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Supportive Care in Cancer : Official... Jul 2022The impact of prostate cancer on the mental wellbeing of patients is increasingly being appreciated. Two important aspects of this include fear of cancer recurrence... (Review)
Review
PURPOSE
The impact of prostate cancer on the mental wellbeing of patients is increasingly being appreciated. Two important aspects of this include fear of cancer recurrence (FCR) and prostate-specific antigen (PSA) anxiety. However, their prevalence, severity and associating factors remain poorly understood. Therefore, this review aims to evaluate the current evidence for the prevalence, severity and associating features of PSA anxiety and FCR.
METHODS
A systematic search of MEDLINE, EMBASE and PsycINFO databases was conducted by two independent reviewers. Observational studies measuring FCR and PSA anxiety in prostate cancer using validated measures were included. Outcome measures were prevalence of significant levels, mean scores and significant correlations of FCR and PSA anxiety scores with patient, disease, treatment or other mental health and quality of life outcomes.
RESULTS
One thousand one hundred forty-eight individual records underwent screening with 32 studies included. Median prevalence of significant FCR and PSA anxiety was 16% and 22% respectively across all studies. Longitudinal studies demonstrated severity of both symptoms peaks at diagnosis, with little variability, even several years following this. Evaluating associating factors revealed younger age, generalised quality of life and mental health symptoms to be important factors for both outcomes. Few studies evaluated associations and differences between other patient, disease and treatment characteristics.
CONCLUSION
FCR and PSA anxiety are prominent symptoms for prostate cancer patients and importantly when present, are associated with poorer quality of life and mental health symptoms. Screening for these constructs and referral to appropriate services should form part of routine follow-up care.
Topics: Anxiety; Fear; Humans; Male; Neoplasm Recurrence, Local; Prostate-Specific Antigen; Prostatic Neoplasms; Quality of Life
PubMed: 35106656
DOI: 10.1007/s00520-022-06876-z -
Prostate Cancer and Prostatic Diseases Jun 2016Mixed evidence exists regarding the effects of statins among men with prostate cancer. We aimed to determine the association between statin use and clinical outcomes in... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Mixed evidence exists regarding the effects of statins among men with prostate cancer. We aimed to determine the association between statin use and clinical outcomes in prostate cancer using systematic review and meta-analysis.
METHODS
Original articles published until second week of August 2015 were searched in electronic databases (Medline-Ovid, Pubmed, Scopus, The Cochrane Library, Web of Science, ProQuest) for studies on statin use in prostate cancer. The main clinical outcomes for the review were: biochemical recurrence (BCR), metastases, and all-cause and prostate cancer-specific mortality. Meta-analysis was performed to calculate the pooled hazard ratio (pHR) and their 95% confidence interval (95% CI). Heterogeneity between the studies was examined using I(2) statistics. Meta-regression was performed, wherever significant heterogeneity was found in the meta-analyses, to find factors associated with poor outcomes, and sensitivity analyses were conducted to assess the robustness of findings. The analyses were conducted using RevMan v5.3, STATA v14, and R v3.1.1.
RESULTS
Out of the 1002 retrieved citations, 34 observational cohort studies met the inclusion criteria. Statin use was associated with a 21% reduction in the risk of BCR among those treated with radiation therapy (pHR: 0.79, 95% CI: 0.65, 0.95, P-value=0.01, 10 studies, I(2)=54%), whereas it was not associated with the BCR among those treated with radical prostatectomy (pHR: 0.94, 95% CI: 0.81, 1.09, P-value=0.43, 15 studies, I(2)=65%). Statin use was associated with a 22% reduction in the risk of metastases (pHR: 0.78, 95% CI: 0.68, 0.87, P-value<0.001, 6 studies, I(2)=0%), and a 24% reduction in risk of both all-cause mortality (pHR: 0.76, 95% CI: 0.63, 0.91, P-value=0.004, 6 studies, I(2)=71%), and prostate cancer-specific mortality (pHR: 0.76, 95% CI: 0.64, 0.89, P-value=0.0007, 5 studies, I(2)=40%).
CONCLUSIONS
Our systematic review found that statin significantly reduced the all-cause and prostate cancer-specific mortality and improved the BCR in certain subgroup of men with prostate cancer. In future, randomized controlled trials should be conducted to establish efficacy of statins among men with prostate cancer.
Topics: Biomarkers, Tumor; Cause of Death; Combined Modality Therapy; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Male; Neoplasm Metastasis; Neoplasm Staging; Patient Outcome Assessment; Proportional Hazards Models; Prostatic Neoplasms
PubMed: 26782711
DOI: 10.1038/pcan.2015.58 -
Investigative and Clinical Urology May 2023The oncologic outcomes of cytoreductive prostatectomy (CRP) in oligometastatic prostate cancer (OmPCa) are still controversial. Therefore, we conducted a systematic... (Meta-Analysis)
Meta-Analysis
The oncologic outcomes of cytoreductive prostatectomy (CRP) in oligometastatic prostate cancer (OmPCa) are still controversial. Therefore, we conducted a systematic review and meta-analysis on the oncologic outcome of CRP in OmPCa. OVID-Medline, OVID-Embase, and Cochrane Library databases were searched to identify eligible studies published before January 2023. A total of 11 studies (929 patients), 1 randomized controlled trial (RCT) and 10 non-RCT studies, were included in the final analysis. RCT and non-RCT were further analyzed separately. End points were progression-free-survival (PFS), time to castration-resistant prostate cancer (CRPCa), cancer-specific-survival (CSS) and overall-survival (OS). It was analyzed using hazard ratio (HR) and 95% confidence intervals (CIs). In PFS, in RCT, HR=0.43 (CIs=0.27-0.69) was shown statistically significant, but in non-RCTs, HR=0.50 (CIs=0.20-1.25), there was no statistical difference. And, in time to CRPCa was statistically significant in the CRP group in all analyses (RCT; HR=0.44; CIs=0.29-0.67) (non-RCTs; HR=0.64; CIs=0.47-0.88). Next, CSS was not statistically different between the two groups (HR=0.63; CIs=0.37-1.05). Finally, OS showed better results in the CRP group in all analyses (RCT; HR=0.44; CIs=0.26-0.76) (non-RCTs; HR=0.59; CIs=0.37-0.93). Patients who received CRP in OmPCa showed better oncologic outcomes compared to controls. Notably, time to CRPC and OS showed significantly improved compared with control. We recommend that experienced urologists who are capable of managing complications consider CRP as a strategy to achieve good oncological outcomes in OmPCa. However, since most of the included studies are non-RCT studies, caution should be exercised in interpreting the results.
Topics: Male; Humans; Cytoreduction Surgical Procedures; Prostatic Neoplasms; Prostatectomy; Randomized Controlled Trials as Topic
PubMed: 37341004
DOI: 10.4111/icu.20230058 -
Prostate Cancer and Prostatic Diseases Mar 2015The role of global DNA methylation in prostate cancer (PCa) remains largely unknown. Our aim was to summarize evidence on the role of global DNA hypomethylation in PCa... (Review)
Review
BACKGROUND
The role of global DNA methylation in prostate cancer (PCa) remains largely unknown. Our aim was to summarize evidence on the role of global DNA hypomethylation in PCa development and progression.
METHODS
We searched PubMed through December 2013 for all studies containing information on global methylation levels in PCa tissue and at least one non-tumor comparison tissue and/or studies reporting association between global methylation levels in PCa tissue and survival, disease recurrence or at least one clinicopathological prognostic factor. We summarized results using non-parametric comparisons and P-value summary methods.
RESULTS
We included 15 studies in the review: 6 studies with both diagnostic and prognostic information, 5 studies with only diagnostic information and 4 studies with only prognostic information. Quantitative meta-analysis was not possible because of the large heterogeneity in molecular techniques, types of tissues analyzed, aims and study designs. Summary statistical tests showed association of DNA hypomethylation with PCa diagnosis (P<0.006) and prognosis (P<0.001). Restriction to studies assessing 5-methylcytosine or long interspersed nucleotide element-1 revealed results in the same direction. Analyses restricted to specific clinicopathological features showed association with the presence of metastasis and tumor stage in all tests with P<0.03, and no association with Gleason score (all tests P>0.1 except for the weighted Z-test, P=0.05).
CONCLUSION
DNA hypomethylation was associated with PCa development and progression. However, due to the heterogeneity and small sample sizes of the included studies, along with the possibility of publication bias, this association requires additional assessment.
Topics: DNA Methylation; Disease Progression; Humans; Long Interspersed Nucleotide Elements; Male; Neoplasm Grading; Neoplasm Recurrence, Local; Prognosis; Prostatic Neoplasms; PubMed
PubMed: 25384337
DOI: 10.1038/pcan.2014.45 -
European Journal of Nuclear Medicine... Mar 2018There is a controversy as to the relative efficacy of Lu prostate specific membrane antigen (PSMA) radioligand therapy (RLT) and third-line treatment for patients with... (Review)
Review
AIMS
There is a controversy as to the relative efficacy of Lu prostate specific membrane antigen (PSMA) radioligand therapy (RLT) and third-line treatment for patients with metastatic castration-resistant prostate cancer (mCRPC). The aim of our systematic review was to elucidate whether Lu-PSMA RLT and third-line treatment have similar effects and adverse effects (PROSPERO ID CRD42017067743).
METHODS
The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Searches in Pubmed and Embase selected articles up to September 2017. A search in ClinicalTrials.gov indicated ongoing studies. The meta-analysis used the random-effects model.
RESULTS
Twelve studies including 669 patients reported Lu-PSMA RLT. Overall, 43% of the patients had a maximum decline of PSA of ≥50% following treatment with Lu-PSMA RLT. The treatment with Lu-PSMA-617 and Lu-PSMA for imaging and therapy (I&T) had mainly transient adverse effects. Sixteen studies including 1338 patients reported third-line treatment. Overall, 21% of the patients had a best decline of PSA of ≥50% following third-line treatment. After third-line treatment with enzalutamide and cabazitaxel, adverse effects caused discontinuation of treatment for 10% to 23% of the patients. Lu-PSMA RLT gave a best PSA decline ≥50% more often than third-line treatment (mean 44% versus 22%, p = 0.0002, t test). Lu-PSMA RLT gave objective remission more often than third-line treatment (overall 31 of 109 patients versus 43 of 275 patients, p = 0.004, χ test). Median survival was longer after Lu-PSMA RLT than after third-line treatment, but the difference was not statistically significant (mean 14 months versus 12 months, p = 0.32, t test). Adverse effects caused discontinuation of treatment more often for third-line treatment than for Lu-PSMA RLT (22 of 66 patients versus 0 of 469 patients, p < 0.001, χ test).
CONCLUSIONS
As for patients with mCRPC, treatment with Lu-PSMA-617 RTL and Lu-PSMA I&T gave better effects and caused fewer adverse effects than third-line treatment.
Topics: Antigens, Surface; Glutamate Carboxypeptidase II; Humans; Ligands; Lutetium; Male; Neoplasm Metastasis; Prostatic Neoplasms, Castration-Resistant; Radioisotopes
PubMed: 29247284
DOI: 10.1007/s00259-017-3895-x -
European Urology Oncology Jun 2024Testing for mutations in Breast Cancer Gene 1/2 (BRCA) has emerged as a novel decision-making tool for clinicians. Patients with metastatic castration-resistant prostate... (Meta-Analysis)
Meta-Analysis Comparative Study Review
Poly (ADP-ribose) Polymerase Inhibitors Have Comparable Efficacy with Platinum Chemotherapy in Patients with BRCA-positive Metastatic Castration-resistant Prostate Cancer. A Systematic Review and Meta-analysis.
CONTEXT
Testing for mutations in Breast Cancer Gene 1/2 (BRCA) has emerged as a novel decision-making tool for clinicians. Patients with metastatic castration-resistant prostate cancer (mCRPC) harboring pathogenic BRCA mutations can benefit from poly (ADP-ribose) polymerase inhibitor (PARPi) and platinum treatments, whereas the impact of the mutation on sensitivity to cabazitaxel and prostate-specific membrane antigen (PSMA)-ligand therapy is currently unknown.
OBJECTIVE
To assess the efficacy of PARPi, platinum, cabazitaxel, and PSMA-ligand therapies in BRCA-positive mCRPC.
EVIDENCE ACQUISITION
Databases were queried in February 2022. We performed data synthesis by using both proportional and individual patient data. For prostate-specific antigen (PSA) response rate (≥50% decrease from baseline [PSA50]) evaluation, we pooled event rates with 95% confidence intervals (CIs). Progression-free (PFS) and overall (OS) survival analyses with individual patient data were performed with the mixed-effect Cox proportional hazard model and single-arm random-effect analysis, providing pooled medians.
EVIDENCE SYNTHESIS
We included 23 eligible studies with 901 BRCA-positive mCRPC patients. PSA50 response rates for PARPi and platinum were 69% (CI: 53-82%), and 74% (CI: 49-90%), respectively. Analyses of OS data showed no difference between PARPi and platinum treatments (hazard ratio: 0.86; CI: 0.49-1.52; p = 0.6). The single-arm OS and PFS analyses revealed similarities among different PARPis; pooled PFS and OS medians were 9.7 mo (CI: 8.1-12.5) and 17.4 mo (CI: 12.7-20.1), respectively.
CONCLUSIONS
Our data revealed that different PARPis were similarly effective in terms of PFS and OS. Moreover, we found that PARPi and platinum therapy were comparable in terms of PSA50 response rate and OS, highlighting that platinum is a valid treatment option for BRCA-positive mCRPC patients. However, prospective interventional studies comparing these agents are essential to provide a higher level of evidence.
PATIENT SUMMARY
In this report, we found that different poly (ADP-ribose) polymerase inhibitors had similar efficacy, and platinum was a valid treatment option in BRCA-positive metastatic castration-resistant prostate cancer patients.
Topics: Humans; Prostatic Neoplasms, Castration-Resistant; Poly(ADP-ribose) Polymerase Inhibitors; Male; Treatment Outcome; BRCA2 Protein; Antineoplastic Agents; Neoplasm Metastasis; BRCA1 Protein
PubMed: 37722977
DOI: 10.1016/j.euo.2023.09.001 -
Diabetes Research and Clinical Practice Mar 2013Prior studies have reported that diabetes mellitus might reduce the overall prostate cancer risk. We examined this association by conducting a detailed meta-analysis of... (Meta-Analysis)
Meta-Analysis Review
AIM
Prior studies have reported that diabetes mellitus might reduce the overall prostate cancer risk. We examined this association by conducting a detailed meta-analysis of the studies published in peer-reviewed literature on the association between diabetes mellitus and prostate cancer risk of different stage or grade.
METHODS
A comprehensive search for articles of MEDLINE and EMBASE databases and bibliographies of retrieved articles published up to October 23, 2012 was performed. Methodological quality assessment of the trials was based on the Newcastle-Ottawa Scale. Meta-analysis was performed using STATA 12.0.
RESULTS
We included 9 studies in the meta-analysis (5 studies examining the relation of different stage only, 2 studies for grade only, and 2 studies for both grade and stage), and found an inverse association between diabetes mellitus and prostate cancer of different stage or grade. The relative risk (RRs) was moderately stronger for low grade (RR 0.74, 95% confidence interval (CI), 0.64-0.86) and localized disease (RR 0.72, 95% CI 0.67-0.76) compared with high grade (RR 0.78, 95% CI 0.67-0.90) and advanced disease (RR 0.85, 95% CI 0.75-0.97).
CONCLUSION
This study suggests an inverse relationship between diabetes mellitus and prostate cancer of different stage or grade. Possible biases underlying this association are discussed.
Topics: Diabetes Complications; Humans; Male; Prostatic Neoplasms; Risk
PubMed: 23298664
DOI: 10.1016/j.diabres.2012.12.003 -
Supportive Care in Cancer : Official... May 2023Worldwide, prostate cancer is both the second-most diagnosed cancer and most common solid tumor in men. Prostate cancer patients present with a symptom burden that is... (Meta-Analysis)
Meta-Analysis Review
Efficacy in urinary symptom burden, psychological distress, and self-efficacy of education-enhanced interventions in prostate cancer patients: a systematic review and meta-analyses.
BACKGROUND
Worldwide, prostate cancer is both the second-most diagnosed cancer and most common solid tumor in men. Prostate cancer patients present with a symptom burden that is compounded by the impact of medical oncology treatment, affecting different domains of their perceived health status. Education active techniques are a key role in chronic disease to increase participation in their recovery.
PURPOSE
The purpose of the current review was to examine the efficacy of education-enhanced in urinary symptom burden, psychological distress, and self-efficacy in patients diagnosed with prostate cancer.
METHODS
A wide search of the literature was conducted for articles from their inception to June 2022. Only randomized controlled trials were included. Data extraction and methodologic quality assessment of the studies were carried out by two reviewers. We previously registered the protocol of this systematic review on PROSPERO (CRD42022331954).
RESULTS
A total of six studies were included in the study. After education-enhanced intervention showed significant improvements in any of perceived urinary symptom burden, one in psychological distress, and one in self-efficacy in the experimental group. The meta-analysis showed that education-enhanced interventions have a significant effect on depression.
CONCLUSION
Education-enhanced could have positive effects on urinary symptom burden, psychological distress, and self-efficacy in prostate cancer survivors. Our review was unable to demonstrate the best timing to apply education-enhanced strategies.
Topics: Male; Humans; Self Efficacy; Quality of Life; Prostatic Neoplasms; Health Status; Psychological Distress
PubMed: 37191890
DOI: 10.1007/s00520-023-07803-6 -
The Journal of Urology Apr 2021To characterize the global epidemiology of metastatic castration-sensitive prostate cancer (mCSPC), nonmetastatic castration-resistant prostate cancer (nmCRPC) and...
PURPOSE
To characterize the global epidemiology of metastatic castration-sensitive prostate cancer (mCSPC), nonmetastatic castration-resistant prostate cancer (nmCRPC) and metastatic castration-resistant prostate cancer (mCRPC). Additionally, to assess the prevalence of homologous recombination repair gene alterations (HRRm) and their prognostic impact in advanced disease setting.
MATERIALS AND METHODS
A systematic literature review of real-world evidence published from January 2009 through May 2019 was conducted to assess global epidemiology and clinical practice trends for mCSPC, nmCRPC, mCRPC and HRRm; 4,732 papers were systematically screened for inclusion. Ten conference proceedings from 2014 through 2019 were reviewed.
RESULTS
Of the screened articles 22 relevant publications were identified for this paper. Six publications reported global epidemiology of advanced prostate cancer. The prevalence of nmCRPC was estimated as 1.1% to 12.3% of prostate cancer cases and for mCRPC 1.2% to 2.1% of prostate cancer cases. No mCSPC prevalence was captured. Sixteen publications investigated HRRm prevalence in advanced prostate cancer with the majority conducted in mCRPC assessed using next-generation sequencing of tissue and germline samples. In mCRPC, the highest prevalence HRRm in both germline (3.3%-6.0%) and somatic (5.0%-15.1%) was . Five publications reported the prognostic impact of HRRm in advanced prostate cancer.
CONCLUSIONS
Published real-world evidence quantifying the prevalence of advanced prostate cancer and HRRm beyond mCRPC is sparse. Published data on HRRm, specifically , are consistent with published clinical trial data for poly (ADP-ribose) polymerase inhibitors in mCRPC. In mCRPC, real-world evidence suggests that patients with HRRm have different clinical outcomes to noncarriers. More data are needed to better understand real-world patient segmentation and clinical outcomes for biomarkers given increasing interest in profiling.
Topics: Biomarkers, Tumor; Circulating Tumor DNA; DNA Mutational Analysis; Disease Progression; Genetic Predisposition to Disease; Germ-Line Mutation; Humans; Male; Neoplasm Metastasis; Prevalence; Prognosis; Prostate-Specific Antigen; Prostatic Neoplasms, Castration-Resistant; Recombinational DNA Repair
PubMed: 33332152
DOI: 10.1097/JU.0000000000001570 -
The Journal of Urology May 2015Prostate specific antigen is an important tool to monitor patients with prostate cancer after radical prostatectomy. Ultrasensitive prostate specific antigen assays are... (Review)
Review
PURPOSE
Prostate specific antigen is an important tool to monitor patients with prostate cancer after radical prostatectomy. Ultrasensitive prostate specific antigen assays are increasingly used with a lower limit of detection as low as 0.001 ng/ml. We systematically reviewed currently available ultrasensitive prostate specific antigen technologies and the role of this method in monitoring patients after radical prostatectomy.
MATERIALS AND METHODS
We searched the relevant literature using the MEDLINE® database. For various study objectives the series eligible for review provided serial ultrasensitive prostate specific antigen (lower detection limit less than 0.1 ng/ml) data on men after radical prostatectomy as well as comparative data on standard prostate specific antigen (lower detection limit 0.1 ng/ml or greater).
RESULTS
Ultrasensitive prostate specific antigen could potentially detect prostate cancer recurrence years earlier than standard prostate specific antigen assays. The specificity of detectable ultrasensitive prostate specific antigen is low. Ultrasensitive prostate specific antigen kinetics may improve the positive predictive value for detecting cancer recurrence. However, the usefulness of prostate specific antigen doubling time at the ultrasensitive level remains controversial. Undetectable nadir ultrasensitive prostate specific antigen after radical prostatectomy confers a low risk of disease recurrence while a detectable nadir above 0.01 ng/ml requires additional measurement and consideration of other risk factors to determine management and avoid overtreatment. This monitoring method may spare patients with high risk disease adjuvant radiation therapy and enable more selective early salvage radiation. Currently no data demonstrate improved survival after early salvage therapy prompted by ultrasensitive prostate specific antigen surveillance.
CONCLUSIONS
Ultrasensitive prostate specific antigen is useful in the early diagnosis of cancer recurrence after radical prostatectomy but specificity is poor. To date there is a lack of evidence that earlier detection of recurrence translates into prolonged time to metastasis. Integrating ultrasensitive prostate specific antigen with other clinicopathological factors can help determine optimal adjuvant and salvage therapy.
Topics: Humans; Male; Neoplasm Recurrence, Local; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms; Sensitivity and Specificity
PubMed: 25444980
DOI: 10.1016/j.juro.2014.10.087