The incidence of prostate cancer in Iran: a systematic review and meta-analysis

Providing a Prostate Cancer Detection and Prevention Method With Developed Deep Learning Approach

Introduction: Prostate cancer is the second most common cancer among men worldwide. This cancer has become extremely noticeable due to the increase of prostate cancer in Iranian men in recent years due to the lack of marriage and sexual intercourse, as well as the abuse of hormones in sports without any standards. Methods: The histopathology images from a treatment center to diagnose prostate cancer are used with the help of deep learning methods, considering the two characteristics of Tile and Grad-CAM. The approach of this research is to present a prostate cancer diagnosis model to achieve proper performance from histopathology images with the help of a developed deep learning method based on the manifold model. Results: Similarly, in addition to the diagnosis of prostate cancer, a study on the methods of preventing this disease was investigated in literature reviews, and finally, after simulation, prostate cancer presentation factors were determined. Conclusions: The simulation results indicated that the proposed method has a performance advantage over the other state-of-the-art methods, and the accuracy of this method is up to 97.41%.

Evaluation of several farnesyloxycarbostyril derivatives as potential 15-LOX-1 inhibitors for prostate cancer treatment

The impact of 15-lipoxygenase-1 (15-LOX-1) in the progression of prostate cancer (PCa) is noteworthy, as it correlates with the Gleason score of the disease. Thus, development of specific 15-LOX-1 inhibitors would be desirable for targeted therapy of PCa. This study focused on evaluating the anti-prostate cancer potency of three farnesyloxycarbostyril derivatives, 6-, 7- and 8-farnesyloxycarbostyril (6-, 7- and 8-FQ), as potential inhibitors of 15-LOX-1 on PCa cells. To this end, the enzymatic activity of 15-LOX was first assessed in PCa and human dermal fibroblast (HDF) cells. Subsequently, the cytotoxic effects and apoptosis-inducing capabilities of the compounds were assessed through MTT assay and FITC-annexin V/PI staining, respectively. Among the compounds, 8-FQ was selected for further assessment in a mouse model bearing xenograft human PCa tumor. The results demonstrated that the most effective compound, 8-FQ, caused an 84-fold and 15.7-fold reduction in 15-LOX activity in PC-3 cells at 30 and 14 μM concentrations, respectively. The MTT assay revealed a dose- and time-dependent toxicity of the compounds on PCa cells, and flow cytometry results indicated that apoptosis served as the dominant mechanism of cell death. Given the upregulation of 15-LOX-1 in human PCa cells, the study concludes that the heightened sensitivity to 8-FQ is likely associated with elevated levels of 15-LOX-1. In vivo experiments using immunosuppressed C57BL/6 mice bearing human PC-3 tumors revealed that 8-FQ, at a dosage of 10 mg/kg, exhibited strong antitumor effects with minimal side effects, indicating its potential as a promising therapeutic agent for PCa following further optimization.

Epidemiology of Burden of Prostate Cancer in Iran during 2009-2019: Estimates from the Global Burden of Disease Study 2019

Background

Prostate cancer (PC) is the second most common cancer in men and the fifth leading cause of death worldwide. The purpose of this study is to investigate the epidemiological situation concerning the incidence, prevalence, and burden of prostate cancer in Iran from 2009 to 2019.

Methods

The present research is a descriptive-analytical study. To assess the spatial distribution of prostate cancer, data on the incidence, mortality, Disability-adjusted life years (DALY), Years of Life Lost due to premature mortality (YLL), and Years of Life Lost due to disability (YLD) in each province of Iran from 2009 to 2019 were obtained from the Global Burden of Disease (GBD) 2019 website. The incidence and mortality zoning in Iran was mapped using the ArcGIS 10.3 environment. The two-variable Pearson correlation coefficient was used to analyze the data extracted to study the correlation between PC and the Human Development Index.

Results

The highest Age-Standardized Incidence Rate (ASIR) of prostate cancer (40.55 per 100,000), mortality (17.09 per 100,000), YLL (254.1 per 100,000), YLD (23.88 per 100,000), and DALY (277.98 per 100,000) is related to Bushehr province. The results of the Pearson correlation reveal a positive and statistically significant correlation between the ASIR of prostate cancer and the Human Development Index (r=0.651, P=0.0001) in Iran. The highest Percentage of Annual Changes (PAC) in ASIR, Age-Standardized Mortality Rate (ASMR), Age-Standardized Prevalence Rate (ASPR), YLL, YLD, and DALY were related to the provinces of West Azarbayejan (62.9%), Golestan (30.86%), West Azarbayejan (87.66%), Golestan (29.38%), West Azarbayejan (76.95%), and Alborz (31.45%), respectively.

Conclusion

The incidence and mortality rates of prostate cancer in all provinces of the country are on the rise. Therefore, screening programs for early detection to reduce the mortality of the disease, and etiology studies to identify the causes of increased incidence and related factors, can be effective in controlling this cancer in the country.

A Clinicopathologic Study of 1598 Ultrasound-Guided Needle Prostate Biopsies and Trends in Prostate Cancer Over a 14-Year Period

BACKGROUND

Prostate cancer manifests in various forms, ranging from occult and localized to metastatic disease. Analyzing prostate biopsies offers insights into histopathological characteristics, enhancing disease understanding and management.

METHODS

This 14-year study reviewed ultrasound-guided needle prostate biopsies, collecting data via questionnaires and medical records, focusing on Gleason group, tumor involvement percentage, and predicted cancer stage. A comparative analysis across 2 distinct 7-year intervals was conducted. Statistical analyses included the Kolmogorov-Smirnov test, chi-square test, Fisher's exact test, and Analysis of Covariance, all performed using SPSS software.

RESULTS

Among 1,598 biopsies, 624 cases of adenocarcinoma were identified. Malignancy incidence significantly correlated positively with age, prostate-specific antigen (PSA), and PSA density (PSAD), and inversely with prostate volume and the free-to-total PSA ratio (%fPSA). Notably, 30.8% of malignancies were classified as Gleason groups 4 or 5, displaying significantly higher PSA levels. Patients with prior transurethral resection of the prostate exhibited increased malignancy rates and higher Gleason groups. Diagnostic accuracy, measured by Area Under the Curve, was 0.719 for PSA, 0.730 for %fPSA, and 0.817 for PSAD. The later phase of the study showed higher cancer detection, lower PSA levels, and a greater incidence of higher Gleason groups despite a lower predicted stage.

CONCLUSION

The prevalence of higher Gleason groups was similar to other studies. PSAD demonstrated greater diagnostic reliability than PSA alone. Additionally, higher malignancy rates and Gleason groups were observed in patients with prior transurethral resection of the prostate. The increase in cancer detection rates during the second period likely indicates improved biopsy candidate selection.

Investigating the Relationship of G-137C, C-607A, and A-1447G Polymorphisms in the Promoter of IL-18 and CXCL10 Inflammatory Genes with Prostate Cancer in an Iranian Population

Introduction

Genetic and environmental factors are involved in prostate cancer. The current study was conducted to study the relationship between G-137C, C-607A, and A-1447G polymorphisms in the promoter of IL-18 and CXCL10 inflammatory genes with prostate cancer.

Methods

As a genetic association study with a case-control design, the genomes of people living in Khorasan, Iran, were compared in two groups of cases and controls. The genotype of the A-1447G polymorphism present in the CXCL10 gene promoter was investigated by the PCR-RFLP method. PCR-SSP was used to study the genotype of G-137C and C-607A polymorphisms present in the IL-18 gene promoter. Odds ratio (OR) and 95% confidence interval (CI) were reported.

Results

One mutant allele in CXCL10 A-1447G polymorphism (AG) increased the chance of cancer (OR = 4.902, 95% CI = 2.70-8.87) and two mutant alleles (GG) increased more (OR = 7.174, 95% CI = 2.48-20.68). One mutant allele in IL-18 G-137C polymorphism (CG) increased the chance of cancer (OR = 5.583, 95% CI = 3.04-10.22) and two mutant alleles (CC) increased more (OR = 9.571, 95% CI = 3.10-29.46). One mutant allele in IL-18 C607A polymorphism (CA) increased the chance of cancer (OR = 5.359, 95% CI = 2.95-9.70) and two mutant alleles (AA) increased more (OR = 7.083, 95% CI = 2.61-19.15) (P < 0.001).

Conclusion

According to the results, the mutant alleles in polymorphisms CXCL10 A-1447G, IL-18 G-137C, and IL-18 C-607A alleles were associated with an increased chance of prostate cancer in this population.

The association between healthy diet indicator and phytochemical index with prostate cancer odds ratio: a case-control study

BACKGROUND AND OBJECTIVE

Healthy diets and diets rich in phytochemicals can have health-promoting benefits in prostate cancer. Therefore, this study aimed to explore the possible association between Healthy Diet Indicator (HDI) and Phytochemical Index (PI) with prostate cancer odds ratio.

METHODS

This is a case-control study conducted in Shiraz, Iran, involving 62 newly diagnosed prostate cancer cases and 63 hospital-based controls. The study collected demographic and anthropometric data, as well as dietary intake information via a semi-quantitative food frequency questionnaire. Logistic regression models were employed to evaluate the association between HDI and PI with prostate cancer.

RESULTS

The study included 120 participants and found that individuals with higher HDI and PI scores had a lower odds ratio of prostate cancer (HDI: odds ratio (OR): 0.322 - confidence interval (CI) 95%: 0.14-0.700 - PI: OR: 0.426 - CI 95%: 0.204-0.888). After adjusting for potential confounders, a lower odds ratio of prostate cancer was observed specifically among those with higher HDI scores (OR: 0.376 - CI 95%: 0.163-0.868).

CONCLUSION

The findings of the present study suggest that adopting healthier dietary habits rich in dietary phytochemicals could be effective in preventing and halting the progression of prostate cancer.

Cost-effectiveness and budget impact analysis of enzalutamide in comparison to abiraterone in treatment of metastatic prostate cancer resistant to castration in Iran

INTRODUCTION

In recent years, enzalutamide and abiraterone have been widely used as treatments for metastatic castration-resistant prostate cancer (mCRPC). However, the cost-effectiveness of these drugs in Iran is unknown. This study evaluated the cost-effectiveness of enzalutamide for the treatment of metastatic prostate cancer resistant to castration in Iran.

METHODS

A 3-state Markov model was developed to evaluate the cost-effectiveness of enzalutamide and abiraterone from a social perspective over 10 years. The clinical inputs were obtained from the meta-analysis studies. The direct medical costs were obtained from the tariffs of the healthcare system, while the direct non-medical and indirect costs were collected from the patients. The data of utilities were derived from the literature. In addition, sensitivity analyses were conducted to assess the uncertainties.

RESULTS

Compared with Abiraterone, enzalutamide was associated with a high incremental cost-effectiveness ratio (ICER) of $6,260 per QALY gained. According to the one-way sensitivity analysis, ICER was most heavily influenced by the prices of enzalutamide and Abiraterone, non-medical costs, and indirect costs. Regardless of the variation, enzalutamide remained cost-effective. The budget impact analysis of enzalutamide in the health system during 5 years was estimated at $6,362,127.

CONCLUSIONS

At current prices, adding enzalutamide to pharmaceutical lists represents the cost-effective use of the healthcare resources in Iran for the treatment of metastatic castration-resistant prostate cancer.

Cancer patterns in Iran: a gender-specific spatial modelling of cancer incidence during 2014-2017

BACKGROUND

Cancer is a significant public health concern and the second leading cause of death. This study aims to visualize spatial patterns of top common cancer types and identify high-risk and low-risk counties for these cancers in Iran from 2014 to 2017.

METHODS

In this study, we analyzed 482,229 newly diagnosed cancer cases recorded by the Iranian National Population-Based Cancer Registry from 2014 to 2017. We employed a purely spatial scanning model and local Moran I analysis to explore spatial patterns across Iran.

RESULTS

Approximately 53% of all cases were male. The average age of cancer diagnosis was 62.58 ± 17.42 years for males and 56.11 ± 17.33years for females. Stomach cancer was the most common cancer in men. The northern and northwestern regions of Iran were identified as high-risk areas for stomach cancer in both genders, with a relative risk (RR) ranging from 1.26 to 2.64 in males and 1.19 to 3.32 in females. These areas recognized as high-risk areas for trachea, bronchus, and lung (TBL) cancer specifically in males (RR:1.15-2.02). Central regions of Iran were identified as high-risk areas for non-melanoma skin cancers in both genders, ranking as the second most common cancer (RR:1.18-5.93 in males and 1.24-5.38 in females). Furthermore, bladder cancer in males (RR:1.32-2.77) and thyroid cancer in females (RR:1.88-3.10) showed concentration in the central part of Iran. Breast cancer, being the most common cancer among women (RR:1.23-5.54), exhibited concentration in the northern regions of the country. Also, northern regions of Iran were identified as high-risk clusters for colon cancer (RR:1.31-3.31 in males and 1.33-4.13 in females), and prostate cancer in males (RR:1.22-2.31). Brain, nervous system cancer, ranked sixth among women (RR:1.26-5.25) in central areas.

CONCLUSIONS

The study's revelations on the spatial patterns of common cancer incidence in Iran provide crucial insights into the distribution and trends of these diseases. The identification of high-risk areas equips policymakers with valuable information to tailor targeted screening programs, facilitating early diagnosis and effective disease control strategies.

Finding the PSA-based screening stopping age using prostate cancer risk

BACKGROUND

Prostate Cancer screening was not rational for people who were suffered from other serious diseases and had a low quality of life. Biopsy and Prostate-Specific Antigen based screening also had imperfect information, pain, and costs. Finding the Prostate Cancer screening stopping age was important because after an age, Prostate-Specific Antigen test was not recommended and patients should not perform subsequent procedures. It could reduce the economic burden of Prostate Cancer. In this study, we modeled the effects of Prostate Cancer risk and comorbidities on the Prostate Cancer screening stopping age.

METHODS

first, using a Markov model for PC progression, we provided a model for optimal Prostate Cancer screening stopping age. Second, we explored the relationship between comorbidities effects, Prostate Cancer risk and the stopping age.

RESULTS

Our results suggest that the stopping age was an increasing function of PC risk and comorbidities effects. Screening should be stopped before 70 years. Finding showed that for men with diseases such as stroke or heart diseases, screening should not be performed at any age.

CONCLUSIONS

Personalizing PC screening through paying more attention to PC risk can improve efficiency of screening. The role of personal characteristics such as race, family history, and previous PSA in PC screening decision-making was highlighted by stratifying men in different PC risk groups to find their stopping age. Incorporating comorbidity effects shows that severity of comorbidity was a crucial factor in PC screening stopping age decision-making process.

Optimal age to stop prostate cancer screening and early detection

BACKGROUND

Prostate Cancer screening should be discontinued at older ages because competing mortality risks eventually dominate the risk of Prostate Cancer and harms exceed benefits. We explored the Prostate Cancer screening stopping age from the patient, healthcare system, and social perspectives in Iran.

METHODS

We applied Bellman Equations to formulate the net benefits biopsy and "do nothing". Using difference between the net benefits of two alternatives, we calculated the stopping age. The cancer states were without cancer, undetected cancer, detected cancer, metastatic cancer, and death. To move between states, we applied Markov property. Transition probabilities, rewards, and costs were inferred from the medical literature. The base-case scenario estimated the stopping age from the patient, healthcare system, and social perspectives. A one-way sensitivity used to find the most influential parameters on the stopping age.

RESULTS

Our results suggested that Prostate Cancer screening stopping ages from the patient, healthcare system, and social were 70, 68, and 68 respectively. The univariate sensitivity analysis showed that the stopping ages were sensitive to the disutility of treatment, discount factor, the disutility of metastasis, the annual probability of death from other causes, and the annual probability of developing metastasis from the hidden cancer state.

CONCLUSIONS

Men should not be screened for Prostate Cancer beyond 70 years old, as this results in the net benefit of "do nothing" above the biopsy. Nevertheless, this finding needs to be further studied with more detailed cancer progression models (considering re-biopsy, comorbidities, and more complicated states transition) and using local utility and willingness to pay value information.

Cancer incidence in Southern Iran, 2015-2018: A population based study on cancer registry profile of Fars province

Background and Aims

Cancer registry profiles provide an insight into the trend of cancer in a specific region. The present study aimed to report the cancer incidence in Fars during 2015-2018, based on the cancer registry of Fars province.

Methods

The present population-based study electronically gathered new cancer patient's data from all pathology, radiology, radiotherapy, chemotherapy departments, and mortality data of Fars province. This electronic connection was first established in 2015, in Fars Cancer Registry database. After data gathering, all duplicated patients are removed from the database. The Fars Cancer Registry database includes data such as gender, age, cancer ICD-O code, and city from March 2015 to 2018. Furthermore, the death certificate only (DCO%) and microscopic verification (MV%) were calculated using SPSS software.

Results

A total of 34,451 patients with cancer were registered in the Fars Cancer Registry database during these 4 years. Among these patients, 51.9% (n = 17,866) were male, and 48.1% (n = 16,585) were female. Furthermore, the mean age of patients with cancer was about 57.3 ± 19 (60.50 ± 19 in males, 53.86 ± 18 in females). In men, prostate, skin (non-melanoma), bladder, colon and rectum, and stomach are the most common cancers. Also, in women, breast, skin (non-melanoma), thyroid gland, colon and rectum, and uterus were the most common cancers in the studied population.

Conclusion

Overall, breast, prostate, skin (non-melanoma), colon and rectum, and thyroid cancers were the most common cancers among the studied population. Healthcare decision-makers could make evidence-based policies to decrease cancer incidence based on the reported data.

Human BKV large T genome detection in prostate cancer and benign prostatic hyperplasia tissue samples by nested PCR: A case-control study

Human BK polyomavirus (BKPyV) is a latent infectious agent in the genitourinary tract associated with hemorrhagic cystitis and nephropathy. This virus can be a risk factor for various human malignancies, including prostate cancer (PCa). It may contribute to prostate cancer development, as it demonstrates oncogenic properties by encoding oncoproteins. This study assessed the prevalence of this virus in benign and malignant prostate tissues. Between 2009 and 2019, 49 formalin-fixed paraffin-embedded (FFPE) PCa and 49 benign prostatic hyperplasia (BPH) samples were gathered from the pathology department of a tertiary care university hospital. They were used as cases and controls, respectively. After deparaffinization and DNA extraction, nested PCR was applied to identify the BKPyVgp5 gene (LTAg) using inner and outer primers. The nested PCR showed a 278-bp bond corresponding to the BKPyVgp5 genome (LTAg) in 53.1% (26/49) of PCa and 14.3% (7/49) of BPH (p<0.001). The presence of BKV was significantly associated with an increased risk of PCa development (OR=6.78, 95% CI=2.55-18.02, p<0.001). The BKV LTAg gene was significantly more prevalent in PCa samples than in BPH samples. These results demonstrate the presence of the virus in prostate cancer tissues.

The Impact of Environmental Factors on Skin Cancer

Background: Skin cancer, as one of the most common cancers, is partly associated with environmental conditions. Objectives: The main purpose of this study was to investigate the effect of environmental factors on the incidence of skin cancer. Methods: The dataset contains the age-standardized incidence rate (ASR) of skin cancer in all provinces of Iran during a six-year period of time. Also, there were meteorological variables for a 29-year period for the provinces. We used the mean of meteorological variables for the 29-year period for each province as predictors. The ASR of skin cancer in each province in six years was considered as the response variable. Also, gender, latitude, altitude, wind speed, relative humidity, cloudy hours duration, and maximum air temperature in each province were considered independent variables. A mixed effects polynomial regression model was applied to data analysis. Results: Based on the applied model, the trend of ASR of skin cancer in different provinces was statistically significant (P < 0.001). The ASR of skin cancer for males was more than the females (P < 0.001). Furthermore, the positive linear effect of latitude was significant (P = 0.002). However, the quadratic term showed a deceleration in the growth rate of skin cancer incidence with increasing latitude. Furthermore, there was a positive significant impact of altitude on skin cancer incidence (P = 0.045). Conclusions: Health policymakers in their prevention planning should consider geographical conditions as influencing factors on skin cancer incidence. Moreover, men should be given more attention as the main group at risk for this cancer.

Evaluation of secondary cancers, synchronous and metachronous with bladder cancer

The number of bladder cancer survivors worldwide is increasing due to the advancement of diagnostic methods and bladder cancer treatment. Besides, bladder cancer is the sixth most common cancer in Iran. Nowadays, many secondary cancers have been proven with bladder cancer. This study focused on synchronous and metachronous cancers with bladder cancer. This study was performed retrospectively. A total of 276 patients with a definitive diagnosis of bladder cancer were included in the study. Tumors were diagnosed using ultrasound and cystoscopy. Out of 276 patients with bladder tumor, 240 underwent resection, 25 underwent radical cystectomy, and 31 underwent chemotherapy in addition to resection. The mean age of patients was 65±3.9 years. Among the patients, 184 were male (67%), and 92 were female (33%). Smoking was the most common known risk factor. There were 165 smokers, 135 of whom were male and 30 female. Sixty-nine patients had no known risk factor (P <0.05). Gastric cancer was the most common secondary cancer with bladder cancer in all individuals (5.7%). Prostate cancer (20%) in men and cervical cancer (11.9%) in women was the most common secondary cancer simultaneous with bladder cancer. Given the importance of SPC as a cause of cancer death, early detection and screening of primary cancer survivors will increase patients' life expectancy and quality of life.

Dietary supplements consumption and its association with socioeconomic factors, obesity and main non-communicable chronic diseases in the north of Iran: the PERSIAN Guilan Cohort Study (PGCS)

BACKGROUND

Dietary supplements (DSs) use have become a growing trend worldwide, and it may be affected by demographic and sociocultural factors. Some people use supplements with the thought that they can improve their health, reduce symptoms and prevent disease. The aim of the present study was to define the frequency of DS use and its association with socioeconomic factors among participants with selected main non-communicable chronic diseases (NCDs) (diabetes, cardiovascular disease (CVD), hypertension (HTN), cancers, and obesity in the north of Iran.

METHODS

This large cross-sectional study was conducted as a part of the PERSIAN Guilan cohort study. Supplement use during last year and its type, demographic factors, socioeconomic status, lifestyle habits were asked by face-to-face interview. The history of chronic disease was defined by a trained team. Data were analyzed using SPSS. The chance of supplement use according to demographic, socioeconomic, and lifestyle variables and history of chronic disease was analyzed by logistic regression.

RESULTS

10,520 men and women aged 35-70 years in Some'e Sara County (including urban regions and 39 villages) were studied. About 25% of participants consumed DSs. The highest consumption of DS was calcium/vitamin D (11.1%), ferrous sulfate (8.8%), and vitamin D pearl or ampoule (7.7%). The highest percent of the history of chronic disease was central obesity (62.7%), HTN (43.2%), and general obesity (32.7), respectively. After adjustment for confounders, those with female gender, the highest age ranges (55-65 and > 65 years), high academic education, living in urban regions, and good economic status were more likely to be DSs consumers; however, married and smoker subjects were more likely to consume DS. Participants who had a history of diabetes, HTN, CVD, Obesity, and Central Obesity were more likely to intake DS in comparison with healthy subjects.

CONCLUSION

This study showed that a quarter of the participants were DS users. Female sex, older age groups, and higher educated participants, and among chronic disease, patients with HTN, CVD, and diabetes were more likely to be users of any DS.

Prevalence of Human Polyomavirus BK Virus in Prostate Cancer Patients and Benign Prostatic Hyperplasia: A Cross-sectional Study on Prostate Patients Referred to Imam Khomeini Hospital in Ahvaz Between 2015 and 2017

Background: Human polyomavirus BK virus (BKV) belongs to the Polyomaviridae family and seems to be a drastic virus in prostate cancer (PCa) etiology. BK virus induces oncogenesis via the expression of large tumor antigen (LTAg) and small tumor antigen (stAg). Also, BKV infection seems to play an essential role in prostate cancer development. Objectives: In this study was aimed to study the prevalence of BKV in benign and cancerous prostate tissues. Methods: In this study, 100 formalin-fixed paraffin-embedded tissues of PCa specimens and benign prostatic hyperplasia (BPH) were collected. The DNA was extracted from tissue samples, and the BKV DNA was investigated using a semi-nested polymerase chain reaction (PCR). The MEGA 6.0 software was used for phylogenetic analysis to assemble the viral genome. A phylogenetic tree was constructed by neighbor-joining analysis with 1,000 replicates of the bootstrap resampling test. Results: The BKV DNA was found in 66% (33/50) of patients with PCa and 36% (18/50) of patients with benign prostatic hyperplasia (BPH) (P = 0.003). The frequency of BKV DNA in different classes of Gleason score (5 - 10) was not significant (0.094). The distribution of BKV DNA among different age groups was not significant (P = 0.086). Conclusions: High frequency of BKV infection was detected in patients with PCa compared to patients with BPH (P = 0.003), and the coexistence of BKV DNA was confirmed in 51% (51/100) of tissue samples, which were confirmed to be subtype 1 of BKV infection.

The Association between Dietary Diversity Score and Risk of Prostate Cancer: (A Case-Control Study)

There are few studies that evaluated the relationship between dietary diversity score (DDS) and risk of cancer. The purpose of this study was to examine the association of DDS with the risk of prostate cancer (PC) among Iranian men. This case-control study was performed among 60 cases with prostate cancer and 60 hospital-based controls. Anthropometric measurements were done and demographic information was recorded using standard protocols. A validated 160-item semi-quantitative food frequency questionnaire (FFQ) was used to assess usual dietary intakes. Also, Binary logistic regression was performed to estimate the risk of PC in relation to DDS. After controlling for several confounders (age, body mass index, physical activity, energy intake, job, education, and antihypertensive drugs usage) higher adherence to DDS (OR = 0.33; 95% CI (0.11-0.97)), fruits group (OR = 0.19; 95% CI (0.06-0.63)), and vegetables group (OR = 0.17; 95% CI (0.05 - 0.58)) were significantly associated with lower risk of PC. In contrast, greater adherence to the meat group (OR = 3.88; 95% CI (1.32-11.42)) was significantly associated with increased PC risk. Our results showed that adherence to a diet with higher DDS, especially higher amounts of fruits and vegetables and a lower amount of meat could decrease the risk of PC.

Evaluation of NUF2 and GMNN Expression in Prostate Cancer: Potential Biomarkers for Prostate Cancer Screening

BACKGROUND

Prostate cancer (PC) is one of the most abundant cancers among men, and In Iran, has been responsible for 6% of all deaths from cancer in men. NUF2 and GMNN genes are considered as loci of susceptibility to tumorigenesis in humans. Alterations in expression of these genes have been reported in various malignancies. The aim of our study was to test whether different NUF2 and GMNN expression levels are associated with PC incidence and hence, might be considered as new molecular tools for PC screening.

METHODS

Biopsy samples from 40 PC patients and 41 healthy Iranian men were used to determine the relative gene expression. After RNA extraction and cDNA synthesis, samples were analyzed using TaqMan Quantitative Real time PCR. Patients' background information, included smoking habits and family histories of PC, were recorded. Stages and grades of their PC were classified by the TNM tumor, node, metastasis (TMN) staging system based on standard guidelines.

RESULTS

NUF2 expression did not significantly differ between the groups, while GMNN expression was significantly greater in the PC specimens than in the controls.

CONCLUSION

Regarding the significant role of GMNN in various tumor phenotypes, and its importance in PC progression, the alteration in GMNN expression in PC samples vs. controls indicate that the genetic profiling of this cancer might be considered to personalize therapy for each patient in the future.

Prevalence of Human Papillomavirus (HPV) DNA among Men with Oropharyngeal and Anogenital Cancers: A Systematic Review and Meta-Analysis

OBJECTIVE

The term ''Human Papillomavirus'' or ''HPV'' has become synonymous with uterine cervical cancer leading to feminisation of all the preventive measures, especially immunisation. Taking into consideration the rising number of HPV associated cancers among men in many developed countries and the risk of transmission to women, male HPV infection is a serious concern. A systematic review and meta-analysis of literature was performed to determine the global prevalence of HPV among men with oropharyngeal and anogenital cancers.

METHODS

A systematic review and meta-analysis of literature was performed searching electronic databases for published articles in English between January 1984- April 2020 based on standard systematic review guidelines. The meta-analysis component was modified appropriately for the synthesis of prevalence study results. National Institutes of Health checklist for observational, cohort and cross-sectional studies was used to assess the quality of the studies selected after the abstract and content review. The meta-analysis was performed in STATA version 13.0 (College Station, Texas 77,845 USA) and the forest plots were constructed using metan package in STATA.

RESULTS

Through the electronic search of databases, 3486 original articles were screened for eligibility. Fifty-eight articles were systematically reviewed and 42 articles were qualified for meta-analysis including 4,250 men with oropharyngeal, penile and prostate cancers. The pooled prevalence of HPV DNA in oropharyngeal cancers was 45% (95%CI 24.0%-66.0%). Meanwhile the pooled prevalence rates of 48% (CI 40.0%- 57.0%) and 19% (CI 10.0%-29.0%) were observed in penile and prostate cancers respectively. Even though, articles regarding HPV prevalence in anal cancers were systematically reviewed, none of the studies were qualified for meta-analysis.

CONCLUSION

Higher pooled prevalence of HPV DNA was observed among men with oropharyngeal and penile cancers. Multicentric molecular studies investigating the prevalence of HPV in prostate cancers have to be planned in future.

Molecular Expression of Some Oncogenes and Predisposing Behaviors Contributing to the Aggressiveness of Prostate Cancer

Background

Prostate cancer is the second most common cancer in men in Iran. It can be treated in the early stages of the disease; therefore, early diagnosis can be lifesaving. The aim of this study was to investigate the molecular expression of some oncogenes and predisposing behaviors contributing to the aggressiveness of prostate cancer.

Methods

In this case-control study, prostate cancer specimens were collected from both patients and healthy volunteers. Several factors such as age, family history, smoking, and stage of the disease, were investigated based on the criteria of this study. Real-time PCR was used to measure the expression of four oncogenes. Statistical analysis of our data was carried out using SPSS software version 22.

Results

The X² test showed that there was a difference in the incidence of prostate cancer in different age groups (X²= 9.30; p= 0.026). Although data analysis by the X² test showed that family history had a significant effect on prostate cancer (X²= 14.43; p= 0.001), smoking did not show a significant effect on the incidence of this disorder (X²= 4.67; p= 0.097). The T2N1M0 stage is the most common form of prostate cancer in patients with family history of prostate cancer and the habit of smoking. Also, the expression of KRAS1P, GLB1L2, SChLAP1 and PACSIN3 oncogenes reduced in prostate cancer samples compared to the control group.

Conclusion

Overall, functional interpretation of gene expression in the prostate tissue can affect tumor progression. Yet, further practical studies are required to reveal the accurate underlying mechanisms.

Trends in Mortality Rates for Gastrointestinal Cancers in Fars Province, Iran (2005-2015)

PURPOSE

In Iran, cancers are the third leading cause of death, and gastrointestinal cancers are the primary cause of mortality among all the cancers. This study aimed to determine the trend of crude and age-standardized mortality rates (ASMR) for different types of gastrointestinal cancers over an 11-year period in Fars province (Iran).

METHODS

In this study, all the mortality data for gastrointestinal cancers were derived from the Electronic Death Registration System (EDRS) between 2005 and 2015. Subsequently, we calculated the crude and age-standardized mortality rates (ASMR) and their trends for different types of gastrointestinal cancers based on age groups and gender over the study period.

RESULTS

A total of 6547 deaths from gastrointestinal cancers were identified, with an average age of 66.0 ± 16.4 years. The crude and age-standardized mortality rates for gastrointestinal cancers were respectively 10.9 and 15.0 per 100,000 population in 2005 which significantly increased to 17.4 and 19.4 per 100,000 population in 2015 (P < 0.001). The ASMR for colon, pancreatic, and oral cancers showed an increasing trend; for small intestine cancers, a decreasing trend; and for esophageal, gastric, rectal, and hepatobiliary cancers displayed an almost constant trend.

CONCLUSIONS

Our study shows a higher ASMR and an increasing trend of gastrointestinal cancers in Fars province. Prevention and early diagnosis programs with screening techniques should be implemented to control the mortality rate of gastrointestinal cancers in the future.

Association study between common variations in some candidate genes and prostate adenocarcinoma predisposition through multi-stage approach in Iranian population

BACKGROUND

Prostate cancer is one of the five common cancers and has the second incidence rate and the third mortality rate in Iranian population. The purpose of this study was to evaluate the association of rs16901979, rs4242382 and rs1447295 on 8q24 locus, rs2735839 (KLK3 gene) and rs721048 (EHBP1 gene) with prostate adenocarcinoma through multi-stage approach to identify the polymorphisms associated with prostate cancer and use them as screening factors. Screening tests can identify people who may have a chance of developing the disease before detection and any symptoms.

METHODS

The case-control study included 103 cases (prostate adenocarcinoma) and 100 controls (benign prostatic hyperplasia). Tetra-primer ARMS-PCR was used to genotyping of each participant. A Multi-stage approach was used for efficient genomic study. In this method, a smaller number of people can be used. Chi-squared, Fisher's exact test and logistic regression were used to investigate the SNPs associated with prostate cancer and Gleason score.

RESULTS

In the first stage (59 men), the frequency of polymorphisms rs16901979, rs4242382, rs1447295, rs2735839 and rs721048 in the prostate adenocarcinoma group was evaluated compared to the control group (P-value < 0.3) in order to select meaningful polymorphisms. There was not any significant difference between genotype frequency rs16901979 (P = 0.671) and rs721048 (P = 0.474) in the case group compared to BPH. Therefore, these polymorphisms were eliminated, and in the second step (144 men), rs4242382, rs2735839 and rs1447295 were evaluated (P-value < 0.05). According to the total population (203 men), there was significant difference between genotype frequency rs4242382 (P = 0.001), rs2735839 (P = 0.000) and rs1447295 (P = 0.005) even after using Bonferroni correction (p = 0.016). The effect of these three polymorphisms on prostate cancer was not modified by age and PSA. There was a significant difference between the allelic frequency of A vs G (rs4242382, rs2735839) at all classes of Gleason score and A vs C (rs1447295) at Gleason score ≥ 8.

CONCLUSIONS

The results of this study for rs2735839, rs4242382 and rs1447295 indicate the association of these polymorphisms with prostate adenocarcinoma predisposition in Iranian population. Exposure effect is homogeneous between different ages and PSA level categories. These three polymorphisms should be studied in a larger population to confirm these results.

Palliative Care in the Health System of Iran: A Review of the Present Status and the Future Challenges

Objectives:

In the near future, the health system of Iran will face serious public health challenges means increase in the elderly population and the rate of chronic diseases. Therefore, it is anticipated that providing palliative care for chronic diseases will be one of the priorities of the country’s health system. The purpose of the present study was to explain the present status and the future challenges of providing palliative care in the health system of Iran and help policy-makers to create a future roadmap by presenting a picture of the present status.

Methods:

In this qualitative study, 17 semi-structured interviews were conducted with policy-makers, researchers, and managers of the centers providing palliative care in 2018-2019. Interviews were analyzed using directed content analysis based on the Public Health Strategy and framework analysis.

Results:

According to the WHO Public Health Strategy, palliative care challenges categorized in 13 subcategory and four main category include policy-making, program implementation, comprehensive education and drug availability.

Conclusion:

Providing palliative care that is currently dispersed in some centers does not meet the needs of chronic diseases. Establishing the palliative care system as one of the major goals of the health system of Iran is possible through reforming the fourfold structure of policy-making, implementation, education and drug availability. Therefore, it is suggested that authorities perform comprehensive and systematic management of challenges using foresight methods.

Genetic and molecular determinants of prostate cancer among Iranian patients: An update

Prostate cancer (PCa) is one of the most common age-related cancers among men. Various environmental and genetic factors are involved in the development and progression of PCa. In most cases, the primary symptoms of disease are not severe. Therefore, it is common for patients to be referred with severe clinical manifestations at advanced stages of disease. Since this malignancy is age related and Iran will face a significant increase in the number of seniors, it is expected that the prevalence of PCa among Iranian men will rise. PCa progression has been observed to be associated with genetic and ethnic factors. It may therefore be clinically useful to determine a panel of genetic markers, in addition to routine diagnostic methods, to detect tumors in the early stages. In the present review, we have summarized the reported genetic markers in PCa Iranian patients to pave the way for the determination of an ethnic specific genetic marker panel for the early detection of PCa. To understand the genetic and molecular biology of PCa among Iranians, we have categorized these genetic markers based on their cellular functions.

Investigation of GSTP1 and epigenetic regulators expression pattern in a population of Iranian patients with prostate cancer

BACKGROUND AND AIM

Prostate cancer is the leading cause of death in many countries. It is important to diagnose the disease in the early stages. Current methods detect the disease with low specificity. Examining the expression of genes responsible for disease and their epigenetic regulators are good tools in this regard.

MATERIAL AND METHODS

In this prospective case-control study, 40 Iranian patients with cancer, 40 Iranian patients with prostate hyperplasia, and 40 control samples were examined. After blood sampling from each individual, RNA extraction and cDNA synthesis, GSTP1, HDAC, DNMT3A, and DNMT3B expressions were measured in three understudy groups using specific primers and Real-Time PCR method.

RESULTS

A reverse correlation was identified between loss of GSTP1 expression and overexpression of HDAC, DNMT3A, and DNMT3B (P value < 0.0001) with a beneficial pattern of cancer development with high efficiency. The significant decrease of GSTP1 expression in patients in comparison to the healthy controls and the elevated expression levels of the studied epigenetic regulators in PCA and BPH samples indicate the impact of the regulators on GSTP1 expression activity.

CONCLUSION

This study showed that the measurement of combined GSTP1 and its epigenetic regulators' expression could be used as suitable genetic markers for the detection and separation of healthy individuals from prostatic patient groups in the Iranian population. However, a similar study in a larger population of case and control could help us to distinguish between normal, benign, and malignant conditions.

A systematic review and meta-analysis on incidence of prostate cancer in Iran

Background: Prostate cancer is a global health concern. In Iran, its epidemiology is not precisely recognized. We aimed to evaluate incidence of prostate cancer among Iranian populations.

Methods: In this systematic review, we searched the databases PubMed, Web of Sciences, Scopus and Google Scholar for English studies and the databases Magiran, Scientific information Database, IranMedex and IranDoc for Persian studies, using related keywords. The cross sectional articles published from inception to 31 December 2018 were included. Meta-analysis was conducted on the collected data with STATA software using random effects model.

Results: Out of 763 articles initially obtained, 9 articles were finally included after applying the predefined exclusion criteria. Analysis of 9 studies on the incidence of prostate cancer showed a crude rate of 7.1 per 100000 population (95% confidence interval [CI]: 5.6-8.6). Also, the pooled age-standardized incidence rate was 8.7 per 100000 (95% CI: 6.7-10.4). Studies performed in the period 2004-2012 had significantly a higher pooled estimate of the crude incidence rate (9.2 per 100000 [95% CI: 7.9-10.4]) compared with those conducted in the period 1996-2003 (4.5 per 100000 [95% CI: 2.8-6.2]). This trend was also observed based on the age-standardized incidence rate (11 per 100000 [95% CI: 9.4-12.5] versus 6.3 per 100000[95% CI: 4-8.5]).

Conclusion: Despite low rate of prostate cancer occurrence in Iran, it is recommended that preventive measures be taken against this disease by health policymakers. Also, more epidemiological studies are needed to better find out the pattern of prostate cancer among Iranian populations.

Dietary Nutrient Patterns and Prostate Cancer Risk: A Case-Control Study from Iran

Background:

Prostate cancer is the second common cancer in the world. Although some associations between dietary intakes and prostate cancer have been found, the effects of dietary nutrients interactions have not yet evaluated. The aim of this study is to assess the association between nutrient patterns and risk of prostate cancer.

Methods and Materials:

Ninety-seven patients with prostate cancer and 205 controls were asked about their demographic and dietary intakes using validated questionnaires. To extract nutrient patterns, Principal Component Analysis (PCA) based on the 35 nutrient items were applied. Varimax rotation was used for improving interpretation and minimizing correlation between the factors. Logistic regression was used to determine the odds ratio (OR) with 95% confidence interval (CI) of prostate cancer by higher scores on the nutrient patterns.

Results:

High adherence to the “plant source” pattern was negatively associated with prostate cancer risk (OR 0.29 for the highest vs. the lowest score tertile; 95% CI= 0.13 – 0.65; P value for trend: <0.003). Similarly, the “antioxidant and fiber” pattern was associated with decreasing risk of prostate cancer (OR 0.06 for the highest vs. the lowest score tertile;95% CI=0.02 – 0.19; P value for trend: <0.001). There was no significant association for the “mixed” and “vitamin and minerals” pattern with risk of prostate cancer.

Conclusion:

This study confirms the potential and important role of nutrients on prostate cancer risk. Our finding revealed that “antioxidant and fiber” and “plant source” pattern is inversely associated with prostate cancer risk; however, further longitudinal and trial studies are needed to make a firm conclusion.

RRBP1 is highly expressed in prostate cancer and correlates with prognosis

Objective: Recently, ribosome binding protein 1 (RRBP1) is reported to be involved in tumorigenesis. However, the expression and clinical significance of RRBP1 in prostate cancer (PCa) remains unknown. This study is aimed to investigate the expression and clinical significance of RRBP1 in PCa.

Materials and methods: RRBP1 expression was firstly detected in 6 cases of PCa and matched adjacent non-cancerous prostate tissues by reverse transcription-quantitative PCR (RT-qPCR) and Western blot. Then, RRBP1 expression was further detected in 127 cases of PCa and 40 cases of non-cancerous prostate tissues by immunohistochemistry (IHC). The relationship of RRBP1 with clinical-pathological characters and patients’ prognosis was analyzed in PCa.

Results: RT-qPCR and Western blot analysis showed that RRBP1 expression levels in PCa tissues were significantly higher compared with those in matched adjacent non-cancerous prostate tissues. IHC results shown that the high-expression rate of RRBP1 in PCa was 69.3%, which was significantly greater than those in non-cancerous prostate tissues (15.0%, P<0.001). RRBP1 expression was significantly associated with T stage, lymph node metastasis, PSA and Gleason score in PCa. Survival analysis indicated that patients with RRBP1 low-expression presented longer survival time compared with those with RRBP1 high-expression. Moreover, RRBP1 as well as T stage, lymph node metastasis and Gleason score could serve as independent prognostic factors in PCa.

Conclusion: RRBP1 is highly expressed in PCa and correlates with prognosis, which may serve as a potential biomarker in PCa.

The First Screening Program for Colorectal Cancer in the North of Iran

PURPOSE

Colorectal cancer (CRC) is the second leading cause of cancer deaths. This screening aimed to determine the positivity of the fecal occult blood test (FOBT) and the results of colonoscopy among a medium-risk population in the northern regions of Iran.

METHODS

This cross-sectional study was conducted in 2016 on 924 eligible samples from people over the age of 50. After completing the questionnaire, participants were referred to a laboratory for three immunochemical fecal occult blood tests (IFOBTs). If the result of at least one test was found to be positive, they were submitted to the state hospital for colonoscopy. Results were recorded according to the number of people with CRC, polyps, and other diseases.

RESULTS

Among a total number of 897 (97.1%) cases, at least two acceptable samples were sent to the laboratory and in 229 (25.5%) cases, at least one case was IFOBT-positive. Finally, 118 (64.1%) cases were referred to the hospital for colonoscopy; among these, 5 colonoscopies were incomplete, while 113 had complete colonoscopies with 42 healthy subjects, 3 cases of cancer, 28 cases of polyps, and other diseases identified in the remaining patients.

CONCLUSIONS

Based on the results, the prevalence of positive IFOBT, polyps, and cancer was high. The results of this study will play an important role in establishing a CRC screening program in the country. With reference to the status of the general population, the target group in the country should be reviewed and not limited to the first-degree relatives of patients.

A Contribution into Developing a Model for Prostate Cancer Self-Care Mobile Application

INTRODUCTION

New Healthcare models are developed with the focus on the community members and towards their self-accomplishment of the healthy activities. Mobile Health, as a newbie technology, seems to be appropriate to help prostate cancer self-care.

AIM

this study aimed to provide a comparative model of mobile application for prostate cancer care self-care for Iranians.

MATERIAL AND METHODS

This is an applied mixed method study, which was conducted in three phases from 2017 to 2018 as follows: 1) searching and thematic content analyzing of prostate cancer mobile applications and their related articles to extract technical features and clinical functions; 2) selecting the common extracted features and functions to design an initial model of the application; and 3) confirming validity of the features and functions through 2 rounds of Delphi technique.

RESULTS

This applied model was developed for the appropriate prostate cancer self-care, with such functionalities as user training, care, diagnosis, interaction, and alerting the user. Also, some technical features of the model include settings and data sharing.

CONCLUSION

The applied model of mobile application for prostate cancer has been done in compliance with requirements of Iranian health information technologists, urologists and oncologists. It seems it would be of help in self-care of patients with needed to prostate cancer care.