Nead KT, et al. – Researchers conducted a systematic review and meta–analysis which indicated that the recently available evidence suggests that androgen deprivation therapy (ADT) in the treatment of prostate cancer is associated with an increased risk of depression.

Methods

• Researchers searched PubMed, Web of Science, Embase, and PsycINFO on April 5, 2017.
• They detected depression among individuals with prostate cancer exposed to a course of ADT vs. a lesser–exposed group (e.g., any–ADT vs. no ADT and continuous ADT vs. intermittent ADT).
• They applied the MOOSE statement guidelines and the Cochrane Review Group’s data extraction template.
• They assessed study quality by Newcastle–Ottawa Scale criteria.
• They performed a random–effects meta–analysis to estimate summary statistic risk ratios (RRs) and 95% CIs.
• They evaluated heterogeneity applying the I2 statistic and prespecified subgroup analysis.
• They assessed small study applying Begg and Egger statistics.

Results

• They initially distinguished and assessed a total of 1,128 studies.
• A meta–analysis of 18 studies among 168,756 individuals observed that androgen deprivation therapy use conferred a 41% increased risk of depression (RR = 1.41; 95% CI: 1.18–1.70; P<0.001).
• They observed a consistent strong statistically significant association when limiting their analysis to studies in localized disease (RR = 1.85; 95% CI: 1.20–2.85; P = 0.005) and those using a clinical diagnosis of depression (RR = 1.19; 95% CI: 1.08–1.32; P = 0.001).
• They did not observe a correlation for continuous ADT with depression risk compared to intermittent ADT (RR = 1.00; 95% CI: 0.50–1.99; P = 0.992).
• No statistically significant evidence of small study effects was observed.
• In addition, statistically significant heterogeneity in the full analysis (I2 = 80%; 95% CI: 69–87; P<0.001) resolved when examining studies using a clinical diagnosis of depression (I2 = 16%; 95% CI: 0–60; P = 0.310).