Radiotherapy cannot prolong overall survival of young prostate cancer patients with bone metastases

Tumor characteristics, treatments, and oncological outcomes of prostate cancer in men aged ≤60 years: real-world data from a single urological center over a 10-year period

BACKGROUND

Prostate cancer (PCa) has emerged as one of the most common malignancies among men globally. However, its pathogenesis, clinical features, and treatment responses in younger patients (aged 60 years or below) remain underexplored. This study aims to evaluate the distinctive clinical features, treatment strategies, and oncological outcomes of PCa in men aged 60 years or younger over a 10-year period at a single urological center.

METHODS

We retrospectively analyzed data from The Second Hospital of Tianjin Medical University, spanning January 2010 to June 2020. The study included patients aged ≤60 years who underwent prostate biopsies. We examined clinical characteristics, pathological findings, treatment approaches, and survival outcomes using t-tests and chi-square tests. Adjusted linear regression models evaluated the relationships between treatment modalities and outcomes, while Kaplan-Meier survival analysis and Cox regression assessed progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS).

RESULTS

Of the 5,686 patients who underwent prostate biopsy, 643 (11.3%) were ≤60 years old. Among these, 42.8% (275/643) were diagnosed with PCa, with 59.6% presenting at advanced stages. Compared to those with negative pathology, patients with PCa were older and more likely to have hypertension, alcohol consumption, and metabolic syndrome. Most patients (69.8%) received definitive local therapy, while 22.2% opted for palliative care and 8.0% were loss to follow-up. The median follow-up period for the entire cohort was 28.0 months and the median PFS was 77.0 months. For patients receiving definitive local therapy, the median CSS and OS were not reached, while those undergoing palliative therapy had median CSS and OS of 52.0 and 59.0 months, respectively. Multivariable analysis identified prostate-specific antigen >20 ng/mL, International Society of Urological Pathology >3, bone metastasis, and localized treatment as independent factors affecting PFS. Propensity score matching showed that definitive therapy led to superior PFS compared to palliative therapy for patients with localized PCa and a life expectancy of over 5 years.

CONCLUSIONS

Our findings highlight the influence of incidence, diagnostic characteristics, and treatment methods in younger men with PCa, emphasizing the need to identify specific risk factors and treatment response patterns. Further large-scale, multi-center research is necessary to improve diagnosis and outcomes for PCa patients in this age group.

Stabilisation of pathological humerus fractures using cement augmented plating: A case series

The humerus is the second most common long bone for metastatic tumours. These lesions result in weakened bone architecture and increased fracture risk with patients suffering pain, loss of function and diminished quality of life, often when life expectancy is short. Fractures or impending fractures require surgical stabilisation to relieve pain and restore function for the remainder of the patient's life without the need for further surgery. Conventional management of these lesions in the humerus is intramedullary nailing, however there are issues with this technique, particularly regarding rigidity of fixation. Advances in contoured locking plates have led to the development of different stabilisation techniques. The preferred technique in our regional oncology unit is curettage of the tumour and plating, augmented with cement to fill the defect and restore the structural morphology. In this case series we evaluate the survivorship of the construct and the clinical outcomes in patients who had an established or prospective pathological humeral fracture treated with curettage and cement augmented plating, since 2010. We identified 19 patients; 17 had metastasis and 2 myeloma of whom 15 had established fractures and four impending. The mean age at surgery was 69 years (51-86), and mean time since surgery 3.2 years. Overall mean follow up time was 20 months with 14 patients deceased and 5 surviving. There was 100% survivorship of the construct with no mechanical failures and no re-operations. There were no post-operative wound complications. Excellent early pain control was achieved in 18 patients with one experiencing pain controlled by analgesia. Function was assessed using Toronto Extremity Salvage Score (TESS) and was satisfactory; mean 79/100 (range 72-85). Cement augmented plating for pathological humerus fractures is a suitable alternative to intramedullary nailing and addresses several of the concerns with that technique. It provides immediate rigidity and allows early unrestricted function.

Prognostic value of alkaline phosphatase in hormone-sensitive prostate cancer: a systematic review and meta-analysis

Purpose

To assess the prognostic value of alkaline phosphatase in patients with hormone-sensitive prostate cancer.

Methods

A systematic review and meta-analysis was performed using the PUBMED, Web of Science, Cochrane Library, and Scopus in April 2019 according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. Studies were deemed eligible if they compared hormone-sensitive prostate cancer patients with high vs. low alkaline phosphatase to determine its predictive value for overall survival, cancer-specific survival, and progression-free survival. We performed a formal meta-analysis of these outcomes.

Results

42 articles with 7938 patients were included in the systematic review and 28 studies with 5849 patients for the qualitative assessment. High alkaline phosphatase was associated with worse overall survival (pooled HR 1.72; 95% CI 1.37−2.14) and progression-free survival (pooled HR 1.30; 95% CI 1.10−1.54). In subgroup analyses of patients with “high-volume” and “low-volume”, alkaline phosphatase was associated with the overall survival (pooled HR 1.41; 95% CI 1.21−1.64 and pooled HR 1.64; 95% CI, 1.06−2.52, respectively).

Conclusions

In this meta-analysis, elevated serum levels of alkaline phosphatase were associated with an increased risk of overall mortality and disease progression in patients with hormone-sensitive prostate cancer. In contrast, those were not associated with an increased risk of cancer-specific mortality. Alkaline phosphatase was independently associated with overall survival in both patients with “high-volume” and “low-volume” hormone-sensitive prostate cancer. Alkaline phosphatase may be useful for being integrated into prognostic tools that help guide treatment strategy, thereby facilitating the shared decision making process.