-
European Urology Focus Nov 2021As an emerging technique, three-dimensional (3D) visualization has become more popular and can facilitate education, training, surgical planning, and intraoperative... (Review)
Review
CONTEXT
As an emerging technique, three-dimensional (3D) visualization has become more popular and can facilitate education, training, surgical planning, and intraoperative guidance for prostate cancer surgery.
OBJECTIVE
In this review, we aim to present the impact of 3D printing, virtual reality (VR), and augmented reality (AR) techniques for prostate cancer procedures, specifically prostate biopsy and radical prostatectomy (RP).
EVIDENCE ACQUISITION
A systematic review was performed by two investigators according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria.
EVIDENCE SYNTHESIS
A total of 541 papers were identified in PubMed, Scopus, and Embase. Of these, 53 studies were identified for detailed review and 25 were qualified. Two more studies were identified from the references; thus, 27 studies were finally included in this systematic review. Nine papers reported on the use of 3D reconstructed models, mainly in education/training and intraoperative guidance; nine reported on VR, focusing on simulation training model and intraoperative guidance; and nine reported on AR technique with its best indication for surgical guidance in robotic RP.
CONCLUSIONS
Three-dimensional visualization techniques have gradually been introduced and developed in prostate procedures, and demonstrate potential utility not only for education/training, but also for surgical planning and intraoperative guidance. Prospective studies are needed to demonstrate clinical utility and validation of these technologies.
PATIENT SUMMARY
Despite low-quality evidence, promising signals were identified to demonstrate that three-dimensional visualization could help facilitate prostate procedures, in terms of education/training, surgical planning, and intraoperative guidance. It is still in a very early stage, and more studies need to be conducted to justify its widespread use.
Topics: Humans; Imaging, Three-Dimensional; Male; Prostate; Prostatectomy; Prostatic Neoplasms; Robotic Surgical Procedures
PubMed: 32873515
DOI: 10.1016/j.euf.2020.08.002 -
British Journal of Cancer Mar 2016It has been hypothesised that intrauterine exposures are important for subsequent prostate cancer risk. Prior epidemiological studies have used birthweight as a proxy of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
It has been hypothesised that intrauterine exposures are important for subsequent prostate cancer risk. Prior epidemiological studies have used birthweight as a proxy of cumulative intrauterine exposures to test this hypothesis, but results have been inconsistent partly because of limited statistical power.
METHODS
We investigated birthweight in relation to prostate cancer in the Medical Research Council (MRC) National Survey of Health and Development (NSHD) using Cox proportional hazards models. We then conducted a meta-analysis of birthweight in relation to total and aggressive/lethal prostate cancer risks, combining results from the NSHD analysis with 13 additional studies on this relationship identified from a systematic search in four major scientific literature databases through January 2015.
RESULTS
Random-effects models found that per kg increase in birthweight was positively associated with total (OR=1.02, 95% confidence interval (95% CI)=1.00, 1.05; I(2)=13%) and aggressive/lethal prostate cancer (OR=1.08, 95% CI=0.99, 1.19; I(2)=40%). Sensitivity analyses restricted to studies with birthweight extracted from medical records demonstrated stronger positive associations with total (OR=1.11, 95% CI=1.03, 1.19; I(2)=0%) and aggressive/lethal (OR=1.37, 95% CI=1.09, 1.74; I(2)=0%) prostate cancer. These studies heavily overlapped with those based in Nordic countries.
CONCLUSIONS
This study provides evidence that heavier birthweight may be associated with modest increased risks of total and aggressive/lethal prostate cancer, which supports the hypothesis that intrauterine exposures may be related to subsequent prostate cancer risks.
Topics: Birth Weight; Case-Control Studies; Humans; Male; Prognosis; Prostatic Neoplasms; Risk Assessment
PubMed: 26930450
DOI: 10.1038/bjc.2016.38 -
International Urology and Nephrology Dec 2022Magnetic resonance imaging (MRI) is a precise, systemic and advantageous imaging technique when compared to transrectal ultrasound (TRUS) which is very operator...
PURPOSE
Magnetic resonance imaging (MRI) is a precise, systemic and advantageous imaging technique when compared to transrectal ultrasound (TRUS) which is very operator dependent. The negative correlation between prostate volume and the incidence of prostate cancer (PCa) obtained by TRUS biopsy has been well documented in the literature. The purpose of this systemic review is analyzing the reported MRI-fusion study results on prostate biopsies regarding any correlation between prostate volume and the incidence of PCa.
METHODS
After defining the inclusion and exclusion criteria an in-depth review were performed between 01.01.2000 and 02.08.2022 using the PubMed database and applying the "PRISMA" guidelines.
RESULTS
Twelve studies qualified, and all showed an inverse/negative relationship between prostate volume and incidence of PCa. Sample sizes ranged from 33 to 2767 patients in single and multi-institutional studies. All studies showed a statistically significant inverse relationship with a p value < 0.05. The graph summarizing all of studies and using Fisher's method revealed a highly significant combined p level of 0.00001. Additionally, not one single study was found showing the contrary (a positive correlation between prostate size and the incidence of PCa).
CONCLUSION
To our knowledge, this is the first systemic review of reported MRI-Fusion data on the incidence of PCa in correlation with prostate volume. This MRI review confirms previous TRUS-biopsy studies which demonstrated an inverse relationship between prostate volume and the incidence of PCa, and thus further supports the hypothesis that large prostates size may be protective against PCa when compared to smaller prostates.
Topics: Humans; Male; Image-Guided Biopsy; Incidence; Magnetic Resonance Imaging; Prostate; Prostatic Neoplasms
PubMed: 36040649
DOI: 10.1007/s11255-022-03351-w -
Progres En Urologie : Journal de... Nov 2015Multiparametric magnetic resonance imaging (mp-MRI) and Tomography with Emission of Positons are increasingly used in prostate cancer. (Review)
Review
OBJECTIVES
Multiparametric magnetic resonance imaging (mp-MRI) and Tomography with Emission of Positons are increasingly used in prostate cancer.
MATERIALS AND METHOD
A systematic review of the scientific literature was performed in the Medline database (PubMed), using different associations of the following keywords: MRI, PET MRI, prostate cancer.
RESULTS
Accuracy in the detection of prostate cancer is improved by the combined use of standard T2-weighted MR imaging and advanced functional MR imaging techniques such as diffusion-weighted imaging and dynamic contrast-enhanced imaging. Multiparametric MR imaging provides the highest accuracy in detection, localization, and staging of prostate cancer. This accurate assessment is a prerequisite for optimal clinical management and therapy selection. Another recent advancement in the field is MR imaging guidance for targeted prostate biopsy, which is an alternative to the current standard of transrectal ultrasonography-guided systematic biopsy. Prostate MRI plays also an important role in tumor detection when there is clinical or biochemical suspicion of residual or recurrent disease after treatment. The emergence of new technologies such as Tomography with Emission of Positons (TEP) after injection of 18F-choline, allows to improve the staging of prostate cancer (nodes status, sentinel node and occult metastases) and thus to change the management, especially when relapse.
CONCLUSION
The first results with modern imaging are already very promising, and numerous prospects are expected, either by improving technologies (parametric fusion of PET and MRI) or the appearance of new tracers more sensitive and more specific than the choline. Bone scan still retains an important place especially since its realization is now coupled with a tomographic study merged with a low dose scanner, thereby remarkably improving its diagnostic performance.
Topics: Humans; Magnetic Resonance Imaging; Male; Neoplasm Recurrence, Local; Positron-Emission Tomography; Prostatic Neoplasms
PubMed: 26519961
DOI: 10.1016/j.purol.2015.07.016 -
International Journal of Radiation... Jul 2023Current risk-stratification systems for prostate cancer (PCa) do not sufficiently reflect the disease heterogeneity. Genomic classifiers (GC) enable improved risk... (Review)
Review
Current risk-stratification systems for prostate cancer (PCa) do not sufficiently reflect the disease heterogeneity. Genomic classifiers (GC) enable improved risk stratification after surgery, but less data exist for patients treated with definitive radiation therapy (RT) or RT in oligo-/metastatic disease stages. To guide future perspectives of GCs for RT, we conducted (1) a systematic review on the evidence of GCs for patients treated with RT and (2) a survey of experts using the Delphi method, addressing the role of GCs in personalized treatments to identify relevant fields of future clinical and translational research. We performed a systematic review and screened ongoing clinical trials on ClinicalTrials.gov. Based on these results, a multidisciplinary international team of experts received an adapted Delphi method survey. Thirty-one and 30 experts answered round 1 and round 2, respectively. Questions with ≥75% agreement were considered relevant and included in the qualitative synthesis. Evidence for GCs as predictive biomarkers is mainly available to the postoperative RT setting. Validation of GCs as prognostic markers in the definitive RT setting is emerging. Experts used GCs in patients with PCa with extensive metastases (30%), in postoperative settings (27%), and in newly diagnosed PCa (23%). Forty-seven percent of experts do not currently use GCs in clinical practice. Expert consensus demonstrates that GCs are promising tools to improve risk-stratification in primary and oligo-/metastatic patients in addition to existing classifications. Experts were convinced that GCs might guide treatment decisions in terms of RT-field definition and intensification/deintensification in various disease stages. This work confirms the value of GCs and the promising evidence of GC utility in the setting of RT. Additional studies of GCs as prognostic biomarkers are anticipated and form the basis for future studies addressing predictive capabilities of GCs to optimize RT and systemic therapy. The expert consensus points out future directions for GC research in the management of PCa.
Topics: Male; Humans; Consensus; Prostatic Neoplasms; Genomics
PubMed: 36596346
DOI: 10.1016/j.ijrobp.2022.12.038 -
World Journal of Urology Nov 2023Around 40% of men with intermediate-risk or high-risk prostate cancer will experience a biochemical recurrence after radical prostatectomy (RP). The aim of this review...
PURPOSE
Around 40% of men with intermediate-risk or high-risk prostate cancer will experience a biochemical recurrence after radical prostatectomy (RP). The aim of this review is to describe both toxicity and oncological outcomes following stereotactic body radiation therapy (SBRT) delivered to the prostate bed (PB).
METHOD
In april 2023, we performed a systematic review of studies published in MEDLINE or ClinicalTrials.gov according to Preferred Reporting Items for Systematic Reviews, using the keywords "stereotactic radiotherapy" AND "postoperative" AND "prostate cancer".
RESULTS
A total of 14 studies assessing either adjuvant or salvage SBRT to the whole PB or macroscopic local recurrence (MLR) within the PB, and SBRT on radiorecurrent MLR within the PB were included. Doses delivered to either whole PB or MLR between 30 to 40 Gy are associated with a low rate of late grade ≥ 2 genitourinary (GU) toxicity, ranging from 2.2 to 15.1%. Doses above 40 Gy are associated with increased rate of late GU toxicity, raising up to 38%. Oncological outcomes should be interpreted with caution, due to both short follow-up, heterogeneous populations and androgen deprivation therapy (ADT) use.
CONCLUSION
PB or MLR SBRT delivered at doses up to 40 Gy appears safe with relatively low late severe GU toxicity rates. Caution is needed with dose-escalated RT schedules above 40 Gy. Further prospective trials are eagerly awaited in this disease setting.
Topics: Male; Humans; Prostatic Neoplasms; Prostate; Radiosurgery; Androgen Antagonists; Prostatectomy; Salvage Therapy
PubMed: 37725131
DOI: 10.1007/s00345-023-04605-7 -
European Urology Jun 2015Many men with clinically localized prostate cancer are being monitored as part of active surveillance (AS) programs, but little is known about reasons for receiving... (Meta-Analysis)
Meta-Analysis Review
CONTEXT
Many men with clinically localized prostate cancer are being monitored as part of active surveillance (AS) programs, but little is known about reasons for receiving radical treatment.
OBJECTIVES
A systematic review of the evidence about AS was undertaken, with a meta-analysis to identify predictors of radical treatment.
EVIDENCE ACQUISITION
A comprehensive search of the Embase, MEDLINE and Web of Knowledge databases to March 2014 was performed. Studies reporting on men with localized prostate cancer followed by AS or monitoring were included. AS was defined where objective eligibility criteria, management strategies, and triggers for clinical review or radical treatment were reported.
EVIDENCE SYNTHESIS
The 26 AS cohorts included 7627 men, with a median follow-up of 3.5 yr (range of medians 1.5-7.5 yr). The cohorts had a wide range of inclusion criteria, monitoring protocols, and triggers for radical treatment. There were eight prostate cancer deaths and five cases of metastases in 24,981 person-years of follow-up. Each year, 8.8% of men (95% confidence interval 6.7-11.0%) received radical treatment, most commonly because of biopsy findings, prostate-specific antigen triggers, or patient choice driven by anxiety. Studies in which most men changed treatment were those including only low-risk Gleason score 6 disease and scheduled rebiopsies.
CONCLUSIONS
The wide variety of AS protocols and lack of robust evidence make firm conclusions difficult. Currently, patients and clinicians have to make judgments about the balance of risks and benefits in AS protocols. The publication of robust evidence from randomized trials and longer-term follow-up of cohorts is urgently required.
PATIENT SUMMARY
We reviewed 26 studies of men on active surveillance for prostate cancer. There was evidence that studies including men with the lowest risk disease and scheduled rebiopsy had higher rates of radical treatment.
Topics: Biopsy; Disease Progression; Humans; Male; Neoplasm Grading; Prostate; Prostate-Specific Antigen; Prostatic Neoplasms; Risk Factors; Watchful Waiting
PubMed: 25616709
DOI: 10.1016/j.eururo.2015.01.004 -
Minerva Chirurgica Feb 2019We provide a comprehensive description of the physio-pathological theories behind oligometastatic prostate cancer (PCa) and analyze modern imaging techniques, presenting...
INTRODUCTION
We provide a comprehensive description of the physio-pathological theories behind oligometastatic prostate cancer (PCa) and analyze modern imaging techniques, presenting a systematic review of the available evidences regarding salvage lymph node dissection (sLND).
EVIDENCE ACQUISITION
A systematic review was attempted. The PubMed/Medline database was searched for "salvage" AND ("lymph node dissection" OR "lymphadenectomy") AND "prostate" AND "cancer." Only English publications were targeted. Relevant original articles addressing the role of sLND in PCa were selected.
EVIDENCE SYNTHESIS
Biochemical response (BR) was reported in 10-79.5% of the cases overall. These results were not durable and biochemical recurrence occurred in 54.5-93.8% of the cases, within 5 years. Furthermore, 50-80% of patients received some kind of adjuvant treatment right after sLND, regardless post-operative prostate-specific antigen levels. Surgery-related morbidity was low, with a 0-27% incidence of Clavien-Dindo III complications. No sLND-related deaths were observed.
CONCLUSIONS
sLND is not associated with a durable response over time but may postpone HT and its related complications, in selected patients. Although a limited morbidity was reported, sLND remains technically demanding and a careful selection of patients is advisable.
Topics: Humans; Lymph Node Excision; Lymphatic Metastasis; Male; Neoplasm Micrometastasis; Prostatic Neoplasms; Salvage Therapy
PubMed: 29806760
DOI: 10.23736/S0026-4733.18.07796-9 -
Supportive Care in Cancer : Official... Dec 2022This systematic review and meta-analysis aimed to synthesize the evidence on the effect of couple-based interventions on quality of life (QOL) among prostate cancer... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
This systematic review and meta-analysis aimed to synthesize the evidence on the effect of couple-based interventions on quality of life (QOL) among prostate cancer patients and their spouses.
METHOD
Six English databases and two Chinese databases were systematically searched to identify relevant RCTs that examined the effect of couple-based interventions on QOL. The data from the included studies were extracted by two independent reviewers using a standardized data extraction form. Methodological quality was assessed by using the Cochrane Risk of Bias Tool. Meta-analysis was conducted among the suitable studies that the available data were sufficient.
RESULTS
One thousand ninety-five studies were identified, and 11 studies met the inclusion criteria for qualitative synthesis and 7 studied for meta-analysis. Couple-based interventions involve different formats of physical and psychosocial interventions. Physical exercise-based interventions were popular among couples, and these interventions had the highest level of adherence among all interventions examined herein. However, the meta-analysis of total QOL and physical and mental health revealed a non-significant effect on both prostate cancer patients and their spouses. More RCTs examining couple-based interventions may be needed in developing countries, especially in Asian countries.
CONCLUSION
Couple-based interventions had non-significant effect on improving the total QOL and physical and mental health of prostate cancer patients and their spouses. However, the current evidence is limited because the sample size of the studies is small. Thus, more studies with large sample sizes need to be included to detect the efficacy of couple-based interventions on prostate cancer patients and their spouses.
Topics: Male; Humans; Quality of Life; Spouses; Prostatic Neoplasms; Mental Health; Patients
PubMed: 36517615
DOI: 10.1007/s00520-022-07532-2 -
Future Oncology (London, England) 2015This review, based on published papers, aims to describe the costs of prostate cancer screening and to examine whether prostate cancer screening is cost effective. The... (Meta-Analysis)
Meta-Analysis Review
This review, based on published papers, aims to describe the costs of prostate cancer screening and to examine whether prostate cancer screening is cost effective. The estimated cost per cancer detected ranged from €1299 in The Netherlands to US$44,355 in the USA. The estimated cost per life-year saved ranged from US$3000 to US$729,000, while the cost per quality-adjusted life year (QALY) was AU$291,817 and Can$371,100. The most appropriate data for economic evaluation of prostate cancer screening should be the cost per QALY gained. The estimated costs per QALY gained by prostate cancer screening were significantly higher than the cost-effectiveness threshold, suggesting that even when based on favorable randomized controlled trials in younger age groups, prostate cancer screening is still not cost effective.
Topics: Costs and Cost Analysis; Early Detection of Cancer; Humans; Male; Prostatic Neoplasms
PubMed: 25675126
DOI: 10.2217/fon.14.273