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Theranostics 2024Radical prostatectomy (RP) combined with pelvic lymph node dissection (PLND) is the first step in multimodal treatment of prostate cancer (PCa) without distant... (Review)
Review
Radical prostatectomy (RP) combined with pelvic lymph node dissection (PLND) is the first step in multimodal treatment of prostate cancer (PCa) without distant metastases. For a long time, the surgical resection range has been highly dependent on the surgeon's visualization and experience with preoperative imaging. With the rapid development of prostate-specific membrane antigen positron emission tomography and single-photon emission computed tomography (PSMA-PET and PSMA-SPECT), PSMA-targeted surgery has been introduced for a more accurate pathological diagnosis and complete resection of positive surgical margins (PSMs) and micro-lymph node metastases (LNMs). We reviewed PSMA-targeted surgeries, including PSMA-PET-guided prostatic biopsy (PSMA-TB), PSMA-targeted radio-guided surgery (PSMA-RGS), PSMA-targeted fluorescence-guided surgery (PSMA-FGS), and multi-modality/multi-targeted PSMA-targeted surgery. We also discuss the strengths and challenges of PSMA-targeted surgery, and propose that PSMA-targeted surgery could be a great addition to existing surgery protocols, thereby improving the accuracy and convenience of surgery for primary and recurrent PCa in the near future.
Topics: Humans; Male; Prostatic Neoplasms; Glutamate Carboxypeptidase II; Antigens, Surface; Prostatectomy; Surgery, Computer-Assisted; Positron-Emission Tomography; Tomography, Emission-Computed, Single-Photon; Lymph Node Excision
PubMed: 38773975
DOI: 10.7150/thno.95039 -
Urologic Oncology Sep 2023Financial toxicity is a growing problem in the delivery of cancer care and contributes to inequities in outcomes across the cancer care continuum. Racial/ethnic... (Review)
Review
Financial toxicity is a growing problem in the delivery of cancer care and contributes to inequities in outcomes across the cancer care continuum. Racial/ethnic inequities in prostate cancer, the most common cancer diagnosed in men, are well described, and threaten to widen in the era of precision oncology given the numerous structural barriers to accessing novel diagnostic studies and treatments, particularly for Black men. Gaps in insurance coverage and cost sharing are 2 such structural barriers that can perpetuate inequities in screening, diagnostic workup, guideline-concordant treatment, symptom management, survivorship, and access to clinical trials. Mitigating these barriers will be key to achieving equity in prostate cancer care, and will require a multi-pronged approach from policymakers, health systems, and individual providers. This narrative review will describe the current state of financial toxicity in prostate cancer care and its role in perpetuating racial inequities in the era of precision oncology.
Topics: Humans; Male; Black People; Health Services Accessibility; Healthcare Disparities; Precision Medicine; Prostatic Neoplasms; Racial Groups; Black or African American; Insurance Coverage; Cost Sharing
PubMed: 37164775
DOI: 10.1016/j.urolonc.2023.04.012 -
Seminars in Nuclear Medicine Jan 2024Prostate-specific membrane antigen (PSMA)-targeted PET agents have revolutionized the care of patients with prostate cancer, supplanting traditional methods of imaging... (Review)
Review
Prostate-specific membrane antigen (PSMA)-targeted PET agents have revolutionized the care of patients with prostate cancer, supplanting traditional methods of imaging prostate cancer, and improving the selection and delivery of therapies. This has led to a rapid expansion in both the number of PSMA PET scans performed and the imaging specialists required to interpret those scans. To aid those imagers and clinicians who are new to the interpretation of PSMA PET, this review provides an overview of the interpretation of PSMA PET/CT imaging and pearls for overcoming commonly encountered pitfalls. We discuss the physiologic distribution of the clinically available PSMA-targeted radiotracers, the commonly encountered patterns of prostate cancer spread, as well as the benign and malignant mimics of prostate cancer. Additionally, we review the standardized PSMA PET reporting systems and the role of PSMA in selecting appropriate patients for PSMA-targeted therapies.
Topics: Male; Humans; Positron Emission Tomography Computed Tomography; Diagnostic Imaging; Prostatic Neoplasms
PubMed: 37980186
DOI: 10.1053/j.semnuclmed.2023.11.001 -
Prostate Cancer and Prostatic Diseases Mar 2024The discovery of small molecules that target the extracellular domain of prostate-specific membrane antigen (PSMA) has led to advancements in diagnostic imaging and the... (Review)
Review
The discovery of small molecules that target the extracellular domain of prostate-specific membrane antigen (PSMA) has led to advancements in diagnostic imaging and the development of precision radiopharmaceutical therapies. In this review, we present the available existing data and highlight the key ongoing clinical evaluations of PSMA-based imaging in the management of primary, biochemically recurrent, and metastatic prostate cancer. We also discuss clinical studies that explore the use of PSMA-based radiopharmaceutical therapy (RPT) in metastatic prostate cancer and forthcoming trials that investigate PSMA RPT in earlier disease states. Multidisciplinary collaboration in clinical trial design and therapeutic administration is critical to the continued progress of this evolving radiotheranostics field.
Topics: Male; Humans; Prostatic Neoplasms; Radiopharmaceuticals
PubMed: 37069330
DOI: 10.1038/s41391-023-00670-6 -
Glycobiology Dec 2023Aberrant glycosylation is a hallmark of cancer and is not just a consequence, but also a driver of a malignant phenotype. In prostate cancer, changes in fucosylated and...
Aberrant glycosylation is a hallmark of cancer and is not just a consequence, but also a driver of a malignant phenotype. In prostate cancer, changes in fucosylated and sialylated glycans are common and this has important implications for tumor progression, metastasis, and immune evasion. Glycans hold huge translational potential and new therapies targeting tumor-associated glycans are currently being tested in clinical trials for several tumor types. Inhibitors targeting fucosylation and sialylation have been developed and show promise for cancer treatment, but translational development is hampered by safety issues related to systemic adverse effects. Recently, potent metabolic inhibitors of sialylation and fucosylation were designed that reach higher effective concentrations within the cell, thereby rendering them useful tools to study sialylation and fucosylation as potential candidates for therapeutic testing. Here, we investigated the effects of global metabolic inhibitors of fucosylation and sialylation in the context of prostate cancer progression. We find that these inhibitors effectively shut down the synthesis of sialylated and fucosylated glycans to remodel the prostate cancer glycome with only minor apparent side effects on other glycan types. Our results demonstrate that treatment with inhibitors targeting fucosylation or sialylation decreases prostate cancer cell growth and downregulates the expression of genes and proteins important in the trajectory of disease progression. We anticipate our findings will lead to the broader use of metabolic inhibitors to explore the role of fucosylated and sialylated glycans in prostate tumor pathology and may pave the way for the development of new therapies for prostate cancer.
Topics: Male; Humans; Glycosylation; Prostatic Neoplasms; Protein Processing, Post-Translational; Polysaccharides
PubMed: 37847613
DOI: 10.1093/glycob/cwad085 -
BMC Urology Feb 2024Although prostate cancer is a prevalent malignancy worldwide, its clinical presentation and management in the Middle East are not well-documented. This study aims to...
BACKGROUND
Although prostate cancer is a prevalent malignancy worldwide, its clinical presentation and management in the Middle East are not well-documented. This study aims to provide insights into the initial clinical presentation and management of prostate cancer in this region.
METHODS
A retrospective review was conducted on seven institutional databases from six Middle Eastern countries, including Türkiye, Lebanon, Iraq, Syria, Bahrain, and Jordan, to identify patients diagnosed with prostate cancer in 2021. Descriptive analysis was performed on the collected data to provide an overview of the demographic, clinical, and treatment variables.
RESULTS
A total of 1,136 patients were identified with a median age of 70 (range, 50-84). Most patients (78%) received their prostate cancer diagnosis after presenting with symptoms, as opposed to routine PSA screening. At the time of diagnosis, 35% of men had clinical T3 or T4 disease, 54% with Stage IV disease and 50% with Gleason score ≥ 8. Regarding treatment, 20% of non-metastatic and 22% of metastatic patients received no treatment.
CONCLUSION
Most men in this study sought prostate cancer evaluation due to symptoms and were subsequently diagnosed with advanced-stage disease, providing a foundation for future research aimed at understanding the underlying factors behind the observed trends and enabling informed interventions.
Topics: Male; Humans; Prostate-Specific Antigen; Prostatic Neoplasms; Retrospective Studies; Iraq; Lebanon; Neoplasm Staging
PubMed: 38336732
DOI: 10.1186/s12894-024-01427-6 -
Magnetic Resonance in Chemistry : MRC Dec 2023Prostate cancer (PCa) is one of the most prevalent cancers in men worldwide. For its detection, serum prostate-specific antigen (PSA) screening is commonly used, despite...
Prostate cancer (PCa) is one of the most prevalent cancers in men worldwide. For its detection, serum prostate-specific antigen (PSA) screening is commonly used, despite its lack of specificity, high false positive rate, and inability to discriminate indolent from aggressive PCa. Following increases in serum PSA levels, clinicians often conduct prostate biopsies with or without advanced imaging. Nuclear magnetic resonance (NMR)-based metabolomics has proven to be promising for advancing early-detection and elucidation of disease progression, through the discovery and characterization of novel biomarkers. This retrospective study of urine-NMR samples, from prostate biopsy patients with and without PCa, identified several metabolites involved in energy metabolism, amino acid metabolism, and the hippuric acid pathway. Of note, lactate and hippurate-key metabolites involved in cellular proliferation and microbiome effects, respectively-were significantly altered, unveiling widespread metabolomic modifications associated with PCa development. These findings support urine metabolomics profiling as a promising strategy to identify new clinical biomarkers for PCa detection and diagnosis.
Topics: Male; Humans; Prostate-Specific Antigen; Retrospective Studies; Biomarkers, Tumor; Prostatic Neoplasms; Magnetic Resonance Spectroscopy; Metabolomics
PubMed: 37654196
DOI: 10.1002/mrc.5391 -
Hematology/oncology Clinics of North... Feb 2024Prostate cancer is among the most prevalent cancer globally and within Eastern Europe, where there are also higher levels of mortality compared with Western Europe.... (Review)
Review
Prostate cancer is among the most prevalent cancer globally and within Eastern Europe, where there are also higher levels of mortality compared with Western Europe. Cancer control plans exist in most countries in the region. Attention should be given to devising and implementing optimal screening initiatives. Our review has identified that a lack of resources and health system dysfunctions hamper progress in ameliorating the burden of prostate cancer. Regional cooperation is needed as well as drawing on guidelines and findings from elsewhere. Health institutions must also know the latest developments and set up systems that allow swift adoption.
Topics: Male; Humans; Europe, Eastern; Prostatic Neoplasms; Europe; Policy
PubMed: 37516633
DOI: 10.1016/j.hoc.2023.06.007 -
Radiology Dec 2023Two cases involving patients diagnosed with localized prostate cancer and treated with MRI-guided focal therapies are presented. Patient selection procedures,... (Review)
Review
Two cases involving patients diagnosed with localized prostate cancer and treated with MRI-guided focal therapies are presented. Patient selection procedures, techniques, outcomes, challenges, and future directions of MRI-guided focal therapies, as well as their role in the treatment of low- to intermediate-risk localized prostate cancer, are summarized.
Topics: Male; Humans; Prostatic Neoplasms; Magnetic Resonance Imaging; Ablation Techniques
PubMed: 38051187
DOI: 10.1148/radiol.230431 -
European Urology Jul 2024
Topics: Humans; Male; Prostatic Neoplasms; Patient Selection; Androgen Antagonists
PubMed: 38677933
DOI: 10.1016/j.eururo.2024.04.011