Stroke related to androgen deprivation therapy for prostate cancer: a meta-analysis and systematic review.

Whether androgen deprivation therapy (ADT) leads to stroke morbidity is still unclear because of inconsistent evidence. We performed a systematic review and meta-analysis to evaluate if ADT used in men with prostate cancer (PCa) is associated with stroke.

Medline, Embase and Cochrane Library databases up to September 30th 2014 were systematically searched with no date or language restriction, and reports from potentially relevant journals were complementally searched. Both randomized controlled trials and observational studies were included. Two reviewers independently extracted data and assessed study quality. Six observational studies finally met inclusion criteria, with 74,538 ADT users and 85,947 non-ADT users reporting stroke as an endpoint. Although no significant association was observed in pooled estimates, the incidence of stroke in ADT users was 12 % higher than control groups, (HR = 1.12, 95 % confidence interval [CI]: 0.95 to 1.32; P = 0.16). In subgroup-analyses of different ADT types, stroke was found to be significantly associated with gonadotropin-releasing hormone (GnRH) alone (HR = 1.20, 95 % CI: 1.12 to 1.28; P < 0.001), GnRH plus oral antiandrogen (AA) (HR = 1.23, 95 % CI: 1.13 to 1.34; P < 0.001) and orchiectomy (HR = 1.37, 95 % CI: 1.33 to 1. 46; P = 0.001), but not with AA alone (HR = 1.06, 95 % CI: 0.71 to 1.57; P = 0.78).

GnRH alone, GnRH plus AA and orchiectomy is significantly associated with stroke in patients with PCa.

BMC cancer. 2016 Mar 03*** epublish ***

Fanzheng Meng, Shimiao Zhu, Jinsheng Zhao, Larissa Vados, Lei Wang, Yusheng Zhao, Dan Zhao, Yuanjie Niu

Department of Neurology, Tianjin Nankai Hospital, Nankai Clinical School of Tianjin Medical University, Tianjin, China. Department of Urology, Second Hospital of Tianjin Medical Unversity, Tianjin Institute of Urology, 23 Pingjiang Road, Tianjin, 300211, China. Department of Neurology, Tianjin Nankai Hospital, Nankai Clinical School of Tianjin Medical University, Tianjin, China. Tianjin University of Traditional Chinese Medicine, Tianjin, China.  Tianjin Institute of Medical and Pharmaceutical Sciences, Tianjin, China. First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China. Department of Neurology, Tianjin Nankai Hospital, Nankai Clinical School of Tianjin Medical University, Tianjin, China. Department of Urology, Second Hospital of Tianjin Medical Unversity, Tianjin Institute of Urology, 23 Pingjiang Road, Tianjin, 300211, China.