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Donswijk ML, Ettema RH, Meijer D, Wondergem M, Cheung Z, Bekers EM, van Leeuwen PJ, van den Bergh RCN, van der Poel HG, Vis AN, Oprea-Lager DE. The accuracy and intra- and interobserver variability of PSMA PET/CT for the local staging of primary prostate cancer. Eur J Nucl Med Mol Imaging 2024; 51:1741-1752. [PMID: 38273003 PMCID: PMC11043118 DOI: 10.1007/s00259-024-06594-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/02/2024] [Indexed: 01/27/2024]
Abstract
PURPOSE Prostate-specific membrane antigen (PSMA) positron emission tomography/ computed tomography (PET/CT) is recognized as the most accurate imaging modality for detection of metastatic high-risk prostate cancer (PCa). Its role in the local staging of disease is yet unclear. We assessed the intra- and interobserver variability, as well as the diagnostic accuracy of the PSMA PET/CT based molecular imaging local tumour stage (miT-stage) for the local tumour stage assessment in a large, multicentre cohort of patients with intermediate and high-risk primary PCa, with the radical prostatectomy specimen (pT-stage) serving as the reference standard. METHODS A total of 600 patients who underwent staging PSMA PET/CT before robot-assisted radical prostatectomy was studied. In 579 PSMA positive primary prostate tumours a comparison was made between miT-stage as assessed by four nuclear physicians and the pT-stage according to ISUP protocol. Sensitivity, specificity and diagnostic accuracy were determined. In a representative subset of 100 patients, the intra-and interobserver variability were assessed using Kappa-estimates. RESULTS The sensitivity and specificity of the PSMA PET/CT based miT-stage were 58% and 59% for pT3a-stage, 30% and 97% for ≥ pT3b-stage, and 68% and 61% for overall ≥ pT3-stage, respectively. No statistically significant differences in diagnostic accuracy were found between tracers. We found a substantial intra-observer agreement for PSMA PET/CT assessment of ≥ T3-stage (k 0.70) and ≥ T3b-stage (k 0.75), whereas the interobserver agreement for the assessment of ≥ T3-stage (k 0.47) and ≥ T3b-stage (k 0.41) were moderate. CONCLUSION In a large, multicentre study evaluating 600 patients with newly diagnosed intermediate and high-risk PCa, we showed that PSMA PET/CT may have a value in local tumour staging when pathological tumour stage in the radical prostatectomy specimen was used as the reference standard. The intra-observer and interobserver variability of assessment of tumour extent on PSMA PET/CT was moderate to substantial.
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Affiliation(s)
- Maarten L Donswijk
- Department of Nuclear Medicine, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
| | - Rosemarijn H Ettema
- Department of Urology, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Prostate cancer network, Amsterdam, The Netherlands
- Department of Urology, St. Antonius Hospital, Nieuwegein, The Netherlands
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Dennie Meijer
- Department of Urology, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Prostate cancer network, Amsterdam, The Netherlands
| | - Maurits Wondergem
- Department of Nuclear Medicine, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Zing Cheung
- Department of Nuclear Medicine, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Elise M Bekers
- Department of Pathology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Pim J van Leeuwen
- Prostate cancer network, Amsterdam, The Netherlands
- Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | | | - Henk G van der Poel
- Department of Urology, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Prostate cancer network, Amsterdam, The Netherlands
- Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - André N Vis
- Department of Urology, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Prostate cancer network, Amsterdam, The Netherlands
| | - Daniela E Oprea-Lager
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Diniz ALL, Resende JAD, de Andrade CM, Brandão AC, Gasparoni MP, Favorito LA. A nomogram to predict the absence of clinically significant prostate cancer in males with negative MRI. Int Braz J Urol 2024; 50:319-334. [PMID: 37450770 PMCID: PMC10482465 DOI: 10.1590/s1677-5538.ibju.2024.0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 02/16/2024] [Indexed: 04/12/2024] Open
Abstract
PURPOSE To create a nomogram to predict the absence of clinically significant prostate cancer (CSPCa) in males with non-suspicion multiparametric magnetic resonance imaging (mpMRI) undergoing prostate biopsy (PBx). MATERIALS AND METHODS We identified consecutive patients who underwent 3T mpMRI followed by PBx for suspicion of PCa or surveillance follow-up. All patients had Prostate Imaging Reporting and Data System score 1-2 (negative mpMRI). CSPCa was defined as Grade Group ≥2. Multivariate logistic regression analysis was performed via backward elimination. Discrimination was evaluated with area under the receiver operating characteristic (AUROC). Internal validation with 1,000x bootstrapping for estimating the optimism corrected AUROC. RESULTS Total 327 patients met inclusion criteria. The median (IQR) age and PSA density (PSAD) were 64 years (58-70) and 0.10 ng/mL2 (0.07-0.15), respectively. Biopsy history was as follows: 117 (36%) males were PBx-naive, 130 (40%) had previous negative PBx and 80 (24%) had previous positive PBx. The majority were White (65%); 6% of males self-reported Black. Overall, 44 (13%) patients were diagnosed with CSPCa on PBx. Black race, history of previous negative PBx and PSAD ≥0.15ng/mL2 were independent predictors for CSPCa on PBx and were included in the nomogram. The AUROC of the nomogram was 0.78 and the optimism corrected AUROC was 0.75. CONCLUSIONS Our nomogram facilitates evaluating individual probability of CSPCa on PBx in males with PIRADS 1-2 mpMRI and may be used to identify those in whom PBx may be safely avoided. Black males have increased risk of CSPCa on PBx, even in the setting of PIRADS 1-2 mpMRI.
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Affiliation(s)
- André L. Lima Diniz
- Universidade do Estado do Rio de JaneiroUnidade de Pesquisa UrogenitalRio de JaneiroRJBrasilUnidade de Pesquisa Urogenital - Universidade do Estado do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
| | - José Anacleto D. Resende
- Universidade do Estado do Rio de JaneiroUnidade de Pesquisa UrogenitalRio de JaneiroRJBrasilUnidade de Pesquisa Urogenital - Universidade do Estado do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
| | - Cláudio M. de Andrade
- Universidade do Estado do Rio de JaneiroUnidade de Pesquisa UrogenitalRio de JaneiroRJBrasilUnidade de Pesquisa Urogenital - Universidade do Estado do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
| | - Alice C. Brandão
- Universidade do Estado do Rio de JaneiroUnidade de Pesquisa UrogenitalRio de JaneiroRJBrasilUnidade de Pesquisa Urogenital - Universidade do Estado do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
| | - Mauro P. Gasparoni
- Universidade do Estado do Rio de JaneiroUnidade de Pesquisa UrogenitalRio de JaneiroRJBrasilUnidade de Pesquisa Urogenital - Universidade do Estado do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
| | - Luciano A. Favorito
- Universidade do Estado do Rio de JaneiroUnidade de Pesquisa UrogenitalRio de JaneiroRJBrasilUnidade de Pesquisa Urogenital - Universidade do Estado do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
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Fransen SJ, Roest C, Van Lohuizen QY, Bosma JS, Simonis FFJ, Kwee TC, Yakar D, Huisman H. Using deep learning to optimize the prostate MRI protocol by assessing the diagnostic efficacy of MRI sequences. Eur J Radiol 2024; 175:111470. [PMID: 38640822 DOI: 10.1016/j.ejrad.2024.111470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/29/2024] [Accepted: 04/14/2024] [Indexed: 04/21/2024]
Abstract
PURPOSE To explore diagnostic deep learning for optimizing the prostate MRI protocol by assessing the diagnostic efficacy of MRI sequences. METHOD This retrospective study included 840 patients with a biparametric prostate MRI scan. The MRI protocol included a T2-weighted image, three DWI sequences (b50, b400, and b800 s/mm2), a calculated ADC map, and a calculated b1400 sequence. Two accelerated MRI protocols were simulated, using only two acquired b-values to calculate the ADC and b1400. Deep learning models were trained to detect prostate cancer lesions on accelerated and full protocols. The diagnostic performances of the protocols were compared on the patient-level with the area under the receiver operating characteristic (AUROC), using DeLong's test, and on the lesion-level with the partial area under the free response operating characteristic (pAUFROC), using a permutation test. Validation of the results was performed among expert radiologists. RESULTS No significant differences in diagnostic performance were found between the accelerated protocols and the full bpMRI baseline. Omitting b800 reduced 53% DWI scan time, with a performance difference of + 0.01 AUROC (p = 0.20) and -0.03 pAUFROC (p = 0.45). Omitting b400 reduced 32% DWI scan time, with a performance difference of -0.01 AUROC (p = 0.65) and + 0.01 pAUFROC (p = 0.73). Multiple expert radiologists underlined the findings. CONCLUSIONS This study shows that deep learning can assess the diagnostic efficacy of MRI sequences by comparing prostate MRI protocols on diagnostic accuracy. Omitting either the b400 or the b800 DWI sequence can optimize the prostate MRI protocol by reducing scan time without compromising diagnostic quality.
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Affiliation(s)
- Stefan J Fransen
- University Medical Centre Groningen, Department of Radiology, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands.
| | - Christian Roest
- University Medical Centre Groningen, Department of Radiology, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | - Quintin Y Van Lohuizen
- University Medical Centre Groningen, Department of Radiology, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | - Joeran S Bosma
- University Medical Centre Nijmegen, DIAG, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Frank F J Simonis
- Technical University Twente, TechMed Centre, Hallenweg 5, 7522 NH, Enschede, the Netherlands
| | - Thomas C Kwee
- University Medical Centre Groningen, Department of Radiology, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | - Derya Yakar
- University Medical Centre Groningen, Department of Radiology, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | - Henkjan Huisman
- University Medical Centre Nijmegen, DIAG, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
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Andrade GM, Manente FG, Barroso PJDD, Teles SB, Partezani AD, Baccaglini W, Sanchez-Salas R, Olivares R, Nahar B, Lemos GC, Bianco B, Carneiro A. Outcomes of ablative therapy and radical treatment for prostate cancer: a systematic review and meta-analysis. Int Braz J Urol 2024; 50:IBJU20230628. [PMID: 38446906 DOI: 10.1590/s1677-5538.ibju.2023.0628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/19/2024] [Indexed: 03/08/2024] Open
Abstract
PURPOSE To compare biochemical recurrence, sexual potency and urinary continence outcomes of ablative therapy and radical treatment (radical prostatectomy or radiotherapy with androgen deprivation therapy). MATERIAL AND METHODS A systematic review and meta-analysis followed the PRISMA guidelines were performed. We searched MEDLINE/PubMed. Biochemical recurrence at three and five years; incontinence rate (patients who used one pad or more) and erectile dysfunction rate at 12 and 36 months (patients who did not have sufficient erection to achieve sexual intercourse) were evaluated. The Mantel-Haenszel method was applied to estimate the pooled risk difference (RD) in the individual studies for categorical variables. All results were presented as 95% confidence intervals (95%CI). Random effects models were used regardless of the level of heterogeneity (I²). (PROSPERO CRD42022296998). RESULTS Eight studies comprising 2,677 men with prostate cancer were included. There was no difference in biochemical recurrence between ablative and radical treatments. We observed the same biochemical recurrence between ablative therapy and radical treatment within five years (19.3% vs. 16.8%, respectively; RD 0.07; 95%CI=-0.05, 0.19; I2=68.2%; P=0.08) and continence rate at 12 months (9.2% vs. 31.8%, respectively; RD -0.13; 95%CI, -0.27, 0.01; I2=89%; P=0.32). When focal treatment was analyzed alone, two studies with 582 patients found higher erectile function at 12 months in the ablative therapy group than in the radical treatment (88.9% vs. 30.8%, respectively; RD -0.45; 95%CI -0.84, -0.05; I2=93%; P=0.03). CONCLUSION Biochemical recurrence and urinary continence outcomes of ablative therapy and radical treatment were similar. Ablative therapy appears to have a high rate of sexual potency.
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Affiliation(s)
- Guilherme Miranda Andrade
- Departamento de Urologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
- Faculdade de Medicina do ABC - Centro Universitário (FMABC), Santo André, SP, Brasil
| | | | | | | | | | - Willy Baccaglini
- Departamento de Urologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | | | - Ruben Olivares
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Bruno Nahar
- Department of Urology, University of Miami Miller School of Medicine, Miami, USA
| | | | - Bianca Bianco
- Departamento de Urologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
- Faculdade de Medicina do ABC - Centro Universitário (FMABC), Santo André, SP, Brasil
| | - Arie Carneiro
- Departamento de Urologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
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Liu W, Kadier A, Shen D, He Y, Dong S, Zhu K, Xu G, Zhao B, Mao S, Guo C, Yao X, Wei Q, Han D, Yang B. Combined MRI-TRUS fusion targeted and systematic biopsy versus systematic biopsy alone for the detection of prostate cancer: protocol for a prospective single-centre trial. BMJ Open 2024; 14:e080593. [PMID: 38431292 PMCID: PMC10910516 DOI: 10.1136/bmjopen-2023-080593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/14/2024] [Indexed: 03/05/2024] Open
Abstract
INTRODUCTION The classic way of diagnosing prostate cancer (PCa) is by conducting the 12-core systematic biopsy (SB). However, it has a low detection rate for clinically significant PCa (csPCa) and can lead to the detection of clinically insignificant PCa (cisPCa). Although MRI-transrectal ultrasound (MRI-TRUS) fusion targeted biopsy (TB) can effectively improve the detection rate of csPCa, it may still miss some cases. Therefore, we propose using a combination of TB and SB methods to enhance the detection rate of csPCa while minimising the detection rate of cisPCa. METHODS AND ANALYSIS This study is a prospective, single-centre investigation that aims to assess and compare the detection rate of csPCa using MRI-TRUS fusion TB combined with SB versus TRUS 12-core SB alone. Biopsy-naïve men with suspected PCa will be subjected to multiparametric MRI. Patients with Prostate Imaging Reporting and Data System (V.2.1) score ≥3 will be enrolled in the TB-SB combination group. The sample size is established as 660 participants, considering a 10% drop-out rate. The primary outcome is the detection rate of csPCa in men without prior biopsy using MRI-TRUS fusion TB combined with the standard TRUS-guided 12-core SB method. CsPCa will be defined as International Society of Urological Pathology Grade ≥2. ETHICS AND DISSEMINATION This study has been approved by the Ethics Committee at the Shanghai Tenth People's Hospital, an affiliated hospital of Tongji University School of Medicine. The research results will be published in a peer-reviewed international journal. TRIAL REGISTRATION NUMBER ChiCTR2000036089.
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Affiliation(s)
- Wujianhong Liu
- Department of Pathology, Shanghai Tenth People's Hospital, Shanghai, China
- Urologic Cancer Institute, Tongji University School of Medicine, Shanghai, China
| | - Aimaitiaji Kadier
- Urologic Cancer Institute, Tongji University School of Medicine, Shanghai, China
- Department of Urology, Shanghai Tenth People's Hospital, Shanghai, China
| | - Danjing Shen
- Urologic Cancer Institute, Tongji University School of Medicine, Shanghai, China
- Department of Urology, Shanghai Tenth People's Hospital, Shanghai, China
| | - Yanyan He
- Department of Pathology, Shanghai Tenth People's Hospital, Shanghai, China
- Urologic Cancer Institute, Tongji University School of Medicine, Shanghai, China
| | - Shengrong Dong
- Department of Pathology, Shanghai Tenth People's Hospital, Shanghai, China
- Urologic Cancer Institute, Tongji University School of Medicine, Shanghai, China
| | - Kun Zhu
- Department of Pathology, Shanghai Tenth People's Hospital, Shanghai, China
- Urologic Cancer Institute, Tongji University School of Medicine, Shanghai, China
| | - Guang Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Shanghai, China
| | - Binghui Zhao
- Department of Radiology, Shanghai Tenth People's Hospital, Shanghai, China
| | - Shiyu Mao
- Urologic Cancer Institute, Tongji University School of Medicine, Shanghai, China
- Department of Urology, Shanghai Tenth People's Hospital, Shanghai, China
| | - Changcheng Guo
- Urologic Cancer Institute, Tongji University School of Medicine, Shanghai, China
- Department of Urology, Shanghai Tenth People's Hospital, Shanghai, China
| | - Xudong Yao
- Urologic Cancer Institute, Tongji University School of Medicine, Shanghai, China
- Department of Urology, Shanghai Tenth People's Hospital, Shanghai, China
| | - Qin Wei
- Department of Pathology, Shanghai Tenth People's Hospital, Shanghai, China
| | - Dongyan Han
- Department of Pathology, Shanghai Tenth People's Hospital, Shanghai, China
| | - Bin Yang
- Urologic Cancer Institute, Tongji University School of Medicine, Shanghai, China
- Department of Urology, Shanghai Tenth People's Hospital, Shanghai, China
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Talizin TB, Danilovic A, Torricelli FCM, Marchini GS, Batagello C, Vicentini FC, Nahas WC, Mazzucchi E. Postoperative antibiotic prophylaxis for percutaneous nephrolithotomy and risk of infection: a systematic review and meta-analysis. Int Braz J Urol 2024; 50:152-163. [PMID: 38386786 PMCID: PMC10953597 DOI: 10.1590/s1677-5538.ibju.2023.0626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 10/30/2023] [Indexed: 02/24/2024] Open
Abstract
PURPOSE The aim of this study is to perform a high-quality meta-analysis using only randomized controlled trials (RCT) to better define the role of postoperative antibiotics in patients undergoing percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS A literature search for RCTs in EMBASE, PubMed, and Web of Science up to May 2023 was conducted following the PICO framework: Population-adult patients who underwent PCNL; Intervention-postoperative antibiotic prophylaxis until nephrostomy tube withdrawal; Control-single dose of antibiotic during the induction of anesthesia; and Outcome-systemic inflammatory response syndrome (SIRS) or sepsis and fever after PCNL. The protocol was registered on the PROSPERO database (CRD42022361579). We calculated odds ratios (OR) and 95% confidence intervals (CI). A random-effects model was employed, and the alpha risk was defined as < 0.05. RESULTS Seven articles, encompassing a total of 629 patients, were included in the analysis. The outcome of SIRS or sepsis was extracted from six of the included studies, while the outcome of postoperative fever was extracted from four studies. The analysis revealed no statistical association between the use of postoperative antibiotic prophylaxis until nephrostomy tube withdrawal and the occurrence of SIRS/sepsis (OR 1.236, 95% CI 0.731 - 2.089, p=0.429) or fever (OR 2.049, 95% CI 0.790 - 5.316, p=0.140). CONCLUSION Our findings suggest that there is no benefit associated with the use of postoperative antibiotic prophylaxis until nephrostomy tube withdrawal in patients undergoing percutaneous nephrolithotomy (PCNL). We recommend that antibiotic prophylaxis should be administered only until the induction of anesthesia in PCNL.
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Affiliation(s)
- Thalita Bento Talizin
- Universidade de São PauloHospital das ClínicasSão PauloSPBrasilHospital das Clínicas, Universidade de São Paulo - USP, São Paulo, SP, Brasil;
| | - Alexandre Danilovic
- Universidade de São PauloHospital das ClínicasSão PauloSPBrasilHospital das Clínicas, Universidade de São Paulo - USP, São Paulo, SP, Brasil;
- Hospital Alemão Oswaldo CruzSão PauloSPBrasilHospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil;
| | - Fabio Cesar Miranda Torricelli
- Universidade de São PaulFaculdade de MedicinaDisciplina de UrologiaSão PauloSPBrasilDisciplina de Urologia, Faculdade de Medicina, Universidade de São Paulo - USP, São Paulo, SP, Brasil;
| | - Giovanni S. Marchini
- Universidade de São PaulFaculdade de MedicinaDisciplina de UrologiaSão PauloSPBrasilDisciplina de Urologia, Faculdade de Medicina, Universidade de São Paulo - USP, São Paulo, SP, Brasil;
| | - Carlos Batagello
- Universidade de São PauloHospital das ClínicasSão PauloSPBrasilHospital das Clínicas, Universidade de São Paulo - USP, São Paulo, SP, Brasil;
| | - Fabio C. Vicentini
- Universidade de São PaulFaculdade de MedicinaDisciplina de UrologiaSão PauloSPBrasilDisciplina de Urologia, Faculdade de Medicina, Universidade de São Paulo - USP, São Paulo, SP, Brasil;
| | - William Carlos Nahas
- Instituto do Câncer do Estado de São PauloDivisão de UrologiaSão PauloSPBrasilDivisão de Urologia, Instituto do Câncer do Estado de São Paulo - ICESP, São Paulo, SP, Brasil
| | - Eduardo Mazzucchi
- Universidade de São PaulFaculdade de MedicinaDisciplina de UrologiaSão PauloSPBrasilDisciplina de Urologia, Faculdade de Medicina, Universidade de São Paulo - USP, São Paulo, SP, Brasil;
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Mathier E, Althaus A, Zwahlen D, Lustenberger J, Zamboglou C, De Bari B, Aebersold DM, Guckenberger M, Zilli T, Shelan M. HypoFocal SRT Trial: Ultra-hypofractionated focal salvage radiotherapy for isolated prostate bed recurrence after radical prostatectomy; single-arm phase II study; clinical trial protocol. BMJ Open 2024; 14:e075846. [PMID: 38296279 PMCID: PMC10828884 DOI: 10.1136/bmjopen-2023-075846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 01/08/2024] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION Despite radical prostatectomy (RP) and radiotherapy (RT) being established treatments for localised prostate cancer, a significant number of patients experience recurrent disease. While conventionally fractionated RT is still being used as a standard treatment in the postoperative setting, ultra-hypofractionated RT has emerged as a viable option with encouraging results in patients with localised disease in the primary setting. In addition, recent technological advancements in RT delivery and precise definition of isolated macroscopic recurrence within the prostate bed using prostate-specific membrane antigen-positron emission tomography (PSMA-PET) and multiparametric MRI (mpMRI) allow the exploration of ultra-hypofractionated schedules in the salvage setting using five fractions. METHODS AND ANALYSIS In this single-arm prospective phase II multicentre trial, 36 patients with node-negative prostate adenocarcinoma treated with RP at least 6 months before trial registration, tumour stage pT2a-3b, R0-1, pN0 or cN0 according to the UICC TNM 2009 and evidence of measurable local recurrence within the prostate bed detected by PSMA PET/CT and mpMRI within the last 3 months, will be included. The patients will undergo focal ultra-hypofractionated salvage RT with 34 Gy in five fractions every other day to the site of local recurrence in combination with 6 months of androgen deprivation therapy. The primary outcome of this study is biochemical relapse-free survival at 2 years. Secondary outcomes include acute side effects (until 90 days after the end of RT) of grade 3 or higher based on Common Terminology Criteria for Adverse Events V.5, progression-free survival, metastasis-free survival, late side effects and the quality of life (based on European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30, QLQ-PR25). ETHICS AND DISSEMINATION The study has received ethical approval from the Ethics Commission of the Canton of Bern (KEK-BE 2022-01026). Academic dissemination will occur through publications and conference presentations. TRIAL REGISTRATION NUMBER NCT05746806.
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Affiliation(s)
- Etienne Mathier
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alexander Althaus
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel Zwahlen
- Department of Radiation Oncology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Jens Lustenberger
- Department of Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | | | - Berardino De Bari
- Department of Radiation Oncology, Réseau hospitalier neuchâtelois, Neuchatel, Switzerland
| | - Daniel M Aebersold
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Thomas Zilli
- Department of Radiation Oncology, Oncological Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
- Università della Svizzera italiana, Lugano, Switzerland
| | - Mohamed Shelan
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Nevalainen J, Raitanen J, Natunen K, Kilpeläinen T, Rannikko A, Tammela T, Auvinen A. Early detection of clinically significant prostate cancer: protocol summary and statistical analysis plan for the ProScreen randomised trial. BMJ Open 2024; 14:e075595. [PMID: 38195170 PMCID: PMC10806703 DOI: 10.1136/bmjopen-2023-075595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 12/20/2023] [Indexed: 01/11/2024] Open
Abstract
INTRODUCTION Evidence on the effectiveness of prostate cancer screening based on prostate-specific antigen is inconclusive and suggests a questionable balance between benefits and harms due to overdiagnosis, and complications from biopsies and overtreatment. However, diagnostic accuracy studies have shown that detection of clinically insignificant prostate cancer can be reduced by MRI combined with targeted biopsies.The aim of the paper is to describe the analysis of the ProScreen randomised trial to assess the performance of the novel screening algorithm in terms of the primary outcome, prostate cancer mortality and secondary outcomes as intermediate indicators of screening benefits and harms of screening. METHODS The trial aims to recruit at least 111 000 men to achieve sufficient statistical power for the primary outcome. Men will be allocated in a 1:3 ratio to the screening and control arms. Interim analysis is planned at 10 years of follow-up, and the final analysis at 15 years. Difference between the trial arms in prostate cancer mortality will be assessed by Gray's test using intention-to-screen analysis of randomised men. Secondary outcomes will be the incidence of prostate cancer by disease aggressiveness, progression to advanced prostate cancer, death due to any cause and cost-effectiveness of screening. ETHICS AND DISSEMINATION The trial protocol was reviewed by the ethical committee of the Helsinki University Hospital (2910/2017). Results will be disseminated through publications in international peer-reviewed journals and at scientific meetings. TRIAL REGISTRATION NUMBER NCT03423303.
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Affiliation(s)
| | - Jani Raitanen
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center, Tampere University, Tampere, Finland
| | | | - Tuomas Kilpeläinen
- University of Helsinki, Helsinki, Finland
- Helsinki University Central Hospital, Helsinki, Finland
| | - Antti Rannikko
- University of Helsinki, Helsinki, Finland
- Helsinki University Central Hospital, Helsinki, Finland
| | - Teuvo Tammela
- Tampere University, Tampere, Finland
- Tampere University Hospital, Tampere, Finland
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9
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Moschovas MC, Jaber A, Saikali S, Sandri M, Bhat S, Rogers T, Gamal A, Loy D, Patel E, Reddy S, Sighinolfi MC, Rocco B, Harvey T, Ficarra V, Patel V. Impacts on functional and oncological outcomes of Robotic-assisted Radical Prostatectomy 10 years after the US Preventive Service Taskforce recommendations against PSA screening. Int Braz J Urol 2024; 50:65-79. [PMID: 38166224 PMCID: PMC10947651 DOI: 10.1590/s1677-5538.ibju.2023.0530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 10/30/2023] [Indexed: 01/04/2024] Open
Abstract
OBJECTIVE In the following years after the United States Preventive Service Task Force (USPSTF) recommendation against prostate cancer screening with PSA in 2012, several authors worldwide described an increase in higher grades and aggressive prostate tumors. In this scenario, we aim to evaluate the potential impacts of USPSTF recommendations on the functional and oncological outcomes in patients undergoing robotic-assisted radical prostatectomy (RARP) in a referral center. MATERIAL AND METHODS We included 11396 patients who underwent RARP between 2008 and 2021. Each patient had at least a 12-month follow-up. The cohort was divided into two groups based on an inflection point in the outcomes at the end of 2012 and the beginning of 2013. The inflection point period was detected by Bayesian regression with multiple change points and regression with unknown breakpoints. We reported continuous variables as median and interquartile range (IQR) and categorical variables as absolute and relative percent frequencies. RESULTS Group 1 had 4760 patients, and Group 2 had 6636 patients, with a median follow-up of 109 and 38 months, respectively. In the final pathology, Group 2 had 9.5% increase in tumor volume, 24% increase on Gleason ≥ 4+3 (ISUP 3) , and 18% increase on ≥ pT3. This translated to a 6% increase in positive surgical margins and 24% reduction in full nerve sparing in response to the worsening pathology. There was a significant decline in post-operative outcomes in Group 2, including a 12-month continence reduction of 9%, reduction in potency by 27%, and reduction of trifecta by 22%. CONCLUSIONS The increasing number of high-risk patients has led to worse functional and oncologic outcomes. The initial rapid rise in PSM was leveled by the move towards more partial nerve sparing. Among some historical changes in prostate cancer diagnosis and management in the period of our study, the USPSTF recommendation coincided with worse outcomes of prostate cancer treatment in a population who could benefit from PSA screening at the appropriate time.
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Affiliation(s)
- Marcio Covas Moschovas
- AdventHealth Global Robotics InstituteUSAAdventHealth Global Robotics Institute, USA
- University of Central FloridaUSAUniversity of Central Florida (UCF), USA
| | - Abdel Jaber
- AdventHealth Global Robotics InstituteUSAAdventHealth Global Robotics Institute, USA
| | - Shady Saikali
- AdventHealth Global Robotics InstituteUSAAdventHealth Global Robotics Institute, USA
| | - Marco Sandri
- University of BresciaData Methods and StatisticsItalyData Methods and Statistics, University of Brescia, Italy
| | - Seetharam Bhat
- AdventHealth Global Robotics InstituteUSAAdventHealth Global Robotics Institute, USA
| | - Travis Rogers
- AdventHealth Global Robotics InstituteUSAAdventHealth Global Robotics Institute, USA
| | - Ahmed Gamal
- AdventHealth Global Robotics InstituteUSAAdventHealth Global Robotics Institute, USA
| | - David Loy
- AdventHealth Global Robotics InstituteUSAAdventHealth Global Robotics Institute, USA
| | - Evan Patel
- AdventHealth Global Robotics InstituteUSAAdventHealth Global Robotics Institute, USA
| | - Sumeet Reddy
- AdventHealth Global Robotics InstituteUSAAdventHealth Global Robotics Institute, USA
| | - Maria Chiara Sighinolfi
- La Statale UniversityASST Santi Paolo e CarloItalyASST Santi Paolo e Carlo - La Statale University, Italy
| | - Bernardo Rocco
- La Statale UniversityASST Santi Paolo e CarloItalyASST Santi Paolo e Carlo - La Statale University, Italy
| | - Tadzia Harvey
- AdventHealth Global Robotics InstituteUSAAdventHealth Global Robotics Institute, USA
| | - Vincenzo Ficarra
- Università degli Studi di MessinaItalyUniversità degli Studi di Messina, Italy
| | - Vipul Patel
- AdventHealth Global Robotics InstituteUSAAdventHealth Global Robotics Institute, USA
- University of Central FloridaUSAUniversity of Central Florida (UCF), USA
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10
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Schmit S, Allu S, Tanzer JR, Ortiz R, Pareek G, Hyams E. Less qualitative multiparametric magnetic resonance imaging in prostate cancer can underestimate extraprostatic extension in higher grade tumors. Int Braz J Urol 2024; 50:37-45. [PMID: 38166221 PMCID: PMC10947645 DOI: 10.1590/s1677-5538.ibju.2023.0321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/21/2023] [Indexed: 01/04/2024] Open
Abstract
BACKGROUND Multiparametric magnetic resonance imaging (mpMRI) is increasingly used for risk stratification and preoperative staging of prostate cancer. It remains unclear how Grade Group (GG) interacts with the ability of mpMRI to determine the presence of extraprostatic extension (EPE) on surgical pathology. METHODS A retrospective review of a robotic assisted laparoscopic radical prostatectomy (RALP) database from 2016-2020 was performed. Radiology mpMRI reports by multiple attending radiologists and without clear standardization or quality control were retrospectively assessed for EPE findings and compared with surgical pathology reports. The data were stratified by biopsy-based GG and a multivariable cluster analysis was performed to incorporate additional preoperative variables (age at diagnosis, PSA, etc.). Hazard ratios were calculated to determine how mpMRI findings and radiographic EPE relate to positive surgical margins. RESULTS 289 patients underwent at least one mpMRI prior to RALP. Preoperative mpMRI demonstrated sensitivity of 39.3% and specificity of 88.8% for pathological EPE and had a negative predictive value (NPV) of 49.5%, and positive predictive value (PPV) of 84.0%. Stratification of NPV by GG yielded the following values: GG 1-5 (49.5%), GG 3-5 (40.8%), GG 4-5 (43.4%), and GG 5 (30.4%). Additionally, positive EPE on preoperative mpMRI was associated with a significantly decreased risk of positive surgical margins (RR: 0.655; 95% CI: 0.557-0.771). CONCLUSIONS NPV of prostate mpMRI for EPE may be decreased for higher grade tumors. A detailed reference reading and image quality optimization may improve performance. However, urologists should exercise caution in nerve sparing approaches in these patients.
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Affiliation(s)
- Stephen Schmit
- Warren Alpert Medical School of Brown UniversityThe Minimally Invasive Urology Institute at The Miriam HospitalDivision of UrologyProvidenceRIThe Minimally Invasive Urology Institute at The Miriam Hospital, Division of Urology, Warren Alpert Medical School of Brown University, Providence, RI
| | - Sai Allu
- Warren Alpert Medical School of Brown UniversityThe Minimally Invasive Urology Institute at The Miriam HospitalDivision of UrologyProvidenceRIThe Minimally Invasive Urology Institute at The Miriam Hospital, Division of Urology, Warren Alpert Medical School of Brown University, Providence, RI
| | - Joshua Ray Tanzer
- Warren Alpert Medical School of Brown UniversityThe Minimally Invasive Urology Institute at The Miriam HospitalDivision of UrologyProvidenceRIThe Minimally Invasive Urology Institute at The Miriam Hospital, Division of Urology, Warren Alpert Medical School of Brown University, Providence, RI
| | - Rebecca Ortiz
- Warren Alpert Medical School of Brown UniversityThe Minimally Invasive Urology Institute at The Miriam HospitalDivision of UrologyProvidenceRIThe Minimally Invasive Urology Institute at The Miriam Hospital, Division of Urology, Warren Alpert Medical School of Brown University, Providence, RI
| | - Gyan Pareek
- Warren Alpert Medical School of Brown UniversityThe Minimally Invasive Urology Institute at The Miriam HospitalDivision of UrologyProvidenceRIThe Minimally Invasive Urology Institute at The Miriam Hospital, Division of Urology, Warren Alpert Medical School of Brown University, Providence, RI
| | - Elias Hyams
- Warren Alpert Medical School of Brown UniversityThe Minimally Invasive Urology Institute at The Miriam HospitalDivision of UrologyProvidenceRIThe Minimally Invasive Urology Institute at The Miriam Hospital, Division of Urology, Warren Alpert Medical School of Brown University, Providence, RI
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11
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McNeel DG, Emamekhoo H, Eickhoff JC, Kyriakopoulos CE, Wargowski E, Tonelli TP, Johnson LE, Liu G. Phase 2 trial of a DNA vaccine (pTVG-HP) and nivolumab in patients with castration-sensitive non-metastatic (M0) prostate cancer. J Immunother Cancer 2023; 11:e008067. [PMID: 38101860 PMCID: PMC10729272 DOI: 10.1136/jitc-2023-008067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2023] [Indexed: 12/17/2023] Open
Abstract
PURPOSE We have previously reported that a plasmid DNA vaccine encoding prostatic acid phosphatase (pTVG-HP) had greater clinical activity when given in combination with pembrolizumab to patients with metastatic, castration-resistant prostate cancer. The current trial was conducted to evaluate vaccination with PD-1 blockade, using nivolumab, in patients with early, recurrent (M0) prostate cancer. METHODS Patients with M0 prostate cancer were treated with pTVG-HP (100 µg administered intradermally) and nivolumab (240 mg intravenous infusion) every 2 weeks for 3 months, and then every 4 weeks for 1 year of total treatment. Patients were then followed for an additional year off treatment. The primary objectives were safety and complete prostate-specific antigen (PSA) response (PSA<0.2 ng/mL). RESULTS 19 patients were enrolled. No patients met the primary endpoint of complete PSA response; however, 4/19 (21%) patients had a PSA decline >50%. Median PSA doubling times were 5.9 months pretreatment, 25.6 months on-treatment (p=0.001), and 9.0 months in the subsequent year off-treatment. The overall median radiographic progression-free survival was not reached. Grade 3 or 4 events included adrenal insufficiency, fatigue, lymphopenia, and increased amylase/lipase. 9/19 (47%) patients developed immune-related adverse effects (irAE). The development of irAE and increased CXCL9 were associated with increased PSA doubling time. Quantitative NaF PET/CT imaging showed the resolution of subclinical lesions along with the development of new lesions at each time point. CONCLUSIONS In this population, combining nivolumab with pTVG-HP vaccination was safe, and immunologically active, prolonged the time to disease progression, but did not eradicate disease. Quantitative imaging suggested that additional treatments targeting mechanisms of resistance may be required to eliminate tumors. TRIAL REGISTRATION NUMBER NCT03600350.
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Affiliation(s)
- Douglas G McNeel
- Medicine, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - Hamid Emamekhoo
- Medicine, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - Jens C Eickhoff
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | | | - Ellen Wargowski
- Medicine, University of Wisconsin Madison, Madison, Wisconsin, USA
| | | | | | - Glenn Liu
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
- University Of Wisconsin Hospital & Clinics, Madison, Wisconsin, USA
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12
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Danckaert W, Spaas M, Sundahl N, De Bruycker A, Fonteyne V, De Paepe E, De Wagter C, Vanhaecke L, Ost P. Microbiome and metabolome dynamics during radiotherapy for prostate cancer. Radiother Oncol 2023; 189:109950. [PMID: 37827280 DOI: 10.1016/j.radonc.2023.109950] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/02/2023] [Accepted: 10/07/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Prostate cancer patients treated with radiotherapy are susceptible to acute gastrointestinal (GI) toxicity due to substantial overlap of the intestines with the radiation volume. Due to their intimate relationship with GI toxicity, faecal microbiome and metabolome dynamics during radiotherapy were investigated. MATERIAL & METHODS This prospective study included 50 prostate cancer patients treated with prostate (bed) only radiotherapy (PBRT) (n = 28) or whole pelvis radiotherapy (WPRT) (n = 22) (NCT04638049). Longitudinal sampling was performed prior to radiotherapy, after 10 fractions, near the end of radiotherapy and at follow-up. Patient symptoms were dichotomized into a single toxicity score. Microbiome and metabolome fingerprints were analyzed by 16S rRNA gene sequencing and ultra-high-performance liquid chromatography hybrid high-resolution mass spectrometry, respectively. RESULTS The individual α-diversity did not significantly change over time. Microbiota composition (β-diversity) changed significantly over treatment (PERMANOVA p-value = 0.03), but there was no significant difference in stability when comparing PBRT versus WPRT. Levels of various metabolites were significantly altered during radiotherapy. Baseline α-diversity was not associated with any toxicity outcome. Based on the metabolic fingerprint, no natural clustering according to toxicity profile could be achieved. CONCLUSIONS Radiation dose and treatment volume demonstrated limited effects on microbiome and metabolome fingerprints. In addition, no distinctive signature for toxicity status could be established. There is an ongoing need for toxicity risk stratification tools for diagnostic and therapeutic purposes, but the current evidence implies that the translation of metabolic and microbial biomarkers into routine clinical practice remains challenging.
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Affiliation(s)
- Willeke Danckaert
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium; Cancer Research Institute Ghent (CRIG), Ghent, Belgium.
| | - Mathieu Spaas
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium; Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - Nora Sundahl
- Department of Radiation Oncology, AZ Groeninge Kortrijk, Kortrijk, Belgium
| | - Aurélie De Bruycker
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium; Department of Radiation Oncology, AZ Groeninge Kortrijk, Kortrijk, Belgium
| | - Valérie Fonteyne
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium; Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - Ellen De Paepe
- Laboratory of Integrative Metabolomics (LIMET), Department of Translational Physiology, Infectiology and Public Health, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Carlos De Wagter
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Lynn Vanhaecke
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium; Laboratory of Integrative Metabolomics (LIMET), Department of Translational Physiology, Infectiology and Public Health, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium; Institute for Global Food Security, School of Biological Sciences, Queen's University, BT7 1NN Belfast, United Kingdom
| | - Piet Ost
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Cancer Research Institute Ghent (CRIG), Ghent, Belgium; Department of Radiation Oncology, Iridium Netwerk, Wilrijk, Belgium
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13
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Muntz R. [Living with… prostate cancer]. Rev Prat 2023; 73:1107-1108. [PMID: 38294480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
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14
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Abe M, Takata R, Ikarashi D, Sekiguchi K, Tamura D, Maekawa S, Kato R, Kanehira M, Ujiie T, Obara W. Detection of anterior prostate cancer using a magnetic resonance imaging-transrectal ultrasound fusion biopsy in cases with initial biopsy and history of systematic biopsies. Prostate Int 2023; 11:212-217. [PMID: 38196555 PMCID: PMC10772202 DOI: 10.1016/j.prnil.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/18/2023] [Accepted: 08/28/2023] [Indexed: 01/11/2024] Open
Abstract
Background Prostate cancer in the anterior region may be missed on a transrectal systematic biopsy (SBx). Therefore, this study aimed to evaluate the performance of magnetic resonance imaging-transrectal ultrasound (MRI-TRUS) fusion targeted biopsy (TBx) in detecting anterior region cancer in patients with a history of SBxs. Methods Prostate biopsies were performed in 224 patients after multiparametric MRI, among whom 119 patients with prostate imaging reporting and data system (PI-RADS version 2) scores of 3 to 5 underwent MRI-TRUS fusion TBxs. Afterward, cancer detection rates (CDRs) and TBx-positive core regions were compared by categorizing patients into those with or without a history of SBxs. Results Total CDR was 68.8% (44/64 cases) in the initial biopsy group (Initial-Bx group) and 47.3% (26/55 cases) in the previous-negative-systematic biopsy group (Pre-Neg-SBx group) (P = 0.018). Interestingly, both TBx- and SBx-core positive cases were more common in the Initial-Bx group than in the Pre-Neg-SBx group (Initial-Bx group: 75% [33/44 cases] vs. Pre-Neg-SBx group: 42.3% [11/26 cases], P = 0.006). However, only TBx-core positive cases were more common in the Pre-Neg-SBx group than in the Initial-Bx group (Initial-Bx group: 11.4% [5/44 cases] vs. Pre-Neg-SBx group: 30.8% [8/26 cases], P = 0.043). In addition, the proportion of anterior lesions detected by TBx cores was higher in the Pre-Neg-SBx group than in the Initial-Bx group (Initial-Bx group: 26.3% [10/38 cases] vs. Pre-Neg-SBx group: 52.6% [10/19 cases], P = 0.049). Conclusion Using MRI-TRUS fusion TBx in the evaluation of previously negative SBx cases improved the detection rate of anterior lesions, which might have been missed in previous SBxs. Especially in patients with a history of SBxs mpMRI should be performed to screen for anterior lesions.
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Affiliation(s)
- Masakazu Abe
- Department of Urology, Iwate Medical University, Yahaba, Japan
| | - Ryo Takata
- Department of Urology, Iwate Medical University, Yahaba, Japan
| | - Daiki Ikarashi
- Department of Urology, Iwate Medical University, Yahaba, Japan
| | - Kie Sekiguchi
- Department of Urology, Iwate Medical University, Yahaba, Japan
| | - Daichi Tamura
- Department of Urology, Iwate Medical University, Yahaba, Japan
| | | | - Renpei Kato
- Department of Urology, Iwate Medical University, Yahaba, Japan
| | | | - Takashi Ujiie
- Department of Urology, Iwate Prefectural Ofunato Hospital, Ofunato, Japan
| | - Wataru Obara
- Department of Urology, Iwate Medical University, Yahaba, Japan
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15
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Bertolo R, Carilli M, Antonucci M, Maiorino F, Bove P, Vittori M. "Single-Surgeon" versus "Dual-Surgeon" Robot-Assisted Radical Prostatectomy and Pelvic Lymph-nodes Dissection: Comparative Analysis of Perioperative Outcomes. Int Braz J Urol 2023; 49:732-739. [PMID: 37903007 PMCID: PMC10947625 DOI: 10.1590/s1677-5538.ibju.2023.0348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/13/2023] [Indexed: 11/01/2023] Open
Abstract
PURPOSE To compare the perioperative outcomes of robot-assisted radical prostatectomy (RARP) with pelvic lymph-nodes dissection (PLND) when the same surgeon performs RARP and PLND versus one surgeon performs RARP and another surgeon performs PLND. MATERIALS AND METHODS From January 2022 to March 2023, data of consecutive patients who underwent RARP with PLND were prospectively collected. The surgeries were performed by two "young" surgeons with detailed profile. Specifically for the study purpose, one surgeon performed RARP, and the other surgeon performed PLND. A set of surgeries performed according to the standard setup (i.e., the same surgeon performing both RARP and PLND) was retrieved from the institutional database and used as comparator arm. To test the study hypothesis, patients were divided into two groups: "dual-surgeon" versus "single-surgeon". RESULTS Fifty patients underwent RARP and PLND performed according to dual-surgeon setup and were compared to the last 50 procedures performed according to the standard single-surgeon setup. Patients in the groups had comparable baseline characteristics. Dual-surgeon interventions had significantly shorter median total operative (194 [IQR 178-215] versus 174 [IQR 146-195] minutes, p<0.001) and console time (173 [IQR 158-194] versus 154 [IQR 129-170] minutes, p<0.001). No significant differences were found in terms of blood loss, intraoperative complications, postoperative outcomes, and final pathology results. CONCLUSIONS The present analysis found that when RARP and PLND are split onto two surgeons, the operative time is shorter by 20 minutes compared to when a single surgeon performs RARP and PLND. This is an interesting finding that could sponsor further studies.
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Affiliation(s)
- Riccardo Bertolo
- San Carlo di Nancy HospitalDepartment of UrologyRomeItalyDepartment of Urology, San Carlo di Nancy Hospital, Rome, Italy;
| | - Marco Carilli
- San Carlo di Nancy HospitalDepartment of UrologyRomeItalyDepartment of Urology, San Carlo di Nancy Hospital, Rome, Italy;
| | - Michele Antonucci
- San Carlo di Nancy HospitalDepartment of UrologyRomeItalyDepartment of Urology, San Carlo di Nancy Hospital, Rome, Italy;
| | - Francesco Maiorino
- San Carlo di Nancy HospitalDepartment of UrologyRomeItalyDepartment of Urology, San Carlo di Nancy Hospital, Rome, Italy;
| | - Pierluigi Bove
- San Carlo di Nancy HospitalDepartment of UrologyRomeItalyDepartment of Urology, San Carlo di Nancy Hospital, Rome, Italy;
- Tor Vergata University of RomeDepartment of SurgeryUrology UnitRomeItalyUrology Unit, Department of Surgery, Tor Vergata University of Rome, Rome, Italy
| | - Matteo Vittori
- San Carlo di Nancy HospitalDepartment of UrologyRomeItalyDepartment of Urology, San Carlo di Nancy Hospital, Rome, Italy;
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16
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Chebbi A. [Sexual dysfunction after prostate cancer treatment]. Rev Prat 2023; 73:879-884. [PMID: 38354013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
SEXUAL DYSFUNCTION AFTER PROSTATE CANCER TREATMENT. Changes in sexuality after prostate cancer treatment are very common, significantly impacting quality of life. Psychologically, body image, self-esteem and interpersonal relationships are negatively affected. The main treatments for prostate cancer (prostatectomy, radiotherapy, hormone therapy) lead systematically to sexual dysfunctions: erectile dysfunction, low libido, orgasmic dysfunction, sexual incontinence, loss of penile length and girth, penile curvature. In addition to the lifestyle modification strategies, clear and appropriate information on sexual dysfunction secondary to prostate cancer management and on treatment should be provided during a dedicated consultation. The treatments include pharmacological and non-pharmacological treatments, particularly surgery, with the aim of minimizing the negative impact of prostate cancer treatments on sexual function.
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Affiliation(s)
- Ala Chebbi
- Clinique de la région mantaise, Mantes-la-Jolie, centre hospitalier privé du Montgardé, Aubergenville, France Hôpital Paris Saint-Joseph, Paris, France
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17
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Handke A, Kesch C, Fendler WP, Telli T, Liu Y, Hakansson A, Davicioni E, Hughes J, Song H, Lueckerath K, Herrmann K, Hadaschik B, Seifert R. Analysing the tumor transcriptome of prostate cancer to predict efficacy of Lu-PSMA therapy. J Immunother Cancer 2023; 11:e007354. [PMID: 37857524 PMCID: PMC10603337 DOI: 10.1136/jitc-2023-007354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 10/21/2023] Open
Abstract
RATIONALE 177Lu-PSMA ([177Lu]Lutetium-PSMA-617) therapy is an effective treatment option for patients with prostate specific membrane antigen (PSMA)-positive metastatic castration-resistant prostate cancer, but still shows a non-responder rate of approximately 30%. Combination regimes of programmed death-ligand 1 (PD-L1) inhibition and concomitant 177Lu-PSMA therapy have been proposed to increase the response rate. However, the interplay of immune landscape and 177Lu-PSMA therapy efficacy is poorly understood. METHODS Between March 2018 and December 2021, a total of 168 patients were referred to 177Lu-PSMA therapy in our department and received a mean total dose of 21.9 GBq (three cycles in mean). All patients received baseline PSMA positron emission tomography to assess the PSMA uptake. The histopathological specimen of the primary prostate tumor was available with sufficient RNA passing quality control steps for genomic analysis in n=23 patients. In this subset of patients, tumor RNA transcriptomic analyses assessed 74 immune-related features in total, out of which n=24 signatures were not co-correlated and investigated further for outcome prognostication. RESULTS In the subset of patients who received 177Lu-PSMA therapy, PD-L1 was not significantly associated with OS (HR per SD change (95% CI) 0.74 (0.42 to 1.30); SD: 0.18; p=0.29). In contrast, PD-L2 signature was positively associated with longer OS (HR per SD change 0.46 (95% CI 0.29 to 0.74); SD: 0.24; p=0.001; median OS 17.2 vs 5.7 months in higher vs lower PD-L2 patients). In addition, PD-L2 signature correlated with PSA-response (ϱ=-0.46; p=0.04). The PD-L2 signature association with OS was significantly moderated by L-Lactatdehydrogenase (LDH) levels (Cox model interaction p=0.01). CONCLUSION Higher PD-L2 signature might be associated with a better response to 177Lu-PSMA therapy and warrants further studies investigating additional immunotherapy. In contrast, PD-L1 was not associated with outcome. The protective effect of PD-L2 signature might be present only in men with lower LDH levels.
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Affiliation(s)
- Analena Handke
- Department of Urology, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Claudia Kesch
- Department of Urology, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Wolfgang Peter Fendler
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Tugce Telli
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Yang Liu
- Veracyte, Inc, Decipher Biosciences Inc, Vancouver, BC, Canada
| | | | - Elai Davicioni
- Veracyte, Inc, Decipher Biosciences Inc, Vancouver, BC, Canada
| | - Jason Hughes
- Veracyte, Inc, Decipher Biosciences Inc, Vancouver, BC, Canada
| | - Hong Song
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Katharina Lueckerath
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Boris Hadaschik
- Department of Urology, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Robert Seifert
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
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Dahut M, Fousek K, Horn LA, Angstadt S, Qin H, Hamilton DH, Schlom J, Palena C. Fulvestrant increases the susceptibility of enzalutamide-resistant prostate cancer cells to NK-mediated lysis. J Immunother Cancer 2023; 11:e007386. [PMID: 37678915 PMCID: PMC10496692 DOI: 10.1136/jitc-2023-007386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Enzalutamide, a next-generation antiandrogen agent, is approved for the treatment of metastatic castration-resistant prostate cancer (CRPC). While enzalutamide has been shown to improve time to progression and extend overall survival in men with CRPC, the majority of patients ultimately develop resistance to treatment. Immunotherapy approaches have shown limited clinical benefit in this patient population; understanding resistance mechanisms could help develop novel and more effective treatments for CRPC. One of the mechanisms involved in tumor resistance to various therapeutics is tumor phenotypic plasticity, whereby carcinoma cells acquire mesenchymal features with or without the loss of classical epithelial characteristics. This work investigated a potential link between enzalutamide resistance, tumor phenotypic plasticity, and resistance to immune-mediated lysis in prostate cancer. METHODS Models of prostate cancer resistant to enzalutamide were established by long-term exposure of human prostate cancer cell lines to the drug in culture. Tumor cells were evaluated for phenotypic features in vitro and in vivo, as well as for sensitivity to immune effector cell-mediated cytotoxicity. RESULTS Resistance to enzalutamide was associated with gain of mesenchymal tumor features, upregulation of estrogen receptor expression, and significantly reduced tumor susceptibility to natural killer (NK)-mediated lysis, an effect that was associated with decreased tumor/NK cell conjugate formation with enzalutamide-resistant cells. Fulvestrant, a selective estrogen receptor degrader, restored the formation of target/NK cell conjugates and increased susceptibility to NK cell lysis in vitro. In vivo, fulvestrant demonstrated antitumor activity against enzalutamide-resistant cells, an effect that was associated with activation of NK cells. CONCLUSION NK cells are emerging as a promising therapeutic approach in prostate cancer. Modifying tumor plasticity via blockade of estrogen receptor with fulvestrant may offer an opportunity for immune intervention via NK cell-based approaches in enzalutamide-resistant CRPC.
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Affiliation(s)
- Madeline Dahut
- Center for Immuno-Oncology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Kristen Fousek
- Center for Immuno-Oncology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Lucas A Horn
- Center for Immuno-Oncology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Shantel Angstadt
- Center for Immuno-Oncology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Haiyan Qin
- Center for Immuno-Oncology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Duane H Hamilton
- Center for Immuno-Oncology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Jeffrey Schlom
- Center for Immuno-Oncology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Claudia Palena
- Center for Immuno-Oncology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
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Li J, Chen T, Gao J, Peng F, Gu T, Jin B. Developing and validating utility parameters to establish patient-reported outcome-based perioperative symptom management in patients undergoing prostatectomy: a multicentre, prospective, observational cohort study protocol. BMJ Open 2023; 13:e074763. [PMID: 37553190 PMCID: PMC10414067 DOI: 10.1136/bmjopen-2023-074763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 07/20/2023] [Indexed: 08/10/2023] Open
Abstract
INTRODUCTION Symptom monitoring and alerting based on patient-reported outcomes have proven valuable in a postoperative setting. However, the parameters of the implemented patient-centred symptom management system for patients with prostate cancer (PC) remain unclear. This study aims to develop a perioperative symptom scale (PSS) to monitor symptoms, determine the appropriate timing for symptom assessment and establish intervention criteria for physicians. METHODS AND ANALYSIS We will prospectively recruit 387 patients undergoing PC surgery in 3 hospitals. The Chinese version of the MD Anderson Symptom Inventory (MDASI) will be used for longitudinal symptom data collection, presurgery and 1, 2, 3, 5, 7, 14, 21, 28, 42 and 90 days post surgery. A PSS will be generated when symptoms change significantly over time. A linear mixed model will be used to determine appropriate follow-up time points. The functional status determined by MDASI interference can then be used to establish alarm thresholds. ETHICS AND DISSEMINATION This study was approved by the Lishui Municipal Central Hospital Ethics Committee on 13 April 2022 (No. LSMCHEC-2022-54) and the Ethics Committee of Huzhou Central Hospital on 5 July 2023 (No. HZCHEC-202306017-01), the Ethics Committee of the First Affiliated Hospital of Huzhou Normal College on 20 June 2023 (No. HZYYEC-2023KYLL055). The latest protocol used in this study was V.2.0, dated on 25 February 2023. Before publication in a peer-reviewed journal, our findings will be presented and discussed at relevant medical conferences. TRIAL REGISTRATION NUMBER ChiCTR2200059110.
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Affiliation(s)
- Jie Li
- Department of Urology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Urology, Lishui Municipal Central Hospital and Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, Zhejiang, China
| | - Ting Chen
- Department of Urology, Lishui Municipal Central Hospital and Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, Zhejiang, China
| | - Jianguo Gao
- Department of Urology, The First Affiliated Hospital of Huzhou Normal College, Huzhou, Zhejiang, China
| | - Fusheng Peng
- Department of Urology, Huzhou Central Hospital, Huzhou, Zhejiang, China
| | - Tengfei Gu
- Department of Urology, Lishui Municipal Central Hospital and Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, Zhejiang, China
| | - Baiye Jin
- Department of Urology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Zhejiang Engineering Research Center for Urinary Bladder Carcinoma Innovation Diagnosis and Treatment, Hangzhou, Zhejiang, China
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20
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Benzo RM, Moreno PI, Fox RS, Silvera CA, Walsh EA, Yanez B, Balise RR, Oswald LB, Penedo FJ. Comorbidity burden and health-related quality of life in men with advanced prostate cancer. Support Care Cancer 2023; 31:496. [PMID: 37501020 PMCID: PMC10644679 DOI: 10.1007/s00520-023-07962-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 07/21/2023] [Indexed: 07/29/2023]
Abstract
PURPOSE Identifying clinically relevant comorbidities and their effect on health-related quality of life (HRQoL) outcomes among men with advanced prostate cancer (APC) can inform patient care and improve outcomes; however, this is poorly understood. The aim of this observational study was to examine the prevalence of comorbidities, and the relationship of comorbidity burden to HRQoL and other patient-reported outcomes (PROs) among men with APC. METHODS Participants were 192 men (average age 68.8) with APC (stage III or IV) who completed a psychosocial battery including measures of sociodemographic factors, HRQoL and other PROs, and the Charlson Comorbidity Index (CCI). Hierarchical multiple regression analysis was used to examine the relationships between CCI, HRQOL, and PROs. RESULTS The vast majority (82%) of participants had at least one comorbidity, with the most common being: hypertension (59%), connective tissue disease or arthritis (31%), diabetes (24%), and problems with kidneys, vision, or another organ (24%). After controlling for covariates, regressions showed that a higher CCI score was significantly associated with worse HRQoL (p < 0.001), lower levels of positive affect (p < 0.05), and higher levels of depression (p < 0.05), fatigue (p < 0.001), pain (p < 0.01), stress (p < 0.01), and cancer-specific distress (p < 0.05). CONCLUSIONS Comorbidities were common among men with APC, and a greater CCI score was associated with detriments in several domains of HRQoL and other PROs. Our findings show the need to address comorbidities in the presence of a cancer diagnosis and subsequent treatment. TRIAL REGISTRATION CLINICALTRIALS. GOV IDENTIFIER NCT03149185.
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Affiliation(s)
- Roberto M Benzo
- Department of Psychology, University of Miami, 5665 Ponce de Leon Boulevard, Flipse Building, 5thFloor, Coral Gables, Miami, FL, 33146, USA
| | - Patricia I Moreno
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Rina S Fox
- University of Arizona College of Nursing, Tucson, AZ, USA
- University of Arizona Cancer Center, Tucson, AZ, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Carlos A Silvera
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Emily A Walsh
- Department of Psychology, University of Miami, 5665 Ponce de Leon Boulevard, Flipse Building, 5thFloor, Coral Gables, Miami, FL, 33146, USA
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Raymond R Balise
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Urology, University of Miami, Miami, FL, USA
| | - Laura B Oswald
- Department of Health Outcomes and Behavior, Moffit Cancer Center, Tampa, FL, USA
| | - Frank J Penedo
- Department of Psychology, University of Miami, 5665 Ponce de Leon Boulevard, Flipse Building, 5thFloor, Coral Gables, Miami, FL, 33146, USA.
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.
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21
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Wang S, Huang M, Chen M, Sun Z, Jiao Y, Ye G, Pan J, Ye W, Zhao J, Zhang D. Zoledronic acid and thymosin α1 elicit antitumor immunity against prostate cancer by enhancing tumor inflammation and cytotoxic T cells. J Immunother Cancer 2023; 11:e006381. [PMID: 37295817 PMCID: PMC10277537 DOI: 10.1136/jitc-2022-006381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Advanced or metastatic prostate cancer (PCa) is still an incurable malignancy with high lethality and a poor prognosis. Despite the remarkable success of immunotherapy against many types of cancer, most patients with PCa receive minimal benefit from current immunotherapeutic strategies, because PCa is an immune cold tumor with scarce T-cell infiltration in the tumor microenvironment. The aim of this study was to develop an effective immunotherapeutic approach for immune cold PCa tumors. METHODS The therapeutic efficacy of androgen deprivation therapy (ADT) and zoledronic acid (ZA) plus thymosin α1 (Tα1) therapy was analyzed retrospectively in patients with advanced or metastatic PCa. The effects and mechanisms by which ZA and Tα1 regulated the immune functions of PCa cells and immune cells were evaluated by a PCa allograft mouse model, flow cytometric analysis, immunohistochemical and immunofluorescence staining assays, and PCR, ELISA, and Western blot analyses. RESULTS In this study, clinical retrospective analysis revealed that ADT combined with ZA plus Tα1 improved the therapeutic outcomes of patients with PCa, which might be associated with an enhanced frequency of T cells. ZA and Tα1 treatment synergistically inhibited the growth of androgen-independent PCa allograft tumors, with increased infiltration of tumor-specific cytotoxic CD8+ T cells and enhanced tumor inflammation. Functionally, ZA and Tα1 treatment relieved immunosuppression in PCa cells, stimulated pro-inflammatory macrophages, and enhanced the cytotoxic function of T cells. Mechanistically, ZA plus Tα1 therapy blocked the MyD88/NF-κB pathway in PCa cells but activated this signaling in macrophages and T cells, altering the tumor immune landscape to suppress PCa progression. CONCLUSIONS These findings uncover a previously undefined role for ZA and Tα1 in inhibiting the disease progression of immune cold PCa tumors by enhancing antitumor immunity and pave the way for the application of ZA plus Tα1 therapy as an immunotherapeutic strategy for treating patients with immunologically unresponsive PCa.
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Affiliation(s)
- Sheng Wang
- Department of Natural Medicinal Chemistry, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu, China
- State Key Laboratory of Bioactive Molecules and Druggability Assessment, Jinan University, Guangzhou, Guangdong, China
- Guangdong Province Key Laboratory of Pharmacodynamic Constituents of Traditional Chinese Medicine and New Drugs Research, College of Pharmacy, Jinan University, Guangzhou, Guangdong, China
| | - Maohua Huang
- State Key Laboratory of Bioactive Molecules and Druggability Assessment, Jinan University, Guangzhou, Guangdong, China
- Guangdong Province Key Laboratory of Pharmacodynamic Constituents of Traditional Chinese Medicine and New Drugs Research, College of Pharmacy, Jinan University, Guangzhou, Guangdong, China
| | - Minfeng Chen
- State Key Laboratory of Bioactive Molecules and Druggability Assessment, Jinan University, Guangzhou, Guangdong, China
- Guangdong Province Key Laboratory of Pharmacodynamic Constituents of Traditional Chinese Medicine and New Drugs Research, College of Pharmacy, Jinan University, Guangzhou, Guangdong, China
| | - Zhiting Sun
- Research Center of Cancer Diagnosis and Therapy, Department of Oncology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Yubo Jiao
- State Key Laboratory of Bioactive Molecules and Druggability Assessment, Jinan University, Guangzhou, Guangdong, China
- Guangdong Province Key Laboratory of Pharmacodynamic Constituents of Traditional Chinese Medicine and New Drugs Research, College of Pharmacy, Jinan University, Guangzhou, Guangdong, China
| | - Geni Ye
- State Key Laboratory of Bioactive Molecules and Druggability Assessment, Jinan University, Guangzhou, Guangdong, China
- Guangdong Province Key Laboratory of Pharmacodynamic Constituents of Traditional Chinese Medicine and New Drugs Research, College of Pharmacy, Jinan University, Guangzhou, Guangdong, China
| | - Jinghua Pan
- The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Wencai Ye
- Department of Natural Medicinal Chemistry, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu, China
- State Key Laboratory of Bioactive Molecules and Druggability Assessment, Jinan University, Guangzhou, Guangdong, China
- Guangdong Province Key Laboratory of Pharmacodynamic Constituents of Traditional Chinese Medicine and New Drugs Research, College of Pharmacy, Jinan University, Guangzhou, Guangdong, China
| | - Jianfu Zhao
- Research Center of Cancer Diagnosis and Therapy, Department of Oncology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Dongmei Zhang
- State Key Laboratory of Bioactive Molecules and Druggability Assessment, Jinan University, Guangzhou, Guangdong, China
- Guangdong Province Key Laboratory of Pharmacodynamic Constituents of Traditional Chinese Medicine and New Drugs Research, College of Pharmacy, Jinan University, Guangzhou, Guangdong, China
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22
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De la Taille A. [Let's ride against prostate cancer!]. Rev Prat 2023; 73:599-600. [PMID: 37458544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
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23
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Girometti R, Giannarini G, Peruzzi V, Amparore D, Pizzolitto S, Zuiani C. MRI-informed prostate biopsy: What the radiologist should know on quality in biopsy planning and biopsy acquisition. Eur J Radiol 2023; 164:110852. [PMID: 37167683 DOI: 10.1016/j.ejrad.2023.110852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/17/2023] [Accepted: 04/26/2023] [Indexed: 05/13/2023]
Abstract
Quality is currently recognized as the pre-requisite for delivering the clinical benefits expected by magnetic resonance imaging (MRI)-informed prostate biopsy (MRI-i-PB) in patients with a suspicion for clinically significant prostate cancer (csPCa). The "quality chain" underlying MRI-i-PB is multidisciplinary in nature, and depends on several factors related to the patient, imaging technique, image interpretation and biopsy procedure. This review aims at making the radiologist aware of biopsy-related factors impacting on MRI-i-PB quality, both in terms of biopsy planning (threshold for biopsy decisions, association with systematic biopsy and number of targeted cores) and biopsy acquisition (biopsy route, targeting technique, and operator's experience). While there is still space for improvement and better standardization of several biopsy-related procedures, current evidence suggests that high-quality MRI-i-PB can be delivered by acquiring and increased the number of biopsy cores targeted to suspicious imaging findings and perilesional area ("focal saturation biopsy"). On the other hand, uncertainty still exists as to whether software-assisted fusion of MRI and transrectal ultrasound images can outperform cognitive fusion strategy. The role for operator's experience and quality assurance/quality control procedures are also discussed.
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Affiliation(s)
- Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100 Udine, Italy.
| | - Gianluca Giannarini
- Urology Unit, University Hospital Santa Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100 Udine, Italy.
| | - Valeria Peruzzi
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100 Udine, Italy.
| | - Daniele Amparore
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Torino, Italy.
| | - Stefano Pizzolitto
- Unit of Pathology, University Hospital S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100 Udine, Italy.
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100 Udine, Italy.
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Reed-Perino DE, Lai M, Yu EY, Schweizer MT. Re-sensitization to pembrolizumab following PSMA-CD3 T-cell redirection therapy with JNJ-081 in a patient with mismatch repair-deficient metastatic castration-resistant prostate cancer: a case report. J Immunother Cancer 2023; 11:jitc-2023-006794. [PMID: 37220954 DOI: 10.1136/jitc-2023-006794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 05/25/2023] Open
Abstract
While checkpoint inhibitor therapy has revolutionized the treatment landscape of some solid tumors, it has shown limited efficacy in metastatic castration-resistant prostate cancers (mCRPC). A small (~3-5%) but clinically distinct subset of mCRPC tumors have a DNA mismatch repair deficiency (dMMR) and develop a hypermutation phenotype with elevated tumor mutational burden and high microsatellite instability (MSI-H). Retrospective analyses have shown dMMR/MSI-H status to be a predictive biomarker for response to pembrolizumab in prostate tumors. Here, in this report, we present a case of a patient with mCRPC harboring a somatic dMMR who had progressed on pembrolizumab after an initial response. He enrolled on a clinical trial with JNJ-081, a prostate-specific membrane antigen-CD3 bispecific T-cell engager antibody and experienced a partial response with course complicated by cytokine release syndrome. On progression, he was reinitiated on pembrolizumab and experienced an exceptional second response, with his prostate-specific antigen falling from a high of 20.01 to undetectable after 6 weeks and remaining undetectable for >11 months. To our knowledge, this represents the first reported case of bispecific T-cell engager-mediated re-sensitization to checkpoint inhibitor therapy in any cancer.
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Affiliation(s)
- Darien E Reed-Perino
- Division of Oncology, Department of Medicine, University of Washington, Seattle, Washington, USA
- Division of Human Biology, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Michael Lai
- Division of Oncology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Evan Y Yu
- Division of Oncology, Department of Medicine, University of Washington, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Michael T Schweizer
- Division of Oncology, Department of Medicine, University of Washington, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
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25
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Xu P, Yang JC, Chen B, Nip C, Van Dyke JE, Zhang X, Chen HW, Evans CP, Murphy WJ, Liu C. Androgen receptor blockade resistance with enzalutamide in prostate cancer results in immunosuppressive alterations in the tumor immune microenvironment. J Immunother Cancer 2023; 11:e006581. [PMID: 37147019 PMCID: PMC10163595 DOI: 10.1136/jitc-2022-006581] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Emerging data suggest that patients with enzalutamide-treated prostate cancer with increased programmed death-ligand 1 (PD-L1) expression may benefit from anti-PD-L1 treatment. Unfortunately, the Phase III IMbassador250 clinical trial revealed that the combination of atezolizumab (a PD-L1 inhibitor) and enzalutamide failed to extend overall survival in patients with castration-resistant prostate cancer (CRPC). However, the mechanisms underlying treatment failure remain unknown. METHODS Human CRPC C4-2B cells and murine Myc-CaP cells were chronically exposed to increasing concentrations of enzalutamide and the cells resistant to enzalutamide were referred to as C4-2B MDVR and Myc-CaP MDVR, respectively. The mechanisms of action in drug-resistant prostate cancer cells were determined using RNA sequencing analyses, RNA interference, real-time PCR, western blotting, and co-culturing technologies. Myc-CaP and Myc-CaP MDVR tumors were established in syngeneic FVB mice, and tumor-infiltrating leukocytes were isolated after enzalutamide treatment. The stained immune cells were determined by flow cytometry, and the data were analyzed using FlowJo. RESULTS Immune-related signaling pathways (interferon alpha/gamma response, inflammatory response, and cell chemotaxis) were suppressed in human enzalutamide-resistant prostate cancer cells. PD-L1 was overexpressed and negatively regulated by androgen receptor signaling in resistant cells and patient with CRPC cohorts. Enzalutamide treatment decreased CD8+ T-cell numbers but increased monocytic myeloid-derived suppressor cell (M-MDSC) populations and PD-L1 expression within murine Myc-CaP tumors. Similarly, chemotaxis and immune response-regulating signaling pathways were suppressed, and PD-L1 expression was also increased using enzalutamide-resistant Myc-CaP MDVR cells. Notably, MDSC populations were significantly increased in Myc-CaP MDVR orthotopic tumors compared with those in Myc-CaP parental tumors. Co-culturing bone marrow cells with Myc-CaP MDVR cells significantly promoted MDSC differentiation and shifted towards M2 macrophage skewing. CONCLUSIONS Our study suggests that immunosuppressive signaling can be promoted directly by enzalutamide-resistant prostate cancer cells and may be a potential means by which the efficacy of immune checkpoint inhibitors in enzalutamide-resistant prostate cancer is diminished.
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Affiliation(s)
- Pengfei Xu
- Department of Urologic Surgery, University of California Davis, Sacramento, California, USA
| | - Joy C Yang
- Department of Urologic Surgery, University of California Davis, Sacramento, California, USA
| | - Bo Chen
- Department of Urologic Surgery, University of California Davis, Sacramento, California, USA
| | - Christopher Nip
- Department of Urologic Surgery, University of California Davis, Sacramento, California, USA
| | - Jonathan E Van Dyke
- Flow Cytometry Core, University of California Davis, Sacramento, California, USA
| | - Xiong Zhang
- Department of Biochemistry and Molecular Medicine, University of California Davis, Davis, California, USA
| | - Hong-Wu Chen
- Department of Biochemistry and Molecular Medicine, University of California Davis, Davis, California, USA
- University of California Davis Comprehensive Cancer Center, Sacramento, California, USA
| | - Christopher P Evans
- Department of Urologic Surgery, University of California Davis, Sacramento, California, USA
- University of California Davis Comprehensive Cancer Center, Sacramento, California, USA
| | - William J Murphy
- University of California Davis Comprehensive Cancer Center, Sacramento, California, USA
- Department of Dermatology and Department of Internal Medicine, University of California Davis, Sacramento, California, USA
| | - Chengfei Liu
- Department of Urologic Surgery, University of California Davis, Sacramento, California, USA
- University of California Davis Comprehensive Cancer Center, Sacramento, California, USA
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Lv Z, Wang J, Wang M, Hou H, Song L, Li H, Wang X, Liu M. Is it necessary for all patients with suspicious lesions undergo systematic biopsy in the era of MRI-TRUS fusion targeted biopsy? Int Braz J Urol 2023; 49:359-371. [PMID: 37115180 DOI: 10.1590/s1677-5538.ibju.2023.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/20/2023] [Indexed: 04/29/2023] Open
Abstract
PURPOSE Targeted biopsy (TB) combined with systematic biopsy (SB) is an optimized mode of prostate biopsy but can often lead to oversampling and overdiagnosis accompanied by potential biopsy-related complications and patient discomfort. Here, we attempted to reasonably stratify the patient population based on multi-parameter indicators with the aim of avoiding unnecessary SB. METHODS In total, 340 biopsy-naïve men with suspected lesions, prostate-specific antigen (PSA) < 20 ng/mL and prostate imaging-reporting and data system (PI-RADS) ≥ 3 enrolled for study underwent both TB and SB. The primary outcome was to determine independent predictors for a valid diagnosis, assuming that only TB was performed and SB omitted (defined as mono-TB), taking TB + SB as the reference standard. The secondary outcomes were exploration of the predictive factors of mono-TB and TB + SB in detection of prostate cancer (PCa) and clinically significant PCa (csPCa). RESULTS The mean PSA density (PSAD) of patient group was 0.27 ng/mL/mL. Multiparametric MRI PI-RADS scores were 3-5 in 146 (42.94%), 105 (30.88%), and 89 (26.18%) cases, respectively. PCa and csPCa were detected in 178/340 (52.35%) and 162/340 (47.65%) patients, respectively. Overall, 116/178 (65.17%) patients diagnosed with PCa displayed pathological consistencies between mono-TB and TB + SB modes. PSAD and PI-RADS were independent predictors of valid diagnosis using mono-TB. CONCLUSIONS PSAD combined with PI-RADS showed utility in guiding optimization of the prostate biopsy mode. Higher PSAD and PI-RADS values were associated with greater confidence in implementing mono-TB and safely omitting SB, thus effectively balancing the benefits and risks.
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Affiliation(s)
- Zhengtong Lv
- Department of Urology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P.R. China
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, P.R. China
| | - Jinfu Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P.R. China
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, P.R. China
| | - Miao Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P.R. China
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, P.R. China
| | - Huimin Hou
- Department of Urology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P.R. China
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, P.R. China
| | - Liuqi Song
- Department of Urology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P.R. China
- Peking University Fifth School of Clinical Medicine, P.R. China
| | - Haodong Li
- Department of Urology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P.R. China
- Peking University China-Japan Friendship School of Clinical Medicine, P.R. China
| | - Xuan Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P.R. China
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, P.R. China
| | - Ming Liu
- Department of Urology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P.R. China
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, P.R. China
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Gilberto GM, Arcuri MF, Falsarella PM, Mariotti GC, Lemos PLA, Garcia RG. Complication rates of transrectal and transperineal prostate fusion biopsies - is there a learning curve even in high volume interventional center? Int Braz J Urol 2023; 49:334-340. [PMID: 37115178 DOI: 10.1590/s1677-5538.ibju.2023.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 03/22/2023] [Indexed: 04/29/2023] Open
Abstract
PURPOSE To analyze the learning curve regarding complication rates of transrectal prostate biopsy (TRPB) versus transperineal prostate biopsy (TPPB), using real time software-based magnetic resonance imaging ultrasound (MRI-US) fusion techniques, along with first year experience of transperineal approach. MATERIALS AND METHODS retrospective unicentric cohort study at a quaternary care hospital. Medical records of all consecutive patients that underwent TPPB between March 2021 and February 2022, after the introduction of MRI-US fusion device, and those who underwent TRPB throughout the entire years of 2019 and 2020 were analyzed. All complications that occurred as consequences of the procedure were considered. Descriptive statistics, Chi-squared and Fisher tests were used to describe complications and compare the two groups. RESULTS A total of 283 patients were included in the transperineal group and 513 in the transrectal group. The analysis of a learning curve for the transperineal method showed lower complications rates comparing the first six months of TPPB procedures (group 1); The complication rate for TPPB was lower than that of TRPB (55.1% versus 81.9%, respectively; p<0.01). TPPB showed specifically lower rates of hematuria (48.8% versus 66.3%;p<0.001) and rectal bleeding(3.5% versus 18.1%; p<0.001). There were no cases of prostatitis after transperineal biopsies and three cases (0.6%) after transrectal procedures. CONCLUSIONS We evidenced the learning curve for performing the transperineal biopsy, with a lower rate of complications for the experienced team, after 142 cases after 6 months of practice. The lower complication rate of TPPB and the absence of infectious prostatitis imply a safer procedure when compared to TRPB.
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Affiliation(s)
| | - Marcelo Froeder Arcuri
- Centro de Medicina Intervencionista, Hospital Israelita Albert Einstein. São Paulo. SP, Brasil
| | - Priscila M Falsarella
- Centro de Medicina Intervencionista, Hospital Israelita Albert Einstein. São Paulo. SP, Brasil
| | | | - Pedro Lemos Alves Lemos
- Centro de Medicina Intervencionista, Hospital Israelita Albert Einstein. São Paulo. SP, Brasil
| | - Rodrigo Gobbo Garcia
- Centro de Medicina Intervencionista, Hospital Israelita Albert Einstein. São Paulo. SP, Brasil
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Lin Y, Yilmaz EC, Belue MJ, Turkbey B. Prostate MRI and image Quality: It is time to take stock. Eur J Radiol 2023; 161:110757. [PMID: 36870241 PMCID: PMC10493032 DOI: 10.1016/j.ejrad.2023.110757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/15/2023] [Accepted: 02/21/2023] [Indexed: 03/06/2023]
Abstract
Multiparametric magnetic resonance imaging (mpMRI) plays a vital role in prostate cancer diagnosis and management. With the increase in use of mpMRI, obtaining the best possible quality images has become a priority. The Prostate Imaging Reporting and Data System (PI-RADS) was introduced to standardize and optimize patient preparation, scanning techniques, and interpretation. However, the quality of the MRI sequences depends not only on the hardware/software and scanning parameters, but also on patient-related factors. Common patient-related factors include bowel peristalsis, rectal distension, and patient motion. There is currently no consensus regarding the best approaches to address these issues and improve the quality of mpMRI. New evidence has been accrued since the release of PI-RADS, and this review aims to explore the key strategies which aim to improve prostate MRI quality, such as imaging techniques, patient preparation methods, the new Prostate Imaging Quality (PI-QUAL) criteria, and artificial intelligence on prostate MRI quality.
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Affiliation(s)
- Yue Lin
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Enis C Yilmaz
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Mason J Belue
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States.
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Yoshida S, Takahara T, Arita Y, Ito M, Hayakawa S, Oguchi T, Komai Y, Numao N, Yuasa T, Inoue M, Ushijima H, Kudo S, Shimano Y, Nakamura Y, Uchida Y, Uehara S, Tanaka H, Yaegashi H, Izumi K, Yokoyama M, Matsuoka Y, Yoshioka Y, Konishi K, Nakanishi K, Nagahara A, Hirakawa A, Koike R, Koga F, Nishimura K, Mizokami A, Yonese J, Kageyama Y, Yoshimura R, Fujii Y. A phase II randomized trial of metastasis-directed therapy with alpha emitter radium-223 in men with oligometastatic castration-resistant prostate cancer (MEDAL). BMC Urol 2023; 23:33. [PMID: 36879257 PMCID: PMC9987040 DOI: 10.1186/s12894-023-01202-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/20/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND The significance of metastasis-directed therapy for oligometastatic prostate cancer has been widely discussed, and targeted therapy for progressive sites is a feasible option as a multidisciplinary treatment for castration-resistant prostate cancer (CRPC). When oligometastatic CRPC with only bone metastases progresses after targeted therapy, it tends to progress as multiple bone metastases. The progression of oligometastatic CRPC after targeted therapy may be due in part to the presence of micrometastatic lesions that, though undetected on imaging, were present prior to targeted therapy. Thus the systemic treatment of micrometastases in combination with targeted therapy for progressive sites is expected to enhance the therapeutic effect. Radium-223 dichloride (radium-223) is a radiopharmaceutical that selectively binds to sites of increased bone turnover and inhibits the growth of adjacent tumor cells by emitting alpha rays. Therefore, for oligometastatic CRPC with only bone metastases, radium-223 may enhance the therapeutic effect of radiotherapy for active metastases. METHODS This phase II, randomized trial of Metastasis-Directed therapy with ALpha emitter radium-223 in men with oligometastatic CRPC (MEDAL) is designed to assess the utility of radium-223 in combination with metastasis-directed radiotherapy in patients with oligometastatic CRPC confined to bone. In this trial, patients with oligometastatic CRPC with three or fewer bone metastases on whole-body MRI with diffusion-weighted MRI (WB-DWI) will be randomized in a 1:1 ratio to receive radiotherapy for active metastases plus radium-223 or radiotherapy for active metastases alone. The prior use of androgen receptor axis-targeted therapy and prostate-specific antigen doubling time will be used as allocation factors. The primary endpoint will be radiological progression-free survival against progression of bone metastases on WB-DWI. DISCUSSION This will be the first randomized trial to evaluate the effect of radium-223 in combination with targeted therapy in oligometastatic CRPC patients. The combination of targeted therapy for macroscopic metastases with radiopharmaceuticals targeting micrometastasis is expected to be a promising new therapeutic strategy for patients with oligometastatic CRPC confined to bone. Trial registration Japan Registry of Clinical Trials (jRCT) (jRCTs031200358); Registered on March 1, 2021, https://jrct.niph.go.jp/latest-detail/jRCTs031200358.
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Affiliation(s)
- Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan.
| | - Taro Takahara
- Department of Biomedical Engineering, Tokai University School of Engineering, Kanagawa, Japan.,Department of Radiology, Advanced Imaging Center, Yaesu Clinic, Tokyo, Japan
| | - Yuki Arita
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Ito
- Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Sara Hayakawa
- Department of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Tomohiko Oguchi
- Department of Genitourinary Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yoshinobu Komai
- Department of Genitourinary Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Noboru Numao
- Department of Genitourinary Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takeshi Yuasa
- Department of Genitourinary Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masaharu Inoue
- Department of Urology, Saitama Cancer Center, Saitama, Japan
| | - Hiroki Ushijima
- Department of Radiation Oncology, Saitama Cancer Center, Saitama, Japan
| | - Shigehiro Kudo
- Department of Radiation Oncology, Saitama Cancer Center, Saitama, Japan
| | - Yasumasa Shimano
- Department of Radiation Oncology, Saitama Cancer Center, Saitama, Japan
| | - Yuki Nakamura
- Department of Urology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Yusuke Uchida
- Department of Urology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Sho Uehara
- Department of Urology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Hajime Tanaka
- Department of Urology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Hiroshi Yaegashi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Ishikawa, Japan
| | - Kouji Izumi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Ishikawa, Japan
| | - Minato Yokoyama
- Department of Urology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Yoh Matsuoka
- Department of Urology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Yasuo Yoshioka
- Radiation Oncology Department, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Koji Konishi
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Katsuyuki Nakanishi
- Department of Diagnostic and Interventional Radiology, Osaka International Cancer Institute, Osaka, Japan
| | - Akira Nagahara
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Akihiro Hirakawa
- Department of Clinical Biostatistics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ryuji Koike
- Department of Medical Innovation Promotion Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Fumitaka Koga
- Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Kazuo Nishimura
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Atsushi Mizokami
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Ishikawa, Japan
| | - Junji Yonese
- Department of Genitourinary Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yukio Kageyama
- Department of Urology, Saitama Cancer Center, Saitama, Japan
| | - Ryoichi Yoshimura
- Department of Radiation Therapeutics and Oncology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
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Fei X, Du X, Gong Y, Liu J, Fan L, Wang J, Wang Y, Zhu Y, Pan J, Dong B, Xue W. Early Plasma Circulating Tumor DNA as a Potential Biomarker of Disease Recurrence in Non-Metastatic prostate Cancer. Cancer Res Treat 2023:crt.2022.1557. [PMID: 36915250 PMCID: PMC10372593 DOI: 10.4143/crt.2022.1557] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/27/2023] [Indexed: 03/05/2023] Open
Abstract
Purpose In non-metastatic prostate cancer (nmPCa) setting, it is important to early identify the patients at risk of biochemical recurrence (BCR) for immediate postoperative intervention. Our study aimed to evaluate the potential clinical utility of circulating tumor DNA (ctDNA) for predicting disease recurrence. Materials and Methods This real-world observational study evaluated 161 cases of nmPCa undergoing next-generation sequencing at our institution. A total of 139 ctDNA samples and 31 biopsied tumor tissue underwent genomic profiling. The study endpoint was BCR after radical prostatectomy. Relationships between the ctDNA status and the biochemical progression-free survival (bPFS) were analyzed by log-rank test and multivariate Cox regression. Results Of 161 enrolled patients, 19(11.8%) harbored deleterious alterations in NCOR2, followed by BRCA2(3.7%), ATR(2.5%) and CDK12(2.5%). Of available pre-operative blood samples(n=139), ctDNA was detectable in 91(65.5%). Until last follow-up, 56 of 68(85.3%) patients with detectable ctDNA had achieved BCR, whereas only 8 of 39(20.5%) patients with undetectable ctDNA had achieved BCR. Patients who had undetectable ctDNA experienced significantly longer bPFS compared with those who had detectable ctDNA (NA vs. 8.2 mo, hazard ratio[HR]: 0.14, p<0.01). Pre-operative ctDNA status was a significant prognostic factor of disease recurrence. Conclusion Pre-operative ctDNA detection could identify patients at high risk of recurrence and has the potential to inform immediate postoperative interventions, but these approaches remain to be validated in prospective studies. ctDNA studies can provide insights into accurate monitoring and precise treatment rather than simply following routine clinical care.
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Affiliation(s)
- Xiaochen Fei
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinxing Du
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiming Gong
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiazhou Liu
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liancheng Fan
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiayi Wang
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanqing Wang
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yinjie Zhu
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiahua Pan
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Baijun Dong
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Xue
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Andrade GM, Sesconetto L, da Silva RBR, Dos Santos GGR, Kayano PP, Baccaglini W, Bezerra MB, Bianco B, Lemos GC, Carneiro A. Impact of COVID-19 pandemic on prostate cancer outcomes at an uro-oncology referral center. Int Braz J Urol 2023; 49:233-242. [PMID: 36826377 DOI: 10.1590/s1677-5538.ibju.2022.0393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/09/2022] [Indexed: 02/25/2023] Open
Abstract
INTRODUCTION To evaluate the possible effects of the coronavirus disease 2019 (COVID-19) pandemic on the oncologic results of patients with prostate cancer regarding clinical staging, presence of adverse pathological outcomes, and perioperative complications. MATERIALS AND METHODS This retrospective study included patients who underwent radical prostatectomy. The time between biopsy and surgery, staging tests, final histopathological evaluation after surgery, lymphadenectomy rate, postoperative complications, and prostatic specific antigen (PSA) levels (initial and 30 days after surgery) were analyzed and compared in a group of patients before and during the pandemic period. RESULTS We included 226 patients: 88 in the pre-pandemic period and 138 during the pandemic period. There was no statistically significant difference in mean age, body mass index, ASA, pathological locally advanced disease, the proportion of patients who underwent lymphadenectomy, and ISUP grade in the biopsy between the groups. Positive surgical margins, prostatic extracapsular extension, and PSA levels at 30 days were also similar between the groups. The mean time between medical consultation and surgery was longer in the pandemic period than in the pre-pandemic (124 vs. 107 days, p<0.001), and the mean time between biopsy and medical consultation (69.5 days vs. 114 days, p<0.001) and between biopsy and surgery (198.5 days vs. 228 days, p=0.013) was shorter during the pandemic. The incidence of severe early and late perioperative complications was similar between the periods. CONCLUSIONS There was no delay between diagnosis and treatment at our institution during the COVID-19 pandemic period. No worsening of the prostate cancer features was observed.
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Affiliation(s)
| | - Lucas Sesconetto
- Departamento de Urologia, Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, Brasil
| | | | | | - Paulo Priante Kayano
- Departamento de Urologia, Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, Brasil
| | - Willy Baccaglini
- Departamento de Urologia, Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, Brasil
| | | | - Bianca Bianco
- Departamento de Urologia, Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, Brasil
| | - Gustavo Caserta Lemos
- Departamento de Urologia, Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, Brasil
| | - Arie Carneiro
- Departamento de Urologia, Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, Brasil
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Yin C, Wang M, Wang Y, Lin Q, Lin K, Du H, Lang C, Dai Y, Peng X. BHLHE22 drives the immunosuppressive bone tumor microenvironment and associated bone metastasis in prostate cancer. J Immunother Cancer 2023; 11:jitc-2022-005532. [PMID: 36941015 PMCID: PMC10030795 DOI: 10.1136/jitc-2022-005532] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND The molecular characteristics of prostate cancer (PCa) cells and the immunosuppressive bone tumor microenvironment (TME) contribute to the limitations of immune checkpoint therapy (ICT). Identifying subgroups of patients with PCa for ICT remains a challenge. Herein, we report that basic helix-loop-helix family member e22 (BHLHE22) is upregulated in bone metastatic PCa and drives an immunosuppressive bone TME. METHODS In this study, the function of BHLHE22 in PCa bone metastases was clarified. We performed immunohistochemical (IHC) staining of primary and bone metastatic PCa samples, and assessed the ability to promote bone metastasis in vivo and in vitro. Then, the role of BHLHE22 in bone TME was determined by immunofluorescence (IF), flow cytometry, and bioinformatic analyses. RNA sequencing, cytokine array, western blotting, IF, IHC, and flow cytometry were used to identify the key mediators. Subsequently, the role of BHLHE22 in gene regulation was confirmed using luciferase reporter, chromatin immunoprecipitation assay, DNA pulldown, co-immunoprecipitation, and animal experiments. Xenograft bone metastasis mouse models were used to assess whether the strategy of immunosuppressive neutrophils and monocytes neutralization by targeting protein arginine methyltransferase 5 (PRMT5)/colony stimulating factor 2 (CSF2) could improve the efficacy of ICT. Animals were randomly assigned to treatment or control groups. Moreover, we performed IHC and correlation analyses to identify whether BHLHE22 could act as a potential biomarker for ICT combination therapies in bone metastatic PCa. RESULTS Tumorous BHLHE22 mediates the high expression of CSF2, resulting in the infiltration of immunosuppressive neutrophils and monocytes and a prolonged immunocompromised T-cell status. Mechanistically, BHLHE22 binds to the CSF2 promoter and recruits PRMT5, forming a transcriptional complex. PRMT5 epigenetically activates CSF2 expression. In a tumor-bearing mouse model, ICT resistance of Bhlhe22+ tumors could be overcome by inhibition of Csf2 and Prmt5. CONCLUSIONS These results reveal the immunosuppressive mechanism of tumorous BHLHE22 and provide a potential ICT combination therapy for patients with BHLHE22+ PCa.
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Affiliation(s)
- Chi Yin
- Department of Orthopaedic Surgery, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
- Orthopaedic Research Institute, Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Guangzhou, Guangdong, China
| | - Min Wang
- Department of Orthopaedic Surgery, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
- Orthopaedic Research Institute, Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Guangzhou, Guangdong, China
| | - Yingzhao Wang
- Department of Gastrointestinal Surgery, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Qijun Lin
- Department of Orthopaedic Surgery, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
- Orthopaedic Research Institute, Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Guangzhou, Guangdong, China
| | - Kaiyuan Lin
- Department of Orthopaedic Surgery, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
- Orthopaedic Research Institute, Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Guangzhou, Guangdong, China
| | - Hong Du
- Department of Pathology, the First People's Hospital of Guangzhou City, Guangzhou, Guangdong, China
| | - Chuandong Lang
- Department of Orthopaedic Surgery, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
- Orthopaedic Research Institute, Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Guangzhou, Guangdong, China
| | - Yuhu Dai
- Department of Orthopaedic Surgery, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
- Orthopaedic Research Institute, Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Guangzhou, Guangdong, China
| | - Xinsheng Peng
- Department of Orthopaedic Surgery, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
- Orthopaedic Research Institute, Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Guangzhou, Guangdong, China
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Siddiqui BA, Chapin BF, Jindal S, Duan F, Basu S, Yadav SS, Gu AD, Espejo AB, Kinder M, Pettaway CA, Ward JF, Tidwell RSS, Troncoso P, Corn PG, Logothetis CJ, Knoblauch R, Hutnick N, Gottardis M, Drake CG, Sharma P, Subudhi SK. Immune and pathologic responses in patients with localized prostate cancer who received daratumumab (anti-CD38) or edicotinib (CSF-1R inhibitor). J Immunother Cancer 2023; 11:e006262. [PMID: 36948506 PMCID: PMC10040066 DOI: 10.1136/jitc-2022-006262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND The prostate tumor microenvironment (TME) is immunosuppressive, with few effector T cells and enrichment of inhibitory immune populations, leading to limited responses to treatments such as immune checkpoint therapies (ICTs). The immune composition of the prostate TME differs across soft tissue and bone, the most common site of treatment-refractory metastasis. Understanding immunosuppressive mechanisms specific to prostate TMEs will enable rational immunotherapy strategies to generate effective antitumor immune responses. Daratumumab (anti-CD38 antibody) and edicotinib (colony-stimulating factor-1 receptor (CSF-1R) inhibitor) may alter the balance within the prostate TME to promote antitumor immune responses. HYPOTHESIS Daratumumab or edicotinib will be safe and will alter the immune TME, leading to antitumor responses in localized prostate cancer. PATIENTS AND METHODS In this presurgical study, patients with localized prostate cancer received 4 weekly doses of daratumumab or 4 weeks of daily edicotinib prior to radical prostatectomy (RP). Treated and untreated control (Gleason score ≥8 in prostate biopsy) prostatectomy specimens and patient-matched pre- and post-treatment peripheral blood mononuclear cells (PBMCs) and bone marrow samples were evaluated. The primary endpoint was incidence of adverse events (AEs). The secondary endpoint was pathologic complete remission (pCR) rate. RESULTS Twenty-five patients were treated (daratumumab, n=15; edicotinib, n=10). All patients underwent RP without delays. Grade 3 treatment-related AEs with daratumumab occurred in 3 patients (12%), and no ≥grade 3 treatment-related AEs occurred with edicotinib. No changes in serum prostate-specific antigen (PSA) levels or pCRs were observed. Daratumumab led to a decreased frequency of CD38+ T cells, natural killer cells, and myeloid cells in prostate tumors, bone marrow, and PBMCs. There were no consistent changes in CSF-1R+ immune cells in prostate, bone marrow, or PBMCs with edicotinib. Neither treatment induced T cell infiltration into the prostate TME. CONCLUSIONS Daratumumab and edicotinib treatment was safe and well-tolerated in patients with localized prostate cancer but did not induce pCRs. Decreases in CD38+ immune cells were observed in prostate tumors, bone marrow, and PBMCs with daratumumab, but changes in CSF-1R+ immune cells were not consistently observed with edicotinib. Neither myeloid-targeted agent alone was sufficient to generate antitumor responses in prostate cancer; thus, combinations with agents to induce T cell infiltration (eg, ICTs) will be needed to overcome the immunosuppressive prostate TME.
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Affiliation(s)
- Bilal A Siddiqui
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Brian F Chapin
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sonali Jindal
- The Immunotherapy Platform, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Fei Duan
- The Immunotherapy Platform, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sreyashi Basu
- The Immunotherapy Platform, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Shalini S Yadav
- The Immunotherapy Platform, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ai-Di Gu
- The Immunotherapy Platform, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alexsandra B Espejo
- The Immunotherapy Platform, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michelle Kinder
- Janssen Research & Development, Spring House, Pennsylvania, USA
| | - Curtis A Pettaway
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - John F Ward
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rebecca S S Tidwell
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Patricia Troncoso
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Paul G Corn
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Christopher J Logothetis
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Natalie Hutnick
- Janssen Research & Development, Spring House, Pennsylvania, USA
| | - Marco Gottardis
- Janssen Research & Development, Spring House, Pennsylvania, USA
| | - Charles G Drake
- Janssen Research & Development, Spring House, Pennsylvania, USA
- Department of Medicine, Columbia University Medical Center, New York, New York, USA
- Department of Urology, Columbia University Medical Center, New York, New York, USA
| | - Padmanee Sharma
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- The Immunotherapy Platform, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sumit K Subudhi
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Depotte L, Caroux M, Gligorov J, Canouï-Poitrine F, Belkacemi Y, De La Taille A, Tournigand C, Kempf E. Association between overweight, obesity, and quality of life of patients receiving an anticancer treatment for prostate cancer: a systematic literature review. Health Qual Life Outcomes 2023; 21:11. [PMID: 36721272 PMCID: PMC9887848 DOI: 10.1186/s12955-023-02093-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/17/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Prostate cancer (PCa) and obesity are two ever-increasing public health issues that can independently impair the quality of life (QOL) of affected patients. Our objective was to evaluate the impact of overweight and obesity on the QOL of patients with PCa receiving an anticancer treatment. METHODS We performed a systematic review of the literature using PubMed, Embase, Cochrane Library and Web of Science databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The search equation targeted studies that included PCa patients who had a body mass index (BMI) greater than 25 kg/m2, who were receiving anticancer therapy, and whose QOL was analyzed according to validated or non-validated scores. RESULTS Of 759 identified articles, we selected 20 studies published between 2000 and 2019 of 12,529 patients treated for PCa, including 5549 overweight or obese patients. QOL assessment was performed using nine validated scales and two non-validated questionnaires. Of seven studies on radiotherapy, six found obesity to have a negative impact on patients' QOL (especially urinary, sexual, and bowel-related QOL). Thirteen studies assessed the QOL of patients who underwent radical prostatectomy, with a BMI > 25 kg/m2 having no observed impact. In obese patients under 65 years of age and without comorbidities, nerve-sparing surgery appeared to limit the deterioration of QOL. Four studies on brachytherapy found discordant results. One study showed greater QOL impairment in obese patients receiving first-generation hormone therapy than in those with normal or decreased BMI. No study evaluated the QOL of overweight or obese patients receiving other types of systemic treatment. CONCLUSION Based on the published data, the level of evidence for an association between QOL and overweight or obesity in patients treated for PCa is not high. Prospective cohort studies including this type of patient population are warranted to answer this topical public health issue.
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Affiliation(s)
- Léonard Depotte
- grid.412116.10000 0004 1799 3934Assistance Publique – Hôpitaux de Paris, Department of Medical Oncology, Henri Mondor Teaching Hospital, 1 Rue Gustave Eiffel, 94010 Créteil Cedex, France
| | - Maryline Caroux
- Department of Medical Oncology, Arras Hospital, Arras, France
| | - Joseph Gligorov
- grid.50550.350000 0001 2175 4109Assistance Publique – Hôpitaux de Paris, Department of Medical Oncology, Tenon Teaching Hospital, Paris, France
| | - Florence Canouï-Poitrine
- grid.412116.10000 0004 1799 3934Assistance Publique – Hôpitaux de Paris, NSERM U955, IMRB-CEpiA Team, Henri Mondor Teaching Hospital, Créteil, France
| | - Yazid Belkacemi
- grid.50550.350000 0001 2175 4109Assistance Publique – Hôpitaux de Paris, Department of Radiation Therapy, Henri Mondor and Albert Chenevier Teaching Hospital, Créteil, France
| | - Alexandre De La Taille
- grid.50550.350000 0001 2175 4109Assistance Publique – Hôpitaux de Paris, Department of Urology, Henri Mondor and Albert Chenevier Teaching Hospital, Créteil, France
| | - Christophe Tournigand
- grid.412116.10000 0004 1799 3934Assistance Publique – Hôpitaux de Paris, Department of Medical Oncology, Henri Mondor Teaching Hospital, 1 Rue Gustave Eiffel, 94010 Créteil Cedex, France
| | - Emmanuelle Kempf
- grid.412116.10000 0004 1799 3934Assistance Publique – Hôpitaux de Paris, Department of Medical Oncology, Henri Mondor Teaching Hospital, 1 Rue Gustave Eiffel, 94010 Créteil Cedex, France ,Sorbonne Université, Inserm, Université Sorbonne Paris Nord, Laboratoire d’Informatique Médicale Et d’Ingénierie Des Connaissances Pour La E-Santé, LIMICS, Paris, France
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Hakozaki K, Takeda T, Yasumizu Y, Tanaka N, Matsumoto K, Morita S, Kosaka T, Mizuno R, Asanuma H, Oya M. Predictors of urinary function recovery after laparoscopic and robot-assisted radical prostatectomy. Int Braz J Urol 2022; 49:50-60. [PMID: 36512455 PMCID: PMC9881801 DOI: 10.1590/s1677-5538.ibju.2022.0362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/10/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Even in the era of laparoscopic radical prostatectomy (LRP) and robot-assisted laparoscopic radical prostatectomy (RALP), we sometimes encounter patients with severe urinary incontinence after surgery. The aim of the present study was to identify predictors of urinary continence recovery among patients with urinary incontinence immediately after surgery (UIIAS). MATERIALS AND METHODS We identified 274 patients with clinically localized prostate cancer who underwent LRP and RALP between 2011 and 2018. UIIAS was defined as a urine loss ratio > 0.15 on the first day of urethral catheter removal. Urinary continence recovery was defined as using ≤ 1 pad/day one year after surgery. In the present study, we evaluated factors affecting urinary function recovery one year after surgery among patients with urinary incontinence immediately after LRP and RALP. RESULTS UIIAS was observed in 191 out of 274 patients (69.7%). A multivariate analysis identified age (<65 years, p = 0.015) as an independent predictor affecting immediate urinary continence. Among 191 incontinent patients, urinary continence one year after surgery improved in 153 (80.1%). A multivariate analysis identified age (<65 years, p = 0.003) and estimated blood loss (≥ 100 mL, p = 0.044) as independent predictors affecting urinary continence recovery one year after surgery. CONCLUSION The present results suggest that younger patients and patients with higher intraoperative blood loss recover urinary continence one year after surgery even if they are incontinent immediately after surgery.
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Affiliation(s)
- Kyohei Hakozaki
- Keio University School of MedicineDepartment of UrologyTokyoJapanDepartment of Urology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Toshikazu Takeda
- Keio University School of MedicineDepartment of UrologyTokyoJapanDepartment of Urology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan,Correspondence address: Toshikazu Takeda, MD, PhD Department of Urology, Keio University School of Medicine 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan Fax: +81-3-3225-1985 E-mail:
| | - Yota Yasumizu
- Keio University School of MedicineDepartment of UrologyTokyoJapanDepartment of Urology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Nobuyuki Tanaka
- Keio University School of MedicineDepartment of UrologyTokyoJapanDepartment of Urology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Kazuhiro Matsumoto
- Keio University School of MedicineDepartment of UrologyTokyoJapanDepartment of Urology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Shinya Morita
- Keio University School of MedicineDepartment of UrologyTokyoJapanDepartment of Urology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Takeo Kosaka
- Keio University School of MedicineDepartment of UrologyTokyoJapanDepartment of Urology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Ryuichi Mizuno
- Keio University School of MedicineDepartment of UrologyTokyoJapanDepartment of Urology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Hiroshi Asanuma
- Keio University School of MedicineDepartment of UrologyTokyoJapanDepartment of Urology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Mototsugu Oya
- Keio University School of MedicineDepartment of UrologyTokyoJapanDepartment of Urology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan
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Ziayee F, Schimmöller L, Blondin D, Boschheidgen M, Wilms LM, Vach M, Arsov C, Albers P, Antoch G, Ullrich T. Impact of dynamic contrast-enhanced MRI in 1.5 T versus 3 T MRI for clinically significant prostate cancer detection. Eur J Radiol 2022; 156:110520. [PMID: 36116141 DOI: 10.1016/j.ejrad.2022.110520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/21/2022] [Accepted: 09/06/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE This study analyzes the value of dynamic contrast-enhanced MRI (DCE) of the prostate on 1.5 T and 3 T examinations in patients within PI-RADS category 4. METHODS In this retrospective, bi-centric, cohort study all consecutive patients classified as PI-RADS 4 in mpMRI with 100 verified prostate cancers (PCa) in subsequent MRI/US-guided fusion biopsy were included for 1.5 T and 3 T, each. PCa detection in index lesions (IL) upgraded to PI-RADS 4 based on positive DCE findings was compared between 1.5 T and 3 T. Secondary objectives are subgroup analysis of PZ lesions and comparison of ISUP grade group distribution between 1.5 T and 3 T. RESULTS In total, 293 patients within PI-RADS category 4, including 152 (mean 66 ± 8y; median PSA 6.4 ng/ml;116 PZ IL) in the 1.5 T group and 141 (mean 65 ± 8y; median PSA 7.2 ng/ml;100 PZ IL) in the 3 T group were included. Overall amount of PCa (66 % vs 71 %; p = 0.346) and portion of upgraded IL (28 % vs 21 %; p = 0.126) did not differ significantly. At 1.5 T PCa detection was higher in upgraded PZ lesions compared to 3 T (23 % vs 14 %; p = 0.048). The amount of upgraded PZ lesions with ISUP grade group 2-5 PCa was significantly higher at 1.5 T versus 3 T (13.8 % vs 4.0 %; p = 0.007). 33 % (11/33; 1.5 T) and 32 % (10/31; 3 T) of the ISUP grade group 1 PCa of the PZ lesions were detected in upgraded lesions (10% of all PZ index lesions, respectively). CONCLUSION DCE enabled the detection of a substantial amount of additional clinically significant PCa in prostate mpMRI at 1.5 T. The effect was smaller at 3 T and was accompanied in relation to 1.5 T by higher risk of overdiagnosis due to detection of additional low-risk PCa.
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Affiliation(s)
- F Ziayee
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - L Schimmöller
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - D Blondin
- Community Hospital Moenchengladbach GmbH, Elisabeth-Hospital Rheydt, Department of Radiology, Vascular Radiology, and Nuclear Medicine, D-41239 Moenchengladbach, Germany.
| | - M Boschheidgen
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - L M Wilms
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - M Vach
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - C Arsov
- University Dusseldorf, Medical Faculty, Department of Urology, D-40225 Dusseldorf, Germany.
| | - P Albers
- University Dusseldorf, Medical Faculty, Department of Urology, D-40225 Dusseldorf, Germany.
| | - G Antoch
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - T Ullrich
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
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Noël J, Moschovas MC, Sandri M, Jaber AR, Rogers T, Patel V. Comparing the outcomes of robotic assisted radical prostatectomy in black and white men: Experience of a high-volume center. Int Braz J Urol 2022; 49:123-135. [PMID: 36512460 PMCID: PMC9881802 DOI: 10.1590/s1677-5538.ibju.2022.9979] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 09/30/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Global cancer incidence ranks Prostate Cancer (CaP) as the second highest overall, with Africa and the Caribbean having the highest mortality. Previous literature suggests disparities in CaP outcomes according to ethnicity, specifically functional and oncological are suboptimal in black men. However, recent data shows black men achieve post radical prostatectomy (RP) outcomes equivalent to white men in a universally insured system. Our objective is to compare outcomes of patients who self-identified their ethnicity as black or white undergoing RP at our institution. MATERIALS AND METHODS From 2008 to 2017, 396 black and 4929 white patients underwent primary robotic-assisted radical prostatectomy (RARP) with a minimum follow-up of 5 years. Exclusion criteria were concomitant surgery and cancer status not available. A propensity score (PS) match was performed with a 1:1, 1:2, and 1:3 ratio without replacement. Primary endpoints were potency, continence recovery, biochemical recurrence (BCR), positive surgical margins (PSM), and post-operative complications. RESULTS After PS 1:1 matching, 341 black vs. 341 white men with a median follow-up of approximately 8 years were analyzed. The overall potency and continence recovery at 12 months was 52% vs 58% (p=0.3) and 82% vs 89% (p=0.3), respectively. PSM rates was 13.4 % vs 14.4% (p = 0.75). Biochemical recurrence and persistence PSA was 13.8% vs 14.1% and 4.4% vs 3.2% respectively (p=0.75). Clavien-Dindo complications (p=0.4) and 30-day readmission rates (p=0.5) were similar. CONCLUSION In our study, comparing two ethnic groups with similar preoperative characteristics and full access to screening and treatment showed compatible RARP results. We could not demonstrate outcomes superiority in one group over the other. However, this data adds to the growing body of evidence that the racial disparity gap in prostate cancer outcomes can be narrowed if patients have appropriate access to prostate cancer management. It also could be used in counseling surgeons and patients on the surgical intervention and prognosis of prostate cancer in patients with full access to gold-standard screening and treatment.
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Affiliation(s)
- Jonathan Noël
- AdventHealth Global Robotics InstituteCelebrationFLUSAAdventHealth Global Robotics Institute, Celebration, FL, USA,Guy's and St Thomas’ NHS Foundation TrustLondonUKGuy's and St Thomas’ NHS Foundation Trust, London, UK,Correspondence address: Jonathan Noel, MD, AdventHealth Global Robotics Institute, 380 Celebration Pl Suite 401, Celebration, FL 34747, USA E-mail:
| | - Marcio Covas Moschovas
- AdventHealth Global Robotics InstituteCelebrationFLUSAAdventHealth Global Robotics Institute, Celebration, FL, USA,University of Central FloridaOrlandoFLUSAUniversity of Central Florida (UCF), Orlando, FL, USA
| | - Marco Sandri
- University of BresciaBig and Open Data, Innovation LaboratoryBresciaItalyBig and Open Data, Innovation Laboratory, University of Brescia, Brescia, Italy
| | - Abdel Rahman Jaber
- AdventHealth Global Robotics InstituteCelebrationFLUSAAdventHealth Global Robotics Institute, Celebration, FL, USA
| | - Travis Rogers
- AdventHealth Global Robotics InstituteCelebrationFLUSAAdventHealth Global Robotics Institute, Celebration, FL, USA
| | - Vipul Patel
- AdventHealth Global Robotics InstituteCelebrationFLUSAAdventHealth Global Robotics Institute, Celebration, FL, USA
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Brant A, Lewicki P, Johnson JP, Weinstein IC, Bowman A, Sze C, Shoag JE. Predictors and trends of opioid-sparing radical prostatectomy from a large national cohort. Urology 2022; 168:104-109. [PMID: 35931239 DOI: 10.1016/j.urology.2022.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/02/2022] [Accepted: 06/08/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine the use of pain medications after radical prostatectomy using a large national database. METHODS The Premier Hospital Database was queried to identify all robotic and laparoscopic radical prostatectomies from January 2015 - March 2020 with length of stay ≥1 day. "Opioid-sparing" was defined as absence of intravenous opioid use after post-operative day 0 and absence of oral opioid use throughout admission. Comparisons were made between opioid-sparing and non-opioid-sparing prostatectomy. Logistic multivariable regression was used to identify predictors of opioid-sparing prostatectomy. RESULTS A total of 62,660 patients were included, of whom 14,806 (23.6%) underwent opioid-sparing prostatectomy. Opioid-sparing prostatectomy was associated with older age (65 vs. 63 years, p<0.01), white vs. black race (76.3% vs. 73.4%, p<0.01), high-volume surgeons (75.2% vs. 70.0%, p<0.01), and use of intravenous ketorolac (62.2% vs. 48.0%, p<0.01), intravenous acetaminophen (32.5% vs. 30.1%, p<0.01), and liposomal bupivacaine (5.4% vs. 4.9%, p<0.01). On multivariable regression, ketorolac was the strongest predictor of opioid-sparing prostatectomy (odds ratio: 1.86, 95% confidence interval: 1.79 - 1.93, p<0.01), and black race was predictive of non-opioid sparing prostatectomy (odds ratio: 0.75, 95% confidence interval: 0.71 - 0.80, P<0.01). Ketorolac was not associated with increased risk of postoperative bleeding (0.3% vs. 0.3%, p=1.0) or dialysis requirement (<0.1% vs. <0.1%, p=0.91). CONCLUSION Opioid-sparing radical prostatectomy was feasible and associated with administration of each of the non-opioid pain medications assessed. Ketorolac was the strongest predictor of opioid-sparing prostatectomy and was not associated with increased risk of bleeding or dialysis.
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Affiliation(s)
- Aaron Brant
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY
| | - Patrick Lewicki
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY
| | - Jeffrey P Johnson
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY
| | - Ilon C Weinstein
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Anise Bowman
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Christina Sze
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY
| | - Jonathan E Shoag
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH.
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Potluri HK, Ferreira CA, Grudzinski J, Massey C, Aluicio-Sarduy E, Engle JW, Kwon O, Marsh IR, Bednarz BP, Hernandez R, Weichert JP, McNeel DG. Antitumor efficacy of 90Y-NM600 targeted radionuclide therapy and PD-1 blockade is limited by regulatory T cells in murine prostate tumors. J Immunother Cancer 2022; 10:jitc-2022-005060. [PMID: 36002185 PMCID: PMC9413196 DOI: 10.1136/jitc-2022-005060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2022] [Indexed: 12/14/2022] Open
Abstract
Background Systemic radiation treatments that preferentially irradiate cancer cells over normal tissue, known as targeted radionuclide therapy (TRT), have shown significant potential for treating metastatic prostate cancer. Preclinical studies have demonstrated the ability of external beam radiation therapy (EBRT) to sensitize tumors to T cell checkpoint blockade. Combining TRT approaches with immunotherapy may be more feasible than combining with EBRT to treat widely metastatic disease, however the effects of TRT on the prostate tumor microenvironment alone and in combinfation with checkpoint blockade have not yet been studied. Methods C57BL/6 mice-bearing TRAMP-C1 tumors and FVB/NJ mice-bearing Myc-CaP tumors were treated with a single intravenous administration of either low-dose or high-dose 90Y-NM600 TRT, and with or without anti-PD-1 therapy. Groups of mice were followed for tumor growth while others were used for tissue collection and immunophenotyping of the tumors via flow cytometry. Results 90Y-NM600 TRT was safe at doses that elicited a moderate antitumor response. TRT had multiple effects on the tumor microenvironment including increasing CD8 +T cell infiltration, increasing checkpoint molecule expression on CD8 +T cells, and increasing PD-L1 expression on myeloid cells. However, PD-1 blockade with TRT treatment did not improve antitumor efficacy. Tregs remained functional up to 1 week following TRT, but CD8 +T cells were not, and the suppressive function of Tregs increased when anti-PD-1 was present in in vitro studies. The combination of anti-PD-1 and TRT was only effective in vivo when Tregs were depleted. Conclusions Our data suggest that the combination of 90Y-NM600 TRT and PD-1 blockade therapy is ineffective in these prostate cancer models due to the activating effect of anti-PD-1 on Tregs. This finding underscores the importance of thorough understanding of the effects of TRT and immunotherapy combinations on the tumor immune microenvironment prior to clinical investigation.
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Affiliation(s)
- Hemanth K Potluri
- University of Wisconsin Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Carolina A Ferreira
- University of Wisconsin Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Joseph Grudzinski
- University of Wisconsin Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Christopher Massey
- University of Wisconsin Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | | | - Jonathan W Engle
- Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ohyun Kwon
- University of Wisconsin Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ian R Marsh
- University of Wisconsin Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Bryan P Bednarz
- University of Wisconsin Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Reinier Hernandez
- University of Wisconsin Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jamey P Weichert
- University of Wisconsin Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Douglas G McNeel
- University of Wisconsin Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Loloi J, Wei M, Babar M, Zhu D, Fram EB, Maria P. Rates of False-Negative Screening in Prostate Specific Antigen Secondary to 5-Alpha Reductase Inhibitor Usage: A Quality-Improvement Initiative. Int Braz J Urol 2022; 48:688-695. [PMID: 35594325 PMCID: PMC9306367 DOI: 10.1590/s1677-5538.ibju.2022.0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/05/2022] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Patients often take 5-alpha reductase inhibitors (5-ARIs) for the management of benign prostatic hyperplasia. However, 5-ARIs can decrease prostate specific antigen (PSA) by approximately half and therefore may lead to false negative PSA tests. We investigated false-screening rates in men on 5-ARIs undergoing PSA testing and whether ordering physicians noticed false negative findings. MATERIALS AND METHODS A single institution, retrospective study was conducted on patients with a PSA value documented between 2014 and 2017. Patient demographics, PSA results, 5-ARI usage, and providing clinician characteristics were collected. Published normal PSA values were used to determine PSA test positivity; values for those on 5-ARIs were doubled. RESULTS A total of 29,131 men were included. 1,654 (5.7%) were prescribed 5-ARIs at least 12 months prior to PSA evaluation. 118 men (7.1%) had a value that would be positive if corrected for 5-ARI usage, 33 (27.9%) of which had no indication that the provider had noted this. There was no effect on rates of false negative values if the PSA was ordered by a different provider than the one who prescribed the 5-ARI (p = 0.837). However, if the provider who ordered the PSA test was an urologist, the likelihood that a false negative value would be identified was lower (p=0.001). CONCLUSIONS More than a quarter of men with false negative tests were missed. This occurred more often when the ordering provider was not an urologist. An educational opportunity exists to improve the quality of PSA testing by preventing false negative tests.
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Affiliation(s)
- Justin Loloi
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Matthew Wei
- Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Denzel Zhu
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ethan B Fram
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Pedro Maria
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Rymarczyk D, Borowa A, Bracha A, Chronowski M, Ozimek W, Zieliński B. Comparison of Supervised and Self-Supervised Deep Representations Trained on Histological Images. Stud Health Technol Inform 2022; 290:1052-1053. [PMID: 35673201 DOI: 10.3233/shti220263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Self-supervised methods gain more and more attention, especially in the medical domain, where the number of labeled data is limited. They provide results on par or superior to their fully supervised competitors, yet the difference between information coded by both methods is unclear. This work introduces a novel comparison framework for explaining differences between supervised and self-supervised models using visual characteristics important to the human perceptual system. We apply this framework to models trained for Gleason score and conclude that self-supervised methods are more biased toward contrast and texture transformation than their supervised counterparts. At the same time, supervised methods code more information about the shape.
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Affiliation(s)
- Dawid Rymarczyk
- Faculty of Mathematics and Computer Science, Jagiellonian University, Lojasiewicza 6, 30-348 Kraków, Poland.,Ardigen SA, Podole 76, 30-394 Kraków, Poland
| | - Adriana Borowa
- Faculty of Mathematics and Computer Science, Jagiellonian University, Lojasiewicza 6, 30-348 Kraków, Poland.,Ardigen SA, Podole 76, 30-394 Kraków, Poland
| | - Anna Bracha
- Ardigen SA, Podole 76, 30-394 Kraków, Poland
| | | | | | - Bartosz Zieliński
- Faculty of Mathematics and Computer Science, Jagiellonian University, Lojasiewicza 6, 30-348 Kraków, Poland.,Ardigen SA, Podole 76, 30-394 Kraków, Poland
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42
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Tristán-Martínez PD, Doubova SV, Sauceda-Valenzuela AL. [Quality of care in patients with prostate cancer treated in Mexico]. Rev Med Inst Mex Seguro Soc 2022; 60:275-282. [PMID: 35759755 PMCID: PMC10395871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/10/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Patient-centered care model improves quality of care, decreases unnecessary use of services, optimizes costs and quality of life and survival for cancer patients. OBJECTIVE To compare the patient-centered quality of care of prostate cancer patients with and without social security in two oncology hospitals in Mexico City. MATERIAL AND METHODS The information of the 2019 survey of prostate cancer patients in two oncology hospitals, one from the Mexican Institute of Social Security (IMSS) and the other from the Ministry of Health (SSA), was analyzed (n = 307). The survey included sociodemographic and patient-centered quality of care variables. A descriptive and bivariate analysis was performed to compare the quality of care between both hospitals using chi-square test, Fisher's exact test and Student's t test. RESULTS 234 patients treated at the IMSS and 73 at the SSA were included, with a mean age of 66.6 years. In both hospitals, more than 90% of the patients perceived respectful and coordinated care, as well as clear information. Only 58.9% of patients treated at SSA received information for decision-making, in contrast to 80.8% at IMSS (p = 0.001). Supportive care for biopsychosocial needs was low in both places (IMSS: 23.9%, SSA: 13.7%, p = 0.063). CONCLUSIONS The quality of care focused on patients with prostate cancer was perceived as good, except in the care of biopsychosocial needs; given the importance of this last aspect, it is recommended a multidisciplinary approach in their care.
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Affiliation(s)
| | - Svetlana V Doubova
- Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Unidad de Investigación Epidemiológica y en Servicios de Salud. Ciudad de México, México
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Kim HY, Choi YH, Lee SJ. Effect of Sedation Anesthesia With Intravenous Propofol on Transrectal Ultrasound-Guided Prostate Biopsy Outcomes. J Korean Med Sci 2022; 37:e115. [PMID: 35437964 PMCID: PMC9015899 DOI: 10.3346/jkms.2022.37.e115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/21/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Sedation anesthesia during transrectal ultrasound (TRUS)-guided prostate biopsy is known to decrease patient pain and anxiety, but little is known whether it affects the procedure's prostate cancer detection and complication rates. This study aimed to determine the effect of sedation anesthesia with intravenous (IV) propofol on TRUS-guided prostate biopsy outcomes. METHODS A retrospective analysis of 2,119 patients who underwent TRUS-guided prostate biopsy between November 2009 and February 2019 was undertaken. The patients were divided into two groups: patients who underwent sedation anesthesia with IV propofol and patients who underwent local anesthesia with intrarectal lidocaine gel instillation. Cancer detection and complication rates were compared between the two groups. Univariate and multivariate binary logistic regression and multinomial logistic regression analyses were conducted to investigate the effects of sedation anesthesia with IV propofol on prostate cancer detection and complication rates. RESULTS The cancer detection rate of patients in the sedation group was 34.0%, whereas it was 29.2% in the local group (P = 0.024). Multivariate logistic regression analysis regarding factors associated with cancer detection rate after TRUS-guided prostate biopsy in patients with prostate specific antigen (PSA) < 10 showed that IV propofol usage, age, PSA density and core length were significant factors. Multivariate logistic regression analysis regarding factors associated with complications (voiding dysfunction, bleeding and infection) showed that IV propofol usage, age and prostate size were significant factors for voiding dysfunction. CONCLUSION Sedation anesthesia with IV propofol during TRUS-guided prostate biopsy was associated with a higher cancer detection rate than local anesthesia with intrarectal lidocaine gel instillation. Cancer detection rate could be an important factor to consider when selecting for the optimal anesthesia for TRUS-guided prostate biopsy.
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Affiliation(s)
- Hee Youn Kim
- Department of Urology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Hyo Choi
- Department of Urology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung-Ju Lee
- Department of Urology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Savaee M, Bakhshi A, Yaghoubi F, Pourrajab F, Goodarzvand Chegini K. Evaluating the Effects of Separate and Concomitant Use of MK-2206 and Salinomycin on Prostate Cancer Cell Line. Rep Biochem Mol Biol 2022; 11:157-65. [PMID: 35765523 DOI: 10.52547/rbmb.11.1.157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 12/25/2021] [Indexed: 01/11/2023]
Abstract
Background Prostate cancer is known as one of the most prevalent health disorders in the male population globally. The aim of the current study was to evaluate the effects of separate and concomitant use of MK-2206 and salinomycin on prostate cancer cell line. Methods The antitumor potential of separate and concomitant use of MK-2206 and salinomycin was evaluated in a panel of prostate cancer cell line (PC-3). To get insights into the underlying mechanism of action, different assays including the rate of apoptosis, cell viability, and gene expression were performed in treated prostate cancer cells. Results A significant reduction was detected in the viability percentage of prostate cancer cells (p< 0.001) and the rate of Akt expression (p< 0.001) in all salinomycin, MK-2206, and salinomycin+MK-2206 groups compared to the negative control group. Furthermore, in comparison with the negative control group, there was a notable increase in both the rate of Bad expression (p< 0.001) and prostate cancer cells apoptosis after salinomycin, MK-2206, and salinomycin+MK-2206 treatments. Moreover, the concomitant use of salinomycin+MK-2206 revealed synergistic improvements regarding the viability of prostate cancer cells and the rate of the Akt and Bad expressions compared to the separate administration of salinomycin and MK-2206 (all p< 0.05). Conclusion The findings of the present study may contribute to improving the efficacy of the therapies regarding the management of prostate cancer and providing a beneficial strategy in clinical trials.
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Lapierre A, Hennequin C, Beneux A, Belhomme S, Benziane N, Biston MC, Crehange G, de Crevoisier R, Dumas JL, Fawzi M, Lisbona A, Pasquier D, Pelissier S, Graff-Cailleaud P, Pommier P, Sargos P, Simon JM, Supiot S, Tantot F, Chapet O. Highly hypofractionated schedules for localized prostate cancer: Recommendations of the GETUG radiation oncology group. Crit Rev Oncol Hematol 2022; 173:103661. [PMID: 35341986 DOI: 10.1016/j.critrevonc.2022.103661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 01/25/2022] [Accepted: 03/21/2022] [Indexed: 10/18/2022] Open
Abstract
Stereotactic body radiotherapy (SBRT) has become treatment option for localized prostate cancer but the evidence base remains incomplete. Several clinical studies, both prospective and retrospective, have been published. However, treatment techniques, target volumes and dose constraints lack consistency between studies. Based on the current available literature, the French Genito-Urinary Group (GETUG) suggests that.
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Affiliation(s)
- Ariane Lapierre
- Ariane Lapierre: Département of de radiothérapie oncologie, centre hospitalier universitaire Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Université de Lyon, 69000 Lyon, France
| | - Christophe Hennequin
- Christophe Hennequin: Department of Radiation Oncology, Hôpital Saint-Louis, 75475, Paris, France
| | - Amandine Beneux
- Amandine Beneux: Service de Physique Médicale et de Radioprotection, centre hospitalier universitaire Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - Sarah Belhomme
- Sarah Belhomme: Radiation Oncology Department, Bergonie Institute, 229, cours de l'Argonne, 33076 Bordeaux Cedex, France
| | - Nicolas Benziane
- Nicolas Benziane: Radiation Oncology Department, Bergonie Institute, 229, cours de l'Argonne, 33076 Bordeaux Cedex, France
| | - Marie-Claude Biston
- Marie-Claude Biston: Léon Bérard Cancer Center, University of Lyon, France; Université de Lyon, CREATIS, CNRS UMR5220, Inserm U1044, INSA, Lyon, France
| | - Gilles Crehange
- Gilles Crehange: Département de radiothérapie oncologique, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - Renaud de Crevoisier
- Renaud de Crevoisier: Département de Radiothérapie, Centre Eugène Marquis, Rennes
| | - Jean-Luc Dumas
- Jean-luc Dumas: Institut Curie, Radiotherapy department / Medical physics, 26 rue d'Ulm, 75005 PARIS cedex, France
| | - Maher Fawzi
- Maher Fawzi: Institut Curie, Site Saint Cloud, Service de Radiotherapie, 35, rue Dailly 92210 Saint Cloud
| | - Albert Lisbona
- Albert Lisbona: Medical Physics Department Institut de Cancérologie de l'Ouest, Bd J. Monod, 44805 Saint Herblain France
| | - David Pasquier
- David Pasquier: Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille; CRIStAL UMR 9189, Lille University
| | | | - Pierre Graff-Cailleaud
- Pierre Graff-Cailleaud: University Institute of Cancer Toulouse-Oncopôle, Toulouse, France
| | - Pascal Pommier
- Pascal Pommier: Radiotherapy Department, Centre Léon Bérard, Lyon, France
| | - Paul Sargos
- Paul Sargos: Radiation Oncology Department, Bergonie Institute, Bordeaux, France
| | - Jean-Marc Simon
- Jean-Marc Simon: Department of Radiotherapy, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital, Paris, France
| | - Stéphane Supiot
- Stéphane Supiot: Department of Radiation Oncology, Institut de Cancérologie de l'Ouest, Nantes, St-Herblain, France
| | | | - Olivier Chapet
- Département of de radiothérapie oncologie, centre hospitalier universitaire Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Université de Lyon, 69000 Lyon, France
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Cagliari M, Bressi B, Bassi MC, Fugazzaro S, Prati G, Iotti C, Costi S. Feasibility and Safety of Physical Exercise to Preserve Bone Health in Men With Prostate Cancer Receiving Androgen Deprivation Therapy: A Systematic Review. Phys Ther 2022; 102:pzab288. [PMID: 34972863 PMCID: PMC8970430 DOI: 10.1093/ptj/pzab288] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 07/30/2021] [Accepted: 11/21/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Men with prostate cancer (PCa) receiving androgen deprivation therapy (ADT) experience the loss of bone mineral density (BMD) and lean body mass, which can increase their risk of falls and fractures. Physical exercise programs with appropriate components and dosage are suggested to preserve BMD and muscle strength, thereby potentially reducing accidental falls and fractures and associated morbidity and mortality. These benefits can be obtained if exercise programs are feasible and safe and if patient adherence is adequate. This systematic review investigates the feasibility and safety of exercise programs aimed at preventing the risk of accidental falls and fractures and BMD loss in men with PCa undergoing ADT. METHODS MEDLINE, Embase, CINAHL, and the Cochrane Library were searched from database inception to June 7, 2021. Randomized controlled trials were included when they analyzed the feasibility and safety of experimental exercise programs targeting bone health in men with PCa receiving ADT. Two reviewers independently selected the studies, assessed their methodological quality, and extracted the data. Exercise feasibility was measured through recruitment, retention, and adherence rates. Exercise safety was measured through the number, type, and severity of adverse events. Furthermore, the components, setting, intensity, frequency, and duration of exercise programs were extracted. RESULTS Ten studies were included, with a total of 633 participants. Exercise consisted of a combination of aerobic, resistance, and impact-loading exercise or football training. Exercise is feasible in men with PCa undergoing ADT, although football training should be prescribed with caution for safety reasons. CONCLUSION Multicomponent exercise programs targeting bone health seem feasible and safe in this population; however, adverse events should be systematically documented according to current guidelines. IMPACT The study shows that men with PCa receiving ADT can safely perform exercise programs to preserve bone health and supports that those programs should become part of lifestyle habits. LAY SUMMARY Men with PCa who are receiving ADT can safely perform exercise programs to preserve bone health and should make exercise an important part of their lifestyle.
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Affiliation(s)
- Maribel Cagliari
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Barbara Bressi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Neuromotor Physiopathology and Rehabilitation Medicine, Physical Medicine and Rehabilitation Unit, Azienda USL–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Maria Chiara Bassi
- Medical Library, Azienda USL–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Stefania Fugazzaro
- Department of Neuromotor Physiopathology and Rehabilitation Medicine, Physical Medicine and Rehabilitation Unit, Azienda USL–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giuseppe Prati
- Department of Oncology and Advanced Technologies, Oncology Unit, Azienda USL–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cinzia Iotti
- Department of Oncology and Advanced Technologies, Radiotherapy Unit, Azienda USL–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Stefania Costi
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Scientific Directorate, Azienda USL–IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Lane GI, Dupati A, Qi J, Ferrante S, Dunn RL, Paudel R, Wittmann D, Wallner L, Berry DL, Ellimoottil C, Montie J, Clemens JQ. Factors Associated with Decision Aid Use in Localized Prostate Cancer. Urol Pract 2022; 9:108-15. [PMID: 35722246 DOI: 10.1097/upj.0000000000000283] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Purpose Decision aids have been found to improve patients' knowledge of treatments and decrease decisional regrets. Despite these benefits, there is not widespread use of decision aids for newly diagnosed prostate cancer (PCa). This analysis investigates factors that impact men's choice to use a decision aid for newly diagnosed prostate cancer. Materials and Methods This is a retrospective analysis of a PCa registry from the Michigan Urological Surgery Improvement Collaborative (MUSIC). We included data from men with newly diagnosed, clinically localized PCa seen from 2018-21 at practices offering a PCa decision aid (Personal Patient Profile-Prostate; P3P). The primary outcome was men's registration to use P3P. We fit a multilevel logistic regression model with patient-level factors and included urologist specific random intercepts. We estimated the intra-class correlation (ICC) and predicted the probability of P3P registration among urologists. Results A total of 2629 men were seen at practices that participated in P3P and 1174 (45%) registered to use P3P. Forty-one percent of the total variance of P3P registration was attributed to clustering of men under a specific urologist's care. In contrast, only 1.5% of the variance of P3P registration was explained by patient factors. Our model did not include data on socioeconomic, literacy or psychosocial factors, which limits the interpretation of the results. Conclusions These results suggest that urologists' effect far outweighs patient factors in a man's decision to enroll in P3P. Strategies that encourage providers to increase decision aid adoption in their practices are warranted.
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Moschovas MC, Patel V. Neurovascular bundle preservation in robotic-assisted radical prostatectomy: How I do it after 15.000 cases. Int Braz J Urol 2021; 48:212-219. [PMID: 34786925 PMCID: PMC8932039 DOI: 10.1590/s1677-5538.ibju.2022.99.04] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/05/2021] [Indexed: 11/25/2022] Open
Abstract
Despite the neuroanatomy knowledge of the prostate described initially in the 1980's and the robotic surgery advantages in terms of operative view magnification, potency outcomes following robotic-assisted radical prostatectomy still challenge surgeons and patients due to its multifactorial etiology. Recent studies performed in our center have described that, in addition to the surgical technique, some important factors are associated with erectile dysfunction (ED) following robotic-assisted radical prostatectomy (RARP). These include preoperative Sexual Health Inventory for Men (SHIM) score, age, preoperative Gleason score, and Charlson Comorbidity Index (CCI). After performing 15,000 cases, in this article we described our current Robotic-assisted Radical Prostatectomy technique with details and considerations regarding the optimal approach to neurovascular bundle preservation.
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Affiliation(s)
| | - Vipul Patel
- AdventHealth Global Robotics Institute, Celebration, FL, USA
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49
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Borja Menéndez DA, Borja Menéndez KA, Sánchez Núñez JE, de la Santis García Velandria FA. [Treatment of prostate cancer using high-intensity focused ultrasound, literature review.]. ARCH ESP UROL 2021; 74:815-820. [PMID: 34726617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The treatment of prostatecancer has recently been questioned because ofthe adverse effects it causes may out weigh the benefitsin many patients, so, it has increased interest in active surveillance for low-risk diseases and tissue preservation with focal therapy, thereby reducing the burden on medical care and side effects that may occur after radical prostatectomy and radiation therapy. OBJECTIVE provide updated information on the treatment of prostate cancer with high intensity focused ultrasound therapy. MATERIALS AND METHODS Bibliographic reviewstudy and systematic analysis of 27 scientific articlesfound in the Medline, Scielo and PubMed databases, whose publication dates correspond to the last 5 years.The search criteria used consisted of terms: prostatic neoplasms, ablation techniques, high-intensity focused ultrasound ablation. RESULTS Focal therapy is a therapeutic option forlow-risk prostate cancer, clinical studies report a 75% cancer-free survival, 99% cancer-specific survival and 96% metastasis-free survival, the prostate antigen is maintained at values lower than 0.1 ng/ml in long-term controls, while the adverse effects of surgery such as incontinence and sexual impotence are rare. CONCLUSIONS HIFU is a less invasive option for the treatment of low-risk prostate cancer, with oncological results similar to radiotherapy and radical prostatectomy.
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Remmers S, Hollemans E, Nieboer D, Luiting HB, van Leenders GJLH, Helleman J, Roobol MJ. Improving the prediction of biochemical recurrence after radical prostatectomy with the addition of detailed pathology of the positive surgical margin and cribriform growth. Ann Diagn Pathol 2021; 56:151842. [PMID: 34717190 DOI: 10.1016/j.anndiagpath.2021.151842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/08/2021] [Accepted: 10/14/2021] [Indexed: 11/15/2022]
Abstract
The risk on biochemical recurrence (BCR) after radical prostatectomy (RP) is usually estimated using PSA and pathological stage and grading including the presence of positive surgical margins (PSM). Objective was to investigate whether the presence of cribriform growth in the primary tumor, Grade Group (GG) at the PSM, and length of the PSM have added value in the prognostication. We analyzed data of 835 patients initially treated with RP between 2000 and 2017. Cox regression models were developed to compare the baseline model (PSA, pT-stage, pN-stage, GG at RP, and presence of PSM) with an extended model (adding the presence of cribriform growth, length and GG at the PSM) using the likelihood ratio test. Discrimination was assessed at internal validation by the time-dependent area under the receiver operating characteristic curve (AUC) at 3- and 5-year. A total of 224 men experienced BCR. Median follow-up for men without BCR was 50.4 months (interquartile range, IQR 11.9-95.5). The extended model had a significant better fit, χ2(4) = 31.0, p < 0.001 than the baseline model. The AUC of the 3- and 5-year extended model was 0.85 (95% CI 0.81-0.88) compared to 0.83 (95% CI 0.79-0.87) for the baseline model. Importantly, the presence of cribriform growth in the primary tumor, and GG ≥ 2 at PSM were associated with a higher risk on BCR. In conclusion, the addition of pathological variables improved the prediction of the risk on BCR after RP slightly. However, the clinical implications of this model are important.
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Affiliation(s)
- Sebastiaan Remmers
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, the Netherlands.
| | - Eva Hollemans
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, the Netherlands
| | - Daan Nieboer
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, the Netherlands; Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Henk B Luiting
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, the Netherlands
| | - Geert J L H van Leenders
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, the Netherlands
| | - Jozien Helleman
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, the Netherlands
| | - Monique J Roobol
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, the Netherlands
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