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The effect of different administrations of testosterone therapy on adverse prostate events: A Bayesian network
Bin Zeng1, Shi Qiu1,2, Xingyu Xiong1
1Department of Urology, Institute of Urology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.
Background:
Hypogonadism has become a major cause endangering men's health and quality of life all over the world. Testosterone Therapy (TT) is a widely accepted treatment for relieving hypogonadal symptoms. However, the effect of different administrations of TT on prostate safety is still unclear.
Methods:
We did a thorough search of PubMed, Embase and Cochrane Library to identify eligible studies up to January 2022. Randomized controlled trials (RCTs) and Cohort studies evaluating the impacts of using different formulations of TT on prostate parameters were included. Changes of prostate-specific antigen (PSA) level and prostate cancer (Pca) cases were used as the primary outcomes. Quality of individual studies was estimated by RoB2 (Cochrane tool for assessing the risk of bias in randomized trials) and the Newcastle-Ottawa scale (Tool for assessing non-RCTs). Certainty of evidence for each study was evaluated according to the evidence assessment criteria of the Oxford Evidence-based Medicine Center. Random-effect network meta-analysis(NMA)was performed based on the Bayesian model.
Results:
Thirty-five studies (30 RCTs and 5 Cohort studies) with 7,740 participants were included. TT administration led to fewer Pca patients (RR=0.62, 95%CI [0.39,0.99], I2=0%), while little decreasing in PSA level (MD=-0.05, 95%CI [-0.08, -0.02], I2=0%). The NMA revealed that compared with other formulations, the intramuscular injection was the most likely to rank first in decreasing Pca cases. The TT also resulted in more biopsy cases (RR=2.38, 95%CI [1.01,5.60], I2=0%). As for NMA, intramuscular injection also performed relatively better in fewer prostate biopsy cases compared with transdermal group.
Conclusion:
TT does not lead to abnormal PSA changes and increased risk of Pca in patients with hypogonadism or low testosterone level. Compared with other preparations of TT, intramuscular injection proved better in minimizing Pca cases and was more likely to result in fewer prostate biopsy cases.
Insights
Testosterone Therapy (TT) does not increase prostate cancer risk and may reduce cases. Intramuscular injections appear most effective for lowering prostate cancer incidence and biopsy rates compared to other TT formulations.
Area of Science:
- Endocrinology
- Urology
- Oncology
Background:
- Hypogonadism poses a global health challenge, impacting men's quality of life.
- Testosterone Therapy (TT) is a standard treatment for hypogonadism, but its prostate safety profile across different administration methods remains uncertain.
Approach:
- A systematic review and Bayesian network meta-analysis (NMA) of 35 studies (30 RCTs, 5 Cohort) involving 7,740 participants were conducted.
- Primary outcomes included changes in prostate-specific antigen (PSA) levels and prostate cancer (Pca) incidence.
- Study quality was assessed using RoB2 and Newcastle-Ottawa scales, with evidence certainty evaluated by Oxford criteria.
Key Points:
- Testosterone Therapy (TT) was associated with a reduction in prostate cancer (Pca) cases (RR=0.62) and minimal change in PSA levels.
- Intramuscular injection formulations of TT demonstrated the highest likelihood of reducing Pca incidence compared to other methods.
- However, TT overall was linked to an increase in prostate biopsy cases (RR=2.38), though intramuscular injections showed a relative benefit over transdermal methods in NMA.
Conclusions:
- Testosterone Therapy (TT) does not appear to elevate PSA levels or increase prostate cancer (Pca) risk in hypogonadal men.
- Intramuscular TT formulations are potentially superior in minimizing Pca incidence and reducing the need for prostate biopsies.
- Further research may elucidate optimal TT administration strategies for prostate safety.
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