title: Gonadotropin-releasing hormone antagonists versus standard androgen suppression therapy for advanced prostate cancer A systematic review with meta-analysis.
abstract: OBJECTIVE
  To evaluate efficacy and safety of gonadotropin-releasing hormone (GnRH) antagonists compared to standard androgen suppression therapy for advanced prostate cancer.
  
  
  METHODS
  The international review team included methodologists of the German Cochrane Centre and clinical experts.
  
  
  METHODS
  We searched CENTRAL, MEDLINE, Web of Science, EMBASE, trial registries and conference books for randomised controlled trials (RCT) for effectiveness data analysis, and randomised or non-randomised controlled studies (non-RCT) for safety data analysis (March 2015). Two authors independently screened identified articles, extracted data, evaluated risk of bias and rated quality of evidence according to GRADE.
  
  
  RESULTS
  13 studies (10 RCTs, 3 non-RCTs) were included. No study reported cancer-specific survival or clinical progression. There were no differences in overall mortality (RR 1.35, 95% CI 0.63 to 2.93), treatment failure (RR 0.91, 95% CI 0.70 to 1.17) or prostate-specific antigen progression (RR 0.83, 95% CI 0.64 to 1.06). While there was no difference in quality of life related to urinary symptoms, improved quality of life regarding prostate symptoms, measured with the International Prostate Symptom Score (IPSS), with the use of GnRH antagonists compared with the use of standard androgen suppression therapy (mean score difference -0.40, 95% CI -0.94 to 0.14, and -1.84, 95% CI -3.00 to -0.69, respectively) was found. Quality of evidence for all assessed outcomes was rated low according to GRADE. The risk for injection-site events was increased, but cardiovascular events may occur less often by using GnRH antagonist. Available evidence is hampered by risk of bias, selective reporting and limited follow-up.
  
  
  CONCLUSIONS
  There is currently insufficient evidence to make firm conclusive statements on the efficacy of GnRH antagonist compared to standard androgen suppression therapy for advanced prostate cancer. There is need for further high-quality research on GnRH antagonists with long-term follow-up.
  
  
  BACKGROUND
  CRD42012002751.
authors.affiliation: Department of Urology, University Hospital Erlangen, Erlangen, Germany UroEvidence, Deutsche Gesellschaft für Urologie, Düsseldorf/Berlin, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Kunath
authors.affiliation: UroEvidence, Deutsche Gesellschaft für Urologie, Düsseldorf/Berlin, Germany Department of Urology, University Hospital Frankfurt, Frankfurt, Germany.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Borgmann
authors.affiliation: German Cochrane Centre, Medical Center-University of Freiburg, Freiburg, Germany.
authors.forename: Anette
authors.initials: A
authors.lastname: Blümle
authors.affiliation: Department of Urology, University Hospital Erlangen, Erlangen, Germany.
authors.forename: Bastian
authors.initials: B
authors.lastname: Keck
authors.affiliation: Department of Urology, University Hospital Erlangen, Erlangen, Germany UroEvidence, Deutsche Gesellschaft für Urologie, Düsseldorf/Berlin, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Wullich
authors.affiliation: German Cochrane Centre, Medical Center-University of Freiburg, Freiburg, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Schmucker
authors.affiliation: Department of Urology, University Hospital Erlangen, Erlangen, Germany.
authors.forename: Danijel
authors.initials: D
authors.lastname: Sikic
authors.affiliation: Department of Urology, University Hospital Erlangen, Erlangen, Germany.
authors.forename: Catharina
authors.initials: C
authors.lastname: Roelle
authors.affiliation: UroEvidence, Deutsche Gesellschaft für Urologie, Düsseldorf/Berlin, Germany.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Schmidt
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Medicine, Cairo University Hospital, Cairo, Egypt.
authors.forename: Amr
authors.initials: A
authors.lastname: Wahba
authors.affiliation: German Cochrane Centre, Medical Center-University of Freiburg, Freiburg, Germany.
authors.forename: Joerg J
authors.initials: JJ
authors.lastname: Meerpohl
mesh_terms: D000726:Androgen Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D007987:Gonadotropin-Releasing Hormone / Q000009:adverse effects / Q000819:agonists*; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000401:mortality*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D017211:Treatment Failure
chemical_list: D000726:Androgen Antagonists; D007987:Gonadotropin-Releasing Hormone; D017430:Prostate-Specific Antigen