title: Stroke related to androgen deprivation therapy for prostate cancer: a meta-analysis and systematic review.
abstract: BACKGROUND
  Whether androgen deprivation therapy (ADT) leads to stroke morbidity is still unclear because of inconsistent evidence. We performed a systematic review and meta-analysis to evaluate if ADT used in men with prostate cancer (PCa) is associated with stroke.
  
  
  RESULTS
  Medline, Embase and Cochrane Library databases up to September 30th 2014 were systematically searched with no date or language restriction, and reports from potentially relevant journals were complementally searched. Both randomized controlled trials and observational studies were included. Two reviewers independently extracted data and assessed study quality. Six observational studies finally met inclusion criteria, with 74,538 ADT users and 85,947 non-ADT users reporting stroke as an endpoint. Although no significant association was observed in pooled estimates, the incidence of stroke in ADT users was 12 % higher than control groups, (HR = 1.12, 95 % confidence interval [CI]: 0.95 to 1.32; P = 0.16). In subgroup-analyses of different ADT types, stroke was found to be significantly associated with gonadotropin-releasing hormone (GnRH) alone (HR = 1.20, 95 % CI: 1.12 to 1.28; P < 0.001), GnRH plus oral antiandrogen (AA) (HR = 1.23, 95 % CI: 1.13 to 1.34; P < 0.001) and orchiectomy (HR = 1.37, 95 % CI: 1.33 to 1. 46; P = 0.001), but not with AA alone (HR = 1.06, 95 % CI: 0.71 to 1.57; P = 0.78).
  
  
  CONCLUSIONS
  GnRH alone, GnRH plus AA and orchiectomy is significantly associated with stroke in patients with PCa.
authors.affiliation: Department of Neurology, Tianjin Nankai Hospital, Nankai Clinical School of Tianjin Medical University, Tianjin, China.|Department of Urology, Second Hospital of Tianjin Medical Unversity, Tianjin Institute of Urology, 23 Pingjiang Road, Tianjin, 300211, China.
authors.forename: Fanzheng
authors.initials: F
authors.lastname: Meng
authors.affiliation: Department of Urology, Second Hospital of Tianjin Medical Unversity, Tianjin Institute of Urology, 23 Pingjiang Road, Tianjin, 300211, China.
authors.forename: Shimiao
authors.initials: S
authors.lastname: Zhu
authors.affiliation: Department of Neurology, Tianjin Nankai Hospital, Nankai Clinical School of Tianjin Medical University, Tianjin, China.
authors.forename: Jinsheng
authors.initials: J
authors.lastname: Zhao
authors.affiliation: Tianjin University of Traditional Chinese Medicine, Tianjin, China.
authors.forename: Larissa
authors.initials: L
authors.lastname: Vados
authors.affiliation: Tianjin Institute of Medical and Pharmaceutical Sciences, Tianjin, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Wang
authors.affiliation: First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.
authors.forename: Yusheng
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Department of Neurology, Tianjin Nankai Hospital, Nankai Clinical School of Tianjin Medical University, Tianjin, China.
authors.forename: Dan
authors.initials: D
authors.lastname: Zhao
authors.affiliation: Department of Urology, Second Hospital of Tianjin Medical Unversity, Tianjin Institute of Urology, 23 Pingjiang Road, Tianjin, 300211, China. yuanjieniu68@hotmail.com.
authors.forename: Yuanjie
authors.initials: Y
authors.lastname: Niu
mesh_terms: D000726:Androgen Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects* / Q000627:therapeutic use; D016022:Case-Control Studies; D007987:Gonadotropin-Releasing Hormone / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D009919:Orchiectomy / Q000009:adverse effects*; D016016:Proportional Hazards Models; D011471:Prostatic Neoplasms / Q000150:complications* / Q000188:drug therapy; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology*
chemical_list: D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal; D007987:Gonadotropin-Releasing Hormone