抗雄激素受体信号抑制剂（ARSi）正在不同程度的前列腺癌中成为标准治疗方法，但尚不清楚它们的副作用与其他药物的比较情况。为了系统评估四种抗雄激素药物（阿比特龙、阿帕卢胺、达罗替胺和恩扎卢胺）在治疗转移性去势抵抗性前列腺癌（mCRPC）、非转移性CRPC（nmCRPC）和转移性去势敏感前列腺癌（mCSPC）中的不良事件（AEs），我们查询了PubMed、Web of Science和Embase，并根据Preferred Reporting Items for Systematic Review and Meta-Analysis（PRISMA）声明，找到了双盲、随机对照试验（RCTs）的ARSi疗法，截至2022年9月。两个小组进行了标题和摘要的审阅，并收集了14篇RCTs进行分析。我们使用森林图来总结最常见AE的风险比。根据累积排名曲线下面积（SUCRA）的值，在mCRPC和nmCRPC中，恩扎卢胺在高血压结果方面被评为最有毒的治疗（SUCRA 0%，最有可能被排名最低的治疗），在所有前列腺癌实体中，恩扎卢胺在头痛方面也被评为最有毒的（SUCRA 0%对于mCRPC，1%对于nmCRPC，3%对于mCSPC）。 我们的研究结果表明，ARSi的副作用基本相似，除了在mCRPC和nmCRPC中，恩扎卢胺在高血压方面被评为最有毒，在所有前列腺癌实体中，在头痛方面也被评为最有毒的。这些结果突显了密切监测恩扎卢胺血压的重要性，未来的研究应该探索ARSi疗法与心血管和神经风险之间的可能联系。此外，这些比较依赖于跨试验比较的有效性。 我们查阅了用于治疗前列腺癌的第二代抗雄激素药物的副作用资料。除了恩扎卢胺的高血压和头痛风险较高之外，副作用类似。 版权所有 © 2023 European Association of Urology。由Elsevier B.V.出版。保留所有权利。

Androgen receptor signaling inhibitor (ARSi) agents are emerging as standard treatments for prostate cancer across the disease spectrum, but much remains unknown regarding how their side-effect profiles compare.To systematically evaluate the literature regarding adverse events (AEs) between the ARSi drugs abiraterone, apalutamide, darolutamide, and enzalutamide in the treatment of metastatic castration-resistant prostate cancer (mCRPC), nonmetastatic CRPC (nmCRPC), and metastatic castration-sensitive prostate cancer (mCSPC).PubMed, Web of Science, and Embase were queried for double-blind, randomized controlled trials (RCTs) of ARSi therapy up to September 2022 according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. Two teams reviewed titles and abstracts, and 14 RCTs were included for analysis.Forest plots were used to summarize risk ratios for the most common AEs. According to surface under the cumulative ranking curve (SUCRA) values, enzalutamide was ranked as the most toxic treatment regarding hypertension outcomes (SUCRA 0%, most likely to be the bottom-ranked treatment) in both mCRPC and nmCRPC (SUCRA 0%). Enzalutamide was also ranked as the most toxic regarding headache across all prostate cancer entities (SUCRA 0%, for mCRPC, 1% for nmCRPC, and 3% for mCSPC).Our findings suggest that the ARSi side-effect profiles do not significantly differ, except that enzalutamide was ranked the most toxic regarding hypertension in mCRPC and nmCRPC, and the most toxic regarding headache across all prostate cancer settings. These results highlight the importance of close blood-pressure monitoring for enzalutamide, and future research should explore possible connections between cardiovascular and neurological risk with ARSi therapy. In addition, these comparisons rely on the validity of cross-trial comparisons.We reviewed the side-effect profiles of second-generation antiandrogen drugs for the treatment of prostate cancer. Side effects were similar, apart from higher risk of high blood pressure and headache risk with enzalutamide.Copyright © 2023 European Association of Urology. Published by Elsevier B.V. All rights reserved.