title: Chemotherapy plus estramustine for management of castration-resistant prostate cancer: meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  Estramustine, an agent with both hormonal and non-hormonal effects in men, is supposed to be effective in treating castration-resistant prostate cancer. However, previous studies have reported conflicting results. We conducted this meta-analysis to evaluate the efficacy and toxicity of additional estramustine to chemotherapy.
  
  
  METHODS
  Data sources including PubMed, Medline, EMBASE, and Cochrane Controlled Trials Register were searched to identify potentially relevant randomized controlled trials. Prostate specific antigen (PSA) response, overall survival, and grade 3 to 4 toxicity were analyzed.
  
  
  RESULTS
  Seven randomized controlled trials, a total of 839 patients, were enrolled. The pooled odds ratio for PSA response was 3.02 (95% CI=1.69-5.39, P=.0002); the pooled hazard ratio for overall survival was .95 (95% CI=.80-1.14, P=.58); the pooled odds ratio for nausea/vomiting and cardiovascular toxicity were 3.90 (95% CI=1.05-14.45, P=.04) and 2.22 (95% CI=1.15-4.30, P=.02). No significant difference was detected for neutropenia, anemia, thrombocytopenia, diarrhea, fatigue, or neuropathy (P>.05).
  
  
  CONCLUSIONS
  According to this meta-analysis, chemotherapy with additional estramustine increased the PSA response rate. However, it increased the risk of grade 3 or 4 adverse effects such as nausea/vomiting and cardiovascular events, and the overall survival was not improved for castration-resistant prostate cancer patients.
authors: Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors: C
authors: C
authors: Zhang
authors: Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors: T
authors: T
authors: Jing
authors: Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors: F
authors: F
authors: Wang
authors: Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors: X
authors: X
authors: Gao
authors: Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors: C
authors: C
authors: Xu
authors: Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China. Electronic address: sunyh@medmail.com.cn.
authors: Y
authors: Y
authors: Sun
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000188:drug therapy* / Q000601:surgery; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000139:chemically induced; D003131:Combined Modality Therapy; D000077143:Docetaxel; D015251:Epirubicin / Q000008:administration & dosage; D034261:Epothilones / Q000008:administration & dosage; D004961:Estramustine / Q000008:administration & dosage / Q000009:adverse effects; D005221:Fatigue / Q000139:chemically induced; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D006402:Hematologic Diseases / Q000139:chemically induced; D006801:Humans; D008297:Male; D009919:Orchiectomy; D017239:Paclitaxel / Q000008:administration & dosage; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000601:surgery; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D016879:Salvage Therapy; D016019:Survival Analysis; D043823:Taxoids / Q000008:administration & dosage; D016896:Treatment Outcome; D014747:Vinblastine / Q000008:administration & dosage
chemical_list: D018931:Antineoplastic Agents, Hormonal; D034261:Epothilones; D043823:Taxoids; D000077143:Docetaxel; D004961:Estramustine; D015251:Epirubicin; D014747:Vinblastine; D017430:Prostate-Specific Antigen; C430592:ixabepilone; D017239:Paclitaxel
keywords: Chemotherapy; Cáncer de próstata; Estramustina; Estramustine; Meta-analysis; Metaanálisis; Prostate cancer; Quimioterapia