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Rural and Remote Health 2012Prostate cancer is a common health problem in men worldwide. This systematic review has been undertaken to determine if there are differences in incidence of and... (Review)
Review
INTRODUCTION
Prostate cancer is a common health problem in men worldwide. This systematic review has been undertaken to determine if there are differences in incidence of and mortality from prostate cancer between rural and urban men. The understanding of geographical patterns of prostate cancer incidence and mortality is necessary in order to identify and assess any disparities between rural and urban residents in gaining access to healthcare services, such as screening, diagnosis and treatment.
METHODS
Medline, CINAHL and Embase were searched using relevant mesh phrases, such as 'prostate cancer incidence rural' or 'prostatic neoplasms mortality rural'. Secondary literature and reports not published in peer-reviewed journals were included if inclusion criteria had been met. The following inclusion criteria were applied: cohort (population-based study) of adult men, diagnosis of prostate cancer, comparing rural and urban groups, and incidence or mortality with available statistical parameters as outcome.
RESULTS
In total, 25 studies were found to fit the inclusion criteria. Sixteen cohort studies were identified that examined incidence of prostate cancer in rural and urban populations, while 18 studies focused on mortality. Nine of these publications discussed both aspects. Twenty of these studies were published in scientific journals, while five were reports identified through secondary literature search. Prostate cancer incidence was found to be higher in urban men, while mortality patterns seemed to vary to some degree depending on different definitions of rural/urban groups, as well as on variations in demographic factors and study periods. There is evidence, however, that after prostate-specific antigen testing was introduced death rates tended to be higher in rural men with prostate cancer.
CONCLUSIONS
The review of the literature showed that in spite of inconsistent definitions of rural/urban categories among studies the majority reported higher incidence rates in urban men. This finding suggests that rural men are less likely to be screened and less likely to be subsequently diagnosed with prostate cancer. Although mortality patterns tended to be heterogeneous, there was some evidence that rural residents with prostate cancer experience higher death rates. It would be beneficial if future studies take into consideration factors such as stage at initial diagnosis, ethnicity, and socioeconomic and health status when assessing differences in cancer outcomes. Few studies in this review accounted for one or more of these variables, although there are indications that they contribute to differences in prostate cancer incidence and mortality between rural and urban populations.
Topics: Cohort Studies; Humans; Incidence; Male; Mass Screening; Prostatic Neoplasms; Rural Population; Urban Population
PubMed: 22616627
DOI: No ID Found -
BMJ (Clinical Research Ed.) Sep 2010To examine the evidence on the benefits and harms of screening for prostate cancer. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To examine the evidence on the benefits and harms of screening for prostate cancer.
DESIGN
Systematic review and meta-analysis of randomised controlled trials.
DATA SOURCES
Electronic databases including Medline, Embase, CENTRAL, abstract proceedings, and reference lists up to July 2010. Review methods Included studies were randomised controlled trials comparing screening by prostate specific antigen with or without digital rectal examination versus no screening. Data abstraction and assessment of methodological quality with the GRADE approach was assessed by two independent reviewers and verified by the primary investigator. Mantel-Haenszel and inverse variance estimates were calculated and pooled under a random effects model expressing data as relative risks and 95% confidence intervals.
RESULTS
Six randomised controlled trials with a total of 387 286 participants that met inclusion criteria were analysed. Screening was associated with an increased probability of receiving a diagnosis of prostate cancer (relative risk 1.46, 95% confidence interval 1.21 to 1.77; P<0.001) and stage I prostate cancer (1.95, 1.22 to 3.13; P=0.005). There was no significant effect of screening on death from prostate cancer (0.88, 0.71 to 1.09; P=0.25) or overall mortality (0.99, 0.97 to 1.01; P=0.44). All trials had one or more substantial methodological limitations. None provided data on the effects of screening on participants' quality of life. Little information was provided about potential harms associated with screening.
CONCLUSIONS
The existing evidence from randomised controlled trials does not support the routine use of screening for prostate cancer with prostate specific antigen with or without digital rectal examination.
Topics: Age Factors; Aged; Aged, 80 and over; Cause of Death; Digital Rectal Examination; Evidence-Based Medicine; Humans; Male; Mass Screening; Middle Aged; Prostatic Neoplasms; Randomized Controlled Trials as Topic
PubMed: 20843937
DOI: 10.1136/bmj.c4543 -
Frontiers in Endocrinology 2023econd-generation androgen receptor inhibitors (SGARIs), namely enzalutamide, apalutamide, and darolutamide, are good for improving survival outcomes in prostate cancer... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
econd-generation androgen receptor inhibitors (SGARIs), namely enzalutamide, apalutamide, and darolutamide, are good for improving survival outcomes in prostate cancer patients, but some researchers have shown that using SGARIs increases side effects, which complicates clinicians' choice of. Therefore, we performed this network meta-analysis to assess the efficacy and toxicity of several SGARIs in the treatment of patients with metastatic hormone-sensitive prostate cancer (mHSPC), non-metastatic castration-resistant prostate cancer (nmCRPC), and metastatic castration-resistant prostate cancer (mCRPC).
METHODS
We searched PubMed, EMBASE and Cochrane Library databases from January 2000 to December 2022 to identify randomized controlled studies associated with SGARIs. We use Stata 16.0 and R 4.4.2 for data analysis, hazard ratio (HR) with 95% confidence intervals (CI) were used to assess the results.
RESULTS
This meta-analysis included 7 studies with a total of 9488 patients. In mHSPC, enzalutamide and darolutamide had a positive effect on overall survival (OS) (HR, 0.70; 95% CI, 0.59-0.82), but we did not find a difference in their efficacy to improve OS (HR, 1.19; 95% CI, 0.75-1.89). Also in nmCRPC, enzalutamide, apalutamide and darolutamide were beneficial for metastasis-free survival (MFS) (HR, 0.32; 95% CI, 0.25-0.41). Compared to darolutamide, enzalutamide (HR, 0.71; 95% CI, 0.54-0.93) and apalutamide (HR, 0.68; 95% CI, 0.51-0.91) prolonged MFS, but there was no difference in efficacy between enzalutamide and apalutamide (HR, 0.97; 95% CI, 0.73-1.28). Finally in mCRPC, there was no significant difference in indirect effects on OS between pre- and post-chemotherapy enzalutamide (HR, 0.89; 95% CI, 0.70-1.13). However, using enzalutamide before chemotherapy to improve radiographic progression-free survival (rPFS) was a better option (HR, 2.11; 95% CI, 1.62-2.73).
CONCLUSION
The SGARIs used in each trial were beneficial for the primary endpoint in the study. Firstly there was no significant difference in the effect of enzalutamide and darolutamide in improving OS in patients with mHSPC. Secondly improving MFS in patients with nmCRPC was best achieved with enzalutamide and apalutamide. In addition both pre- and post-chemotherapy use of enzalutamide was beneficial for OS in mCRPC patients, but for improving rPFS pre-chemotherapy use of enzalutamide should be preferred.The INPLASY registration number of this systematic review is INPLASY202310084.
Topics: Male; Humans; Prostatic Neoplasms, Castration-Resistant; Receptors, Androgen; Network Meta-Analysis; Phenylthiohydantoin; Androgen Receptor Antagonists
PubMed: 36967752
DOI: 10.3389/fendo.2023.1134719 -
Medicine Jul 2018The relationship between male pattern baldness and incidence of prostate cancer remains inconclusive. Hence, we performed the present meta-analysis based on all eligible... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The relationship between male pattern baldness and incidence of prostate cancer remains inconclusive. Hence, we performed the present meta-analysis based on all eligible cohort and case-control studies.
METHODS
A comprehensive literature search was performed in October 2017 based on PubMed and Web of Science databases. Pooled relative risk (RR) and its 95% confidence interval (95% CI) was calculated with a DerSimonian and Laird random-effects model.
RESULTS
A total of 15 studies were included in this meta-analysis. Overall, no statistically significant association between baldness (any pattern) and prostate cancer risk was identified (RR: 1.03, 95% CI 0.96-1.11). There was obvious heterogeneity across included studies (P < .078 for heterogeneity, I = 36.4%). When subgroup analysis by types of baldness, a statistically significant association was observed for vertex baldness (RR 1.24, 95% CI 1.05-1.46) but not for other types of baldness.
CONCLUSION
Individuals with vertex baldness may have an increased risk of prostate cancer. Given the obvious heterogeneity and null results in overall analysis and most of subgroup analyses, further large well-designed prospective cohort studies are warranted to confirm our preliminary findings.
Topics: Alopecia; Humans; Incidence; Male; Prostatic Neoplasms; Risk Factors
PubMed: 29995779
DOI: 10.1097/MD.0000000000011379 -
Andrology Jul 2015The results of published literature focusing on the association between vasectomy and the incidence of prostate cancer are often inconsistent. We conducted a... (Meta-Analysis)
Meta-Analysis Review
The results of published literature focusing on the association between vasectomy and the incidence of prostate cancer are often inconsistent. We conducted a meta-analysis to provide a quantitative assessment of the association between vasectomy and the risk of prostate cancer. We identified all cohort studies by searching the PubMed, Embase, and Cochrane Library before August 2014. The quality of the studies was evaluated using the Newcastle-Ottawa Scale checklist. Summary effect estimates with 95% confidence intervals (CI) were derived using a fixed or random effects model, depending on the heterogeneity of the included studies. Nine cohort studies that spanned across two continents involving 1 127 096 participants (ages 20-75) with 7539 cases of prostate cancer cases were included in the meta-analysis. The overall combined relative risks for men with the reference group were 1.08 (95% CI: 0.87-1.34) in a random effects, however, the association was not statistically significant (p = 0.48). Estimates of total effects were generally consistent in the sensitivity and subgroup analyses. No evidence of publication bias was observed. This meta-analysis indicated that vasectomy may not contribute to the risk of prostate cancer. The conclusion might have a far-reaching significance for the public health, especially in countries with high prevalence rates of vasectomy.
Topics: Cohort Studies; Humans; Male; Prostatic Neoplasms; Vasectomy
PubMed: 26041315
DOI: 10.1111/andr.12040 -
Swiss Medical Weekly 2018Men facing prostate cancer screening and treatment need to make critical and highly preference-sensitive decisions that involve a variety of potential benefits and... (Review)
Review
INTRODUCTION
Men facing prostate cancer screening and treatment need to make critical and highly preference-sensitive decisions that involve a variety of potential benefits and risks. Shared decision-making (SDM) is considered fundamental for "preference-sensitive" medical decisions and it is guideline-recommended. There is no single definition of SDM however. We systematically reviewed the extent of SDM implementation in interventions to facilitate SDM for prostate cancer screening and treatment.
METHODS
We searched Medline Ovid, Embase (Elsevier), CINHAL (EBSCOHost), The Cochrane Library (Wiley), PsychINFO (EBSCOHost), Scopus, clinicaltrials.gov, ISRCTN registry, the WHO search portal, ohri.ca, opengrey.eu, Google Scholar, and the reference lists of included studies, clinical guidelines and relevant reviews. We also contacted the authors of relevant abstracts without available full text. We included primary peer-reviewed and grey literature of randomised controlled trials (RCTs) reported in English, conducted in primary and specialised care, addressing interventions aiming to facilitate SDM for prostate cancer screening and treatment. Two reviewers independently selected studies, appraised interventions and assessed the extent of SDM implementation based on the key features of SDM, namely information exchange, deliberation and implementation. We considered bi-directional deliberation as a central and mandatory component of SDM. We performed a narrative synthesis.
RESULTS
Thirty-six RCTs including 19 196 randomised patients met the eligibility criteria; they were mainly conducted in North America (n = 28). The median year of publication was 2008 (1997-2015). Twenty-three RCTs addressed decision-making for screening, twelve for treatment and one for both screening and treatment for prostate cancer. Bi-directional interactions between healthcare providers and patients were verified in 31 RCTs, but only 14 fulfilled the three key SDM features, 14 had at least "deliberation", one had "unclear deliberation" and two had no signs of deliberation.
CONCLUSIONS
There is significant variation in the extent of SDM implementation among studies addressing SDM for prostate cancer screening and treatment. Further evaluation of these results on patient outcomes, a standardised SDM definition and guidance for an effective implementation in several clinical settings are needed.
Topics: Decision Making; Early Detection of Cancer; Health Personnel; Humans; Male; Mass Screening; Patient Participation; Prostatic Neoplasms; Randomized Controlled Trials as Topic
PubMed: 29473938
DOI: 10.4414/smw.2018.14584 -
Ethiopian Journal of Health Sciences May 2023Globally prostate cancer is one of the most prevalent cancer among men and a leading cause of morbidity and mortality, especially in a developing country, which is... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Globally prostate cancer is one of the most prevalent cancer among men and a leading cause of morbidity and mortality, especially in a developing country, which is mainly due to lack of knowledge and awareness regarding the screening of prostate cancer. The main objective of this review and meta-analysis is to evaluate the knowledge, awareness and practice of adult men about prostate cancer.
METHOD
An extensive literature search was performed on studies published between January 2000 to 2021. The systematic review initially yielded 137 studies, out of which 7 studies were covered on this meta-evaluation.
RESULT
We noted that the pooled estimate of knowledge and awareness were respectively 65% [CI: 29%, 100%], and 74% [CI: 66%, 82%] about prostate cancer. However, there were limited practices noted in screening of prostate cancer.
CONCLUSION
In order to increase the awareness and screening practice rate for prostate cancer, an improved health education is highly recommended.
Topics: Male; Adult; Humans; Early Detection of Cancer; Prostatic Neoplasms; Health Knowledge, Attitudes, Practice; Health Education
PubMed: 37576174
DOI: 10.4314/ejhs.v33i3.19 -
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 -
Nutricion Hospitalaria Jun 2023Objective: the purpose of this study was to assess the impact of 14 treatments including a total of 10 dietary antioxidants on the risk of prostate cancer. Material and... (Meta-Analysis)
Meta-Analysis
Objective: the purpose of this study was to assess the impact of 14 treatments including a total of 10 dietary antioxidants on the risk of prostate cancer. Material and methods: we searched PubMed, Embase, the Cochrane Library, and the Web of Science for only randomized controlled trials (RCTs) to investigate the effect of these 10 antioxidants on the risk of getting prostate cancer. Using the Cochrane Risk of Bias Assessment Tool, the methodological quality of the included studies was evaluated. Data extraction: studies were appraised by two investigators and data were extracted. Using a surface under cumulative ranking (SUCRA) probability, a Bayesian network meta-analysis was undertaken to evaluate the relative ranking of agents. Results: from the earliest accessible date through August 2022, RCTs were gathered. A total of 14 randomized controlled trials were included with a total sample size of 73,365 males. The results of the network meta-analysis showed that green tea catechins (GTCs) significantly reduced the risk of prostate cancer (SUCRA, 88.6 %) followed by vitamin D (SUCRA, 55.1 %), vitamin B6 (54.1 %), and folic acid was the lowest (22.0 %). Conclusion: based on the Ranking Plot of the Network, we can state that GTCs might have an impact on the prevention of prostate cancer compared to other dietary antioxidants, but we still need quality literature to further prove it.
Topics: Male; Humans; Antioxidants; Network Meta-Analysis; Vitamins; Folic Acid; Prostatic Neoplasms
PubMed: 37154035
DOI: 10.20960/nh.04558 -
Annals of Internal Medicine Mar 2008The comparative effectiveness of localized prostate cancer treatments is largely unknown. (Review)
Review
BACKGROUND
The comparative effectiveness of localized prostate cancer treatments is largely unknown.
PURPOSE
To compare the effectiveness and harms of treatments for localized prostate cancer.
DATA SOURCES
MEDLINE (through September 2007), the Cochrane Library (through Issue 3, 2007), and the Cochrane Review Group in Prostate Diseases and Urologic Malignancies registry (through November 2007).
STUDY SELECTION
Randomized, controlled trials (RCTs) published in any language and observational studies published in English that evaluated treatments and reported clinical or biochemical outcomes in localized prostate cancer.
DATA EXTRACTION
2 researchers extracted information on study design, sample characteristics, interventions, and outcomes.
DATA SYNTHESIS
18 RCTs and 473 observational studies met inclusion criteria. One [one randomized controlled trial] [corrected] RCT enrolled mostly men without prostate-specific antigen (PSA)-detected disease and reported that, compared with watchful waiting, radical prostatectomy reduced crude [corrected] all-cause mortality (24% vs. 30%; P = 0.04) and prostate cancer-specific mortality (10% [corrected] vs. 15% [corrected]; P = 0.01) at 10 years [corrected] Effectiveness was limited to men younger than age 65 years but was not associated with Gleason score or baseline PSA level. An older, smaller trial found no significant overall survival differences between radical prostatectomy and watchful waiting (risk difference, 0% [95% CI, -19% to 18%]). Radical prostatectomy reduced disease recurrence at 5 years compared with external-beam radiation therapy in 1 small, older trial (14% vs. 39%; risk difference, 21%; P = 0.04). No external-beam radiation regimen was superior to another in reducing mortality. No randomized trials evaluated primary androgen deprivation. Androgen deprivation used adjuvant to radical prostatectomy did not improve biochemical progression compared with radical prostatectomy alone (risk difference, 0% [CI, -7% to 7%]). No randomized trial evaluated brachytherapy, cryotherapy, robotic radical prostatectomy, or photon-beam or intensity-modulated radiation therapy. Observational studies showed wide and overlapping effectiveness estimates within and between treatments. Adverse event definitions and severity varied widely. The Prostate Cancer Outcomes Study reported that urinary leakage (> or =1 event/d) was more common with radical prostatectomy (35%) than with radiation therapy (12%) or androgen deprivation (11%). Bowel urgency occurred more often with radiation (3%) or androgen deprivation (3%) than with radical prostatectomy (1%). Erectile dysfunction occurred frequently after all treatments (radical prostatectomy, 58%; radiation therapy, 43%; androgen deprivation, 86%). A higher risk score incorporating histologic grade, PSA level, and tumor stage was associated with increased risk for disease progression or recurrence regardless of treatment.
LIMITATIONS
Only 3 randomized trials compared effectiveness between primary treatments. No trial enrolled patients with prostate cancer primarily detected with PSA testing.
CONCLUSION
Assessment of the comparative effectiveness and harms of localized prostate cancer treatments is difficult because of limitations in the evidence.
Topics: Androgen Antagonists; Brachytherapy; Cause of Death; Disease Progression; Humans; Male; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms; Radiotherapy
PubMed: 18252677
DOI: 10.7326/0003-4819-148-6-200803180-00209