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Clinical Genitourinary Cancer Jun 2024Several phase II trials have investigated neoadjuvant novel androgen receptor signaling inhibitors (ARSIs) in combination with androgen deprivation therapy (ADT)... (Meta-Analysis)
Meta-Analysis Review
Cardiovascular and Thromboembolic Events in Patients With Localized Prostate Cancer Receiving Intensified Neoadjuvant Androgen Deprivation: A Systematic Review and Meta-Analysis.
Several phase II trials have investigated neoadjuvant novel androgen receptor signaling inhibitors (ARSIs) in combination with androgen deprivation therapy (ADT) followed by radical prostatectomy (RP) in prostate cancer (PC) patients. However, data regarding complications of intense hormone therapy and surgical complications are scarce. Our objective was to evaluate the occurrence of cardiovascular (CV) and thromboembolic (TE) adverse events (AE) in patients with localized PC who have received intense neoadjuvant ADT followed by prostatectomy. A comprehensive search in MEDLINE, Embase, Scopus and conference abstracts was performed. The strategies were developed and applied for each electronic database on March 7th, 2023. Eligible studies included randomized and single-arm trials testing ARSIs prior to prostatectomy that adequately reported safety data regarding CV and TE AE, peri-operative complications, and mortality during therapy. Pooled incidence (PI) of AE with 95% confidence interval (95% CI) was estimated using a random effects model. Quality assessment and reporting followed Cochrane Collaboration Handbook and PRISMA guidelines. PROSPERO: CRD42022344104. Nine randomized controlled trials and three single-arm phase II trials were included, comprising 702 patients (702 patients for CV AE and 522 for perioperative complications). The neoadjuvant regimen was classified as monotherapy with ARSI (100 patients), combination therapy with ADT + ARSI (383 patients), or ADT + ARSI + ARSI (219 patients). The PI of TE within the perioperative interval was 4.2% (95% CI = 2.6%-6.6%, I2 = 0.0%, P = .65), and the PI for CV AE was 4.6% (95% CI = 3.1%-6.7%, I2 = 0.0%, P = .71). Seven deaths were reported, resulting in a PI of 2.2% (95% CI = 1.3%-3.8%, I2 = 0.0%, P = .99), of which two were considered treatment-related and occurred within the perioperative period. The PI of hypertension grade 3-5 was 7.3% (95% CI = 4.8%-11.0%, I2 = 38.8%, P = .04). CV and TE AE associated with intense neoadjuvant hormone therapy in patients with localized PC can occur in up to 4.6% of cases. Our data warns for further assessment of thrombotic risk and prophylactic anticoagulation in this setting.
Topics: Humans; Male; Prostatic Neoplasms; Neoadjuvant Therapy; Thromboembolism; Prostatectomy; Androgen Antagonists; Cardiovascular Diseases; Randomized Controlled Trials as Topic; Clinical Trials, Phase II as Topic; Postoperative Complications
PubMed: 38718699
DOI: 10.1016/j.clgc.2024.102088 -
The British Journal of Radiology Jun 2024Prostate cancer ranks among the most prevalent cancers affecting men globally. While conventional MRI serves as a diagnostic tool, its extended acquisition time,...
BACKGROUND
Prostate cancer ranks among the most prevalent cancers affecting men globally. While conventional MRI serves as a diagnostic tool, its extended acquisition time, associated costs, and strain on healthcare systems, underscore the necessity for more efficient methods. The emergence of AI-acceleration in prostate MRI offers promise to mitigate these challenges.
METHODS
A systematic review of studies looking at AI-accelerated prostate MRI was conducted, with a focus on acquisition time along with various qualitative and quantitative measurements.
RESULTS
Two primary findings were observed. Firstly, all studies indicated that AI-acceleration in MRI achieved notable reductions in acquisition times without compromising image quality. This efficiency offers potential clinical advantages, including reduced scan durations, improved scheduling, diminished patient discomfort, and economic benefits. Secondly, AI demonstrated a beneficial effect in reducing or maintaining artefact levels in T2-weighted images despite this accelerated acquisition time. Inconsistent results were found in all other domains, which were likely influenced by factors such as heterogeneity in methodologies, variability in AI models, and diverse radiologist profiles. These variances underscore the need for larger, more robust studies, standardization, and diverse training datasets for AI models.
CONCLUSION
The integration of AI-acceleration in prostate MRI thus far shows some promising results for efficient and enhanced scanning. These advancements may fill current gaps in early detection and prognosis. However, careful navigation and collaborative efforts are essential to overcome challenges and maximize the potential of this innovative and evolving field.
ADVANCES IN KNOWLEDGE
This article reveals overall significant reductions in acquisition time without compromised image quality in AI-accelerated prostate MRI, highlighting potential clinical and diagnostic advantages.
Topics: Humans; Male; Prostatic Neoplasms; Magnetic Resonance Imaging; Prostate; Artificial Intelligence
PubMed: 38718224
DOI: 10.1093/bjr/tqae093 -
Critical Reviews in Oncology/hematology Jun 2024Poly (ADP-ribose) polymerase inhibitors (PARPi) have been associated with thrombotic events, although the association with thrombosis risk in different cancers remains... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Poly (ADP-ribose) polymerase inhibitors (PARPi) have been associated with thrombotic events, although the association with thrombosis risk in different cancers remains poorly defined.
METHODS
This meta-analysis included phase II and phase III clinical trials in which patients with metastatic prostate cancer were treated with PARPi either as monotherapy or in combination. The primary endpoints were the rates of thromboembolic events in prostate cancer patients.
RESULTS
A total of 2210 and 1662 patients with prostate cancer were compared in the PARP inhibitor and control groups, respectively. 96 (4.3 %) and 37 (2.2 %) patients had thrombosis in the PARPi and control groups, respectively. PARPi had a statistically significant increased risk of thrombosis in prostate cancer patients (Odds Ratio (OR)=1.98, 95 % CI: 1.06-3.70, P=0.030).
CONCLUSION
The heightened thrombotic risk associated with PARPi treatment in prostate cancer emphasizes the need for comprehensive management protocols to effectively reduce the risk and ensure safer outcomes.
Topics: Humans; Male; Poly(ADP-ribose) Polymerase Inhibitors; Prostatic Neoplasms; Thromboembolism; Clinical Trials, Phase III as Topic; Risk Factors
PubMed: 38685459
DOI: 10.1016/j.critrevonc.2024.104376 -
BMC Cancer Apr 2024Hypertension is associated with the risk of prostate cancer (PCa) and its progression, however, it remains unclear whether antihypertensive medicines alter PCa risk or...
BACKGROUND
Hypertension is associated with the risk of prostate cancer (PCa) and its progression, however, it remains unclear whether antihypertensive medicines alter PCa risk or prognosis. This systematic review evaluated the role of calcium channel blockers (CCBs) and renin-angiotensin system (RAS) inhibitors in the risk and prognosis of PCa. This review was performed in line with PRISMA 2020 guidelines.
METHODS
Eligible studies comprised peer-reviewed observational studies which reported the role of CCBs and RAS inhibitors in PCa, had accessible full texts, and were written in English. Using a combination of keywords, 5 electronic bibliographic databases which included Web of Science, EMBASE, PubMed, Google Scholar and Scopus were searched.
RESULTS
A total of 1,346 studies were retrieved and 18 met the inclusion criteria. Thirteen studies reported reduced or no associated risk, improved prognosis, and survival with the use of RAS inhibitors. Studies on CCBs showed evidence of associated risk of PCa. Data extraction from retrieved studies focused on included study characteristics, setting, authors, year, outcomes of interest, and risk ratios. The quality assessment of included studies by the National Heart, Lung, and Blood Institute study assessment tools, showed that all studies had good quality.
CONCLUSIONS
The use of RAS inhibitors was mostly associated with lower risks or improved prognosis of PCa. CCBs may also be associated with risks of PCa. This suggests that high-risk patients managed with CCBs should be actively monitored for PCa. However, there is need for further evidence from large-scale prospective, controlled cohort studies to determine any influence of CCBs on PCa.
Topics: Humans; Prostatic Neoplasms; Male; Antihypertensive Agents; Calcium Channel Blockers; Hypertension; Prognosis; Renin-Angiotensin System; Angiotensin Receptor Antagonists
PubMed: 38684963
DOI: 10.1186/s12885-024-12218-5 -
Asian Journal of Urology Apr 2024To analyze data available in the literature regarding a possible prognostic value of the platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) in... (Review)
Review
Prognostic role of platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio in patients with non-metastatic and metastatic prostate cancer: A meta-analysis and systematic review.
OBJECTIVE
To analyze data available in the literature regarding a possible prognostic value of the platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) in prostate cancer (PCa) patients stratified in non-metastatic and metastatic diseases.
METHODS
A literature search process was performed following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. In our meta-analysis, the pooled event rate estimated and the pooled hazard ratio were calculated using a random effect model.
RESULTS
Forty-two articles were selected for our analysis. The pooled risk difference for non-organ confined PCa between high and low NLR cases was 0.06 (95% confidence interval [CI]: -0.03-0.15) and between high and low PLR cases increased to 0.30 (95% CI: 0.16-0.43). In non-metastatic PCa cases, the pooled hazard ratio for overall mortality between high and low NLR was 1.33 (95% CI: 0.78-1.88) and between high and low PLR was 1.47 (95% CI: 0.91-2.03), whereas in metastatic PCa cases, between high and low NLR was 1.79 (95% CI: 1.44-2.13) and between high and low PLR was 1.05 (95% CI: 0.87-1.24).
CONCLUSION
The prognostic values of NLR and PLR in terms of PCa characteristics and responses after treatment show a high level of heterogeneity of results among studies. These two ratios can represent the inflammatory and immunity status of the patient related to several conditions. A higher predictive value is related to a high NLR in terms of risk for overall mortality in metastatic PCa cases under systemic treatments.
PubMed: 38680577
DOI: 10.1016/j.ajur.2023.01.002 -
World Journal of Urology Apr 2024To prevent infectious complications after transrectal ultrasound-guided prostate biopsy (TRUS-PB), some studies have investigated the efficacy of rectal disinfection... (Meta-Analysis)
Meta-Analysis
BACKGROUND
To prevent infectious complications after transrectal ultrasound-guided prostate biopsy (TRUS-PB), some studies have investigated the efficacy of rectal disinfection using povidone-iodine (PI) and antibiotic prophylaxis (AP).
OBJECTIVE
To summarize available data and compare the efficacy of rectal disinfection using PI with non-PI methods prior to TRUS-PB.
EVIDENCE ACQUISITION
Three databases were queried through November 2023 for randomized controlled trials (RCTs) analyzing patients who underwent TRUS-PB. We compared the effectiveness of rectal disinfection between PI groups and non-PI groups with or without AP. The primary outcomes of interest were the rates of overall infectious complications, fever, and sepsis. Subgroups analyses were conducted to assess the differential outcomes in patients using fluoroquinolone groups compared to those using other antibiotics groups.
EVIDENCE SYNTHESIS
We included ten RCTs in the meta-analyses. The overall rates of infectious complications were significantly lower when rectal disinfection with PI was performed (RR 0.56, 95% CI 0.42-0.74, p < 0.001). Compared to AP monotherapy, the combination of AP and PI was associated with significantly lower risk of infectious complications (RR 0.54, 95% CI 0.40-0.73, p < 0.001) and fever (RR 0.47, 95% CI 0.30-0.75, p = 0.001), but not with sepsis (RR 0.49, 95% CI 0.23-1.04, p = 0.06). The use of fluoroquinolone antibiotics was associated with a lower risk of infectious complications and fever compared to non-FQ antibiotics.
CONCLUSION
Rectal disinfection with PI significantly reduces the rates of infectious complications and fever in patients undergoing TRUS-PB. However, this approach does not show a significant impact on reducing the rate of sepsis following the procedure.
Topics: Humans; Male; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Disinfection; Image-Guided Biopsy; Povidone-Iodine; Prostate; Prostatic Neoplasms; Rectum
PubMed: 38652324
DOI: 10.1007/s00345-024-04941-2 -
Radiotherapy and Oncology : Journal of... Jul 2024Stereotactic Ablative Radiotherapy (SABR) for the treatment of oligometastatic disease can improve survival and delay the requirement for systemic therapy. The benefits... (Review)
Review
BACKGROUND
Stereotactic Ablative Radiotherapy (SABR) for the treatment of oligometastatic disease can improve survival and delay the requirement for systemic therapy. The benefits of SABR in oligoprogressive disease are less well-defined. Here, we evaluate the available evidence investigating the efficacy of SABR in the treatment of oligoprogressive disease.
METHODS
A systematic review was carried out following PRISMA guidelines. Medline and Embase databases were searched using the terms "stereotactic radiotherapy" OR "SABR" OR "Stereotactic Ablative Body Radiotherapy" OR "SBRT" OR "SRT" AND "oligoprogression" in May 2022, June 2023, and February 2024. Studies were excluded where: SABR was used as a radical treatment, a specific oligoprogressive cohort could not be identified, publication was as a conference abstract or where fewer than 10 patients were recruited. Studies treating only brain metastases were also excluded. The site of primary tumour, oligoprogressive sites, rates of overall survival (OS), progression free survival (PFS), local control (LC) and time to next systemic therapy were collected.
RESULTS
Thirty-three full text studies were included. These consisted of single centre and multi-institutional observational studies, case series and phase II trials. Twenty-two studies were related to a specific tumour type: 12 urological cancer (9 prostate, 3 renal cancer), 6 non-small cell lung cancer, 2 colorectal cancer, 2 breast cancer and 11 were studies covering multiple tumour sites (5 studies involving SABR to a single organ and 6 studies involving SABR to multi-organ). Median PFS was >6 months in patients with oligoprogressive prostate, non-small cell lung cancer and renal cancer patients.
CONCLUSIONS
SABR appears to have clinical benefit in oligoprogresssive prostate, lung, and renal patients. However, the optimal management of patients with oligoprogressive disease is still somewhat uncertain due to lack of prospective data. This will hopefully become clearer in the near future with the publication of further randomised trials.
Topics: Humans; Radiosurgery; Disease Progression; Neoplasms; Neoplasm Metastasis
PubMed: 38648995
DOI: 10.1016/j.radonc.2024.110288 -
Zhonghua Nan Ke Xue = National Journal... Dec 2023Image fusion technology had been widely applied in image guided radiotherapy (IGRT) for prostate cancer (PCa) based on the gold fiducial mark (GFM). Image fusion...
Image fusion technology had been widely applied in image guided radiotherapy (IGRT) for prostate cancer (PCa) based on the gold fiducial mark (GFM). Image fusion technology included the fusion of CT image, magnetic resonance image, and ultrasound image internally or externally. The application of image fusion technology had improved the identification accuracy of GFM and was helpful for the plan design of PCa radiotherapy. This article provided a systematic review of the application of fusion of various medical images in PCa IGRT in recent years. Among them, the application and result of image fusion technology in GFM identification and the impact on the plan design for PCa radiotherapy were emphasized. It hoped that this review could provide some theoretical reference for the deeper integration of image fusion technology with PCa IGRT.
Topics: Male; Humans; Fiducial Markers; Gold; Prostatic Neoplasms; Biomarkers; Technology
PubMed: 38639959
DOI: No ID Found -
Cancers Mar 2024Prostate cancer (PCa) is one of the most frequently occurring malignancies. Although most cases are not life-threatening, approximately 20% endure an unfavorable... (Review)
Review
BACKGROUND
Prostate cancer (PCa) is one of the most frequently occurring malignancies. Although most cases are not life-threatening, approximately 20% endure an unfavorable outcome. PSA-based screening reduced mortality but at the cost of an increased overdiagnosis/overtreatment of low-risk (lrPCa) and favorable intermediate-risk (firPCa) PCa. PCa risk-groups are usually identified based on serum Prostate-Specific Antigen (PSA), the Gleason score, and clinical T stage, which have consistent although variable specificity or subjectivity. Thus, more effective and specific tools for risk assessment are needed, ideally making use of minimally invasive methods such as liquid biopsies. In this systematic review we assessed the clinical potential and analytical performance of liquid biopsy-based biomarkers for pre-treatment risk stratification of PCa patients.
METHODS
Studies that assessed PCa pre-treatment risk were retrieved from PubMed, Scopus, and MedLine. PCa risk biomarkers were analyzed, and the studies' quality was assessed using the QUADAS-2 tool.
RESULTS
The final analysis comprised 24 full-text articles, in which case-control studies predominated, mostly reporting urine-based biomarkers (54.2%) and biomarker quantification by qPCR (41.7%). Categorization into risk groups was heterogeneous, predominantly making use of the Gleason score.
CONCLUSION
This systematic review unveils the substantial clinical promise of using circulating biomarkers in assessing the risk for prostate cancer patients. However, the standardization of groups, categories, and biomarker validation are mandatory before this technique can be implemented. Circulating biomarkers might represent a viable alternative to currently available tools, obviating the need for tissue biopsies, and allowing for faster and more cost-effective testing, with superior analytical performance, specificity, and reproducibility.
PubMed: 38611041
DOI: 10.3390/cancers16071363 -
Expert Review of Anticancer Therapy Jun 2024Statins, in the role of anti-cancer agents, have been used in many types of cancers with results in some cases promising while, in others, disappointing.
INTRODUCTION
Statins, in the role of anti-cancer agents, have been used in many types of cancers with results in some cases promising while, in others, disappointing.
AREAS COVERED
The purpose of this review is to identify and highlight data from literature on the successes or failure of using statins as anti-cancer agents. We asked ourselves the following two questions:1. 2.
EXPERT OPINION
There are data which correlate statins with a possible tumor suppressive action among the following cancers: breast, lung, prostate and head and neck. Lastly, for gastric cancer and colorectal there is no evidence of a correlation. The onco-suppressive efficacy of statins is mainly related to the histopathological and/or molecular characteristics of the tumor cells, which have different characteristics.
Topics: Animals; Humans; Antineoplastic Agents; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Neoplasm Recurrence, Local; Neoplasms; Prognosis
PubMed: 38609343
DOI: 10.1080/14737140.2024.2343338