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Progres En Urologie : Journal de... Nov 2020Male lower urinary tract symptoms (LUTS) and in particular overactive bladder (OAB) are a frequent reason for consultation in urology and have a significant functional...
INTRODUCTION
Male lower urinary tract symptoms (LUTS) and in particular overactive bladder (OAB) are a frequent reason for consultation in urology and have a significant functional impact in patients.
OBJECTIVE
To synthesize current knowledge on non-neurogenic OAB in male patients.
METHOD
A systematic literature review based on Pubmed, Embase, Google Scholar was conducted in June 2020.
RESULTS
The prevalence of OAB and benign prostatic hyperplasia increases with age. Symptoms of OAB, on the one hand, and symptoms of prostatic bladder outlet obstruction, on the other hand, can be concomitant and the causal link between the two types of symptoms is difficult to establish. In case of mixed symptoms, it is recommended to treat the most troublesome type of symptoms first and to inform the patient of the risks of failure or deterioration. Indeed, many patients remain symptomatic after prostate surgery and the predictive factors for failure remain to be defined. Thus, preoperative urodynamics is not routinely performed even in case of OAB. De novo detrusor overactivity after radical prostatectomy can reach 77% and persists in the majority of cases. The overall relative risk of storage symptoms after radiotherapy and brachytherapy is higher than that after prostatectomy. The etiology of OAB after prostate surgery is multifactorial. While drug treatments have proven to be effective, little data exists on second-line treatments for OAB after prostate surgery.
CONCLUSION
OAB in men is often linked to a prostatic bladder outlet obstruction. It is essential to inform patients about the possibility of persistence, deterioration, or occurrence of OAB after prostate surgery while the predictors of surgical failure are not clearly defined.
Topics: Humans; Male; Prostatic Hyperplasia; Syndrome; Urinary Bladder Neck Obstruction; Urinary Bladder, Overactive
PubMed: 33220816
DOI: 10.1016/j.purol.2020.09.005 -
Advanced Biology Jul 2023Extracellular vesicles (EVs) are emerging as biomarker candidates for early detection of prostate cancer. Studies compare EV-microRNA (miRNA) expression in individuals...
Extracellular vesicles (EVs) are emerging as biomarker candidates for early detection of prostate cancer. Studies compare EV-microRNA (miRNA) expression in individuals with prostate cancer (PCa) with cancer-free samples for diagnostic purposes. The aim of this study is to review miRNA signatures to investigate the overlap between miRNAs enriched in PCa tissue and miRNAs enriched in EVs isolated from subjects with PCa biofluids (i.e., urine, serum, and plasma). Signatures dysregulated in EVs from PCa biofluids and tissue are potentially associated with the primary tumor site and might be more indicative of PCa at an early stage. A systematic review of EV-derived miRNAs and a reanalysis of PCa tissue miRNA sequencing data for comparison is presented. Articles in the literature are screened for validated miRNA dysregulation in PCa and compared with TCGA primary PCa tumor data using DESeq2. This resulted in 190 dysregulated miRNAs being identified. Thirty-one eligible studies are identified, indicating 39 dysregulated EV-derived miRNAs. The top ten markers identified as significantly dysregulated in the PCa tissue dataset TCGA (e.g., miR-30b-3p, miR-210-3p, miR-126-3p, and miR-196a-5p) have a significant expression change in EVs with the same directionality in one or several statistically significant results. This analysis highlights several less frequently studied miRNAs in PCa literature.
Topics: Male; Humans; MicroRNAs; Prostatic Neoplasms; Extracellular Vesicles
PubMed: 37300338
DOI: 10.1002/adbi.202200327 -
European Urology Focus Nov 2021As an emerging technique, three-dimensional (3D) visualization has become more popular and can facilitate education, training, surgical planning, and intraoperative... (Review)
Review
CONTEXT
As an emerging technique, three-dimensional (3D) visualization has become more popular and can facilitate education, training, surgical planning, and intraoperative guidance for prostate cancer surgery.
OBJECTIVE
In this review, we aim to present the impact of 3D printing, virtual reality (VR), and augmented reality (AR) techniques for prostate cancer procedures, specifically prostate biopsy and radical prostatectomy (RP).
EVIDENCE ACQUISITION
A systematic review was performed by two investigators according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria.
EVIDENCE SYNTHESIS
A total of 541 papers were identified in PubMed, Scopus, and Embase. Of these, 53 studies were identified for detailed review and 25 were qualified. Two more studies were identified from the references; thus, 27 studies were finally included in this systematic review. Nine papers reported on the use of 3D reconstructed models, mainly in education/training and intraoperative guidance; nine reported on VR, focusing on simulation training model and intraoperative guidance; and nine reported on AR technique with its best indication for surgical guidance in robotic RP.
CONCLUSIONS
Three-dimensional visualization techniques have gradually been introduced and developed in prostate procedures, and demonstrate potential utility not only for education/training, but also for surgical planning and intraoperative guidance. Prospective studies are needed to demonstrate clinical utility and validation of these technologies.
PATIENT SUMMARY
Despite low-quality evidence, promising signals were identified to demonstrate that three-dimensional visualization could help facilitate prostate procedures, in terms of education/training, surgical planning, and intraoperative guidance. It is still in a very early stage, and more studies need to be conducted to justify its widespread use.
Topics: Humans; Imaging, Three-Dimensional; Male; Prostate; Prostatectomy; Prostatic Neoplasms; Robotic Surgical Procedures
PubMed: 32873515
DOI: 10.1016/j.euf.2020.08.002 -
European Urology Oncology Dec 2023It is unclear whether a magnetic resonance imaging (MRI)-targeted transperineal (TP) biopsy can improve the detection of clinically significant prostate cancer (csPCa). (Meta-Analysis)
Meta-Analysis Review
Is There an Impact of Transperineal Versus Transrectal Magnetic Resonance Imaging-targeted Biopsy in Clinically Significant Prostate Cancer Detection Rate? A Systematic Review and Meta-analysis.
CONTEXT
It is unclear whether a magnetic resonance imaging (MRI)-targeted transperineal (TP) biopsy can improve the detection of clinically significant prostate cancer (csPCa).
OBJECTIVE
To compare the MRI-targeted TP and transrectal (TR) approaches for csPCa detection.
EVIDENCE ACQUISITION
A literature search was conducted using the PubMed/Medline, Embase, and Web of Science databases to identify reports published until February 2023. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed to identify eligible studies. The primary outcome was the detection of csPCa (Gleason grade group ≥2). Sensitivity analyses were performed to investigate csPCa detection rates according to tumor location, Prostate Imaging Reporting and Data System (PI-RADS) score, and type of fusion (cognitive or software based).
EVIDENCE SYNTHESIS
Eleven studies met our inclusion criteria, and data from 3522 and 5140 patients who underwent, respectively, TR and TP MRI-targeted biopsies were reviewed. No statistically significant difference in the detection of csPCa was observed between the TR and TP approaches (odds ratio [OR] 1.11, 95% confidence interval [CI] 0.98-1.25; p = 0.1). When stratifying patients according to lesion location, the TP approach was associated with higher csPCa detection in case of anterior (OR 2.17, 95% CI 1.46-3.22; p < 0.001) and apical (OR 1.86, 95% CI 1.14-3.03; p = 0.01) lesions. In the subgroup analysis based on PI-RADS score, the TP approach was associated with higher csPCa detection (OR 1.57, 95% CI 1.07-2.29; p = 0.02) in PI-RADS 4 lesions. Conversely, no difference was found in PI-RADS 3 and 5 lesions (p > 0.05). The main limitation was the retrospective design of most included studies.
CONCLUSIONS
No significant association was found between the prostate biopsy approach and csPCa detection rate when we considered all biopsy indications. The TP approach provides a detection advantage in anterior and apical tumors, arguing for a preferred use of the TP approach in these lesion locations.
PATIENT SUMMARY
The transperineal magnetic resonance imaging-targeted prostate biopsy approach appears to be more effective only for selected lesions. No clear benefit was seen for the transperineal approach in the overall population.
Topics: Male; Humans; Prostatic Neoplasms; Prostate; Magnetic Resonance Imaging; Retrospective Studies; Biopsy
PubMed: 37634971
DOI: 10.1016/j.euo.2023.08.001 -
Radiography (London, England : 1995) Jul 2024Evidence suggests the bladder trigone to be a potential organ at risk (OAR) in predicting acute and late genitourinary (GU) side effects when treating prostate cancer... (Review)
Review
INTRODUCTION
Evidence suggests the bladder trigone to be a potential organ at risk (OAR) in predicting acute and late genitourinary (GU) side effects when treating prostate cancer with radiotherapy.
METHODS
A search of MEDLINE, Cinahl, EMBASE, PubMed, the Cochrane Database of Systematic Reviews and OpenGrey was conducted and no current or underway systematic reviews or scoping reviews on the topic were identified. A systematic literature review was carried out assessing the quality of this evidence. All evidence that prospectively or retrospectively reviewed radiotherapy or modelled radiotherapy dose to the bladder trigone were included. The search was conducted on the 8th July 2021 with 32 studies included in this review. This was repeated 10th June 2023 and two additional studies were identified. Any evidence published since this date have not been included and are a limitation of this review.
RESULTS
MRI imaging is recommended to assist in delineating the trigone which has been shown to have a high amount of inter-observer variability and the use of specific training may reduce this. Across all radiotherapy treatment modalities, trigone dose contributed to GU acute and late toxicity symptoms. Trigone motion is relative to prostate motion but further research is required to confirm if the prostate can be used as a reliable surrogate for trigone position. The dose tolerance given for specific trigone related toxicities is debated within the literature, and on analysis the authors of this review suggest bladder trigone dose limits: Dmean < 45.8 Gy, V61.0Gy < 40%, V59.8Gy < 25%, V42.5Gy-V41.0Gy < 91% and V47.4Gy-V43.2Gy < 91% with α/β of 3 Gy to reduce acute and late GU toxicities.
CONCLUSION
There is evidence to support further research into bladder trigone sparing radiotherapy to improve patient outcomes.
IMPLICATION FOR PRACTICE
Using the bladder trigone as an organ at risk is possible and the authors are currently seeking funding for a feasibility trial to further investigate this.
Topics: Humans; Male; Prostatic Neoplasms; Urinary Bladder; Organs at Risk; Radiotherapy Dosage; Magnetic Resonance Imaging; Organ Sparing Treatments; Radiation Injuries
PubMed: 38905764
DOI: 10.1016/j.radi.2024.06.004 -
The Cochrane Database of Systematic... Apr 2023Men may need to undergo prostate surgery to treat prostate cancer or benign prostatic hyperplasia. After these surgeries, men may experience urinary incontinence (UI).... (Review)
Review
BACKGROUND
Men may need to undergo prostate surgery to treat prostate cancer or benign prostatic hyperplasia. After these surgeries, men may experience urinary incontinence (UI). Conservative treatments such as pelvic floor muscle training (PFMT), electrical stimulation and lifestyle changes can be undertaken to help manage the symptoms of UI.
OBJECTIVES
To assess the effects of conservative interventions for managing urinary incontinence after prostate surgery.
SEARCH METHODS
We searched the Cochrane Incontinence Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, ClinicalTrials.gov, WHO ICTRP and handsearched journals and conference proceedings (searched 22 April 2022). We also searched the reference lists of relevant articles.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) and quasi-RCTs of adult men (aged 18 or over) with UI following prostate surgery for treating prostate cancer or LUTS/BPO. We excluded cross-over and cluster-RCTs. We investigated the following key comparisons: PFMT plus biofeedback versus no treatment; sham treatment or verbal/written instructions; combinations of conservative treatments versus no treatment, sham treatment or verbal/written instructions; and electrical or magnetic stimulation versus no treatment, sham treatment or verbal/written instructions.
DATA COLLECTION AND ANALYSIS
We extracted data using a pre-piloted form and assessed risk of bias using the Cochrane risk of bias tool. We used the GRADE approach to assess the certainty of outcomes and comparisons included in the summary of findings tables. We used an adapted version of GRADE to assess certainty in results where there was no single effect measurement available.
MAIN RESULTS
We identified 25 studies including a total of 3079 participants. Twenty-three studies assessed men who had previously undergone radical prostatectomy or radical retropubic prostatectomy, while only one study assessed men who had undergone transurethral resection of the prostate. One study did not report on previous surgery. Most studies were at high risk of bias for at least one domain. The certainty of evidence assessed using GRADE was mixed. PFMT plus biofeedback versus no treatment, sham treatment or verbal/written instructions Four studies reported on this comparison. PFMT plus biofeedback may result in greater subjective cure of incontinence from 6 to 12 months (1 study; n = 102; low-certainty evidence). However, men undertaking PFMT and biofeedback may be less likely to be objectively cured at from 6 to 12 months (2 studies; n = 269; low-certainty evidence). It is uncertain whether undertaking PFMT and biofeedback has an effect on surface or skin-related adverse events (1 study; n = 205; very low-certainty evidence) or muscle-related adverse events (1 study; n = 205; very low-certainty evidence). Condition-specific quality of life, participant adherence to the intervention and general quality of life were not reported by any study for this comparison. Combinations of conservative treatments versus no treatment, sham treatment or verbal/written instructions Eleven studies assessed this comparison. Combinations of conservative treatments may lead to little difference in the number of men being subjectively cured or improved of incontinence between 6 and 12 months (RR 0.97, 95% CI 0.79 to 1.19; 2 studies; n = 788; low-certainty evidence; in absolute terms: no treatment or sham arm: 307 per 1000 and intervention arm: 297 per 1000). Combinations of conservative treatments probably lead to little difference in condition-specific quality of life (MD -0.28, 95% CI -0.86 to 0.29; 2 studies; n = 788; moderate-certainty evidence) and probably little difference in general quality of life between 6 and 12 months (MD -0.01, 95% CI -0.04 to 0.02; 2 studies; n = 742; moderate-certainty evidence). There is little difference between combinations of conservative treatments and control in terms of objective cure or improvement of incontinence between 6 and 12 months (MD 0.18, 95% CI -0.24 to 0.60; 2 studies; n = 565; high-certainty evidence). However, it is uncertain whether participant adherence to the intervention between 6 and 12 months is increased for those undertaking combinations of conservative treatments (RR 2.08, 95% CI 0.78 to 5.56; 2 studies; n = 763; very low-certainty evidence; in absolute terms: no intervention or sham arm: 172 per 1000 and intervention arm: 358 per 1000). There is probably no difference between combinations and control in terms of the number of men experiencing surface or skin-related adverse events (2 studies; n = 853; moderate-certainty evidence), but it is uncertain whether combinations of treatments lead to more men experiencing muscle-related adverse events (RR 2.92, 95% CI 0.31 to 27.41; 2 studies; n = 136; very low-certainty evidence; in absolute terms: 0 per 1000 for both arms). Electrical or magnetic stimulation versus no treatment, sham treatment or verbal/written instructions We did not identify any studies for this comparison that reported on our key outcomes of interest.
AUTHORS' CONCLUSIONS
Despite a total of 25 trials, the value of conservative interventions for urinary incontinence following prostate surgery alone, or in combination, remains uncertain. Existing trials are typically small with methodological flaws. These issues are compounded by a lack of standardisation of the PFMT technique and marked variations in protocol concerning combinations of conservative treatments. Adverse events following conservative treatment are often poorly documented and incompletely described. Hence, there is a need for large, high-quality, adequately powered, randomised control trials with robust methodology to address this subject.
Topics: Male; Adult; Humans; Prostate; Electric Stimulation Therapy; Exercise Therapy; Pelvic Floor; Urinary Incontinence; Prostatic Neoplasms
PubMed: 37070660
DOI: 10.1002/14651858.CD014799.pub2 -
Life (Basel, Switzerland) Jul 2022Currently, medication for benign prostate hyperplasia (BPH) and prostate cancer (PCa) are mainly based on modulating the hormone and nervous systems. However, side... (Review)
Review
Currently, medication for benign prostate hyperplasia (BPH) and prostate cancer (PCa) are mainly based on modulating the hormone and nervous systems. However, side effects often affect patients, and might decrease their commitment to continuing the medication and lower their quality of life. Some studies have indicated that chronic inflammation might be the cause of BPH and PCa. Based on this hypothesis, the effect of phloretin, a potent anti-inflammatory and anti-oxidative flavonoid, has been researched since 2010. Results from animal and in-vitro studies, obtained from databases, also indicate that the use of phloretin in treating BPH and PCa is promising. Due to its effect on inflammatory cytokines, apoptosis or anti-apoptosis, reactive oxygen species, anti-oxidant enzymes and oxidative stress, phloretin is worthy of further study in human clinical trials regarding safety and effective dosages.
PubMed: 35888117
DOI: 10.3390/life12071029 -
Clinical Nuclear Medicine Jul 2023Multiparametric MRI (mpMRI) has been promoted as an auxiliary diagnostic tool for prostate biopsy. However, prostate-specific membrane antigen (PSMA) including 68... (Meta-Analysis)
Meta-Analysis
Comparing the Detection Performance Between Multiparametric Magnetic Resonance Imaging and Prostate-Specific Membrane Antigen PET/CT in Patients With Localized Prostate Cancer: A Systematic Review and Meta-analysis.
PURPOSE
Multiparametric MRI (mpMRI) has been promoted as an auxiliary diagnostic tool for prostate biopsy. However, prostate-specific membrane antigen (PSMA) including 68 Ga-PSMA-11, 18 F-DCFPyL, and 18 F-PSMA-1007 applied PET/CT imaging was an emerging diagnostic tool in prostate cancer patients for staging or posttreatment follow-up, even early detecting. Many studies have used PSMA PET for comparison with mpMRI to test the diagnostic ability for early prostate cancer. Unfortunately, these studies have shown conflicting results. This meta-analysis aimed to compare the differences in diagnostic performance between PSMA PET and mpMRI for detecting and T staging localized prostatic tumors.
METHODS
This meta-analysis involved a systematic literature search of PubMed/MEDLINE and Cochrane Library databases. The pooling sensitivity and specificity of PSMA and mpMRI verified by pathological analysis were calculated and used to compare the differences between the 2 imaging tools.
RESULTS
Overall, 39 studies were included (3630 patients in total) from 2016 to 2022 in the current meta-analysis and found that the pooling sensitivity values for localized prostatic tumors and T staging T3a and T3b of PSMA PET were 0.84 (95% confidence interval [CI], 0.83-0.86), 0.61 (95% CI, 0.39-0.79), and 0.62 (95% CI, 0.46-0.76), respectively, whereas those of mpMRI were found to be 0.84 (95% 0.78-0.89), 0.67 (95% CI, 0.52-0.80), and 0.60 (95% CI, 0.45-0.73), respectively, without significant differences ( P > 0.05). However, in a subgroup analysis of radiotracer, the pooling sensitivity of 18 F-DCFPyL PET was higher than mpMRI (relative risk, 1.10; 95% CI, 1.03-1.17; P < 0.01).
CONCLUSIONS
This meta-analysis found that whereas 18 F-DCFPyL PET was superior to mpMRI at detecting localized prostatic tumors, the detection performance of PSMA PET for localized prostatic tumors and T staging was comparable to that of mpMRI.
Topics: Male; Humans; Multiparametric Magnetic Resonance Imaging; Prostate; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Gallium Radioisotopes; Sensitivity and Specificity; Magnetic Resonance Imaging
PubMed: 37145456
DOI: 10.1097/RLU.0000000000004646 -
BMC Urology Apr 2023Benign prostatic hyperplasia (BPH) is a common chronic condition among men aged 50 or older, causing voiding and obstructive lower urinary tract symptoms. Water vapor... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Benign prostatic hyperplasia (BPH) is a common chronic condition among men aged 50 or older, causing voiding and obstructive lower urinary tract symptoms. Water vapor thermal therapy (WVTT) using the Rezūm® system is a new minimally invasive surgical technique that is increasingly reported as a treatment for BPH.
METHODS
The protocol was submitted to the PROSPERO registry. We searched PubMed, Web of Science, Embase, Cochrane Library and ClinicalTrials.gov up to July 29, 2022. Quality assessment was carried out by a 20-item checklist form prepared by the Institute of Health Economics (IHE). Double arcsine transformation was performed to stabilize the variance of the original ratio. When I > 50%, the random effect model was used to calculate the pooled parameters. Otherwise, the fixed effect model was used. 95% confidence intervals (CIs) were calculated. A leave-one-out sensitivity analysis was performed to evaluate the impact of each study on the pooled outcomes, and finally, Egger's test was used to assess publication bias.
RESULTS
A total of seven single-arm observational studies and one random controlled trial, including 1015 patients, were included. One year after WVTT, the International Prostate Symptom Score decreased by 11.37 (95% CI: -12.53, -10.21), the IPSS Quality of Life scale decreased by 2.59 (95% CI: -2.92, -2.26), the maximum urine flow rate increased by 5.26 ml/s (95% CI: 4.53, 5.99), and the postvoid residual decreased by 13.18 ml (95% CI: -24.32, -2.03). The most common complication was dysuria, with a pooled incidence of 21% (95% CI: 14%, 29%), and the second most common complication was hematuria, with a pooled incidence of 14% (95% CI: 10%, 18%). The pooled incidence of retreatment was 3% (95% CI: 2%, 5%).
CONCLUSIONS
WVTT is an attractive alternative to medication or more invasive surgical procedures and can serve as first-line therapy for men with BPH.
Topics: Male; Humans; Prostatic Hyperplasia; Steam; Prostate; Quality of Life; Hyperplasia; Lower Urinary Tract Symptoms; Treatment Outcome
PubMed: 37118692
DOI: 10.1186/s12894-023-01237-2 -
Journal of Robotic Surgery Dec 2023To compare perioperative outcomes between Holmium laser enucleation of the prostate (HoLEP) and robotic-assisted simple pasta-ectomy (RASP)for large-volume benign... (Meta-Analysis)
Meta-Analysis Review
Efficacy and safety of transurethral thulium laser enucleation versus robot-assisted prostatectomy for large-volume benign prostatic hyperplasia: a systematic review and meta-analysis.
To compare perioperative outcomes between Holmium laser enucleation of the prostate (HoLEP) and robotic-assisted simple pasta-ectomy (RASP)for large-volume benign prostatic hyperplasia(> 80 ml). In August 2023, we undertook a comprehensive search of major global databases including PubMed, Embase, and Google Scholar, focusing solely on articles written in English. Studies that were merely reviews or protocols without any specific published data were omitted. Furthermore, articles that comprised conference abstracts or content not pertinent to our subject of study were also disregarded. To calculate the inverse variances and 95% confidence intervals (CIs) for categorical variables' mean differences, we employed the Cochran-Mantel-Haenszel approach along with random-effects models. The findings were denoted in the form of odds ratios (ORs) and 95% CIs. A p-value less than 0.05 was deemed to indicate statistical significance. Our finalized meta-analysis incorporated six articles, including one randomized controlled trial (RCT) and five cohort studies. These studies accounted for a total of 1218 patients, 944 of whom underwent Holmium Laser Enucleation of the Prostate (HoLEP) and 274 who underwent Robotic-Assisted Simple Prostatectomy (RASP). The pooled analysis from these six papers demonstrated that compared to RASP, HoLEP had a shorter hospital stay, shorter catheterization duration, and a lower blood transfusion rate. Moreover, HoLEP patients exhibited a smaller reduction in postoperative hemoglobin levels. Statistically, there were no significant differences between the two procedures regarding operative time, postoperative PSA, the weight of prostate specimens, IPSS, Qmax, PVR, QoL, and postoperative complications. (HoLEP) and (RASP) are both effective and safe procedures for treating large-volume benign prostatic hyperplasia. HoLEP, with its benefits of shorter catheterization and hospitalization duration, lesser decline in postoperative hemoglobin, and reduced blood transfusion needs, stands as a preferred choice for treating extensive prostate enlargement. However, further validation through more high-quality clinical randomized trials is required.
Topics: Humans; Male; Hemoglobins; Laser Therapy; Lasers, Solid-State; Prostatectomy; Prostatic Hyperplasia; Quality of Life; Randomized Controlled Trials as Topic; Robotic Surgical Procedures; Thulium; Transurethral Resection of Prostate; Treatment Outcome
PubMed: 37731152
DOI: 10.1007/s11701-023-01715-7