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Urologic Oncology Jun 2023Meningeal metastases (MM) are a rare progression in advanced prostate. Here we aimed to characterize the incidence, clinical presentation, and outcomes of patients with... (Review)
Review
Meningeal metastases (MM) are a rare progression in advanced prostate. Here we aimed to characterize the incidence, clinical presentation, and outcomes of patients with MM, including dural and leptomeningeal metastases, from primary prostate cancer. A systematic search was performed on MEDLINE, EMBASE, Scopus, and Web of Science. Studies that included patients who developed MM from primary prostate cancer were abstracted. Assessed outcomes included time from primary cancer to MM and MM to death, and clinical presentation of MM, among others. Case reports were compared qualitatively, while observational studies were pooled for quantitative synthesis. The systematic review was prospectively registered on PROSPERO (CRD42020205378). Our institutional series, 11 observational studies, and 46 case reports were synthesized, comprising a total of 191 patients. From the observational studies, the mean age at developing MM was 63.0 years (range: 58.4, 70.9). Presenting neurological symptoms were variable and largely depended on location of MM. The mean time from prostate cancer to MM was 54.6 months (range: 21.0, 101.5), and the mean time from MM to death was 9.0 months (range: 2.6, 23.0). Patients requiring resection for MM had shorter survival after disease progression compared to patients receiving radiation or supportive therapy. All articles had at least moderate risk of bias. We describe the largest synthesis of patients with progression to MM from prostate cancer. Current evidence is very low-quality and primarily stems from small observational studies. Neurological symptoms in the setting of advanced prostate cancer, especially in high-risk disease, warrants radiographic imaging for MM. Further prospective research on risk factors and treatment for MM is warranted.
Topics: Humans; Male; Prostate; Prostatic Neoplasms
PubMed: 36088245
DOI: 10.1016/j.urolonc.2022.08.004 -
Prostate Cancer and Prostatic Diseases Sep 2023Prostate cancer (PC) is the second most diagnosed cancer in men worldwide. While racial and ethnic differences exist in incidence and mortality, increasing data suggest... (Review)
Review
BACKGROUND
Prostate cancer (PC) is the second most diagnosed cancer in men worldwide. While racial and ethnic differences exist in incidence and mortality, increasing data suggest outcomes by race among men with newly diagnosed PC are similar. However, outcomes among races beyond Black/White have been poorly studied. Moreover, whether outcomes differ by race among men who all have metastatic PC (mPC) is unclear. This systematic literature review (SLR) provides a comprehensive synthesis of current evidence relating race to survival in mPC.
METHODS
An SLR was conducted and reported in accordance with PRISMA guidelines. MEDLINE®, Embase, and Cochrane Library using the Ovid® interface were searched for real-world studies published from January 2012 to July 2022 investigating the impact of race on overall survival (OS) and prostate cancer-specific mortality (PCSM) in patients with mPC. A supplemental search of key congresses was also conducted. Studies were appraised for risk of bias.
RESULTS
Of 3228 unique records identified, 62 records (47 full-text and 15 conference abstracts), corresponding to 54 unique studies (51 United States and 3 ex-United States) reporting on race and survival were included. While most studies showed no difference between Black vs White patients for OS (n = 21/27) or PCSM (n = 8/9), most showed that Black patients demonstrated improved OS on certain mPC treatments (n = 7/10). Most studies found no survival difference between White patients and Hispanic (OS: n = 6/8; PCSM: n = 5/6) or American Indian/Alaskan Native (AI/AN) (OS: n = 2/3; PCSM: n = 5/5). Most studies found Asian patients had improved OS (n = 3/4) and PCSM (n = 6/6) vs White patients.
CONCLUSIONS
Most studies found Black, Hispanic, and AI/AN patients with mPC had similar survival as White patients, while Black patients on certain therapies and Asian patients showed improved survival. Future studies are needed to understand what aspects of race including social determinants of health are driving these findings.
Topics: Humans; Male; American Indian or Alaska Native; Asian People; Black People; Prostate; Prostatic Neoplasms; Neoplasm Metastasis; Hispanic or Latino; Asian; White; United States; Survival Analysis
PubMed: 37592001
DOI: 10.1038/s41391-023-00710-1 -
World Journal of Urology Aug 2023To systematically review studies focused on the feasibility and outcomes of outpatient endoscopic enucleation of the prostate for benign prostatic obstruction. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To systematically review studies focused on the feasibility and outcomes of outpatient endoscopic enucleation of the prostate for benign prostatic obstruction.
METHODS
A literature search was conducted through December 2022 using PubMed/Medline, Web of Science, and Embase databases. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to identify eligible studies. Risk of bias assessment was performed according to the Newcastle-Ottawa Scale for case control studies.
RESULTS
Of 773 studies, ten were included in the systematic review (n = 1942 patients) and four in the meta-analysis (n = 1228 patients). The pooled incidence of successful same-day discharge was 84% (95% CI 0.72-0.91). Unplanned readmission was recorded in 3% (95% CI 0.02-0.06) of ambulatory cases. In the reported criteria-selected patients submitted to SDD surgery, the forest plot suggested a lower rate of postoperative readmission (OR 0.56, 95% CI 0.34-0.91, p = 0.02) and complications (OR 0.69, 95% CI 0.48-1, p < 0.05) rates compared to standard protocols.
CONCLUSION
We provide the first systematic review and meta-analysis on SDD for endoscopic prostate enucleation. Despite the lack of randomized controlled trials, we confirm the feasibility and safety of the protocol with no increase in complications or readmission rate in well-selected patients.
Topics: Male; Humans; Prostate; Prostatic Hyperplasia; Patient Discharge; Treatment Outcome; Transurethral Resection of Prostate
PubMed: 37395755
DOI: 10.1007/s00345-023-04471-3 -
Investigative and Clinical Urology May 2017To assess the effectiveness and safety of robot-assisted radical prostatectomy (RARP) versus laparoscopic radical prostatectomy (LRP) in the treatment of prostate cancer. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To assess the effectiveness and safety of robot-assisted radical prostatectomy (RARP) versus laparoscopic radical prostatectomy (LRP) in the treatment of prostate cancer.
MATERIALS AND METHODS
Existing systematic reviews were updated to investigate the effectiveness and safety of RARP. Electronic databases, including Ovid MEDLINE, Ovid Embase, the Cochrane Library, KoreaMed, Kmbase, and others, were searched through July 2014. The quality of the selected systematic reviews was assessed by using the revised assessment of multiple systematic reviews (R-Amstar) and the Cochrane Risk of Bias tool. Meta-analysis was performed by using Revman 5.2 (Cochrane Community) and Comprehensive Meta-Analysis 2.0 (CMA; Biostat). Cochrane Q and I2 statistics were used to assess heterogeneity.
RESULTS
Two systematic reviews and 16 additional studies were selected from a search performed of existing systematic reviews. These included 2 randomized controlled clinical trials and 28 nonrandomized comparative studies. The risk of complications, such as injury to organs by the Clavien-Dindo classification, was lower with RARP than with LRP (relative risk [RR], 0.44; 95% confidence interval [CI], 1.23-0.85; p=0.01). The risk of urinary incontinence was lower (RR, 0.43; 95% CI, 0.31-0.60; p<0.000001) and the potency rate was significantly higher with RARP than with LRP (RR, 1.38; 95% CI, 1.11-1.70; I=78%; p=0.003). Regarding positive surgical margins, no significant difference in risk between the 2 groups was observed; however, the biochemical recurrence rate was lower after RARP than after LRP (RR, 0.59; 95% CI, 0.48-0.73; I=21%; p<0.00001).
CONCLUSIONS
RARP appears to be a safe and effective technique compared with LRP with a lower complication rate, better potency, a higher continence rate, and a decreased rate of biochemical recurrence.
Topics: Humans; Laparoscopy; Male; Neoplasm Recurrence, Local; Prostate; Prostatectomy; Prostatic Neoplasms; Robotic Surgical Procedures; Urinary Incontinence
PubMed: 28480340
DOI: 10.4111/icu.2017.58.3.152 -
Journal of Cancer Research and... Sep 2018Conflicting data have been reported regarding the association between perioperative blood transfusion (PBT) and clinical outcomes for prostate cancer patients. We... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Conflicting data have been reported regarding the association between perioperative blood transfusion (PBT) and clinical outcomes for prostate cancer patients. We conducted a systematic review and meta-analysis to evaluate the impact of PBT on cancer survival and recurrence for patients who underwent radical prostatectomy (RP).
METHODS
A systematic review of PubMed, EMBASE, and Cochrane libraries was performed to identify all eligible studies that evaluate the association between PBT and clinical outcomes for prostate cancer patients undergoing RP. The analyzed outcomes were overall survival (OS) and recurrence-free survival (RFS) at 3, 5, and 10 years.
RESULTS
A total of eight articles met our criteria. Meta-analysis indicated that prostate cancer patients with PBT had decreased OS (hazard ratio [HR] =1.51, 95% confidence interval [CI], 1.22-1.85, P < 0.01; HR = 1.57, 95% CI, 1.33-1.85, P < 0.01; HR = 1.55, 95% CI, 1.03-2.33, P = 0.04) and RFS (HR = 1.67, 95% CI, 1.37-2.04, P < 0.01; HR = 1.42, 95% CI, 1.23-1.63, P < 0.01; HR = 1.37, 95% CI, 1.03-1.83, P = 0.03) at 3, 5, and 10 years after surgery compared with those without PBT.
CONCLUSIONS
The findings from the current meta-analysis demonstrate that PBT was associated with adverse survival and recurrence outcomes for prostate cancer patients undergoing RP.
Topics: Blood Transfusion; Disease-Free Survival; Humans; Male; Neoplasm Recurrence, Local; Perioperative Period; Prostate; Prostatectomy; Prostatic Neoplasms; Transfusion Reaction
PubMed: 30249890
DOI: 10.4103/0973-1482.193115 -
The Prostate Jan 2024Preclinical studies have shown that the sympathetic nervous system is involved in the development of metastases, suggesting a potential antitumor effect of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Preclinical studies have shown that the sympathetic nervous system is involved in the development of metastases, suggesting a potential antitumor effect of beta-blockers. These findings sparked a controversy over the past decade regarding the direction of the association between beta-blocker use and prostate cancer (PCa) mortality. To investigate this association, we conducted a systematic review and meta-analysis.
METHODS
The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines to identify eligible studies. The primary outcome was PCa mortality in beta-blocker users versus nonusers, and overall survival was studied as a secondary endpoint. We assessed heterogeneity using the Cochrane Q test and quantified it using I values. In the case of heterogeneity (Cochrane Q test p < 0.05 and I > 50%), random-effect models were used to determine the association between beta-blockers use and survival outcomes.
RESULTS
Ten studies met our inclusion criteria and a total of 74,970 patients were included: 26,674 beta-blocker users and 48,326 nonusers. There was no statistically significant association between beta-blocker exposure and PCa mortality (hazard ratio [HR] 0.97; 95% confidence interval [CI] 0.87-1.09; p = 0.61). However, significant heterogeneity was found. Meta-regression analysis to explain heterogeneity showed no effect of any of the variables assessed (country, percentage of beta-blocker users, type of beta-blocker [selective and nonselective], study period, PCa stage and follow-up duration; all p > 0.05). We found similar results when we restricted the analysis to studies that include only patients with advanced PCa (HR 0.92; 95% CI 0.80-1.06; p = 0.24). Similarly, we found no association with overall survival (HR 1.02; 95% CI 0.94-1.10; p = 0.64). Meta-regression analysis was also performed, but none of the variables assessed explained the observed heterogeneity (all p > 0.05).
CONCLUSIONS
We found no association between beta-blockers use and overall survival or PCa mortality. This meta-analysis, which includes a considerable population and the most recent literature, provides important data for routine clinical care and patient counseling.
Topics: Male; Humans; Adrenergic beta-Antagonists; Prostatic Neoplasms; Prostate; Proportional Hazards Models; Regression Analysis
PubMed: 37710384
DOI: 10.1002/pros.24623 -
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 Focus Jul 2022Focal therapy has emerged as a promising option to treat well-selected men with localised prostate cancer while preserving healthy prostate tissue and key structures,... (Meta-Analysis)
Meta-Analysis Review
CONTEXT
Focal therapy has emerged as a promising option to treat well-selected men with localised prostate cancer while preserving healthy prostate tissue and key structures, such as the urethral sphincter and neurovascular bundles. However, how this tissue preservation may translate into improved outcomes, particularly into improved sexual outcomes, is still an active research field.
OBJECTIVE
We conducted a systematic review and meta-analysis of the literature to summarise the existing evidence, in order to provide patients with updated data on what to expect after treatment and help identify gaps in current knowledge that may warrant future research.
EVIDENCE ACQUISITION
A systematic literature search was conducted on Medline, EMBASE, Scopus, and Web of Science. The search strategy was defined using the "litsearchr" function in R based on a preliminary "naïve" search using the following terms on Medline: (("focal therapy" OR "focal treatment") AND ("prostate cancer") AND ("sexual function" OR "erectile function")). A total of 42 studies, comprising 3117 patients treated and 2352 with available sexual outcomes, were included in the qualitative data synthesis and 26 in a random-effect meta-analysis.
EVIDENCE SYNTHESIS
The five-item International Index of Erectile Function (IIEF-5) was the most frequently used questionnaire (30/42 studies), with completion rates ranging from 24% to 100% at 18-24 mo. A decrease was noted at 3 mo (IIEF-5 decrease estimate -3.70 [95% confidence interval -4.43, -2.96]), with improvements at 6 mo (-2.18 [-2.91, -1.46]) and 12 mo (-2.14 [-2.96, -1.32]). Studies in which patients had an altered baseline sexual function were more likely to report a significant and durable postoperative decrease in erectile function scores. The patient-reported outcome questionnaires used were not designed for a diverse population. Functional outcomes were not the primary endpoint and have not been reported consistently in most studies considered.
CONCLUSIONS
Focal therapy led to changes in erectile function in most cases under the significance threshold of the patient-reported outcome questionnaires used. However, patients should be counselled according to their baseline erectile function. More research is warranted to detail aspects other than erectile function, such as ejaculation or orgasm. The early postoperative period appears key to study sexual changes after focal therapy, while only a moderate decrease is expected at 12 mo.
PATIENT SUMMARY
We reviewed the published literature detailing the sexual consequences of focal therapy for localised prostate cancer using patient-reported outcome questionnaires. Patients were likely to describe a significant decrease in their erectile function at 3 mo, with improvements noted at 6 and 12 mo. The results obtained may not be reproducible in a more diverse population, and further research is warranted to better study aspects other than erectile function, such as ejaculation or orgasm.
Topics: Erectile Dysfunction; Humans; Male; Penile Erection; Prostate; Prostatic Neoplasms; Sexual Behavior
PubMed: 34580049
DOI: 10.1016/j.euf.2021.09.009 -
Research and Reports in Urology 2022To compare efficacy and safety outcomes of GreenLight, Holmium and Thulium laser techniques with standard monopolar and bipolar transurethral resection of the... (Review)
Review
OBJECTIVE
To compare efficacy and safety outcomes of GreenLight, Holmium and Thulium laser techniques with standard monopolar and bipolar transurethral resection of the prostate (TURP) in high-risk patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO).
METHODS
We conducted a systematic literature review of studies in patients undergoing BPO surgeries who may be considered high-risk for standard TURP, with higher risk defined as follows: large prostates (≥80 mL) and/or taking antithrombotic agents and/or urinary retention and/or age >80 years and/or significant comorbidity. Outcomes summarised included bleeding complications, re-intervention rates, hospital length of stay, and standard measures of disease and symptom severity for all available timepoints.
RESULTS
A total of 276 studies of 32,722 patients reported relevant data. Studies were heterogeneous in methodology, population and outcomes reported. IPSS reduction, Qmax improvement and PVR were similar across all interventions. Mean values at baseline and after 12 months across interventions were 13.2-29 falling to 2.3-10.8 for IPSS, 0-19 mL/s increasing to 7.5-34.1 mL/s for Qmax and 41.4-954 mL falling to 5.1-138.3 mL for PVR. Laser treatments show some advantages compared with monopolar and bipolar TURP for some adverse events and safety parameters such as bleeding complications. Duration of hospital stay, reinterventions and recatheterisations were lower with GreenLight, HoLEP, Thulium lasers, and bipolar enucleation than TURP.
CONCLUSIONS
Laser therapies are effective and well-tolerated treatment options in high-risk patients with BPO compared with monopolar or bipolar TURP. The advantageous safety profile of laser treatments means that patients with a higher bleeding risk should be offered laser surgery preferentially to mTURP or bTURP.
PubMed: 35757198
DOI: 10.2147/RRU.S361956 -
Current Urology Reports Jan 2022To present the latest evidence related to interobserver agreement and accuracy; evaluate the strengths, weaknesses, and implications of use; and outline opportunities... (Review)
Review
PURPOSE OF REVIEW
To present the latest evidence related to interobserver agreement and accuracy; evaluate the strengths, weaknesses, and implications of use; and outline opportunities for improvement and future development of the Prostate Imaging Reporting and Data System version 2.1 (PI-RADS v2.1) for detection of prostate cancer (PCa) on multiparametric magnetic resonance imaging (mpMRI).
RECENT FINDINGS
Our review of currently available evidence suggests that recent improvements to the PI-RADS system with PI-RADS v2.1 slightly improved interobserver agreement, with generally high sensitivity and moderate specificity for the detection of clinically significant PCa. Recent evidence additionally demonstrates substantial improvement in diagnostic specificity with PI-RADS v2.1 compared with PI-RADS v2. However, results of studies examining the comparative performance of v2.1 are limited by small sample sizes and retrospective cohorts, potentially introducing selection bias. Some studies suggest a substantial improvement between v2.1 and v2, while others report no statistically significant difference. Additionally, in PI-RADS v2.1, the interpretation and reporting of certain findings remain subjective, particularly for category 2 lesions, and reader experience continues to vary significantly. These factors further contribute to a remaining degree of interobserver variability and findings of improved performance among more experienced readers. PI-RADS v2.1 appears to show at least minimal improvement in interobserver agreement, diagnostic performance, and both sensitivity and specificity, with greater improvements seen among more experienced readers. However, given the decrescent nature of these improvements and the limited power of all studies examined, the clinical impact of this progress may be marginal. Despite improvements in PI-RADS v2.1, practitioner experience in interpreting mpMRI of the prostate remains the most important factor in prostate cancer detection.
Topics: Humans; Magnetic Resonance Imaging; Male; Multiparametric Magnetic Resonance Imaging; Observer Variation; Prostate; Prostatic Neoplasms; Reproducibility of Results; Retrospective Studies
PubMed: 35226257
DOI: 10.1007/s11934-022-01084-y