Prognostic value of testosterone for the castration-resistant prostate cancer patients: a systematic review and meta-ana
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REVIEW ARTICLE
Prognostic value of testosterone for the castration‑resistant prostate cancer patients: a systematic review and meta‑analysis Noriyoshi Miura1,2 · Keiichiro Mori1,3 · Hadi Mostafaei1,4 · Fahad Quhal1,5 · Reza Sari Motlagh1 · Mohammad Abufaraj1,6 · Benjamin Pradere1,7 · Abdulmajeed Aydh1,8 · Ekaterina Laukhtina1,9 · David D’Andrea1 · Takashi Saika2 · Shahrokh F. Shariat1,6,9,10,11,12,13,14 Received: 6 April 2020 / Accepted: 5 July 2020 © The Author(s) 2020
Abstract Introduction This systematic review and meta-analysis aimed to assess the prognostic value of testosterone in patients with castration-resistant prostate cancer (CRPC). Materials and methods PubMed, Web of Science, and Scopus databases were systematically searched until December 2019, according to the Preferred Reporting Items for Systemic Review and Meta-analysis statement. The endpoints were progression-free survival (PFS) and overall survival (OS). Results We identified 11 articles with 4206 patients for systematic review and nine articles with 4136 patients for meta-analysis. Higher testosterone levels were significantly associated with better OS (pooled HR 0.74, 95% CI 0.58–0.95) and better PFS (pooled HR 0.51, 95% CI 0.30–0.87). Subgroup analyses based on the treatment type revealed that higher testosterone levels were significantly associated with better OS in CRPC patients treated with androgen receptor-targeted agents (ARTAs) (pooled HR 0.64, 95% CI 0.55–0.75), but not in those treated with chemotherapy (pooled HR 0.78, 95% CI 0.53–1.14). Conclusion This meta-analysis demonstrated that the PFS and OS were significantly greater in patients with CRPC in those with higher testosterone levels than that of those with lower testosterone levels. In the subgroup analyses, lower testosterone levels were a consistently poor prognostic factor for OS in patients treated with ARTAs, but not in those treated with chemotherapy. Therefore, higher testosterone levels could be a useful biomarker to identify patient subgroups in which ARTAs should be preferentially recommended in the CRPC setting. Keywords Prostate cancer · Testosterone · Meta-analysis · Androgen receptor-targeted agents · Castration-resistant Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10147-020-01747-1) contains supplementary material, which is available to authorized users. * Shahrokh F. Shariat [email protected] 1
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Department of Urology, University Hospital of Tours, Tours, France
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King Faisal Medical City, Abha, Saudi Arabia
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Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
Department of Urology, Ehime University Graduate School of Medicine, Ehime, Japan
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Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
Department of Urology, Weill Cornell Medical College, New York, NY, USA
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Research Center for Evidence base
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