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Minerva Urologica E Nefrologica = the... Oct 2020The aim of this review was to summarize the available evidence on the role of metastasis-directed therapy (MDT) and/or prostate-targeted therapy (PTT) in the setting of...
INTRODUCTION
The aim of this review was to summarize the available evidence on the role of metastasis-directed therapy (MDT) and/or prostate-targeted therapy (PTT) in the setting of oligometastatic prostate cancer (PCa).
EVIDENCE ACQUISITION
We searched PubMed, the Web of Science, and the Cochrane Library databases. The following keywords were used: ("prostate cancer" OR "prostate carcinoma" OR "prostate neoplasm" OR "prostate tumor") AND ("oligometastatic" OR "oligometastasis" OR "PSMA") AND ("surgery" OR "prostatectomy" OR "radical prostatectomy" OR "cytoreductive" OR "local treatment" OR "radiotherapy" OR "stereotactic" OR "stereotaxic") AND ("survival" OR "mortality").
EVIDENCE SYNTHESIS
After evaluating the selection criteria, 81 studies were evaluated for our endpoints. We included 22 studies for PTT of synchronous mPCa. There have been no randomized studies on cytoreductive prostatectomy (cRP). Four prospective studies showed that cRP was feasible but did not contribute to a positive effect on overall survival (OS). Regarding PTT-radiotherapy, two randomized controlled phase 3 trials showed that OS was improved in men with a low metastatic burden. Regarding MDT of metachronous lymph node recurrence, we included 29 retrospective studies. For MDT of oligometastases, we included 30 studies. One randomized phase 2 trial showed that androgen deprivation therapy-free survival improved with stereotactic body radiation therapy compared to that with surveillance; however, benefits on OS remain unclear.
CONCLUSIONS
We performed a comprehensive overview of the current literature on MDT and PTT. The feasibility of MDT and PTT is supported by several retrospective studies. Nevertheless, there remains a lack of high-quality trials to prove its survival benefits. Results from ongoing prospective trials data are awaited.
Topics: Humans; Male; Molecular Targeted Therapy; Neoplasm Metastasis; Neoplasm Recurrence, Local; Prostatic Neoplasms
PubMed: 32550632
DOI: 10.23736/S0393-2249.20.03779-0 -
Asian Journal of Andrology 2021We aimed to confirm the predictive ability of the presence of intraductal carcinoma of the prostate (IDC-P) for prognosis and the associations between IDC-P and... (Meta-Analysis)
Meta-Analysis
We aimed to confirm the predictive ability of the presence of intraductal carcinoma of the prostate (IDC-P) for prognosis and the associations between IDC-P and clinicopathological parameters. Studies were identified in PubMed, Cochrane Library, EMBASE, Web of Science, and SCOPUS up to December 1, 2019. Hazard ratios (HRs) for survival data and odds ratios for clinicopathological data with 95% confidence intervals (CIs) were extracted. Heterogeneity was evaluated by the I value, and quality was assessed by the Newcastle-Ottawa Scale criteria. A total of 4179 patients from 13 studies were included. The results showed that IDC-P presence was significantly associated with poor progression-free survival (PFS; HR = 2.31; 95% CI: 1.96-2.73), cancer-specific survival (HR = 1.89; 95% CI: 1.28-2.77), and overall survival (HR = 2.14; 95% CI: 1.53-3.01). In the subgroup analysis, IDC-P presence was significantly associated with poor PFS in prostate cancer treated by radical prostatectomy (HR = 2.48; 95% CI: 2.05-3.00) and treated by radiotherapy (HR = 2.83; 95% CI: 1.65-4.85). Regarding clinicopathological characteristics, patients with IDC-P presence had significantly higher tumor clinical stages, Gleason scores, probabilities of lymph node invasion, positive surgical margins, and positive extraprostatic extension. Our meta-analysis indicates that the presence of IDC-P is closely associated with poor prognosis and adverse clinicopathological characteristics. Our data support the value and clinical utility of the routine detection of IDC-P by pathological examination. These conclusions need further validation, and prospective studies are needed to find better treatment modalities other than traditional first-line therapy for patients with IDC-P.
Topics: Carcinoma, Intraductal, Noninfiltrating; Humans; Male; Prognosis; Prostatic Neoplasms; Treatment Outcome
PubMed: 32496222
DOI: 10.4103/aja.aja_21_20 -
Lipids in Health and Disease May 2020NAFLD is tightly associated with various diseases such as diabetes, cardiovascular disease, kidney disease, and cancer. Previous studies had investigated the association...
BACKGROUND
NAFLD is tightly associated with various diseases such as diabetes, cardiovascular disease, kidney disease, and cancer. Previous studies had investigated the association between NAFLD and various extrahepatic cancers, but the available data to date is not conclusive. The aim of this study was to investigate the association between NAFLD and various extrahepatic cancers comprehensively.
METHODS
Searches were conducted of various electronic databases (PubMed, EMBASE, Medline, and the Cochrane Library) to identify observational studies published between 1996 and January 2020 which investigated the association between NAFLD and extrahepatic cancers. The pooled OR/HR/IRR of the association between NAFLD and various extrahepatic cancers were analyzed.
RESULTS
A total of 26 studies were included to investigate the association between NAFLD and various extrahepatic cancers. As the results shown, the pooled OR values of the risk of colorectal cancer and adenomas in patients with NAFLD were 1.72 (95%CI: 1.40-2.11) and 1.37 (95%CI: 1.29-1.46), respectively. The pooled OR values of the risk of intrahepatic cholangiocarcinoma and extrahepatic cholangiocarcinoma in patients with NAFLD were 2.46 (95%CI: 1.77-3.44) and 2.24 (95%CI: 1.58-3.17), respectively. The pooled OR value of the risk of breast cancer in patients with NAFLD was 1.69 (95%CI: 1.44-1.99). In addition, NAFLD was also tightly associatied with the risk of gastric cancer, pancreatic cancer, prostate cancer, and esophageal cancer.
CONCLUSIONS
NAFLD could significantly increase the development risk of colorectal adenomas and cancer, intrahepatic and extrahepatic cholangiocarcinoma, breast, gastric, pancreatic, prostate, and esophageal cancer. NAFLD could be considered as one of the influencing factors during the clinical diagnosis and treatment for the extrahepatic cancers.
Topics: Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Cholangiocarcinoma; Colorectal Neoplasms; Esophageal Neoplasms; Humans; Non-alcoholic Fatty Liver Disease; Risk Factors; Stomach Neoplasms
PubMed: 32475354
DOI: 10.1186/s12944-020-01288-6 -
Cancer Cell International 2020Accumulating evidence suggests androgen receptor splice variant 7 (AR-V7) may be associated with the prognosis of castration-resistant prostate cancer (CRPC) received... (Review)
Review
BACKGROUND
Accumulating evidence suggests androgen receptor splice variant 7 (AR-V7) may be associated with the prognosis of castration-resistant prostate cancer (CRPC) received novel hormonal therapy while its characteristic and prognosis value in hormonal sensitive prostate cancer is unclear.
METHODS
We aimed to evaluate the prognostic role of AR-V7 by progression free survival (PFS) and overall survival (OS) in hormonal sensitive prostate cancer (HSPC), and the AR-V7-positive-proportion difference in HSPC and CRPC. A search of PubMed, Embase, and the Web of Science was performed using the keywords prostate cancer, prostate tumor, prostate neoplasm, prostate carcinoma; AR-V7, AR3, androgen receptor splicing variant-7, or androgen receptor-3. Seventeen trials published due December 2019 were enrolled.
RESULTS
AR-V7-positive proportion in CRPC was significantly larger than newly diagnosed prostate cancer (PCa) (odds ratio [OR] 7.06, 95% confidence interval [CI] 2.52-19.83, P < 0.001). Subgroup analyses indicated significantly higher AR-V7-positive proportion in CRPC derived from RNA in situ hybridization (OR 65.23, 95% CI 1.34-3171.43, P = 0.04), exosome RNA (OR 3.88, 95% CI 0.98-15.39, P = 0.05) and tissue RNA (OR 10.89, 95% CI 4.13-28.73, P < 0.001). AR-V7-positive patients had a significantly shorter PFS than those who were AR-V7-negative treated with first-line hormonal therapy (hazard ratio [HR] 3.63, 95% CI 1.85-7.10, P < 0.001) and prostatectomy (HR 2.49, 95% CI 1.33-4.64, P = 0.004). OS (HR 5.59, 95% CI 2.89-10.80, P < 0.001) were better in AR-V7-negative than AR-V7-positive HSPC patients treated with first-line hormonal therapy. The limitations of our meta-analysis were differences in study sample size and design, AR-V7 detection assay, and disease characteristics.
CONCLUSION
AR-V7-positive proportion was significantly higher in CRPC than that in newly diagnosed PCa. AR-V7 positive HSPC patients portend worse prognosis of first-line hormonal therapy and prostatectomy. Additional studies are warranted to confirm these findings.
PubMed: 32390764
DOI: 10.1186/s12935-020-01229-4 -
Cancer Medicine May 2020The risk of prostate cancer in melanoma patients has been frequently assessed. However, a comprehensive meta-analysis specifically examining this association is lacking.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The risk of prostate cancer in melanoma patients has been frequently assessed. However, a comprehensive meta-analysis specifically examining this association is lacking. Our aim was to quantify the risk of prostate cancer in melanoma patients based on the available evidence.
METHODS
A systematic review of the existing literature was performed in PubMed, Scopus, and Cochrane databases by two authors independently. Studies reporting the effect size in the form of standardized incidence ratio (SIR) were used for quantitative analyses.
RESULTS
Of 17 studies included in the review, a total of 15 studies with 282 592 male melanoma patients were used for the analysis. Random-effects meta-analysis found a 24% increased risk (SIR = 1.24, 95% confidence interval 1.18 to 1.30) of prostate cancer in melanoma patients compared to the general population, with a prediction interval of 1.05 to 1.45. The risk was consistently significant for various geographical regions and latitude. Heterogeneity was significant (I = 75%).
CONCLUSION
These results suggest that the incidence of prostate cancer is significantly higher in patients with melanoma compared to the general population.
Topics: Carcinoma; Humans; Incidence; Male; Melanoma; Prostatic Neoplasms; Risk Factors; Skin Neoplasms
PubMed: 32175697
DOI: 10.1002/cam4.2995 -
European Urology Sep 2020There is a critical need for effective bladder-sparing therapies for bacillus Calmette-Guérin (BCG)-unresponsive non-muscle-invasive bladder cancer (NMIBC). Owing to...
CONTEXT
There is a critical need for effective bladder-sparing therapies for bacillus Calmette-Guérin (BCG)-unresponsive non-muscle-invasive bladder cancer (NMIBC). Owing to the current lack of effective agents that can be used as a control, the US Food and Drug Administration began to accept single-arm trials for patients with carcinoma in situ (CIS), using complete response rate (CRR) and duration of response as the primary endpoints to support marketing applications. Despite the ensuing growth of clinical trials in this space, no consensus exists on a clinically relevant benchmark for CRR.
OBJECTIVE
To elucidate the CRR and recurrence-free rate (RFR) using bladder-sparing agents after BCG failure in order to provide a frame of reference for future clinical trial results.
EVIDENCE ACQUISITION
We performed a systematic review of clinical trials utilizing bladder-sparing therapeutics for NMIBC recurring after intravesical BCG (PROSPERO CRD42019130553). The search was performed in MEDLINE, EMBASE, and Cochrane Library. Relevant studies identified from bibliography search and conference abstracts were searched to complement the systematic review. A total of 42 studies utilizing 24 treatment options and consisting of 2254 patients were included for final analysis.
EVIDENCE SYNTHESIS
Median CRRs in the treatment of CIS-containing tumors were 26% at 6 mo, 17% at 12 mo, and 8% at 24 mo after treatment. In comparison, median RFRs in the papillary-only studies were 67% at 6 mo, 44% at 12 mo, and 10% at 24 mo. Specifically in the BCG-unresponsive population, 6- and 12-mo CRRs in CIS-containing patients treated with Mycobacterium phlei cell wall-nucleic acid complex were 45% and 27%, respectively, and the median 6-, 12-, and 24-mo disease-free rates in the other studies were 43%, 35%, and 18%, respectively. The median progression-free rate was 91%: 95% in the CIS-containing studies and 89% in studies restricted to papillary-only recurrences. Toxicities of intravesical agents were generally mild, with very few dose limiting toxicities.
CONCLUSIONS
We demonstrate that, to date, bladder-sparing therapies achieved modest efficacy in patients with NMIBC after BCG. Results from the current study will serve as a frame of reference for emerging trial results in the BCG-unresponsive space.
PATIENT SUMMARY
In this study, we found that bladder-sparing therapies achieved modest efficacy in patients with non-muscle-invasive bladder cancer after bacillus Calmette-Guérin (BCG). These results will serve to inform future clinical trial results for salvage agents used to treat BCG-unresponsive bladder cancer.
Topics: Adjuvants, Immunologic; Administration, Intravesical; BCG Vaccine; Carcinoma in Situ; Humans; Neoplasm Invasiveness; Organ Sparing Treatments; Treatment Outcome; Urinary Bladder Neoplasms
PubMed: 32143924
DOI: 10.1016/j.eururo.2020.02.012 -
Arab Journal of Urology 2020: To address the question of whether antibiotic therapy can obviate the need for prostate biopsy (PBx) in patients presenting with high prostate-specific antigen (PSA)... (Review)
Review
: To address the question of whether antibiotic therapy can obviate the need for prostate biopsy (PBx) in patients presenting with high prostate-specific antigen (PSA) levels. : With the increase in unnecessary PBx in men with high PSA levels, a systematic review was performed according to the Cochrane Reviews guidelines and in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. : The literature search yielded 42 studies, of which 11 were excluded due to irrelevance of data. Most of the studies were retrospective, nine studies were randomised controlled trials, and there were seven prospective non-randomised trials. The age range of the patients was 51-95 years. Antibiotics, predominantly ofloxacin or ciprofloxacin, combined with a non-steroidal anti-inflammatory drug (NSAID) or not, were prescribed for 2-8 weeks. All studies focussed on PSA levels ranging from ≤ 4 to ≥ 10 ng/mL. Furthermore, antibiotic therapy normalised PSA levels by a wide variety of percentages (16-59%), and the PSA level decrease also varied widely and ranged from 17% to 80%. For patients who had unchanged or decreased PSA, carcinoma was found in 40-52% and 7.7-20.3%, respectively. No cancer was detected if the PSA level decreased to < 4 ng/mL. : Antibiotic therapy is clinically beneficial in patients with high PSA levels. PSA reduction or normalisation after medical therapy, either antibiotic and/or NSAID, for ≥ 2 weeks can avoid unnecessary PBx. Antibiotic therapy is more beneficial when the PSA level is < 20 ng/mL. : EPS: expressed prostatic secretion; PBx: prostate biopsy; (%f)(f/t)(t)PSA, (percentage free) (free/total) (total) serum PSA; PSAD: PSA density; RCT: randomised controlled trial; VB3: voided bladder urine 3.
PubMed: 32082627
DOI: 10.1080/2090598X.2019.1677296 -
EFORT Open Reviews Jan 2020Surgery of long bone metastases is associated with a significant risk of perioperative blood loss, which may necessitate blood transfusion.Successful embolization (> 70%... (Review)
Review
Surgery of long bone metastases is associated with a significant risk of perioperative blood loss, which may necessitate blood transfusion.Successful embolization (> 70% obliteration of vascularity) can be achieved in 36-75% of cases.The reported rate of embolization-related complications is 0-9%.Three out of six level III evidence studies showed a reduction in perioperative blood loss and/or blood transfusion requirement after preoperative embolization of renal cell carcinoma metastasis in long bones; three out of six studies did not.One level III evidence study did not show a reduction in perioperative blood loss and/or transfusion requirement after preoperative embolization of hepatocellular carcinoma metastases in long bones.There were no studies found that support preoperative embolization of thyroid metastases or other frequent long bone metastases (e.g. mamma carcinoma, lung carcinoma, or prostate carcinoma).The clinical level of evidence of the studies found is low and randomized studies taking into account primary tumour, location of metastases and type of surgery are therefore desired. Cite this article: 2020;5:17-25. DOI: 10.1302/2058-5241.5.190013.
PubMed: 32071770
DOI: 10.1302/2058-5241.5.190013 -
Annals of Global Health Jan 2020Prostate cancer is one of the most common health issues among men, especially older men. In recent years, incidences of prostate cancer is increasing. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Prostate cancer is one of the most common health issues among men, especially older men. In recent years, incidences of prostate cancer is increasing.
OBJECTIVE
The aim of this study was to provide a comprehensive estimate of the survival of prostate cancer in Asian countries.
METHODS
We searched five international databases including Medline/PubMed, Scopus, Embase, Web of Knowledge and ProQuest until June 1, 2018. The Newcastle-Ottawa Quality Assessment was used to evaluate the quality of selected papers. The review protocol was registered in PROSPERO (CRD42019117044).
RESULTS
A total of 714 titles were retrieved. Thirty-seven studies met the inclusion criteria. Based on the random-effect model one-year, five-year and ten-year survival rate of prostate cancer were 81% (95% CI 77.8-84.2), 61.9% (95% CI 59.5-64.3) and 36.2% (95% CI 9.2-63.2) respectively. Survival rates based on HDI level for five-year were 30.07, 43.43 and 70.84 percent for medium, high and very high levels, respectively.
CONCLUSION
According to the results of our study, the prostate cancer survival rate in Asian countries is relatively lower than in Europe and North America.
Topics: Asia; Carcinoma; Humans; Male; Prostatic Neoplasms; Survival Rate
PubMed: 31976303
DOI: 10.5334/aogh.2607 -
International Journal of Surgery... Dec 2019To investigate the possible prognostic role of pretreatment derived neutrophil-lymphocyte ratio (dNLR) in urological cancers, including renal cell carcinoma (RCC),... (Meta-Analysis)
Meta-Analysis
BACKGROUND
To investigate the possible prognostic role of pretreatment derived neutrophil-lymphocyte ratio (dNLR) in urological cancers, including renal cell carcinoma (RCC), prostate cancer (PCa), and urothelial cancer (UCa).
MATERIALS AND METHODS
Eligible studies were comprehensively searched from PubMed, Embase, Cochrane Library and Web of Science, up to April 2019. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated to assess the relationships.
RESULTS
A total of 12 studies embracing 6585 patients were included in the meta-analysis. Our results indicated that a higher pretreatment dNLR was associated with a decreased cancer-specific survival (CSS, HR 2.67, 95% CI 1.06-6.71, P = 0.037) and disease-free survival (DFS, HR 2.02, 95% CI 1.03-3.94, P = 0.040) in RCC, but not for overall survival (OS, HR 1.05, 95% CI 0.71-1.53, P = 0.818). A higher dNLR was associated with an inferior biochemical recurrence-free survival (BRFS, HR 1.70, 95% CI 1.00-2.87, P = 0.049) and OS (HR 1.35, 95% CI 1.20-1.51, P < 0.001) in PCa. A higher dNLR was associated with a worse OS (HR 1.29, 95% CI 1.03-1.61, P = 0.029) and CSS (HR 1.51, 95% CI 1.06-2.15, P = 0.024) in UCa, but not for DFS (HR 1.44, 95% CI 0.89-2.34, P = 0.139).
CONCLUSION
A higher dNLR level was negatively associated with OS, CSS, DFS and BRFS, forecasting that it could be an independent prognosis predictor in urological cancers.
Topics: Disease-Free Survival; Humans; Lymphocytes; Neutrophils; Prognosis; Urologic Neoplasms
PubMed: 31707011
DOI: 10.1016/j.ijsu.2019.10.043