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American Journal of Clinical and... 2021Hematospermia is an uncommon symptom but can cause significant anxiety among the patient and his partner. The available data on the underlying etiology, management and... (Review)
Review
INTRODUCTION
Hematospermia is an uncommon symptom but can cause significant anxiety among the patient and his partner. The available data on the underlying etiology, management and outcome are variable and inconsistent. This systematic review was aimed to describe the clinical characteristics, etiology, treatment and outcomes of hematospermia.
METHODS
Keywords were searched in PubMed, Scopus, LILACS and Google Scholar. Relevant articles were manually added from the list of references of eligible articles. Studies with a considerable assessment of patients with hematospermia were included. Qualitative analysis was performed using the available data.
RESULTS
Twenty studies (Fifteen prospective and five retrospective, n=2079 patients, mean age =46.2 (range: 15-89) years) were eligible. Community screening reported a 0.5% prevalence of hematospermia (one study). Majority had hematospermia as the main/only symptom while dysuria (n=38/232, 16.4%), lower urinary tract symptoms (n=113/833, 13.6%), Hematuria (65/566, 11.5%) and testicular pain (n=68/631, 10.7%), were associated in some patients. Suspicious rectal examination (one study) and elevated PSA (Prostate Specific Antigen) levels (four studies) were indicative of sinister pathologies. Common etiologies were urogenital infections/inflammatory conditions followed by prostatic, seminal vesicular or urethral calculi. Malignancies were detected in 5.4% (n=74/1362, 11 studies) of patients >40 years old and the majority had prostate cancers (67/74, 90.5%). Etiology was unknown in 51.8% (n=603/1163). Definitive treatment of the underlying etiology (n=260/347, 74.9%) resolved the symptoms while spontaneous resolution occurred in the vast majority 88.9% (n=168/189) with unknown etiology.
CONCLUSIONS
Hematospermia is relatively an innocent symptom. Malignancies are rare and occurred in men over 40 years. Clinical assessment including a rectal examination and a PSA level would be sufficient to identify most causes. Urogenital infections/inflammation and prostatic calculi are the commonly found etiologies. There was no identifiable cause in almost half of those with hematospermia. The majority has a benign course.
PubMed: 33816690
DOI: No ID Found -
Urologia Internationalis 2018To assess MRI/Transrectal Ultrasound (TRUS) fusion three-dimensional model-guided targeted biopsy (3D-Tb) versus TRUS-guided systematic biopsy (Sb) in detecting overall... (Meta-Analysis)
Meta-Analysis Review
Significance of MRI/Transrectal Ultrasound Fusion Three-Dimensional Model-Guided, Targeted Biopsy Based on Transrectal Ultrasound-Guided Systematic Biopsy in Prostate Cancer Detection: A Systematic Review and Meta-Analysis.
PURPOSE
To assess MRI/Transrectal Ultrasound (TRUS) fusion three-dimensional model-guided targeted biopsy (3D-Tb) versus TRUS-guided systematic biopsy (Sb) in detecting overall and high-Gleason-score (≥7) prostate cancer (PCa).
METHODS
Pubmed and Web of science were searched. Studies with men having a suspicious lesion on MRI were included, which were divided into initial biopsy, previous negative biopsy, and mixed groups in meta-analysis.
RESULTS
Totally 13 cohorts in 12 studies, with 3,225 men were included. In total population, 3D-Tb and Sb did not differ significantly in the PCa detection rate (43.1 vs. 42.6%, p = 0.36), but after excluding initial biopsy group, the superiority of 3D-Tb became significant (p = 0.01); 3D-Tb had a significantly higher detection rate of high-Gleason-score PCa compared to Sb (30.0 vs. 24.1%, p < 0.05); 3D-Tb plus Sb significantly improved the PCa detection rate based on Sb alone (52.7 vs. 42.6%, p < 0.05).
CONCLUSIONS
In men with increased serum PSA and/or abnormal DRE and suspicious lesion on MRI but non-previous evidence of PCa, 3D-Tb plus Sb improves the PCa detection rate based on Sb alone. 3D-Tb alone has better performance in detecting high-Gleason-score PCa, and tends to have a higher PCa detection rate in population with previous negative biopsy compared to Sb.
Topics: Humans; Image-Guided Biopsy; Imaging, Three-Dimensional; Magnetic Resonance Imaging; Male; Multimodal Imaging; Prostatic Neoplasms; Rectum; Ultrasonography, Interventional
PubMed: 29084410
DOI: 10.1159/000484144 -
Andrology Jul 2015The results of published literature focusing on the association between vasectomy and the incidence of prostate cancer are often inconsistent. We conducted a... (Meta-Analysis)
Meta-Analysis Review
The results of published literature focusing on the association between vasectomy and the incidence of prostate cancer are often inconsistent. We conducted a meta-analysis to provide a quantitative assessment of the association between vasectomy and the risk of prostate cancer. We identified all cohort studies by searching the PubMed, Embase, and Cochrane Library before August 2014. The quality of the studies was evaluated using the Newcastle-Ottawa Scale checklist. Summary effect estimates with 95% confidence intervals (CI) were derived using a fixed or random effects model, depending on the heterogeneity of the included studies. Nine cohort studies that spanned across two continents involving 1 127 096 participants (ages 20-75) with 7539 cases of prostate cancer cases were included in the meta-analysis. The overall combined relative risks for men with the reference group were 1.08 (95% CI: 0.87-1.34) in a random effects, however, the association was not statistically significant (p = 0.48). Estimates of total effects were generally consistent in the sensitivity and subgroup analyses. No evidence of publication bias was observed. This meta-analysis indicated that vasectomy may not contribute to the risk of prostate cancer. The conclusion might have a far-reaching significance for the public health, especially in countries with high prevalence rates of vasectomy.
Topics: Cohort Studies; Humans; Male; Prostatic Neoplasms; Vasectomy
PubMed: 26041315
DOI: 10.1111/andr.12040 -
Ethiopian Journal of Health Sciences May 2023Globally prostate cancer is one of the most prevalent cancer among men and a leading cause of morbidity and mortality, especially in a developing country, which is... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Globally prostate cancer is one of the most prevalent cancer among men and a leading cause of morbidity and mortality, especially in a developing country, which is mainly due to lack of knowledge and awareness regarding the screening of prostate cancer. The main objective of this review and meta-analysis is to evaluate the knowledge, awareness and practice of adult men about prostate cancer.
METHOD
An extensive literature search was performed on studies published between January 2000 to 2021. The systematic review initially yielded 137 studies, out of which 7 studies were covered on this meta-evaluation.
RESULT
We noted that the pooled estimate of knowledge and awareness were respectively 65% [CI: 29%, 100%], and 74% [CI: 66%, 82%] about prostate cancer. However, there were limited practices noted in screening of prostate cancer.
CONCLUSION
In order to increase the awareness and screening practice rate for prostate cancer, an improved health education is highly recommended.
Topics: Male; Adult; Humans; Early Detection of Cancer; Prostatic Neoplasms; Health Knowledge, Attitudes, Practice; Health Education
PubMed: 37576174
DOI: 10.4314/ejhs.v33i3.19 -
Annals of Palliative Medicine Sep 2021Prostatitis seriously endangers the health of men. While they have been widely used in recent years, there remains a lack of systematic evaluation of the clinical... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Prostatitis seriously endangers the health of men. While they have been widely used in recent years, there remains a lack of systematic evaluation of the clinical efficacy of α-receptor blockers (α-RBs)/α-adrenergic receptor blockers (α-ARBs) in its treatment. Based on this, this study was developed to systematically evaluate the clinical effect of α-ARB in the treatment of prostatitis.
METHODS
Randomized controlled trials (RCTs) studying α-RBs or α-ARBs, placebos, or other measures to treat prostatitis were searched in Cochrane Library, PubMed, Embase, and CBM databases from establishment to December 2020. The quality of included articles was evaluated using the Cochrane System Review Manual and Jadad tools, and a meta-analysis was performed using Review Manager 5.3 software.
RESULTS
A total of six articles meeting the requirements were found and included 450 patients. Meta-analysis showed that the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) score [mean difference (MD) =-1.76, 95% confidence interval (CI): (-3.35 to -0.17), and P=0.03], pain score [MD =-2.24, 95% CI: (-3.65 to -0.83), and P=0.002], voiding symptom score [MD =-1.21, 95% CI: (-2.06 to -0.35), and P=0.006], and quality of life score [MD =-1.40, 95% CI: (-1.48 to -1.33), and P<0.00001] for patients in the experimental group were lower in contrast to those in the control group after the treatment.
DISCUSSION
The use of α-ARB could significantly improve the treatment effect of patients with prostatitis and improve their quality of life.
Topics: Acupuncture Therapy; Chronic Disease; Humans; Male; Prostatitis; Receptors, Adrenergic, alpha; Treatment Outcome; United States
PubMed: 34628913
DOI: 10.21037/apm-21-2160 -
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 -
Frontiers in Endocrinology 2023econd-generation androgen receptor inhibitors (SGARIs), namely enzalutamide, apalutamide, and darolutamide, are good for improving survival outcomes in prostate cancer... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
econd-generation androgen receptor inhibitors (SGARIs), namely enzalutamide, apalutamide, and darolutamide, are good for improving survival outcomes in prostate cancer patients, but some researchers have shown that using SGARIs increases side effects, which complicates clinicians' choice of. Therefore, we performed this network meta-analysis to assess the efficacy and toxicity of several SGARIs in the treatment of patients with metastatic hormone-sensitive prostate cancer (mHSPC), non-metastatic castration-resistant prostate cancer (nmCRPC), and metastatic castration-resistant prostate cancer (mCRPC).
METHODS
We searched PubMed, EMBASE and Cochrane Library databases from January 2000 to December 2022 to identify randomized controlled studies associated with SGARIs. We use Stata 16.0 and R 4.4.2 for data analysis, hazard ratio (HR) with 95% confidence intervals (CI) were used to assess the results.
RESULTS
This meta-analysis included 7 studies with a total of 9488 patients. In mHSPC, enzalutamide and darolutamide had a positive effect on overall survival (OS) (HR, 0.70; 95% CI, 0.59-0.82), but we did not find a difference in their efficacy to improve OS (HR, 1.19; 95% CI, 0.75-1.89). Also in nmCRPC, enzalutamide, apalutamide and darolutamide were beneficial for metastasis-free survival (MFS) (HR, 0.32; 95% CI, 0.25-0.41). Compared to darolutamide, enzalutamide (HR, 0.71; 95% CI, 0.54-0.93) and apalutamide (HR, 0.68; 95% CI, 0.51-0.91) prolonged MFS, but there was no difference in efficacy between enzalutamide and apalutamide (HR, 0.97; 95% CI, 0.73-1.28). Finally in mCRPC, there was no significant difference in indirect effects on OS between pre- and post-chemotherapy enzalutamide (HR, 0.89; 95% CI, 0.70-1.13). However, using enzalutamide before chemotherapy to improve radiographic progression-free survival (rPFS) was a better option (HR, 2.11; 95% CI, 1.62-2.73).
CONCLUSION
The SGARIs used in each trial were beneficial for the primary endpoint in the study. Firstly there was no significant difference in the effect of enzalutamide and darolutamide in improving OS in patients with mHSPC. Secondly improving MFS in patients with nmCRPC was best achieved with enzalutamide and apalutamide. In addition both pre- and post-chemotherapy use of enzalutamide was beneficial for OS in mCRPC patients, but for improving rPFS pre-chemotherapy use of enzalutamide should be preferred.The INPLASY registration number of this systematic review is INPLASY202310084.
Topics: Male; Humans; Prostatic Neoplasms, Castration-Resistant; Receptors, Androgen; Network Meta-Analysis; Phenylthiohydantoin; Androgen Receptor Antagonists
PubMed: 36967752
DOI: 10.3389/fendo.2023.1134719 -
Frontiers in Endocrinology 2022Androgen deprivation therapy combined with radiotherapy for intermediate-risk prostate cancer is still a matter of debate. We conducted a meta-analysis to evaluate the... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Androgen deprivation therapy combined with radiotherapy for intermediate-risk prostate cancer is still a matter of debate. We conducted a meta-analysis to evaluate the necessity of androgen deprivation therapy combined with radiotherapy for intermediate-risk prostate cancer patients.
METHODS
A comprehensive literature search of articles was performed in PubMed, Embase, Cochrane library, Web of Science, Chinese National Knowledge Infrastructure, Chinese Biological Medicine, Wanfang, and VIP Databases published between February 1988 and April 2022. Studies comparing the survival of patients diagnosed with intermediate-risk prostate cancer who were treated with androgen deprivation therapy combined with radiotherapy or radiotherapy alone were included. Data were extracted and analyzed with the RevMan software (version 5.3) and the Stata software (version 17).
RESULTS
Six randomized controlled trials and nine retrospective studies, including 6853 patients (2948 in androgen deprivation therapy combined with radiotherapy group and 3905 in radiotherapy alone group) were enrolled. Androgen deprivation therapy combined with radiotherapy did not provide an overall survival (HR 1.12, 95% CI 1.01-1.12, p=0.04) or biochemical recurrence-free survival (HR 1.23, 95% CI 1.09-1.39, P=0.001) advantage to intermediate-risk prostate cancer patients.
CONCLUSION
Androgen deprivation therapy combined with radiotherapy did not show some advantages in terms of overall survival and biochemical recurrence-free survival and radiotherapy alone may be the effective therapy for intermediate-risk prostate cancer patients.
SYSTEMATIC REVIEW REGISTRATION
https://inplasy.com/inplasy-2022-8-0095/, identifier 202280095.
Topics: Male; Humans; Prostatic Neoplasms; Androgen Antagonists; Androgens; Retrospective Studies
PubMed: 36733800
DOI: 10.3389/fendo.2022.1074540 -
BMJ Open Jan 2021To conduct a systematic review with meta-analysis of cohort studies to evaluate the association of coffee consumption with the risk of prostate cancer. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To conduct a systematic review with meta-analysis of cohort studies to evaluate the association of coffee consumption with the risk of prostate cancer.
DATA SOURCES
PubMed, Web of Science and Embase were searched for eligible studies up to September 2020.
STUDY SELECTION
Cohort studies were included.
DATA EXTRACTION AND SYNTHESIS
Two researchers independently reviewed the studies and extracted the data. Data synthesis was performed via systematic review and meta-analysis of eligible cohort studies. Meta-analysis was performed with the "" and "" commands in Stata 14.0.
MAIN OUTCOMES AND MEASURES
Prostate cancer was the main outcome. It was classified as localised prostate cancer which included localised or non-aggressive cancers; advanced prostate cancer which included advanced or aggressive cancers; or fatal prostate cancer which included fatal/lethal cancers or prostate cancer-specific deaths.
RESULTS
Sixteen prospective cohort studies were finally included, with 57 732 cases of prostate cancer and 1 081 586 total cohort members. Higher coffee consumption was significantly associated with a lower risk of prostate cancer. Compared with the lowest category of coffee consumption, the pooled relative risk (RR) was 0.91 (95% CI 0.84 to 0.98), I= 53.2%) for the highest category of coffee consumption. There was a significant linear trend for the association (p=0.006 for linear trend), with a pooled RR of 0.988 (95% CI 0.981 to 0.995) for each increment of one cup of coffee per day. For localised, advanced and fatal prostate cancer, the pooled RRs were 0.93 (95% CI 0.87 to 0.99), 0.88 (95% CI 0.71 to 1.09) and 0.84 (95% CI 0.66 to 1.08), respectively. No evidence of publication bias was indicated in this meta-analysis.
CONCLUSIONS
This study suggests that a higher intake of coffee may be associated with a lower risk of prostate cancer.
Topics: Coffee; Cohort Studies; Humans; Male; Prospective Studies; Prostatic Neoplasms; Risk; Risk Factors
PubMed: 33431520
DOI: 10.1136/bmjopen-2020-038902