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Abu-Hijlih R, Salah S, Abaza H, Taqash A, Abdelkhaleq H, Al-Ibraheem A, Al-Omari A. Comprehensive Analysis of Metastatic Prostate Cancer: Real-World Data From the Middle East. JCO Glob Oncol 2024; 10:e2400042. [PMID: 39265134 DOI: 10.1200/go.24.00042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/30/2024] [Accepted: 07/19/2024] [Indexed: 09/14/2024] Open
Abstract
PURPOSE Metastatic prostate cancer (Pca) is a complex disease with diverse clinical characteristics and outcomes across the geographical distribution. Herein, we present a series of patients from the Middle East, aiming at identifying disease outcomes and prognostic factors specific to this regional context. METHODS AND MATERIALS This is a retrospective study of patients with metastatic Pca, diagnosed at King Hussein Cancer Center, Jordan, between 2006 and 2018. Survival was estimated using the Kaplan-Meier method and compared using the log-rank test. Factors that significantly affected overall survival (OS) in the univariable analysis were examined in a multivariable Cox regression analysis. RESULTS A total of 188 patients with metastatic Pca were included in this analysis, of whom 168 (89%) had de novo metastatic disease. The median age at diagnosis was 68 years, 144 (77%) had bone metastasis, 32 (17%) had visceral metastasis, and 126 (67%) had high-volume disease. At a median follow-up of 67 months, the median OS was 44.3 months. The following factors predicted inferior OS in univariable analysis: smoking, normal BMI, high-volume disease, high alkaline phosphatase (ALP), previous local therapy for prostate, and orchiectomy versus medical androgen deprivation therapy (ADT). On multivariable analysis, high-volume disease (hazard ratio [HR], 1.92 [95% CI, 1.17 to 3.13]; P = .0094), high ALP (HR, 2.136 [95% CI, 1.38 to 3.31]; P < .001), and orchiectomy (HR, 2.40 [95% CI, 1.51 to 3.82]; P < .001) emerged as independent factors for inferior OS. CONCLUSION Metastatic Pca outcomes in our population closely align with the global benchmark. High volume status, elevated ALP, and performance of surgical as opposed to medical ADT emerge as prognostic indicators of poor survival.
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Affiliation(s)
- Ramiz Abu-Hijlih
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Samer Salah
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Haneen Abaza
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | - Ayat Taqash
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | - Hadeel Abdelkhaleq
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | - Akram Al-Ibraheem
- Department of Nuclear Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Amal Al-Omari
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
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El-Karak F, Shamseddine A, Omar A, Haddad I, Abdelgawad M, Naqqash MA, Kaddour MA, Sharaf M, Abdo E. Prostate cancer across four countries in the Middle East: a multi-centre, observational, retrospective and prognostic study. Ecancermedicalscience 2024; 18:1695. [PMID: 38774566 PMCID: PMC11108050 DOI: 10.3332/ecancer.2024.1695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Indexed: 05/24/2024] Open
Abstract
Prostate cancer (PC) is the second most prevalent cancer in males, with a steadily increasing incidence in the Middle East (ME). The aim of this study was to capture real-world data on the characteristics, disease progression, and treatment patterns among PC patients in the ME. This was a retrospective, observational, multi-centre study conducted across ten hospitals/research centers in Lebanon, Kingdom of Saudi Arabia, Iraq and Kuwait. Data were abstracted from medical records of 615 male patients who were diagnosed with PC between January 2012 and the site initiation date (December 2018-May 2019) and received at least one PC treatment/intervention. The observation period ranged between 84 and 88 months. Data were collected on demographics, clinical characteristics, time to progression to the subsequent clinical state or therapy (progression from localised/locally advanced PC to castration and to metastatic PC (metastatic castration-sensitive PC (mCSPC) or metastatic castration-resistant PC (mCRPC)), progression from mCSPC to mCRPC, and mCRPC patients' progression to first subsequent line of therapy), treatment patterns, and mortality. Most patients had localised/locally advanced PC (57.7%), followed by mCSPC (37.4%), and mCRPC (4.1%) at the time of inclusion in the study. Most patients were at tumours, nodes and metastases (TNM) stage IIIa (40.1%) or TNM stage IVb (27.8%) at study entry. Median time to metastatic disease, castration-resistance and next line therapy was 84 months (95% CI: 68-84), 41 months (95% CI: 30-56) and 7 months (95% CI: 0-41), respectively. The mortality rate was 3.6%. Disease progression was most common among patients with mCSPC (35.1%) or mCRPC (14.8%), and treatment discontinuation was most common among patients with mCRPC (36.6% treatments discontinued). The results show that most patients were at an advanced TNM stage at study entry, suggestive of a lack of awareness regarding PC. Disease progression was most common among patients with metastatic disease, reflecting the challenge of treating metastatic disease and highlighting the need for novel treatments.
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Affiliation(s)
- Fadi El-Karak
- Hematology and Medical Oncology Department, Hotel Dieu de France University Hospital, Beirut, Lebanon
- https://orcid.org/0000-0002-9266-591X
| | - Ali Shamseddine
- Clinical Medicine, American University of Beirut, Beirut, Lebanon
| | - Ayman Omar
- Clinical Oncology and Nuclear Medicine Department, Suez Canal University, Ismailia, Egypt
- Oncology Department, King Faisal Specialist Hospital and Research Center, Faculty of Medicine, Al Faisal University, Riyadh, Saudi Arabia
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Eren MF, Kilic SS, Eren AA, Kaplan SO, Teke F, Kutuk T, Bicakci BC, Hathout L, Moningi S, Orio P, Atalar B, Sayan M. Radiation therapy for prostate cancer in Syrian refugees: facing the need for change. Front Public Health 2023; 11:1172864. [PMID: 37325331 PMCID: PMC10264678 DOI: 10.3389/fpubh.2023.1172864] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/11/2023] [Indexed: 06/17/2023] Open
Abstract
Purpose To report the utilization of radiation therapy in Syrian refugee patients with prostate cancer residing in Turkey. Methods and materials A multi-institutional retrospective review including 14 cancer centers in Turkey was conducted to include 137 Syrian refugee patients with prostate cancer treated with radiation therapy (RT). Toxicity data was scored using the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0. Noncompliance was defined as a patient missing two or more scheduled RT appointments. Results Advanced disease, defined as stage III or IV, was reported in 64.2% of patients while androgen deprivation therapy (ADT) was only administrated to 20% of patients. Conventionally fractionated RT with a median number of 44 fractions was delivered to all patients with curative intent (n = 61) while palliative RT (n = 76) was delivered with a median number of 10 fractions. The acute grade 3-4 toxicity rate for the entire cohort was 16%. Noncompliance rate was 42%. Conclusion Most Syrian refugee prostate cancer patients presented with advanced disease however ADT was seldom used. Despite the low treatment compliance rate, conventional fractionation was used in all patients. Interventions are critically needed to improve screening and increase the use of standard-of-care treatment paradigms, including hypofractionated RT and ADT.
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Affiliation(s)
- Mehmet Fuat Eren
- Marmara University Istanbul Pendik Education and Research Hospital, Istanbul, Türkiye
| | - Sarah S. Kilic
- Taussig Cancer Institute, Cancer Center, Cleveland Clinic, Cleveland, OH, United States
| | - Ayfer Ay Eren
- Istanbul Kartal Dr.Lutfi Kirdar Education and Research Hospital, Istanbul, Türkiye
| | | | | | - Tugce Kutuk
- Malatya Education and Research Hospital, Malatya, Türkiye
| | | | - Lara Hathout
- Rutgers Cancer Institute of New Jersey, The State University of New Jersey, New Brunswick, NJ, United States
| | - Shalini Moningi
- Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Peter Orio
- Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | | | - Mutlay Sayan
- Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
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Awad MA, Hallgarth L, Barayan GA, Shahait M, Abu-Hijlih R, Farkouh A, Azhar RA, Alghamdi MM, Bugis A, Yaiesh S, Aldousari S, Barham A, Saed M, Moussa A, Hassen W, Naud S, Plante MK, Grunert R. Creation and validation of the harmonized Arabic version of the Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP). Arab J Urol 2021; 20:88-93. [PMID: 35530568 PMCID: PMC9067989 DOI: 10.1080/2090598x.2021.2002636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives Tocreate and validate a translated Arabic version of the Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP), a validated patient-reported outcome (PRO) widely used for assessing the quality of life in patients with prostate cancer (PCa). Patients and Methods Using the established protocol as defined by the Professional Society for the Health Economics and Outcomes Research (ISPOR) for translating patient care questionnaires, a harmonised translated Arabic version of EPIC-CP was created. The questionnaire was tested in native Arabic speakers from four different Arabic countries (Saudi Arabia, United Arab Emirates, Jordan, and Kuwait). Cronbach’s alpha and interclass coefficient correlation (ICC) analyses were used to test the internal consistency and test–retest reliability, respectively. In addition, PCa characteristics were collected for participants. Results In total, 168 patients with PCa participated in the study (39 from Saudi Arabia, 23 from United Arab Emirates, 65 from Jordan, and 41 from Kuwait). In all, 52 (31%) participants repeated the questionnaire for test–retest reliability analysis. The median (interquartile range [IQR]) age of patients included in the study was 66 (61–71) years. The median (IQR) PSA level was 9.8 (6–19) ng/mL. Most patients had Grade Group 2 PCa at diagnosis (31%), clinical stage cT1 (42%), managed primarily by urology (79%), and the primary treatment was radical prostatectomy (71%). The total Cronbach’s alpha coefficient was 0.84 demonstrating an acceptable internal consistency. The total ICC was also acceptable at 0.64. Conclusion The Arabic version of the EPIC-CP is a reliable and valid tool for assessing health-related quality of life for Arabic patients with PCa.
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Affiliation(s)
- Mohannad A. Awad
- Department of Surgery, Division of Urology, University of Vermont Medical Center, Burlington, VT, USA
- Department of Surgery, King Abdulaziz University, Rabigh, Saudi Arabia
| | - Luke Hallgarth
- Department of Surgery, Division of Urology, University of Vermont Medical Center, Burlington, VT, USA
| | - Ghassan A. Barayan
- Department of Surgery, Division of Urology, University of Vermont Medical Center, Burlington, VT, USA
- Department of Surgery, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Mohammed Shahait
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Ramiz Abu-Hijlih
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Ala’a Farkouh
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Raed A. Azhar
- Department of Surgery, Division of Urology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Musab M. Alghamdi
- Department of Surgery, Division of Urology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmad Bugis
- Department of Surgery, Division of Urology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Said Yaiesh
- Urology Unit, Department of Surgery, Mubarak Al-Kabeer Hospital, Kuwait, Kuwait
| | - Saad Aldousari
- Department of Surgery (Urology Division), Faculty of Medicine, Kuwait University, Kuwait, Kuwait
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Alaeddin Barham
- Urology, Surgical Subspecialties Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Mohamed Saed
- Urology, Surgical Subspecialties Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Ayman Moussa
- Urology, Surgical Subspecialties Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Waleed Hassen
- Urology, Surgical Subspecialties Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland, OH, USA
| | - Shelly Naud
- Medical Biostatistics, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Mark K. Plante
- Department of Surgery, Division of Urology, University of Vermont Medical Center, Burlington, VT, USA
| | - Richard Grunert
- Department of Surgery, Division of Urology, University of Vermont Medical Center, Burlington, VT, USA
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Lakkis NA, Osman MH. Prostate Cancer in Lebanon: Incidence, Temporal Trends, and Comparison to Countries From Different Regions in the World. Cancer Control 2021; 28:10732748211055267. [PMID: 34758644 PMCID: PMC8591641 DOI: 10.1177/10732748211055267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Prostate cancer is the most common malignancy in men globally. This study aims at investigating the incidence rates and trends of prostate cancer in Lebanon, and to compare them to those of countries from different regions in the world. METHODS Data on prostate cancer were obtained from the Lebanese national cancer registry for the years 2005 to 2016. The calculated age-standardized incidence and age-specific rates were expressed as per 100 000 population. RESULTS In Lebanon, prostate cancer is ranked as the most common cancer in men. The age-standardized incidence rate of prostate cancer has increased from 29.1 per 100 000 in 2005 to 37.3 per 100 000 in 2016; the highest rate was in 2012, surpassing the global average incidence rate for that year. The age-specific incidence rate of prostate cancer has increased exponentially starting at the age of 50 years to reach its peak in men aged 75 years or more. Two trends were identified in the age-standardized incidence rate of prostate cancer; an average significant increase of 7.28% per year for the period 2005-2009 (P-value < .05), followed by a non-significant decrease of around .99% for the period between 2009 and 2016 (P-value > .05). The age-standardized incidence rate in Lebanon was higher than most countries in the Middle East and North Africa region and Asia, but lower than the rates reported in Australia, America, and different European countries. CONCLUSION Prostate cancer is the leading cancer among men in Lebanon. Screening practices, changes in population age structure, and prevalence of genetic and risky lifestyle factors may explain the increased incidence rates of prostate cancer. Given the controversy of screening recommendations and the slow growing nature of prostate cancer, increasing public awareness on ways of prevention, and implementing the latest screening recommendation of the United States Preventive Services Task Force are the suggested way forward.
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Affiliation(s)
- Najla A Lakkis
- Department of Family Medicine, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Mona H Osman
- Department of Family Medicine, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
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Salah S, Abu‐Hijlih R, Abuhijla F, Tamimi F, Al‐Tell A, Shahait M. Pretreatment neutrophil-to-lymphocyte ratio as a potential prognostic biomarker for newly diagnosed patients with metastatic castration-sensitive prostate cancer. Cancer Rep (Hoboken) 2021; 4:e1392. [PMID: 34159754 PMCID: PMC8551990 DOI: 10.1002/cnr2.1392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/15/2021] [Accepted: 03/25/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Although the prognostic role of neutrophil-to-lymphocyte ratio (NLR) has been assessed in patients with metastatic castration-resistant prostate cancer, data on its impact on oncological outcomes of patients with metastatic castration-sensitive prostate cancer (mCSPC) are scarce. AIM This study aims to examine the influence of elevated pretreatment NLR on time to prostatic-specific antigen (PSA) progression and overall survival (OS) of patients with mCSPC. METHODS We retrospectively reviewed patients presenting between June 2007 and June 2019 with mCSPC. Survival was estimated by the Kaplan-Meier method and compared by the log-rank test. Multivariate analyses were used to assess the factors influencing time to PSA progression and OS. RESULTS A total of 189 patients were included; median age = 69 years, median PSA = 155 ng/mL, 41(22%) had visceral metastasis. Median time to PSA progression was shorter for patients with NLR ≥4 (n = 37) compared to patients with NLR < 4 (n = 146); 11.3 and 18.3 months, respectively, P = .015. Patients with NLR ≥4 also had inferior median OS (23.9 vs 49.5 months, P = .001). On multivariate analysis, NLR ≥4 was not an independent factor for time to PSA progression. However, NLR ≥4 was an independent factor of inferior OS (HR: 2.75, 95% CI: 1.01-7.87, P = .047). Other independent factors predicting inferior OS included Eastern Cooperative Oncology Group Performance Status ≥1, high-volume status, and Hb < 12. CONCLUSION Elevated pretreatment NLR independently predicts inferior OS in newly diagnosed patients with mCSPC. However, NLR was not a predictor of time to PSA progression.
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Affiliation(s)
- Samer Salah
- Department of Medical OncologyKing Hussein Cancer CenterAmmanJordan
| | - Ramiz Abu‐Hijlih
- Department of Radiation OncologyKing Hussein Cancer CenterAmmanJordan
| | - Fawzi Abuhijla
- Department of Radiation OncologyKing Hussein Cancer CenterAmmanJordan
| | - Faris Tamimi
- Department of Medical OncologyKing Hussein Cancer CenterAmmanJordan
| | - Abdallah Al‐Tell
- Department of Medical OncologyKing Hussein Cancer CenterAmmanJordan
| | - Mohammed Shahait
- Department of Surgery, Division of UrologyKing Hussein Cancer CenterAmmanJordan
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Survey on the practice of active surveillance for prostate cancer from the Middle East. Prostate Int 2020; 8:41-48. [PMID: 32257977 PMCID: PMC7125368 DOI: 10.1016/j.prnil.2019.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/10/2019] [Accepted: 11/14/2019] [Indexed: 11/29/2022] Open
Abstract
Background Prostate cancer is the most common cancer among Lebanese men. Management of prostate cancer includes medical, radiological, and surgical intervention. In addition, active surveillance (AS) is proven as a valid option in patients with low-risk prostate cancer. Currently, data from the Middle East about AS are scarce. The aim of this study is to assess the rate of implementation of AS by physicians, determine the selection and follow-up criteria used by physicians, and identify potential barriers to its widespread adoption. Methods After receiving ethical approval, a LimeSurvey electronic questionnaire was mailed to 206 eligible urologists, oncologists, and radiation oncologists registered in the order of physicians in Lebanon. The questionnaire included dichotomous, multiple choice questions, and multiple answer questions. The 23 questions tackled sociodemographic information, physician's attitude toward AS, and their current practices. Predictors of AS use were identified using the chi-squared and Fisher's exact test. Then, multivariate logistic regression model for the predictors of AS practice was conducted. Results The response rate was 25%, and the analysis was run on 52 respondents. Although most of the respondents agreed that AS is a valid modality for low-risk prostate cancer, only 34 (65.4%) of them had patients on active surveillance. The rate of patients on AS was also very low. Urologists, physicians with >15 years of experience, and those who practiced in a university hospital were all predictors of AS usage (p = 0.005; p = 0.002; p = 0.025, respectively). However, physicians with fear of patient noncompliance had the odds of resorting to this modality [odds ratio (OR) = 0.07 (0.01 – 0.76)]. Conclusion The main obstacles to implementing AS were fear of patient noncompliance and lack of national awareness as well as acceptance among the Lebanese uro-oncological body. Efforts to decentralize knowledge and expertize to new health-care practitioners and community hospitals would encourage its implementation.
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Management of patients with high-risk and advanced prostate cancer in the Middle East: resource-stratified consensus recommendations. World J Urol 2019; 38:681-693. [PMID: 31297628 PMCID: PMC7064460 DOI: 10.1007/s00345-019-02872-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/04/2019] [Indexed: 12/24/2022] Open
Abstract
Purpose Prostate cancer care in the Middle East is highly variable and access to specialist multidisciplinary management is limited. Academic tertiary referral centers offer cutting-edge diagnosis and treatment; however, in many parts of the region, patients are managed by non-specialists with limited resources. Due to many factors including lack of awareness and lack of prostate-specific antigen (PSA) screening, a high percentage of men present with locally advanced and metastatic prostate cancer at diagnosis. The aim of these recommendations is to assist clinicians in managing patients with different levels of access to diagnostic and treatment modalities. Methods The first Advanced Prostate Cancer Consensus Conference (APCCC) satellite meeting for the Middle East was held in Beirut, Lebanon, November 2017. During this meeting a consortium of urologists, medical oncologists, radiation oncologist and imaging specialists practicing in Lebanon, Syria, Iraq, Kuwait and Saudi Arabia voted on a selection of consensus questions. An additional workshop to formulate resource-stratified consensus recommendations was held in March 2019. Results Variations in practice based on available resources have been proposed to form resource-stratified recommendations for imaging at diagnosis, initial management of localized prostate cancer requiring therapy, treatment of castration-sensitive/naïve advanced prostate cancer and treatment of castration-resistant prostate cancer. Conclusion This is the first regional consensus on prostate cancer management from the Middle East. The following recommendations will be useful to urologists and oncologists practicing in all areas with limited access to specialist multi-disciplinary teams, diagnostic modalities and treatment resources. Electronic supplementary material The online version of this article (10.1007/s00345-019-02872-x) contains supplementary material, which is available to authorized users.
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Cheaito KA, Bahmad HF, Hadadeh O, Saleh E, Dagher C, Hammoud MS, Shahait M, Mrad ZA, Nassif S, Tawil A, Bulbul M, Khauli R, Wazzan W, Nasr R, Shamseddine A, Temraz S, El-Sabban ME, El-Hajj A, Mukherji D, Abou-Kheir W. EMT Markers in Locally-Advanced Prostate Cancer: Predicting Recurrence? Front Oncol 2019; 9:131. [PMID: 30915272 PMCID: PMC6421270 DOI: 10.3389/fonc.2019.00131] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 02/14/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Prostate cancer (PCa) is the second most frequent cause of cancer-related death in men worldwide. It is a heterogeneous disease at molecular and clinical levels which makes its prognosis and treatment outcome hard to predict. The epithelial-to-mesenchymal transition (EMT) marks a key step in the invasion and malignant progression of PCa. We sought to assess the co-expression of epithelial cytokeratin 8 (CK8) and mesenchymal vimentin (Vim) in locally-advanced PCa as indicators of EMT and consequently predictors of the progression status of the disease. Methods: Co-expression of CK8 and Vim was evaluated by immunofluorescence (IF) on paraffin-embedded tissue sections of 122 patients with PCa who underwent radical prostatectomies between 1998 and 2016 at the American University of Beirut Medical Center (AUBMC). EMT score was calculated accordingly and then correlated with the patients' clinicopathological parameters and PSA failure. Results: The co-expression of CK8/Vim (EMT score), was associated with increasing Gleason group. A highly significant linear association was detected wherein higher Gleason group was associated with higher mean EMT score. In addition, the median estimated biochemical recurrence-free survival for patients with < 25% EMT score was almost double that of patients with more than 25%. The validity of this score for prediction of prognosis was further demonstrated using cox regression model. Our data also confirmed that the EMT score can predict PSA failure irrespective of Gleason group, pathological stage, or surgical margins. Conclusion: This study suggests that assessment of molecular markers of EMT, particularly CK8 and Vim, in radical prostatectomy specimens, in addition to conventional clinicopathological prognostic parameters, can aid in the development of a novel system for predicting the prognosis of locally-advanced PCa.
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Affiliation(s)
- Katia A Cheaito
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Hisham F Bahmad
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Ola Hadadeh
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Eman Saleh
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Christelle Dagher
- Division of Hematology/Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Miza Salim Hammoud
- Division of Hematology/Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohammad Shahait
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Zaki Abou Mrad
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Samer Nassif
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ayman Tawil
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Muhammad Bulbul
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Raja Khauli
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Wassim Wazzan
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rami Nasr
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Shamseddine
- Division of Hematology/Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sally Temraz
- Division of Hematology/Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marwan E El-Sabban
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Albert El-Hajj
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Deborah Mukherji
- Division of Hematology/Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Wassim Abou-Kheir
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
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