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The Journal of Urology Mar 2024We sought to systematically review and summarize the peer-reviewed literature on urologic chronic pelvic pain syndrome flares, including their terminology,... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
We sought to systematically review and summarize the peer-reviewed literature on urologic chronic pelvic pain syndrome flares, including their terminology, manifestation, perceived triggers, management and prevention strategies, impact on quality of life, and insights into pathophysiologic mechanisms, as a foundation for future empirical research.
MATERIALS AND METHODS
We searched 6 medical databases for articles related to any aspect of symptom exacerbations for interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome. A total of 1486 abstracts and 398 full-text articles were reviewed, and data were extracted by at least 2 individuals.
RESULTS
Overall, we identified 59 articles, including 36 qualitative, cross-sectional, or case-control; 15 cohort-based; and 8 experimental articles. The majority of studies described North American patients with confirmed diagnoses. "Flare" was a commonly used term, but additional terminology (eg, exacerbation) was also used. Most flares involved significant increases in pain intensity, but less data were available on flare frequency and duration. Painful, frequent, long-lasting, and unpredictable flares were highly impactful, even over and above participants' nonflare symptoms. A large number of perceived triggers (eg, diet, stress) and management/prevention strategies (eg, analgesics, thermal therapy, rest) were proposed by participants, but few had empirical support. In addition, few studies explored underlying biologic mechanisms.
CONCLUSIONS
Overall, we found that flares are painful and impactful, but otherwise poorly understood in terms of manifestation (frequency and duration), triggers, treatment, prevention, and pathophysiology. These summary findings provide a foundation for future flare-related research and highlight gaps that warrant additional empirical studies.
Topics: Humans; Male; Quality of Life; Cross-Sectional Studies; Prostatitis; Cystitis, Interstitial; Pelvic Pain; Chronic Pain
PubMed: 38109700
DOI: 10.1097/JU.0000000000003820 -
The Prostate Dec 2023Cribriform (CBFM) pattern on prostate biopsy has been implicated as a predictor for high-risk features, potentially leading to adverse outcomes after definitive...
BACKGROUND
Cribriform (CBFM) pattern on prostate biopsy has been implicated as a predictor for high-risk features, potentially leading to adverse outcomes after definitive treatment. This study aims to investigate whether the CBFM pattern containing prostate cancers (PCa) were associated with false negative magnetic resonance imaging (MRI) and determine the association between MRI and histopathological disease burden.
METHODS
Patients who underwent multiparametric magnetic resonance imaging (mpMRI), combined 12-core transrectal ultrasound (TRUS) guided systematic (SB) and MRI/US fusion-guided biopsy were retrospectively queried for the presence of CBFM pattern at biopsy. Biopsy cores and lesions were categorized as follows: C0 = benign, C1 = PCa with no CBFM pattern, C2 = PCa with CBFM pattern. Correlation between cancer core length (CCL) and measured MRI lesion dimension were assessed using a modified Pearson correlation test for clustered data. Differences between the biopsy core groups were assessed with the Wilcoxon-signed rank test with clustering.
RESULTS
Between 2015 and 2022, a total of 131 consecutive patients with CBFM pattern on prostate biopsy and pre-biopsy mpMRI were included. Clinical feature analysis included 1572 systematic biopsy cores (1149 C0, 272 C1, 151 C2) and 736 MRI-targeted biopsy cores (253 C0, 272 C1, 211 C2). Of the 131 patients with confirmed CBFM pathology, targeted biopsy (TBx) alone identified CBFM in 76.3% (100/131) of patients and detected PCa in 97.7% (128/131) patients. SBx biopsy alone detected CBFM in 61.1% (80/131) of patients and PCa in 90.8% (119/131) patients. TBx and SBx had equivalent detection in patients with smaller prostates (p = 0.045). For both PCa lesion groups there was a positive and significant correlation between maximum MRI lesion dimension and CCL (C1 lesions: p < 0.01, C2 lesions: p < 0.001). There was a significant difference in CCL between C1 and C2 lesions for T2 scores of 3 and 5 (p ≤ 0.01, p ≤ 0.01, respectively) and PI-RADS 5 lesions (p ≤ 0.01), with C2 lesions having larger CCL, despite no significant difference in MRI lesion dimension.
CONCLUSIONS
The extent of disease for CBFM-containing tumors is difficult to capture on mpMRI. When comparing MRI lesions of similar dimensions and PIRADS scores, CBFM-containing tumors appear to have larger cancer yield on biopsy. Proper staging and planning of therapeutic interventions is reliant on accurate mpMRI estimation. Special considerations should be taken for patients with CBFM pattern on prostate biopsy.
Topics: Male; Humans; Prostate; Prostatic Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Image-Guided Biopsy; Adenocarcinoma
PubMed: 37622756
DOI: 10.1002/pros.24610 -
BMC Cancer Aug 2023Spatial analysis can identify communities where men are at risk for aggressive prostate cancer (PCan) and need intervention. However, there are several definitions for...
BACKGROUND
Spatial analysis can identify communities where men are at risk for aggressive prostate cancer (PCan) and need intervention. However, there are several definitions for aggressive PCan. In this study, we evaluate geospatial patterns of 3 different aggressive PCan definitions in relation to PCan-specific mortality and provide methodologic and practical insights into how each definition may affect intervention targets.
METHODS
Using the Pennsylvania State Cancer Registry data (2005-2015), we used 3 definitions to assign "aggressive" status to patients diagnosed with PCan. Definition one (D1, recently recommended as the primary definition, given high correlation with PCan death) was based on staging criteria T4/N1/M1 or Gleason score ≥ 8. Definition two (D2, most frequently-used definition in geospatial studies) included distant SEER summary stage. Definition three (D3) included Gleason score ≥ 7 only. Using Bayesian spatial models, we identified geographic clusters of elevated odds ratios for aggressive PCan (binomial model) for each definition and compared overlap between those clusters to clusters of elevated hazard ratios for PCan-specific mortality (Cox regression).
RESULTS
The number of "aggressive" PCan cases varied by definition, and influenced quantity, location, and extent/size of geographic clusters in binomial models. While spatial patterns overlapped across all three definitions, using D2 in binomial models provided results most akin to PCan-specific mortality clusters as identified through Cox regression. This approach resulted in fewer clusters for targeted intervention and less sensitive to missing data compared to definitions that rely on clinical TNM staging.
CONCLUSIONS
Using D2, based on distant SEER summary stage, in future research may facilitate consistency and allow for standardized comparison across geospatial studies.
Topics: Male; Humans; Bayes Theorem; Prostatic Neoplasms; Prostate; Prostate-Specific Antigen; Neoplasm Staging
PubMed: 37580675
DOI: 10.1186/s12885-023-11281-8 -
Radiologic Clinics of North America Jan 2024The discovery and clinical development of radiolabeled small-molecule ligands targeting prostate-specific membrane antigen (PSMA) has had a profound influence on the... (Review)
Review
The discovery and clinical development of radiolabeled small-molecule ligands targeting prostate-specific membrane antigen (PSMA) has had a profound influence on the field of nuclear medicine. Such agents have been successfully deployed for both imaging and therapeutic applications. In particular, PSMA radioligand therapy (PRLT) has been shown to be a life-prolonging therapy for men with metastatic, castration-resistant prostate cancer and has also brought nuclear medicine physicians and nuclear radiologists into the forefront of direct patient care. In this review, we will discuss the clinical study data regarding the efficacy and toxicities related to PRLT, outline the key personnel that any center offering PRLT should have, offer salient clinical examples, and provide an overview of future directions for PRLT. As PRLT continues to evolve as a treatment modality, it is paramount that nuclear medicine physicians and nuclear radiologists understand the clinical context, management implications, and practical aspects so as to best deliver high-value care to patients.
Topics: Male; Humans; Treatment Outcome; Ligands; Prostate; Prostatic Neoplasms, Castration-Resistant; Prostate-Specific Antigen; Radiologists
PubMed: 37973242
DOI: 10.1016/j.rcl.2023.07.003 -
Asian Journal of Andrology Nov 2023This study aimed to investigate the impact of the coronavirus disease 2019 (COVID-19) pandemic on erectile function in Chinese patients with chronic prostatitis/chronic...
This study aimed to investigate the impact of the coronavirus disease 2019 (COVID-19) pandemic on erectile function in Chinese patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). A retrospective study was conducted on 657 CP/CPPS patients who visited The Third Xiangya Hospital of Central South University (Changsha, China) from November 2018 to November 2022. Patients were divided into two groups based on the timeline before and after the COVID-19 outbreak in China. The severity of CP/CPPS, penile erection status, anxiety, and depression was evaluated using the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI), International Index of Erectile Function-5 (IIEF-5), Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9) scales, respectively. Compared with patients before the COVID-19 outbreak, more CP/CPPS patients developed severe erectile dysfunction (ED) due to depression and anxiety caused by the pandemic. After developing moderate-to-severe ED, mild and moderate-to-severe CP/CPPS patients exhibited more apparent symptoms of anxiety and depression ( P < 0.001 and P = 0.001, respectively), forming a vicious cycle. The COVID-19 pandemic has adversely affected the psychological status of CP/CPPS patients, exacerbating their clinical symptoms and complicating ED. The exacerbation of clinical symptoms further worsens the anxiety and depression status of patients, forming a vicious cycle. During the COVID-19 pandemic, paying more attention to the mental health of CP/CPPS patients, strengthening psychological interventions, and achieving better treatment outcomes are necessary.
Topics: Male; Humans; Erectile Dysfunction; Pandemics; Penile Erection; Prostatitis; Retrospective Studies; East Asian People; COVID-19; Chronic Disease; Pelvic Pain
PubMed: 37695217
DOI: 10.4103/aja202338 -
European Radiology Dec 2023
Topics: Male; Humans; Prostate; Magnetic Resonance Imaging; Contrast Media; Prostatic Neoplasms
PubMed: 37420101
DOI: 10.1007/s00330-023-09766-y -
European Radiology Dec 2023
Topics: Male; Humans; Prostate; Magnetic Resonance Imaging; Contrast Media; Prostatic Neoplasms
PubMed: 37436510
DOI: 10.1007/s00330-023-09767-x -
Biochemical Pharmacology Aug 2023Prostate cancer is the most common tumor among men. Although the prognosis for early-stage prostate cancer is good, patients with advanced disease often progress to... (Review)
Review
Prostate cancer is the most common tumor among men. Although the prognosis for early-stage prostate cancer is good, patients with advanced disease often progress to metastatic castration-resistant prostate cancer (mCRPC), which usually leads to death owing to resistance to existing treatments and lack of long-term effective therapy. In recent years, immunotherapy, especially immune checkpoint inhibitors (ICIs), has made great progress in the treatment of various solid tumors, including prostate cancer. However, the ICIs have only shown modest outcomes in mCRPC compared with other tumors. Previous studies have suggested that the suppressive tumor immune microenvironment (TIME) of prostate cancer leads to poor anti-tumor immune response and tumor resistance to immunotherapy. It has been reported that non-coding RNAs (ncRNAs) are capable of regulating upstream signaling at the transcriptional level, leading to a "cascade of changes" in downstream molecules. As a result, ncRNAs have been identified as an ideal class of molecules for cancer treatment. The discovery of ncRNAs provides a new perspective on TIME regulation in prostate cancer. ncRNAs have been associated with establishing an immunosuppressive microenvironment in prostate cancer through multiple pathways to modulate the immune escape of tumor cells which can promote resistance of prostate cancer to immunotherapy. Targeting these related ncRNAs presents an opportunity to improve the effectiveness of immunotherapy in this patient population.
Topics: Male; Humans; Prostatic Neoplasms, Castration-Resistant; Immunotherapy; Prostate; Prognosis; Tumor Microenvironment
PubMed: 37364622
DOI: 10.1016/j.bcp.2023.115669 -
Advanced Materials (Deerfield Beach,... Mar 2024Benign prostatic hyperplasia (BPH) as the leading cause of urination disorder is still a refractory disease, and there have no satisfied drugs or treatment protocols...
Benign prostatic hyperplasia (BPH) as the leading cause of urination disorder is still a refractory disease, and there have no satisfied drugs or treatment protocols yet. With identifying excessive Zn , inflammation, and oxidative stress as the etiology of aberrant hyperplasia, an injectable sodium alginate (SA) and glycyrrhizic acid (GA)-interconnected hydrogels (SAGA) featuring Zn -triggered in situ gelation are developed to load lonidamine for reprogramming prostate microenvironment and treating BPH. Herein, SAGA hydrogels can crosslink with Zn in BPH via coordination chelation and switch free Zn to bound ones, consequently alleviating Zn -arisen inflammation and glycolysis. Beyond capturing Zn , GA with intrinsic immunoregulatory property can also alleviate local inflammation and scavenge reactive oxygen species (ROS). Intriguingly, Zn chelation-bridged interconnection in SAGA enhances its mechanical property and regulates the degradation rate to enable continuous lonidamine release, favoring hyperplastic acini apoptosis and further inhibiting glycolysis. These multiple actions cooperatively reprogram BPH microenvironment to alleviate characteristic symptoms of BPH and shrink prostate. RNA sequencing reveals that chemotaxis, glycolysis, and tumor necrosis factor (TNF) inflammation-related pathways associated with M1-like phenotype polarization are discerned as the action rationales of such endogenous Zn -triggered in situ hydrogels, providing a candidate avenue to treat BPH.
Topics: Humans; Male; Prostate; Prostatic Hyperplasia; Hyperplasia; Zinc; Inflammation; Hydrogels
PubMed: 38096869
DOI: 10.1002/adma.202307796 -
Nature Communications Apr 2024Somatic copy number alterations (SCNAs) are pervasive in advanced human cancers, but their prevalence and spatial distribution in early-stage, localized tumors and their...
Somatic copy number alterations (SCNAs) are pervasive in advanced human cancers, but their prevalence and spatial distribution in early-stage, localized tumors and their surrounding normal tissues are poorly characterized. Here, we perform multi-region, single-cell DNA sequencing to characterize the SCNA landscape across tumor-rich and normal tissue in two male patients with localized prostate cancer. We identify two distinct karyotypes: 'pseudo-diploid' cells harboring few SCNAs and highly aneuploid cells. Pseudo-diploid cells form numerous small-sized subclones ranging from highly spatially localized to broadly spread subclones. In contrast, aneuploid cells do not form subclones and are detected throughout the prostate, including normal tissue regions. Highly localized pseudo-diploid subclones are confined within tumor-rich regions and carry deletions in multiple tumor-suppressor genes. Our study reveals that SCNAs are widespread in normal and tumor regions across the prostate in localized prostate cancer patients and suggests that a subset of pseudo-diploid cells drive tumorigenesis in the aging prostate.
Topics: Humans; Male; Prostatic Neoplasms; DNA Copy Number Variations; Single-Cell Analysis; Aneuploidy; Prostate; Clone Cells; Diploidy; Aged
PubMed: 38658552
DOI: 10.1038/s41467-024-47664-z