Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 26, 2021; 9(21): 5932-5942
Published online Jul 26, 2021. doi: 10.12998/wjcc.v9.i21.5932
Fatigue prevalence in men treated for prostate cancer: A systematic review and meta-analysis
Yu-Hong Luo, Yan-Wei Yang, Chang-Fu Wu, Chao Wang, Wen-Juan Li, Hong-Chen Zhang
Yu-Hong Luo, Hong-Chen Zhang, School of Nursing, Lanzhou University, Lanzhou 730000, Gansu Province, China
Yan-Wei Yang, Department of Stomatology, The 940th Hospital of Joint Logistic Support Force of the Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
Chang-Fu Wu, The First Clinical Medical College, Lanzhou University, Lanzhou 730000, Gansu Province, China
Chao Wang, School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou 730000, Gansu Province, China
Wen-Juan Li, Department of Respiratory and Critical Care, Henan Provincial Hospital, Zhengzhou 450003, Henan Province, China
Author contributions: Luo YH and Yang YW contributed equally to this work; Luo YH and Zhang HC contributed to the design; Wang C and Wu CF completed the data collection; Yang YW and Li WJ provided statistical support; Yang YW and Luo YH provided the analysis; Zhang HC, Luo YH and Yang YW contributed to the manuscript preparation.
Supported by National Natural Science Foundation of China, No. 81701029.
Conflict-of-interest statement: The authors declared no conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Hong-Chen Zhang, MD, Lecturer, School of Nursing, Lanzhou University, No. 28 Yanxi Road, Chengguan District, Lanzhou 730000, Gansu Province, China.
Received: January 22, 2021
Peer-review started: January 22, 2021
First decision: April 29, 2021
Revised: May 8, 2021
Accepted: May 27, 2021
Article in press: May 27, 2021
Published online: July 26, 2021

The side effects of prostate cancer (PCa) treatment are very prominent, with cancer-related fatigue (CRF) being the most common. Fatigue is a distressing symptom that interferes with daily functioning and seriously affects patient quality of life during, and for many years after, treatment. However, compared with other types of cancer, such as breast cancer, little is known about the prevalence of PCa-related fatigue.


To determine the prevalence of CRF in patients with PCa.


A systematic search of EMBASE, PubMed, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, WANFANG DATA, Technology Journal Database and the Chinese Biological Medical Database was conducted up to July 28, 2020. Included studies measured the incidence of PCa-related fatigue and differentiated fatigue outcomes (incidence) between treatment modalities and fatigue assessment times. In our meta-analysis, both fixed and random-effects models were used to estimate the pooled prevalence of PCa-related fatigue. Subgroup analyses were performed using treatment modalities and fatigue assessment times. Publication and sensitivity bias analyses were performed to test the robustness of the associations.


Fourteen studies, involving 4736 patients, were eligible for the review. The pooled CRF prevalence was 40% in a total sample of 4736 PCa patients [95% confidence interval (CI): 29-52; P < 0.01; I2 = 98%]. The results of the subgroup analyses showed the prevalence of CRF after androgen deprivation therapy treatment, radical prostatectomy and radiotherapy to be 42% (95%CI: 20-67, P < 0.01, I2 = 91%), 21% (95%CI: 16-26, P = 0.87, I2 = 0%) and 40% (95%CI: 22-58, P < 0.01, I2 = 90%), respectively. The prevalence of acute and persistent fatigue was 44% (95%CI: 25-64; P < 0.01; I2 = 93%) and 29% (95%CI: 25-32; P = 0.30; I2 = 17%), respectively.


Our meta-analysis showed that fatigue is a common symptom in men with PCa, especially those using hormone therapy.

Keywords: Prostate cancer, Fatigue, Prevalence, Meta-analysis, Systematic review

Core Tip: This study was a systematic review conducted to determine the prevalence of cancer-related fatigue in patients with prostate cancer. Compared with other types of cancer, little is known about the prevalence of prostate cancer treatment-related fatigue. In this study, we reviewed the data in 14 papers (4736 patients) and found that the pooled prevalence of cancer treatment-related fatigue was 40%. Interestingly, the prevalence of cancer-related fatigue was associated with the type of treatment that the patients received; those undergoing radical prostatectomy had the lowest prevalence of fatigue.