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European Urology Jul 2023The optimal management for men with prostate cancer (PCa) with unconventional histology (UH) is unknown. The outcome for these cancers might be worse than for...
Impact of Epithelial Histological Types, Subtypes, and Growth Patterns on Oncological Outcomes for Patients with Nonmetastatic Prostate Cancer Treated with Curative Intent: A Systematic Review.
CONTEXT
The optimal management for men with prostate cancer (PCa) with unconventional histology (UH) is unknown. The outcome for these cancers might be worse than for conventional PCa and so different approaches may be needed.
OBJECTIVE
To compare oncological outcomes for conventional and UH PCa in men with localized disease treated with curative intent.
EVIDENCE ACQUISITION
A systematic review adhering to the Referred Reporting Items for Systematic Reviews and Meta-Analyses was prospectively registered on PROSPERO (CRD42022296013) was performed in July 2021.
EVIDENCE SYNTHESIS
We screened 3651 manuscripts and identified 46 eligible studies (reporting on 1 871 814 men with conventional PCa and 6929 men with 10 different PCa UHs). Extraprostatic extension and lymph node metastases, but not positive margin rates, were more common with UH PCa than with conventional tumors. PCa cases with cribriform pattern, intraductal carcinoma, or ductal adenocarcinoma had higher rates of biochemical recurrence and metastases after radical prostatectomy than for conventional PCa cases. Lower cancer-specific survival rates were observed for mixed cribriform/intraductal and cribriform PCa. By contrast, pathological findings and oncological outcomes for mucinous and prostatic intraepithelial neoplasia (PIN)-like PCa were similar to those for conventional PCa. Limitations of this review include low-quality studies, a risk of reporting bias, and a scarcity of studies that included radiotherapy.
CONCLUSIONS
Intraductal, cribriform, and ductal UHs may have worse oncological outcomes than for conventional and mucinous or PIN-like PCa. Alternative treatment approaches need to be evaluated in men with these cancers.
PATIENT SUMMARY
We reviewed the literature to explore whether prostate cancers with unconventional growth patterns behave differently to conventional prostate cancers. We found that some unconventional growth patterns have worse outcomes, so we need to investigate if they need different treatments. Urologists should be aware of these growth patterns and their clinical impact.
Topics: Humans; Male; Prostate; Prostate-Specific Antigen; Prostatectomy; Prostatic Intraepithelial Neoplasia; Prostatic Neoplasms
PubMed: 37117107
DOI: 10.1016/j.eururo.2023.03.014 -
Medical Principles and Practice :... 2023Actinium-225 (Ac-225) labelled PSMA RLT has been tested recently in metastatic castration-resistant prostate cancer (mCRPC), with encouraging results. Ac-225, being an... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Actinium-225 (Ac-225) labelled PSMA RLT has been tested recently in metastatic castration-resistant prostate cancer (mCRPC), with encouraging results. Ac-225, being an alpha emitter, is expected to have higher efficacy and fewer side effects compared to the beta-emitters such as Lutetium-177. We have performed a meta-analysis to assess the therapeutic responses, survival effects, and significant side effects of Ac-225 PSMA RLT in patients with mCRPC.
METHODOLOGY
Systematic literature search was carried out from five electronic databases PubMed/MEDLINE, SCOPUS, EMBASE, Web of Science, and Cochrane Library until March 2021. Eight studies were found to be eligible for this metanalysis.
RESULTS
Eight studies with 226 patients were analyzed in this metanalysis. 81% (95% CI 73-89) patients had a decline in PSA levels. 60% of the patients showed more than 50% PSA decline. Two studies assessed survival effects of radioligand naïve patients compared to patients who had received Lu-PSMA therapy previously and the pooled HR for radioligand naïve patients is 0.22. The most common toxicity reported was xerostomia in 167 patients out of 226 patients (73.9%, 95% CI 67.6-79.5%); however, most of them were confined to grade I and II levels. Other reported side effects include hematologic toxicity and nephrotoxicity.
CONCLUSION
Ac-PSMA RLT is a safe and potentially effective treatment option for patients with mCRPC.
Topics: Male; Humans; Actinium; Prostatic Neoplasms, Castration-Resistant; Prostate-Specific Antigen; Prostate; Dipeptides; Treatment Outcome; Retrospective Studies
PubMed: 37247612
DOI: 10.1159/000531246 -
World Journal of Urology Jun 2022This systematic review aims to evaluate the incidence and influencing factors of urethral stricture (US) in relation to different BPH endoscopic techniques. (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION AND OBJECTIVES
This systematic review aims to evaluate the incidence and influencing factors of urethral stricture (US) in relation to different BPH endoscopic techniques.
MATERIALS AND METHODS
We performed a systematic literature review using MEDLINE, EMBASE, and Cochrane Central Controlled Register of Trials. The incidence of US was estimated through comparative studies between different endoscopic techniques. Patients were assigned into groups according to the type of surgery (enucleation, ablation and resection group). Incidences of US were pooled using the Cochran-Mantel-Haenszel Method with the random effect model and reported as Risk Ratio (RR), 95% Confidence Intervals (CI), and p-values.
RESULTS
A total of 80 studies were included for meta-analysis. The pooled incidence of US was 1.7% after enucleation, 2.1% after ablation, 3.8% after monopolar (M)-TURP and 2.1% after bipolar (B)-TURP. The incidence of US was significantly lower after Enucleation than after TURP (RR 0.58 95% CI 0.39-0.84, p = 0.004). US incidence was lower for Ablation procedures than TURP, but the difference did not reach significance (RR 0.79 95% CI 0.61-1.3, p = 0.08). However, this was significant in the subgroup of M-TURP studies (RR 0.67, 95% CI, 0.49-0.91, p = 0.01). Sub-analysis showed that the risk of US was significantly lower after Enucleation than after TURP within 12 months after surgery (RR 0.51 95% CI 0.33-0.81, p = 0.004).
CONCLUSION
The study shows an increased incidence of US after TURP compared to enucleation and ablation procedures. The main factors related to increased US incidence are the use of monopolar energy, instrument caliber and duration of postoperative catheterization.
Topics: Humans; Male; Prospective Studies; Prostate; Prostatic Hyperplasia; Randomized Controlled Trials as Topic; Transurethral Resection of Prostate; Treatment Outcome; Urethral Stricture
PubMed: 35152322
DOI: 10.1007/s00345-022-03946-z -
European Urology Jan 2017Focal therapy of prostate cancer has been proposed as an alternative to whole-gland treatments. (Review)
Review
CONTEXT
Focal therapy of prostate cancer has been proposed as an alternative to whole-gland treatments.
OBJECTIVE
To summarize the evidence regarding sources of energy employed in focal therapy.
EVIDENCE ACQUISITION
Embase and Medline (PubMed) were searched from 1996 to October 31, 2015 following the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Ongoing trials were selected from electronic registries. The stage of assessment of each source of energy was determined using the Idea, Development, Exploration, Assessment, Long-term study recommendations.
EVIDENCE SYNTHESIS
Thirty-seven articles reporting on 3230 patients undergoing focal therapy were selected. Thirteen reported on high-intensity focused ultrasound, 11 on cryotherapy, three on photodynamic therapy, four on laser interstitial thermotherapy, two on brachytherapy, three on irreversible electroporation, and one on radiofrequency. High-intensity focused ultrasound, cryotherapy, photodynamic therapy, and brachytherapy have been assessed in up to Stage 2b studies. Laser interstitial thermotherapy and irreversible electroporation have been evaluated in up to Stage 2a studies. Radiofrequency has been evaluated in one Stage 1 study. Median follow-up varied between 4 mo and 61 mo, and the median rate of serious adverse events ranged between 0% and 10.6%. Pad-free leak-free continence and potency were obtained in 83.3-100% and 81.5-100%, respectively. In series with intention to treat, the median rate of significant and insignificant disease at control biopsy varied between 0% and 13.4% and 5.1% and 45.9%, respectively. The main limitations were the length of follow-up, the absence of a comparator arm, and study heterogeneity.
CONCLUSIONS
Focal therapy has been evaluated using seven sources of energy in single-arm retrospective and prospective development studies up to Stage 2b. Focal therapy seems to have a minor impact on quality of life and genito-urinary function. Oncological effectiveness is yet to be defined against standard of care.
PATIENT SUMMARY
Seven sources of energy have been employed to selectively ablate discrete areas of prostate cancer. There is high evidence that focal therapy is safe and has low detrimental impact on continence and potency. The oncological outcome has yet to be evaluated against standard of care.
Topics: Ablation Techniques; Brachytherapy; Catheter Ablation; Controlled Clinical Trials as Topic; Cryosurgery; Electrochemotherapy; High-Intensity Focused Ultrasound Ablation; Humans; Laser Therapy; Male; Photochemotherapy; Prostate; Prostatic Neoplasms
PubMed: 27595377
DOI: 10.1016/j.eururo.2016.08.044 -
Urologia Internationalis 2017This systematic review and meta-analysis were performed to evaluate the efficacy of preoperative dutasteride treatment for reducing surgical blood loss in patients... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This systematic review and meta-analysis were performed to evaluate the efficacy of preoperative dutasteride treatment for reducing surgical blood loss in patients undergoing transurethral resection of the prostate (TURP).
METHODS
A systematic search was performed from the electronic databases including PubMed, EMBASE, and Cochrane Library by May 2016. We followed the search strategy based on Preferred Reporting Items for Systematic Reviews and Meta-analysis statement when examining the literature. Identified articles were strictly appraised for quality and relevance.
RESULTS
Five randomized controlled trials (RCTs) and 5 retrospective cohort studies involving 1,022 patients with benign prostate hyperplasia were analyzed based on the inclusion criteria. Pooled analysis revealed that preoperative treatment with dutasteride had a significantly smaller decrease in hemoglobin (weighted mean difference [WMD] -0.47, 95% CI -0.70 to -0.24, p < 0.0001) and hematocrit levels (WMD -1.03, 95% CI -1.73 to -0.33, p = 0.004); However, no significant difference has been found in terms of the total blood loss during TURP and blood loos per gram of resected prostatic tissue, the weight of resected prostate tissue, the microvessel density of the prostate, and the transfusion rate between the dutasteride and the control group.
CONCLUSIONS
This systematic review and meta-analysis indicate that preoperative treatment with dutasteride could reduce surgical bleeding during TURP, but the findings of this study should be further confirmed by well-designed prospective RCTs with a larger patient series.
Topics: 5-alpha Reductase Inhibitors; Blood Loss, Surgical; Blood Transfusion; Dutasteride; Hemoglobins; Humans; Male; Microcirculation; Prospective Studies; Prostate; Prostatic Hyperplasia; Randomized Controlled Trials as Topic; Retrospective Studies; Transurethral Resection of Prostate; Treatment Outcome; Vascular Endothelial Growth Factor A
PubMed: 28006778
DOI: 10.1159/000453669 -
The Cochrane Database of Systematic... Jan 2024Clinical practice guidelines recommend testosterone replacement therapy (TRT) for men with sexual dysfunction and testosterone deficiency. However, TRT is commonly... (Review)
Review
BACKGROUND
Clinical practice guidelines recommend testosterone replacement therapy (TRT) for men with sexual dysfunction and testosterone deficiency. However, TRT is commonly promoted in men without testosterone deficiency and existing trials often do not clearly report participants' testosterone levels or testosterone-related symptoms. This review assesses the potential benefits and harms of TRT in men presenting with complaints of sexual dysfunction.
OBJECTIVES
To assess the effects of testosterone replacement therapy compared to placebo or other medical treatments in men with sexual dysfunction.
SEARCH METHODS
We performed a comprehensive search of CENTRAL (the Cochrane Library), MEDLINE, EMBASE, and the trials registries ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform, with no restrictions on language of publication or publication status, up to 29 August 2023.
SELECTION CRITERIA
We included randomized controlled trials (RCTs) in men (40 years or over) with sexual dysfunction. We excluded men with primary or secondary hypogonadism. We compared testosterone or testosterone with phosphodiesterase-5 inhibitors (PDEI5I) to placebo or PDE5I alone.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened the literature, assessed the risk of bias, extracted data, and rated the certainty of evidence (CoE) according to GRADE using a minimally contextualized approach. We performed statistical analyses using a random-effects model and interpreted them according to standard Cochrane methodology. Predefined primary outcomes were self-reported erectile dysfunction assessed by a validated instrument, sexual quality of life assessed by a validated instrument, and cardiovascular mortality. Secondary outcomes were treatment withdrawal due to adverse events, prostate-related events, and lower urinary tract symptoms (LUTS). We distinguished between short-term (up to 12 months) and long-term (> 12 months) outcomes.
MAIN RESULTS
We identified 43 studies with 11,419 randomized participants across three comparisons: testosterone versus placebo, testosterone versus PDE5I, and testosterone with PDE5I versus PDE5I alone. This abstract focuses on the most relevant comparison of testosterone versus placebo. Testosterone versus placebo (up to 12 months) Based on a predefined sensitivity analysis of studies at low risk of bias, and an analysis combing data from the similar International Index of Erectile Function (IIEF-EF) and IIEF-5 instruments, TRT likely results in little to no difference in erectile function assessed with the IIEF-EF (mean difference (MD) 2.37, 95% confidence interval (CI) 1.67 to 3.08; I² = 0%; 6 RCTs, 2016 participants; moderate CoE) on a scale from 6 to 30 with larger values reflecting better erectile function. We assumed a minimal clinically important difference (MCID) of greater than or equal to 4. TRT likely results in little to no change in sexual quality of life assessed with the Aging Males' Symptoms scale (MD -2.31, 95% CI -3.63 to -1.00; I² = 0%; 5 RCTs, 1030 participants; moderate CoE) on a scale from 17 to 85 with larger values reflecting worse sexual quality of life. We assumed a MCID of greater than or equal to 10. TRT also likely results in little to no difference in cardiovascular mortality (risk ratio (RR) 0.83, 95% CI 0.21 to 3.26; I² = 0%; 10 RCTs, 3525 participants; moderate CoE). Based on two cardiovascular deaths in the placebo group and an assumed MCID of 3%, this would correspond to no additional deaths per 1000 men (95% CI 1 fewer to 4 more). TRT also likely results in little to no difference in treatment withdrawal due to adverse events, prostate-related events, or LUTS. Testosterone versus placebo (later than 12 months) We are very uncertain about the longer-term effects of TRT on erectile dysfunction assessed with the IIEF-EF (MD 4.20, 95% CI -2.03 to 10.43; 1 study, 42 participants; very low CoE). We did not find studies reporting on sexual quality of life or cardiovascular mortality. We are very uncertain about the effect of testosterone on treatment withdrawal due to adverse events. We found no studies reporting on prostate-related events or LUTS.
AUTHORS' CONCLUSIONS
In the short term, TRT probably has little to no effect on erectile function, sexual quality of life, or cardiovascular mortality compared to a placebo. It likely results in little to no difference in treatment withdrawals due to adverse events, prostate-related events, or LUTS. In the long term, we are very uncertain about the effects of TRT on erectile function when compared to placebo; we did not find data on its effects on sexual quality of life or cardiovascular mortality. The certainty of evidence ranged from moderate (signaling that we are confident that the reported effect size is likely to be close to the true effect) to very low (indicating that the true effect is likely to be substantially different). The findings of this review should help to inform future guidelines and clinical decision-making at the point of care.
Topics: Male; Humans; Erectile Dysfunction; Prostatic Hyperplasia; Testosterone; Prostate; Lower Urinary Tract Symptoms; Cardiovascular Diseases
PubMed: 38224135
DOI: 10.1002/14651858.CD013071.pub2 -
International Braz J Urol : Official... 2022To report the prevalence of the definitions used to identify post-prostatectomy incontinence (PPI) after laparoscopic radical prostatectomy (LRP), and to compare the... (Review)
Review
PURPOSE
To report the prevalence of the definitions used to identify post-prostatectomy incontinence (PPI) after laparoscopic radical prostatectomy (LRP), and to compare the rates of PPI over time under different criteria.
MATERIALS AND METHODS
In the period from January 1, 2000, until December 31, 2017, we used a recently described methodology to perform evidence acquisition called reverse systematic review (RSR). The continence definition and rates were evaluated and compared at 1, 3, 6, 12, and >18 months post-operative. Moreover, the RSR showed the "natural history" of PPI after LRP.
RESULTS
We identified 353 review articles in the systematized search, 137 studies about PPI were selected for data collection, and finally were included 203 reports (nr) with 51.436 patients. The most used criterion of continence was No pad (nr=121; 59.6%), the second one was Safety pad (nr=57; 28.1%). A statistically significant difference between continence criteria was identified only at >18 months (p=0.044). From 2013 until the end of our analysis, the Safety pad and Others became the most reported.
CONCLUSION
RSR revealed the "natural history" of PPI after the LRP technique, and showed that through time the Safety pad concept was mainly used. However, paradoxically, we demonstrated that the two most utilized criteria, Safety pad and No pad, had similar PPI outcomes. Further effort should be made to standardize the PPI denomination to evaluate, compare and discuss the urinary post-operatory function.
Topics: Humans; Laparoscopy; Male; Prostate; Prostatectomy; Urinary Incontinence
PubMed: 35168312
DOI: 10.1590/S1677-5538.IBJU.2021.0632 -
Progres En Urologie : Journal de... Nov 2020Male lower urinary tract symptoms (LUTS) and in particular overactive bladder (OAB) are a frequent reason for consultation in urology and have a significant functional...
INTRODUCTION
Male lower urinary tract symptoms (LUTS) and in particular overactive bladder (OAB) are a frequent reason for consultation in urology and have a significant functional impact in patients.
OBJECTIVE
To synthesize current knowledge on non-neurogenic OAB in male patients.
METHOD
A systematic literature review based on Pubmed, Embase, Google Scholar was conducted in June 2020.
RESULTS
The prevalence of OAB and benign prostatic hyperplasia increases with age. Symptoms of OAB, on the one hand, and symptoms of prostatic bladder outlet obstruction, on the other hand, can be concomitant and the causal link between the two types of symptoms is difficult to establish. In case of mixed symptoms, it is recommended to treat the most troublesome type of symptoms first and to inform the patient of the risks of failure or deterioration. Indeed, many patients remain symptomatic after prostate surgery and the predictive factors for failure remain to be defined. Thus, preoperative urodynamics is not routinely performed even in case of OAB. De novo detrusor overactivity after radical prostatectomy can reach 77% and persists in the majority of cases. The overall relative risk of storage symptoms after radiotherapy and brachytherapy is higher than that after prostatectomy. The etiology of OAB after prostate surgery is multifactorial. While drug treatments have proven to be effective, little data exists on second-line treatments for OAB after prostate surgery.
CONCLUSION
OAB in men is often linked to a prostatic bladder outlet obstruction. It is essential to inform patients about the possibility of persistence, deterioration, or occurrence of OAB after prostate surgery while the predictors of surgical failure are not clearly defined.
Topics: Humans; Male; Prostatic Hyperplasia; Syndrome; Urinary Bladder Neck Obstruction; Urinary Bladder, Overactive
PubMed: 33220816
DOI: 10.1016/j.purol.2020.09.005 -
Clinical Nuclear Medicine Jul 2023Multiparametric MRI (mpMRI) has been promoted as an auxiliary diagnostic tool for prostate biopsy. However, prostate-specific membrane antigen (PSMA) including 68... (Meta-Analysis)
Meta-Analysis
Comparing the Detection Performance Between Multiparametric Magnetic Resonance Imaging and Prostate-Specific Membrane Antigen PET/CT in Patients With Localized Prostate Cancer: A Systematic Review and Meta-analysis.
PURPOSE
Multiparametric MRI (mpMRI) has been promoted as an auxiliary diagnostic tool for prostate biopsy. However, prostate-specific membrane antigen (PSMA) including 68 Ga-PSMA-11, 18 F-DCFPyL, and 18 F-PSMA-1007 applied PET/CT imaging was an emerging diagnostic tool in prostate cancer patients for staging or posttreatment follow-up, even early detecting. Many studies have used PSMA PET for comparison with mpMRI to test the diagnostic ability for early prostate cancer. Unfortunately, these studies have shown conflicting results. This meta-analysis aimed to compare the differences in diagnostic performance between PSMA PET and mpMRI for detecting and T staging localized prostatic tumors.
METHODS
This meta-analysis involved a systematic literature search of PubMed/MEDLINE and Cochrane Library databases. The pooling sensitivity and specificity of PSMA and mpMRI verified by pathological analysis were calculated and used to compare the differences between the 2 imaging tools.
RESULTS
Overall, 39 studies were included (3630 patients in total) from 2016 to 2022 in the current meta-analysis and found that the pooling sensitivity values for localized prostatic tumors and T staging T3a and T3b of PSMA PET were 0.84 (95% confidence interval [CI], 0.83-0.86), 0.61 (95% CI, 0.39-0.79), and 0.62 (95% CI, 0.46-0.76), respectively, whereas those of mpMRI were found to be 0.84 (95% 0.78-0.89), 0.67 (95% CI, 0.52-0.80), and 0.60 (95% CI, 0.45-0.73), respectively, without significant differences ( P > 0.05). However, in a subgroup analysis of radiotracer, the pooling sensitivity of 18 F-DCFPyL PET was higher than mpMRI (relative risk, 1.10; 95% CI, 1.03-1.17; P < 0.01).
CONCLUSIONS
This meta-analysis found that whereas 18 F-DCFPyL PET was superior to mpMRI at detecting localized prostatic tumors, the detection performance of PSMA PET for localized prostatic tumors and T staging was comparable to that of mpMRI.
Topics: Male; Humans; Multiparametric Magnetic Resonance Imaging; Prostate; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Gallium Radioisotopes; Sensitivity and Specificity; Magnetic Resonance Imaging
PubMed: 37145456
DOI: 10.1097/RLU.0000000000004646 -
Health & Social Care in the Community Jul 2022The purpose of this systematic review and synthesis of studies reporting qualitative data was to understand the gendered experiences of female partners of prostate... (Review)
Review
The purpose of this systematic review and synthesis of studies reporting qualitative data was to understand the gendered experiences of female partners of prostate cancer survivors to inform psychosocial support for women. We searched Medline, PsycINFO, EMBASE, AMED, CINAHL, Cochrane Database of Systematic Reviews, and Sociological Abstracts for articles on 15 and 16 April 2019, and again on 30 November 2020. English language articles published in peer-reviewed journals were included if they reported solely on findings describing the perspectives of the female partners. Extracted data were analysed using line-by-line coding, organisation of codes into descriptive themes, and development of analytical themes. A theoretical framework was then selected to organise the relationships between issues that were found to be central to the experiences of female partners. Of 4839 articles screened, 14 met inclusion criteria, reporting 13 studies with a total sample of 359 female partners. Ussher and Sandoval's theory to describe the gendered positionings of cancer caregivers accommodated the thematic findings. The overarching theme reflected the substantive psychosocial impact of prostate cancer on female partners. Women's experiences were influenced by self-positioning (as part of a couple; provider of support to their male partner; resilient; and guided by faith and spirituality), being positioned by their partners' response (manager of male partner's psychological distress or strengthened by male partner's positive response) and by their broader contexts (family members and social networks; clinicians and the health system; and cultural values and customs). Findings highlight the need to avoid reductionist approaches to gender. Greater consideration of 'contextualised femininities', or conceptualising the influence of gender roles, relations, and identities within the wider life course contexts of female partners is required in the design and delivery of psychosocial support services.
Topics: Cancer Survivors; Family; Humans; Male; Prostate; Prostatic Neoplasms; Qualitative Research
PubMed: 34761456
DOI: 10.1111/hsc.13644