interval 1.20-1.71） when compared ADT plus RT with ADT alone （P 〈 0.0001）. For metastatic hormonally sensitive PCa, the concurrent use of docetaxel plus ADT was effective and safe （pooled OR of OS： 1.29 [1.01-1.65]： P = 0.04）. In all, long-term ADT plus RT and long-term ADT plus docetaxel should be considered as proper treatment option in locally advanced and metastatic hormonally sensitive PCa, respectively. The major limitation for the paper was that only eight RCTs were available.

关键词： androgen-deprivation chemotherapy prostate cancer quality-of-life radiation therapy

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ndrogen-deprivation therapy in men with metastatic rostate cancer： less may not necessarily be more

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Asian Journal of Andrology 2013年第4期15卷 445-446页

作者： Mark Ng Tang Fui Mathis Grossmann Department of Medicine University of Melbourne Austin Health Heidelberg Victoria 3084 Australia and Endocrinology Austin Health Heidelberg Victoria 3084 Australia

In a pivotal phase 3 randomized con trolled trial, Hussain et al. tested thehypothesis that, with respect to survival, intermittent androgen deprivation therapy （ADT） is noninferior to continuous in men with newly diagnosed metastatic prostate cancer. While the trial findings were statis tically inconclusive, the study suggests, but does not prove, that intermittent may do more harm than good, although findings are not definitive. While outcomes of ongoing trials are awaited, the trial by Hussain et al., in conjunction with an ear lier trial in men with nonmetastatic pro state cancer by Crook et al., does provide important new guidance regarding the choice of ADT in men with androgensensitive prostate cancer. ADT is one of the most effective palliat ive therapies for patients with metastatic prostate cancer, but not without drawbacks. While not as toxic as chemotherapy, ADT carries a significant risk of morbidity, including sexual dysfunction, fatigue, ane mia, accelerated bone loss and fractures, sarcopenia, increased risk of diabetes, and possibly, of cardiovascular events.1＇2 In addition, despite an initial response rate of more than 90%, most patients develop res istance to ADT, resulting in a median sur vival of 2.53 years. Predinical data suggest that continuous use of ADT may accelerate the emergence of resistance to this therapy, and that reexposure of prostate cancer stem cells to androgens can reinduce dif ferentiation and increase their apoptotic potential.3 These ADTassociated shortcom ings, in addition to treatment expense, havespurred the development of strategies to min imize the exposure to ADT, including the use of intermittent ADT. While several smaller randomized controlled clinical trials have compared the use of intermittent with con tinuous ADT, no definitive information is available for patients with metastatic prostate cancer. To fill this evidence gap, a large mul tinational randomized controlled trial led by Hussain et al.4 was designed in

关键词： androgen-deprivation therapy prostate

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