Androgen Deprivation Therapy and the Risk of Stroke in Patients with Prostate Cancer: An Updated Systematic Review and Meta-Analysis

Background: The aim of this article was to review the association between androgen deprivation therapy (ADT) and the risk of stroke in patients with prostate cancer (PC). Thus, we performed this study to understand the impact of ADT on the incidence of stroke in PC patients. Methods: A comprehensive literature search was performed in June 2019 based on PubMed, EMBASE, and Web of science databases. Pooled rate ratio (RR), hazard ratio (HR), and their 95% confidence intervals (95% CIs) were calculated with a DerSimonian and Laird random effects. Result: A total of 239,099 patients from 10 studies were included in this analysis. There was no significant association in pooled RR analysis. Pooled HR analysis showed that ADT treatment increased the risk of stroke (HR = 1.129, 95% CI: 1.019-1.251, p = 0.02). In a subgroup analysis of RR results, we found that different ADT treatments had no significant effect on increasing the risk of stroke. And in the subgroup analysis of HR results, only PC patients treated with gonadotropin-releasing hormone (GnRH) agonists, orchiectomy, or oral antiandrogen had significantly higher risk of stroke. In addition, we observed the result from another comparison that PC patients treated with GnRH agonists combined with oral antiandrogens might have a lower risk of stroke compared with using GnRH agonists alone. Conclusion: Our results showed that GnRH agonists, orchiectomy, or oral antiandrogen might play an important role in the incidence of stroke. We still need further studies to clarify the role of ADT in the increased risk of stroke.