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Meta-Analysis
. 2020 Nov;25(11):1881-1891.
doi: 10.1007/s10147-020-01747-1. Epub 2020 Jul 17.

Prognostic value of testosterone for the castration-resistant prostate cancer patients: a systematic review and meta-analysis

Noriyoshi Miura  1   2 , Keiichiro Mori  1   3 , Hadi Mostafaei  1   4 , Fahad Quhal  1   5 , Reza Sari Motlagh  1 , Mohammad Abufaraj  1   6 , Benjamin Pradere  1   7 , Abdulmajeed Aydh  1   8 , Ekaterina Laukhtina  1   9 , David D'Andrea  1 , Takashi Saika  2 , Shahrokh F Shariat  10   11   12   13   14   15   16   17
Affiliations
Meta-Analysis

Prognostic value of testosterone for the castration-resistant prostate cancer patients: a systematic review and meta-analysis

Noriyoshi Miura et al. Int J Clin Oncol. 2020 Nov.

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: Androgen receptor-targeted agents; Castration-resistant; Meta-analysis; Prostate cancer; Testosterone.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest in this work.

Figures

Fig. 1
Fig. 1
Preferred reporting items for systematic reviews and meta-analyses flow chart for article selection process to analyze the prognostic impact of serum testosterone levels in castration-resistant prostate cancer. The studies in which HR was extracted from the multivariable analysis were included for qualitative meta-analysis
Fig. 2
Fig. 2
Forest and funnel plots showing the association of serum testosterone levels with oncological outcomes in castration-resistant prostate cancer; a overall survival, b progression-free survival
Fig. 3
Fig. 3
Forest and funnel plots showing the association of serum testosterone levels with oncological outcomes in patients with castration-resistant prostate cancer treated with androgen receptor-targeted agents; a overall survival, b progression-free survival
Fig. 4
Fig. 4
Forest and funnel plots showing the association of serum testosterone levels with overall survival in patients with castration-resistant prostate cancer treated with chemotherapy
See this image and copyright information in PMC

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