| Objectives: To assess the efficacy, quality of life and side effects of intermittent androgen blockade (IAB) and continuous androgen blockade (CAB) as treatment of advanced prostate cancer by means of a systematic review and meta analysis,in order to provide evidence for clinical treatment of advanced prostate cancer.Methods:Using the search terms"prostate cancer,intermittent androgen blockade, continuous androgen blockade,RCT",the literature in Chinese and English from 1966 to December 2009 on the difference of IAB and CAB was searched from CNKI, EMCC, Medline, PUBMED, Google Scholar . Then, the studies to be included were identified according to the previously established inclusion criteria, and the studies which were selected should be assessed by methodological quality which was from the protocol recommended by Cochrane. Finally, data of studies included were extracted using self-tabulate table, and the criteria randomized controlled trials (RCTs) were studied by Meta-analysis in RevMan 5.0. At the same time, ORs and WMDs of randomized model and fixed model were calculated to evaluate the sensitivity.Results: There were six RCTs that compared IAB with CAB, but 2 of the RCTs had abstract without full texts. There were 2556 patients to be internalized in all ,of which 1286 were from IAB and 1270 were from CAB. Pooled effect indicated that efficacy was not significantly different between the IAB and CAB group, death and progression rate, OR 0.99 (95%CI 0.57~1.72) and OR 1.07(95%CI 0.86~1.35), respectively. Calculated results indicated that quality of life on sexual activity was significantly lower in the IAB group, OR 0.16 (95%CI 0.03~0.73). However, there were only two studies internalized about side effects: Calais Da Silva F.E reported that the incidence of side effects was not too high in IAB arm, with 7% of patients reporting Hot Flushes, 10% Gynocomastia, 5% Headaches. There was significantly higher rate of side effects in CAB arm (P<0.0001), especially for Hot Flushes (23%) and Gynocomastia (33%) and Headaches (12%) . The other study which was reported by Jacques Irani showed that there was no significant difference in health-related quality of life and side effects between IAB and CAB ,which was estimated by way of EORTC QLQ-30 .Conclusion:Based on the included RCTs, IAB might significantly improve patients'quality of life,reduce therapy-related side effects and expense, have same effects on survival and progression rate as that of CAB,and have wide prospect, thus be the routine treatment modality for the treatment of advanced prostate cancer. Certainly , because of bias,lack of information on methodology and few of studies to be internalized , the conclusion of this systematic review was not stable enough . Therefor , it was necessary to assemble more and more randomized clinical trials with strict design ,which was good for this systematic review to be amended and updated and to confirm the feasibility and superiority of IAB further. |
PDF Full Text Request