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European Urology Open Science Mar 2024Data on racial disparities among patients with metastatic castration-resistant prostate cancer (mCRPC) are limited and there is no uniform conclusion on differences by...
CONTEXT
Data on racial disparities among patients with metastatic castration-resistant prostate cancer (mCRPC) are limited and there is no uniform conclusion on differences by race in this setting.
OBJECTIVE
To provide the latest evidence on racial disparities in survival outcomes between Black and White patients receiving systemic therapies for mCRPC.
EVIDENCE ACQUISITION
Our study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. We systematically searched the PubMed, Web of Science, and Cochrane Library databases up to September 2023 to identify potentially relevant studies. Overall survival (OS) and progression-free survival (PFS) were the outcomes of interest. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were evaluated.
EVIDENCE SYNTHESIS
Nine studies involving 9462 patients with mCRPC (2058 Black and 7404 White men) met the eligibility criteria and were included. Pooled estimates demonstrated significantly better OS for Black than for White men (HR 0.75, 95% CI 0.70-0.80; < 0.0001). The results were similar in a subgroup of men receiving androgen receptor-targeted therapies (HR 0.72, 95% CI 0.66-0.78; < 0.0001) and a subgroup of men receiving other treatments (HR 0.79, 95% CI 0.71-0.88; < 0.0001). Likewise, significantly favorable PFS was observed for Black men receiving ARTs in comparison to their White counterparts (HR 0.84, 95% CI 0.71-0.99; = 0.0373).
CONCLUSIONS
Overall, our meta-analysis of survival outcomes for men with mCRPC stratified by race revealed a significant survival benefit for Black men in comparison to their White counterparts, regardless of systemic therapeutic agent.
PATIENT SUMMARY
Both biological and nonbiological factors could account for racial differences in the efficacy of systemic treatments for metastatic prostate cancer that is resistant to hormone therapy. Our review provides the latest reliable evidence showing better survival outcomes for Black than for White men. The results will be helpful in further understanding the molecular mechanisms that might explain racial differences in this disease stage and in planning treatment.
PubMed: 38384441
DOI: 10.1016/j.euros.2024.01.004 -
European Urology Oncology Feb 2024The addition of androgen receptor signalling inhibitors (ARSIs) to standard androgen deprivation therapy (ADT) has improved survival outcomes in patients with advanced... (Review)
Review
Risk of Fractures and Falls in Men with Advanced or Metastatic Prostate Cancer Receiving Androgen Deprivation Therapy and Treated with Novel Androgen Receptor Signalling Inhibitors: A Systematic Review and Meta-analysis of Randomised Controlled Trials.
CONTEXT
The addition of androgen receptor signalling inhibitors (ARSIs) to standard androgen deprivation therapy (ADT) has improved survival outcomes in patients with advanced prostate cancer (PCa). Advanced PCa patients have a higher incidence of osteoporosis, compounded by rapid bone density loss upon commencement of ADT resulting in an increased fracture risk. The effect of treatment intensification with ARSIs on fall and fracture risk is unclear.
OBJECTIVE
To assess the risk of falls and fractures in men with PCa treated with ARSIs.
EVIDENCE ACQUISITION
A systematic review of EMBASE, MEDLINE, The Cochrane Library, and The Health Technology Assessment Database for randomised control trials between 1990 and June 2023 was conducted in accordance with Preferred Reporting Items for Systematic Review and Meta-analyses guidance. Risk ratios were estimated for the incidence of fracture and fall events. Subgroup analyses by grade of event and disease state were conducted.
EVIDENCE SYNTHESIS
Twenty-three studies were eligible for inclusion. Fracture outcomes were reported in 17 studies (N = 18 811) and fall outcomes in 16 studies (N = 16 537). A pooled analysis demonstrated that ARSIs increased the risk of fractures (relative risk [RR] 2.32, 95% confidence interval [CI] 2.00-2.71; p < 0.01) and falls (RR 2.22, 95% CI 1.81-2.72; p < 0.01) compared with control. A subgroup analysis demonstrated an increased risk of both fractures (RR 2.13, 95% CI 1.70-2.67; p < 0.01) and falls (RR 2.19, 95% CI 1.53-3.12; p < 0.0001) in metastatic hormone-sensitive PCa patients, and an increased risk of fractures in the nonmetastatic (RR 2.27, 95% CI 1.60-3.20; p < 0.00001) and metastatic castrate-resistant (RR 2.85, 95% CI 2.16-3.76; p < 0.00001) settings. The key limitations include an inability to distinguish fragility from pathological fractures and potential for a competing risk bias.
CONCLUSIONS
Addition of an ARSI to standard ADT significantly increases the risk of fractures and falls in men with prostate cancer.
PATIENT SUMMARY
We found a significantly increased risk of both fractures and falls with a combination of novel androgen signalling inhibitors and traditional forms of hormone therapy.
PubMed: 38383277
DOI: 10.1016/j.euo.2024.01.016 -
Archivos Espanoles de Urologia Jan 2024Prostate cancer is one of the most frequently diagnosed cancers in males. Treatment options cause a series of side effects that can lead to a deterioration in the... (Review)
Review
INTRODUCTION
Prostate cancer is one of the most frequently diagnosed cancers in males. Treatment options cause a series of side effects that can lead to a deterioration in the physical and quality of life of patients, such as musculoskeletal changes, atrophy or muscle weakness, due to the testosterone suppression. Scientific evidence has shown that exercise mitigates the side effects induced by cancer treatment. This study aimed to analyse the effects of muscular strength work on the organism of patients with prostate cancer in the treatment phase.
MATERIAL AND METHODS
PubMed, Scopus, SPORTDiscus, CINAHL, Medline, Web of Science and PEDro databases were searched in January 2022. The Medical Subject Headings "resistance training", "prostatic neoplasms", "strength training" and "prostate cancer" were used.
RESULTS
A total of 13 articles were analysed. In all of them, statistically significant changes were found in strength, physical performance, muscle mass and cardiovascular and respiratory health after the implementation of a strength exercise program. Other variables did not achieve the expected changes.
CONCLUSIONS
A strength exercise program improves strength, physical performance, muscle mass and cardiovascular health in patients with prostate cancer. However, whether it improves other parameters, such as body fat, power, bone density and quality of life, is unclear.
Topics: Male; Humans; Resistance Training; Quality of Life; Prostatic Neoplasms; Muscle Strength; Muscles
PubMed: 38374007
DOI: 10.56434/j.arch.esp.urol.20247701.1 -
Cureus Jan 2024The purpose of this systematic review is to summarize all existing evidence, regarding the immunohistochemical expression of REV-7 in different human cancer pathology... (Review)
Review
The purpose of this systematic review is to summarize all existing evidence, regarding the immunohistochemical expression of REV-7 in different human cancer pathology specimens. Moreover, the association of REV-7 expression with disease severity (clinical course), patients' survival, prognosis, and response to various treatments, such as chemotherapy and irradiation, was investigated. Three databases (PubMed, Scopus, and Cochrane) were systematically screened, from inception to September 2, 2023, as suggested by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Only studies using immunohistochemical staining for REV-7 in paraffin-embedded cancer tissues were included. Nine studies met the inclusion criteria and were included in the final qualitative synthesis. All nine studies were retrospective and non-comparative ones. Selected studies reported immunohistochemical expression of REV-7 in different types of cancer, including testicular cancer, ovarian cancer, esophagus squamous cell carcinoma, prostate cancer, colorectal cancer, diffuse large B-cell lymphoma, breast cancer, lung cancer, and skin cancer. High REV-7 expression was associated with faster disease progression, resistance to available treatment options, and worse prognosis in the majority of included studies. These results indicate that immunohistochemical staining of REV-7 protein could potentially be used as a predictive tissue marker in certain cases. Promising results, arising from REV-7 inactivation experiments, render REV-7 targeting a potential therapeutic strategy for future cancer management, especially in the cases of chemoresistant or radioresistant disease.
PubMed: 38371007
DOI: 10.7759/cureus.52542 -
Patient Education and Counseling Jun 2024This systematic review (PROSPERO ID: CRD42022226375) aimed to identify the eHealth literacy of men with prostate cancer, and their caregivers. (Review)
Review
OBJECTIVE
This systematic review (PROSPERO ID: CRD42022226375) aimed to identify the eHealth literacy of men with prostate cancer, and their caregivers.
METHODS
8 databases (MEDLINE, SCOPUS, EMBASE, Web Of Science, PsycINFO, ERIC, CINAHL, Cochrane CENTRAL) and grey literature sources (e.g. Google Scholar) were searched from inception to December 2023. Articles were included if assessing eHealth/digital literacy of men with prostate cancer, or their carers', and health outcome associations. Formats such as case reports, and review papers were excluded. Records and full texts underwent independent screening and data extraction. Author disagreements were resolved by discussion. The Mixed Methods Appraisal Tool (MMAT) was used to appraise included literature, with narrative synthesis of results.
RESULTS
21,581 records were retrieved, with 7 articles satisfying inclusion criteria. A heterogenous field was characterised with lack of modern eHealth literacy measurement tools identified. Results suggest novice eHealth literacy using web 1.0 technologies. Non-validated measures of literacy demonstrate mixed results, while health outcome effects limited in scope and reliability.
CONCLUSION
Prostate cancer survivors' eHealth literacy levels is likely novice, and requires further investigation.
PRACTICE IMPLICATIONS
Digital technologies/resources implemented as part of patient communication practices should be vetted for quality, and tailored to patients' eHealth literacy abilities and/or needs.
Topics: Male; Humans; Reproducibility of Results; Telemedicine; Prostatic Neoplasms; Health Literacy; Caregivers
PubMed: 38354430
DOI: 10.1016/j.pec.2024.108193 -
Insights Into Imaging Feb 2024
Reply to a Letter to the Editor on Comparative performance of fully-automated and semi-automated artificial intelligence methods for the detection of clinically significant prostate cancer on MRI: a systematic review.
PubMed: 38353766
DOI: 10.1186/s13244-023-01594-4 -
International Journal of Surgery... May 2024To conduct a meta-analysis to provide the latest evidence of nonsurgical local salvage options in the first-line radiotherapy (RT) failure setting for localized prostate... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To conduct a meta-analysis to provide the latest evidence of nonsurgical local salvage options in the first-line radiotherapy (RT) failure setting for localized prostate cancer patients.
BACKGROUND
Recurrence of localized prostate cancer after primary RT remains a clinical challenge. There is no consensus on optimal nonsurgical local salvage therapies, which mainly consist of cryotherapy (CRYO), high-intensity focused ultrasound (HIFU), high/low-dose-rate brachytherapy (HDR/LDR), and stereotactic body radiotherapy (SBRT).
METHODS
Our study was performed following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The authors systematically searched PubMed, Web of Science, Cochrane Library, and ClinicalTrials.gov up to September 2023 to identify potentially relevant studies. The risk of bias was assessed using the European Association of Urology (EAU) items. Biochemical recurrence-free survival (bRFS) and genitourinary/gastrointestinal toxicities were the outcomes of interest. Pooled rates with 95% CIs were evaluated.
RESULTS
A total of 99 studies comprising 8440 patients were included. The pooled rate of 1-year biochemical control (BC) was highest for LDR (0.88, 95% CI: 0.72-0.95) and lowest for SBRT (0.68, 95% CI: 0.49-0.83). The pooled rate of 5-year BC was highest for CRYO (0.52, 95% CI: 0.33-0.69) and lowest for HDR (0.23, 95% CI: 0.08-0.51). HIFU presented the worst outcome of grade ≥3 genitourinary toxicities (GU3), with a rate of 0.22 (95% CI: 0.12-0.3). Conversely, CRYO (0.09, 95% CI: 0.04-0.14), HDR (0.05, 95% CI: 0.02-0.07), LDR (0.10, 95% CI: 0.06-0.14), and SBRT (0.06, 95% CI: 0.03-0.09) presented low rates of GU3. All subgroups induced a quite low incidence of grade ≥3 gastrointestinal toxicities (GI3).
CONCLUSIONS
Nonsurgical salvage therapies are promising modalities for prostate cancer in the local radiorecurrence setting. Based on the preliminary evidence from this study, CRYO and SBRT might present a relatively steady efficacy of BC with acceptable treatment-related toxicities.
Topics: Humans; Male; Prostatic Neoplasms; Salvage Therapy; Neoplasm Recurrence, Local; Brachytherapy; Radiosurgery; Cryotherapy
PubMed: 38348896
DOI: 10.1097/JS9.0000000000001164 -
Frontiers in Genetics 2024The association between MTHFR gene polymorphisms (C677T and A1298C) and prostate cancer risk remains controversial. Two independent researchers searched the PubMed,... (Review)
Review
The association between MTHFR gene polymorphisms (C677T and A1298C) and prostate cancer risk remains controversial. Two independent researchers searched the PubMed, Embase, Cochrane and Web of Science databases for all papers published up to 12/19/2023 and used various genetic models to evaluate the relationship between MTHFR polymorphisms and prostate cancer risk. The meta-analysis included 26 case‒control studies with a total of 12,455 cases and 13,900 controls with the C677T polymorphism and 6,396 cases and 8,913 controls with the A1298C polymorphism. Overall, no significant association was found between the MTHFR gene polymorphisms and prostate cancer risk. However, the C677T polymorphism was associated with reduced prostate cancer risk in the Asian population (T allele vs. C allele: OR = 0.759, 95% CI 0.669-0.861, < 0.001; TT + CT vs. CC: OR = 0.720, 95% CI 0.638-0.812, < 0.001; TT vs. CC + CT: OR = 0.719, 95% CI 0.617-0.838, < 0.001; TT vs. CC: OR = 0.620, 95% CI 0.522-0.737, < 0.001); however, the A1298C polymorphism was associated with an increased risk in the mixed race group from the United States (CC + AC vs. AA: OR = 1.464, 95% CI 1.052-2.037, = 0.024; AC vs. AA: OR = 1.615, 95% CI 1.037-2.514, = 0.034). The meta-analysis suggested that MTHFR gene polymorphisms (C677T and A1298C) may have different effects on prostate cancer risk in specific populations.
PubMed: 38343693
DOI: 10.3389/fgene.2024.1343687 -
Cancers Jan 2024Early detection of metastatic prostate cancer (mPCa) is crucial. Whilst the prostate-specific membrane antigen (PSMA) PET scan has high diagnostic accuracy, it suffers... (Review)
Review
Early detection of metastatic prostate cancer (mPCa) is crucial. Whilst the prostate-specific membrane antigen (PSMA) PET scan has high diagnostic accuracy, it suffers from inter-reader variability, and the time-consuming reporting process. This systematic review was registered on PROSPERO (ID CRD42023456044) and aims to evaluate AI's ability to enhance reporting, diagnostics, and predictive capabilities for mPCa on PSMA PET scans. Inclusion criteria covered studies using AI to evaluate mPCa on PSMA PET, excluding non-PSMA tracers. A search was conducted on Medline, Embase, and Scopus from inception to July 2023. After screening 249 studies, 11 remained eligible for inclusion. Due to the heterogeneity of studies, meta-analysis was precluded. The prediction model risk of bias assessment tool (PROBAST) indicated a low overall risk of bias in ten studies, though only one incorporated clinical parameters (such as age, and Gleason score). AI demonstrated a high accuracy (98%) in identifying lymph node involvement and metastatic disease, albeit with sensitivity variation (62-97%). Advantages included distinguishing bone lesions, estimating tumour burden, predicting treatment response, and automating tasks accurately. In conclusion, AI showcases promising capabilities in enhancing the diagnostic potential of PSMA PET scans for mPCa, addressing current limitations in efficiency and variability.
PubMed: 38339239
DOI: 10.3390/cancers16030486 -
Indian Journal of Urology : IJU :... 2024Irreversible electroporation (IRE) is a new and promising focal therapy for the treatment of localized prostate cancer. In this systematic review, we summarize the... (Review)
Review
INTRODUCTION
Irreversible electroporation (IRE) is a new and promising focal therapy for the treatment of localized prostate cancer. In this systematic review, we summarize the literature on IRE for prostate cancer published over the last decade.
METHODS
PubMed and EMBASE were searched with the end date of May 2023 to find relevant publications on prostate cancer ablation using IRE. Original studies with focal IRE as the primary curative treatment which reported on functional or oncological outcomes were included. The bibliography of relevant studies was also scanned to identify suitable articles.
RESULTS
A total of 14 studies reporting on 899 patients treated with IRE for localized prostate cancer were included. Of all the studies reviewed, 77% reported on recurrence within the zone of ablation, and it ranged from 0% to 38.9% for in-field and 3.6% to 28% for out-of-field recurrence. Although, a standardised follow-up protocol was not followed, all the studies employed serial prostate-specific antigen monitoring, a multiparametric magnetic resonance imaging, and a biopsy (6-12 months post-treatment). Across all the studies, 58% reported that the urinary continence returned to the pretreatment levels and 25% reported a minor decrease in the continence from the baseline at 12-months of follow-up. Erections sufficient for intercourse varied from 44% to 75% at the baseline to 55% to 100% at 12-months of follow-up across all the studies.
CONCLUSION
IRE, as a focal therapy, shows promising results with minimal complications and reasonably effective oncological control, but the data comparing it to the standard of care is still lacking. Future research should focus on randomized definitive comparisons between IRE, radical prostatectomy, and radiation therapy.
PubMed: 38314081
DOI: 10.4103/iju.iju_370_23