PMID-10744594 – Single-Therapy Androgen Suppression Systematic Review
Seidenfeld J, Samson DJ, Hasselblad V, Aronson N, Albertsen PC, Bennett CL, Wilt TJ. Single-therapy androgen suppression in men with advanced prostate cancer: a systematic review and meta-analysis. Ann Intern Med. 2000;132(7):566-77.
Quick Reference
| Property | Value |
|---|---|
| PMID | 10744594 |
| DOI | 10.7326/0003-4819-132-7-200004040-00009 |
| Year | 2000 |
| Journal | Annals of Internal Medicine |
| Study Type | Systematic Review / Meta-analysis |
| Evidence Level | I |
| Sample | 24 RCTs, >6,600 patients |
| Peptide(s) Studied | Leuprolide, Goserelin, Triptorelin |
Key Findings
- LHRH agonists (leuprolide, goserelin) produce survival equivalent to bilateral orchiectomy (HR 1.126, 95% CI 0.915-1.386)
- No evidence of clinically meaningful differences in efficacy among different LHRH agonists
- Nonsteroidal antiandrogen monotherapy may produce somewhat lower survival rates compared to LHRH agonists or orchiectomy
- Treatment withdrawal rates were lower with LHRH agonists (0-4%) compared to nonsteroidal antiandrogens (4-10%)
- LHRH agonists are therapeutically interchangeable for androgen deprivation therapy
Study Design
Systematic review and meta-analysis of 24 randomized controlled trials comparing medical and surgical castration approaches, as well as different LHRH agonists, in men with advanced prostate cancer. Survival was the primary endpoint. Random-effects models were used for pooled analyses.
Limitations
- Many included trials had limited follow-up duration
- Heterogeneity in patient populations and disease staging across trials
- Quality-of-life outcomes were not systematically assessed
- Published before newer GnRH antagonists were available for comparison
Clinical Relevance
This landmark meta-analysis established the equivalence of LHRH agonist therapy with surgical castration for advanced prostate cancer, helping to transition the standard of care from orchiectomy to pharmacologic androgen deprivation. It remains a foundational reference for the clinical use of GnRH agonists including leuprolide and goserelin.
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#research #systematic-review #meta-analysis #peptide #sexual-health #evidence-level-I