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European Urology Aug 2023Prostate cancer (PCa) is one of the most common cancers worldwide. Understanding the epidemiology and risk factors of the disease is paramount to improve primary and... (Review)
Review
CONTEXT
Prostate cancer (PCa) is one of the most common cancers worldwide. Understanding the epidemiology and risk factors of the disease is paramount to improve primary and secondary prevention strategies.
OBJECTIVE
To systematically review and summarize the current evidence on the descriptive epidemiology, large screening studies, diagnostic techniques, and risk factors of PCa.
EVIDENCE ACQUISITION
PCa incidence and mortality rates for 2020 were obtained from the GLOBOCAN database of the International Agency for Research on Cancer. A systematic search was performed in July 2022 using PubMed/MEDLINE and EMBASE biomedical databases. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and was registered in PROSPERO (CRD42022359728).
EVIDENCE SYNTHESIS
Globally, PCa is the second most common cancer, with the highest incidence in North and South America, Europe, Australia, and the Caribbean. Risk factors include age, family history, and genetic predisposition. Additional factors may include smoking, diet, physical activity, specific medications, and occupational factors. As PCa screening has become more accepted, newer approaches such as magnetic resonance imaging (MRI) and biomarkers have been implemented to identify patients who are likely to harbor significant tumors. Limitations of this review include the evidence being derived from meta-analyses of mostly retrospective studies.
CONCLUSIONS
PCa remains the second most common cancer among men worldwide. PCa screening is gaining acceptance and will likely reduce PCa mortality at the cost of overdiagnosis and overtreatment. Increasing use of MRI and biomarkers for the detection of PCa may mitigate some of the negative consequences of screening.
PATIENT SUMMARY
Prostate cancer (PCa) remains the second most common cancer among men, and screening for PCa is likely to increase in the future. Improved diagnostic techniques can help reduce the number of men who need to be diagnosed and treated to save one life. Avoidable risk factors for PCa may include factors such as smoking, diet, physical activity, specific medications, and certain occupations.
Topics: Male; Humans; Retrospective Studies; Prostatic Neoplasms; Prostate; Risk Factors; Prostate-Specific Antigen
PubMed: 37202314
DOI: 10.1016/j.eururo.2023.04.021 -
JAMA Internal Medicine Nov 2023Cancer screening tests are promoted to save life by increasing longevity, but it is unknown whether people will live longer with commonly used cancer screening tests. (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Cancer screening tests are promoted to save life by increasing longevity, but it is unknown whether people will live longer with commonly used cancer screening tests.
OBJECTIVE
To estimate lifetime gained with cancer screening.
DATA SOURCES
A systematic review and meta-analysis was conducted of randomized clinical trials with more than 9 years of follow-up reporting all-cause mortality and estimated lifetime gained for 6 commonly used cancer screening tests, comparing screening with no screening. The analysis included the general population. MEDLINE and the Cochrane library databases were searched, and the last search was performed October 12, 2022.
STUDY SELECTION
Mammography screening for breast cancer; colonoscopy, sigmoidoscopy, or fecal occult blood testing (FOBT) for colorectal cancer; computed tomography screening for lung cancer in smokers and former smokers; or prostate-specific antigen testing for prostate cancer.
DATA EXTRACTION AND SYNTHESIS
Searches and selection criteria followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline. Data were independently extracted by a single observer, and pooled analysis of clinical trials was used for analyses.
MAIN OUTCOMES AND MEASURES
Life-years gained by screening was calculated as the difference in observed lifetime in the screening vs the no screening groups and computed absolute lifetime gained in days with 95% CIs for each screening test from meta-analyses or single randomized clinical trials.
RESULTS
In total, 2 111 958 individuals enrolled in randomized clinical trials comparing screening with no screening using 6 different tests were eligible. Median follow-up was 10 years for computed tomography, prostate-specific antigen testing, and colonoscopy; 13 years for mammography; and 15 years for sigmoidoscopy and FOBT. The only screening test with a significant lifetime gain was sigmoidoscopy (110 days; 95% CI, 0-274 days). There was no significant difference following mammography (0 days: 95% CI, -190 to 237 days), prostate cancer screening (37 days; 95% CI, -37 to 73 days), colonoscopy (37 days; 95% CI, -146 to 146 days), FOBT screening every year or every other year (0 days; 95% CI, -70.7 to 70.7 days), and lung cancer screening (107 days; 95% CI, -286 days to 430 days).
CONCLUSIONS AND RELEVANCE
The findings of this meta-analysis suggest that current evidence does not substantiate the claim that common cancer screening tests save lives by extending lifetime, except possibly for colorectal cancer screening with sigmoidoscopy.
Topics: Male; Humans; Early Detection of Cancer; Prostate-Specific Antigen; Mass Screening; Prostatic Neoplasms; Lung Neoplasms; Randomized Controlled Trials as Topic; Colorectal Neoplasms; Colonoscopy; Occult Blood
PubMed: 37639247
DOI: 10.1001/jamainternmed.2023.3798 -
European Urology Open Science Aug 2023Identifying malignant tissue and leaving adjacent structures undisturbed constitute an ongoing challenge in prostate cancer (PCa) surgery. Image and radioguided surgical... (Review)
Review
CONTEXT
Identifying malignant tissue and leaving adjacent structures undisturbed constitute an ongoing challenge in prostate cancer (PCa) surgery. Image and radioguided surgical technologies targeting the prostate-specific membrane antigen (PSMA) receptor may facilitate identification and removal of diseased tissue.
OBJECTIVE
To perform a systematic review of the clinical studies on PSMA-targeted surgery.
EVIDENCE ACQUISITION
The MEDLINE (OvidSP), Embase.com, and Cochrane Library databases were searched. Identified reports were critically appraised according to the Idea, Development, Exploration, Assessment, Long-term framework criteria. The risk of bias (RoB) was assessed as per the Risk Of Bias In Non-randomized Studies-of Interventions tool. The strengths and limitations of the techniques and corresponding oncological outcomes were extracted as areas of interest. Data were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.
EVIDENCE SYNTHESIS
In total, 29 reports were selected, including eight prospective studies, 12 retrospective analyses, and nine case reports, all with a high or an unclear RoB. In 72.4% of studies, PSMA targeting was achieved via radioguided surgery (RGS), predominantly using Tc-PSMA-I&S (66.7%). Hybrid approaches that complement RGS with optical guidance are emerging. The majority of studies retrieved were pilot studies with a short follow-up. In 13 reports, salvage lymph node surgery was discussed (44.8%). In 12 more recent reports (41.4%), PSMA targeting was studied in primary PCa surgery (50.0% lymph nodes and 50.0% surgical margins), and four studied both primary and salvage surgery (13.8%). Overall, specificity was higher than sensitivity (median 98.9% and 84.8%, respectively). Oncological outcomes were discussed only in reports on the use of Tc-PSMA-I&S in salvage surgery (median follow-up of 17.2 mo). A decline in prostate-specific antigen level of >90% ranged from 22.0% to 100.0%, and biochemical recurrence ranged from 50.0% to 61.8% of patients.
CONCLUSIONS
In PSMA-targeted surgery, most studies address salvage PSMA-RGS using Tc-PSMA-I&S. Available evidence suggests that the specificity of intraoperative PSMA targeting is higher than the sensitivity. The studies that included follow-up did not yet objectify a clear oncological benefit. Lacking solid outcome data, PSMA-targeted surgery remains investigational.
PATIENT SUMMARY
In this paper, we review recent advances in prostate-specific membrane antigen (PSMA)-targeted surgery, which is used to help identify and remove prostate cancer. We found good evidence to suggest that PSMA targeting helps identify prostate cancer during surgery. The oncological benefits have yet to be investigated further.
PubMed: 37361200
DOI: 10.1016/j.euros.2023.05.014 -
World Journal of Urology Dec 2023To compare long-term reoperation rate and functional outcomes between EEP (endoscopic enucleation of the prostate) and TURP (transurethral resection of the prostate). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To compare long-term reoperation rate and functional outcomes between EEP (endoscopic enucleation of the prostate) and TURP (transurethral resection of the prostate).
EVIDENCE ACQUISITION
A systematic literature review of Medline, Scopus, and Web of Science was conducted with primary outcome assessed being reoperation rate and secondary outcomes after a long term (> 3 years) being functional outcomes or related values (prostate volume, PSA level, etc.).
EVIDENCE SYNTHESIS
Five studies were found with long-term follow-up 4-7 years. EEP reoperation rate ranged from 0 to 1.27%, while from 1.7 to 17.6% for TURP. Meta-analysis showed significantly lower OR for EEP, 0.27 (95% CI 0.24-0.31), with notable homogeneity of the results, I = 0%. Long-term Qmax and IPSS were significantly better for EEP. Q pooled mean difference was 1.79 (95% CI 1.72-1.86) ml/s with a high concordance among the studies, I = 0%. IPSS mean difference -1.24 (95% CI - 1.28 to - 1.2) points, I = 57% but QoL did not differ, with mean difference being 0.01 (95% CI - 0.02 to 0.04), I = 0%. IIEF-5 score was also significantly better for EEP, mean difference 1.08 (95% CI 1.03-1.13), but heterogeneity was high, I = 70%. PSA level and prostate volume were only reported in one study and favored EEP slightly yet statistically significant.
CONCLUSION
EEP had a significantly lower reoperation rate and better functional outcomes (Q and IPSS) at long term compared with TURP. It may also be beneficial in terms of IIEF-5, PVR, and PSA level.
Topics: Male; Humans; Transurethral Resection of Prostate; Prostatic Hyperplasia; Quality of Life; Prostate-Specific Antigen; Treatment Outcome
PubMed: 37980297
DOI: 10.1007/s00345-023-04666-8 -
Magnetic Resonance Imaging Clinics of... Nov 2023The present systematic review and meta-analysis are focused on the diagnostic accuracy of PSMA PET/MRI in primary prostate cancer assessment. A literature search was... (Meta-Analysis)
Meta-Analysis Review
Systematic Review and Metanalysis on the Role of Prostate-Specific Membrane Antigen Positron Emission Tomography/Magnetic Resonance Imaging for Intraprostatic Tumour Assessment.
The present systematic review and meta-analysis are focused on the diagnostic accuracy of PSMA PET/MRI in primary prostate cancer assessment. A literature search was conducted on the PubMed database using the terms "PSMA" AND "prostate cancer" or "prostate" AND "PET/MRI" or "PET MRI" or "PET-MRI" or "PET-MR" AND "primary" or "staging." Ten articles were eligible for analysis after applying the exclusion criteria. PET/MRI showed better diagnostic accuracy in detecting primary PCa compared to multiparametric (mp) MRI and PET alone. The pooled sensitivity and specificity of 68Ga-PSMA PET/MRI at the per-patient level were 0.976 (CI: 0.943-0.991) and 0.739 (CI: 0.437-0.912); respectively. PSMA PET/MRI has good sensitivity in detecting primary PCa, especially in patients with PIRADS 3 PCa.
Topics: Humans; Male; Magnetic Resonance Imaging; Prostatic Neoplasms; Multiparametric Magnetic Resonance Imaging; Positron-Emission Tomography; Pelvis
PubMed: 37741644
DOI: 10.1016/j.mric.2023.06.006 -
Journal of Clinical Medicine Sep 2023The aim of this systematic review and meta-analysis was to analyze the association between periodontal disease and prostate inflammation with a null hypothesis stating... (Review)
Review
UNLABELLED
The aim of this systematic review and meta-analysis was to analyze the association between periodontal disease and prostate inflammation with a null hypothesis stating that periodontal disease does not increase the incidence of prostate inflammation.
MATERIALS AND METHODS
A systematic literature review and meta-analysis of longitudinal observational cohort and case-control studies that evaluated the odds ratio or hazard ratio and confidence interval was undertaken based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations (2020). A total of four databases were consulted in the literature search: PubMed-Medline, Scopus, Embase, and Web of Science. After eliminating duplicated articles and applying the inclusion criteria, seven articles were selected for the qualitative and quantitative analyses.
RESULTS
Four observational cohort studies and three observational cohort case-control studies were included in the meta-analysis. The four observational cohort studies were combined using the random effects model to estimate a hazard ratio of 1.32 with a confidence interval of 95% between 0.87 and 1.77. The meta-analysis presented high heterogeneity (Q test = 56.1; value < 0.001; I = 94.9%). Moreover, the three observational case-control studies were combined using the random effects model to estimate an odds ratio of 1.62 with a confidence interval of 95% between 1.41 and 1.84. The meta-analysis presented high heterogeneity (Q test = 1.07; value = 0.782; I = 0%).
CONCLUSIONS
The incidence of periodontal disease does not increase the risk of the incidence of prostate inflammation.
PubMed: 37763009
DOI: 10.3390/jcm12186070 -
JAMA Oncology Jun 2024Prostate magnetic resonance imaging (MRI) is increasingly integrated within the prostate cancer (PCa) early detection pathway. (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Prostate magnetic resonance imaging (MRI) is increasingly integrated within the prostate cancer (PCa) early detection pathway.
OBJECTIVE
To systematically evaluate the existing evidence regarding screening pathways incorporating MRI with targeted biopsy and assess their diagnostic value compared with prostate-specific antigen (PSA)-based screening with systematic biopsy strategies.
DATA SOURCES
PubMed/MEDLINE, Embase, Cochrane/Central, Scopus, and Web of Science (through May 2023).
STUDY SELECTION
Randomized clinical trials and prospective cohort studies were eligible if they reported data on the diagnostic utility of prostate MRI in the setting of PCa screening.
DATA EXTRACTION
Number of screened individuals, biopsy indications, biopsies performed, clinically significant PCa (csPCa) defined as International Society of Urological Pathology (ISUP) grade 2 or higher, and insignificant (ISUP1) PCas detected were extracted.
MAIN OUTCOMES AND MEASURES
The primary outcome was csPCa detection rate. Secondary outcomes included clinical insignificant PCa detection rate, biopsy indication rates, and the positive predictive value for the detection of csPCa.
DATA SYNTHESIS
The generalized mixed-effect approach with pooled odds ratios (ORs) and random-effect models was used to compare the MRI-based and PSA-only screening strategies. Separate analyses were performed based on the timing of MRI (primary/sequential after a PSA test) and cutoff (Prostate Imaging Reporting and Data System [PI-RADS] score ≥3 or ≥4) for biopsy indication.
RESULTS
Data were synthesized from 80 114 men from 12 studies. Compared with standard PSA-based screening, the MRI pathway (sequential screening, PI-RADS score ≥3 cutoff for biopsy) was associated with higher odds of csPCa when tests results were positive (OR, 4.15; 95% CI, 2.93-5.88; P ≤ .001), decreased odds of biopsies (OR, 0.28; 95% CI, 0.22-0.36; P ≤ .001), and insignificant cancers detected (OR, 0.34; 95% CI, 0.23-0.49; P = .002) without significant differences in the detection of csPCa (OR, 1.02; 95% CI, 0.75-1.37; P = .86). Implementing a PI-RADS score of 4 or greater threshold for biopsy selection was associated with a further reduction in the odds of detecting insignificant PCa (OR, 0.23; 95% CI, 0.05-0.97; P = .048) and biopsies performed (OR, 0.19; 95% CI, 0.09-0.38; P = .01) without differences in csPCa detection (OR, 0.85; 95% CI, 0.49-1.45; P = .22).
CONCLUSION AND RELEVANCE
The results of this systematic review and meta-analysis suggest that integrating MRI in PCa screening pathways is associated with a reduced number of unnecessary biopsies and overdiagnosis of insignificant PCa while maintaining csPCa detection as compared with PSA-only screening.
Topics: Humans; Male; Prostatic Neoplasms; Magnetic Resonance Imaging; Early Detection of Cancer; Prostate-Specific Antigen
PubMed: 38576242
DOI: 10.1001/jamaoncol.2024.0734 -
European Journal of Medicinal Chemistry Jan 2024Prostate specific membrane antigen (PSMA) has been the subject of several studies in recent decades as a promising molecular target for prostate cancer (PCa), in fact it... (Review)
Review
Prostate specific membrane antigen (PSMA) has been the subject of several studies in recent decades as a promising molecular target for prostate cancer (PCa), in fact it is considered an excellent molecular target for both PCa imaging (both for staging and follow-up), by means of PET/CT and for radioligand therapy. Its interesting molecular features have enabled the development of a new diagnostic and therapeutic approach for PCa, called "theranostics." Considering the abundance of PSMA-based probes that have appeared so far in the literature, the present work focuses the attention on radiopharmaceuticals with increasing clinical application, highlighting advantages and disadvantages in terms of different metabolization and excretion processes, pharmacokinetic, binding affinity and variable internalization rate, tumor-to-background ratio, residence times and toxicity profile.
Topics: Male; Humans; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Radiopharmaceuticals; Precision Medicine; Gallium Radioisotopes
PubMed: 37992520
DOI: 10.1016/j.ejmech.2023.115966 -
Prostate Cancer and Prostatic Diseases Nov 2023Prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT) has become an increasingly established imaging modality in the... (Review)
Review
BACKGROUND
Prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT) has become an increasingly established imaging modality in the staging of prostate cancer (PCa). Numerous PSMA-based tracers are currently available, however, there is a lack of consensus on the optimal radiotracer(s) for PSMA PET/CT. This study aims to investigate whether Fluorine-18 (F)-labelled PSMA PET/CT is significantly different from Gallium-68 (Ga) in primary diagnosis and/or secondary staging of prostate cancer following biochemical recurrence.
METHODS
A critical review of MEDLINE, EMBASE, PubMed and Web of Science databases was performed in May 2023 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Studies that directly compared F-based PSMA radiotracers and [Ga]Ga-PSMA-11 in terms of the normal organ SUV or the lesion SUV or the detection rate were assessed. Quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2).
RESULTS
Twenty-four studies were analysed. [F]DCFPyL and [F]PSMA-1007 were the two most commonly studied F based PSMA tracers. [F]JK-PSMA-7, [F]rhPSMA-7, [F]AlF-PSMA-11 were the new tracers evaluated in a limited number of studies. Overall, [F]DCFPyL was observed to have a similar lesion detection rate to [Ga]Ga-PSMA-11 with no increase in false positive rates. [F]PSMA-1007 was found to have a greater local lesion detection rate because of its predominant hepatobiliary excretory route. However, [Ga]Ga-PSMA-11 was observed to have a similar local lesion detection rate in studies that administer patients with furosemide prior to the scan. In addition, [F]PSMA-1007 was found to have a significant number of benign bone uptakes.
CONCLUSIONS
[F]DCFPyL was observed to be similar to [Ga]Ga-PSMA-11. [F]PSMA-1007 was observed to be less preferrable to [Ga]Ga-PSMA-11 due to its high benign bone uptakes. Overall, there was not enough evidence in differentiating the radiotracers based on their clinical impacts.
PubMed: 38017295
DOI: 10.1038/s41391-023-00755-2 -
Clinical Oncology (Royal College of... Dec 2023After primary radiotherapy, biochemical recurrence is defined according to the Phoenix criteria as a prostate-specific antigen (PSA) value >2 ng/ml relative to the... (Meta-Analysis)
Meta-Analysis
Clinical Usefulness of Prostate-specific Membrane Antigen-ligand Positron Emission Tomography/Computed Tomography for the Detection of Prostate Cancer Biochemical Recurrence after Primary Radiation Therapy in Patients with Prostate-specific Antigen Below the Phoenix Threshold: Systematic Review and...
AIMS
After primary radiotherapy, biochemical recurrence is defined according to the Phoenix criteria as a prostate-specific antigen (PSA) value >2 ng/ml relative to the nadir. Several studies have shown that prostate-specific membrane antigen (PSMA)-ligand positron emission tomography/computed tomography (PET/CT) can help in detecting recurrence in patients with low PSA values. This study aimed to assess the detection rate and patterns of PSMA-ligand PET/CT uptake in patients with suspected biochemical recurrence after primary radiotherapy and with PSA levels below the Phoenix threshold.
MATERIALS AND METHODS
The meta-analysis was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Articles providing data on patients with suspected prostate cancer recurrence after primary radiotherapy with a PSA value below the Phoenix threshold and who underwent PSMA-ligand PET/CT were included. Quality assessment was carried out using the Quality Assessment of Diagnostic Accuracy Studies-2 tool (QUADAS-2).
RESULTS
In total, five studies were included, recruiting 909 patients (202 with PSA ≤2 ng/ml). The PSMA-ligand detection rate in the patients with ≤2 ng/ml ranged from 66 to 83%. The most frequent source of PSMA-ligand PET/CT uptake was local recurrence, followed by lymph node metastasis and bone metastasis. PSMA-ligand PET/CT uptake due to local-only recurrence was more likely in patients with PSA ≤2 ng/ml compared with PSA > 2 ng/ml: risk ratio 0.72 (95% confidence interval 0.58-0.89), P = 0.003. No significant differences were observed in the detection of PSMA-ligand uptake in other areas. Limitations include a lack of biopsy confirmation, cohort reports with small sample sizes and a potentially high risk of bias.
CONCLUSION
A significant detection of PSMA-ligand-avid disease was observed in patients with PSA levels below the Phoenix threshold. There was a higher likelihood of detecting local-only uptake when the PSA value was ≤2 ng/ml. The findings suggest that a critical review of the Phoenix criteria may be warranted in the era of PSMA-ligand PET/CT and highlight the need for further prospective trials.
Topics: Male; Humans; Prostate-Specific Antigen; Positron Emission Tomography Computed Tomography; Prostate; Ligands; Neoplasm Recurrence, Local; Prostatic Neoplasms; Retrospective Studies
PubMed: 37802722
DOI: 10.1016/j.clon.2023.09.012