Clinical Presentation and Management of Prostate Cancer in the Middle East

PURPOSE/OBJECTIVE(S)

Prostate cancer is one of the most common malignancies worldwide and the incidence rate continues to increase in the Middle East. In the absence of large well-established cancer registries, there are no data to reflect the disease stage at initial presentation and patterns of care in this region. In order to mitigate the disease burden and help stakeholders to implement new policies to improve patient outcomes, it is important to study the disease stage at the initial presentation. The purpose of this study was to evaluate the clinical presentation and treatment of prostate cancer in the Middle East.

MATERIALS/METHODS

We performed a retrospective review of 7 institutional databases in 6 Middle Eastern countries to identify patients diagnosed with prostate cancer in 2021. Demographic, clinical, and treatment variables were abstracted. Patients who missed ≥2 scheduled radiation therapy (RT) appointments (excluding planned treatment breaks) were deemed "noncompliant."

RESULTS

A total of 1,132 patients were identified with a median age was 70 (range, 50-84). Most of the patients (78%) were diagnosed after developing symptoms and not on routine PSA screening. Diagnostic workup was completed in 87% of the patient. At time of diagnosis, 35% men presented with clinical T3 or T4 disease, 53% with metastatic disease and 42% with Gleason score ≥ 8. Mean PSA at time of presentation was 84 ng/ml. Among the nonmetastatic patients, 23% underwent a prostatectomy, 48% received definitive RT with or without androgen deprivation therapy (ADT), 9% received ADT alone and 20% received no treatment. No brachytherapy was used. Hypofractionated RT was used in 49% patients and only 8% were deemed "noncompliant". Among the metastatic patients, 74% received ADT with or without additional systemic therapy, 25% had palliative RT and 22% received no treatment.

CONCLUSION

In this large cohort of prostate cancer patients in the Middle East, most men presented with symptoms and were found to have advanced-stage disease. However, substantial proportion of patients did not receive any treatment. Further interventions to optimize prostate cancer diagnosis and treatment in in the Middle East are urgently needed.

N-acetylcysteine protects testicular tissue against ischemia/reperfusion injury via inhibiting endoplasmic reticulum stress and apoptosis

BACKGROUND

In animal models, endoplasmic reticulum (ER) stress has been reported to play a vital role in mediating ischemia/reperfusion (I/R) injury in certain organs, such as brain, liver, and intestine. However, there are a limited number of studies examining the relationship between ER stress and torsion and detorsion (T/D)-induced testicular injury.

OBJECTIVE

To investigate the effects of N-acetylcysteine (NAC) on ER-stress and apoptosis in an experimental testicular I/R injury model.

DESIGN

A non-blinded experimental study with three arms. Rats were divided into three groups: control group, T/D group, and NAC group. In the pretreatment of the NAC group, 20 mg/kg NAC was given intraperitoneally 30 min before detorsion. Tissue 4-hydroxynonenal (4-HNE), 78-kDa glucose-regulated protein (GRP78), and activating transcription factor 6 (ATF6) levels were determined using enzyme-linked immunosorbent assay. The apoptosis levels were evaluated using terminal deoxynucleotide transferase-mediated dUTP nick-end label assay.

RESULTS

In T/D group, tissue 4-HNE, GRP78, ATF6, and apoptotic index levels were significantly higher than control group. These increases were significantly reversed with NAC pretreatment.

DISCUSSION

There are some potential drugs that have been shown to reduce ER stress in the experimental ischemia model, and it is questioned that these drug candidates can be used as a therapeutic agent in the treatment of ischemic diseases in the near future. This study was not without limitations. First, the authors applied NAC only 20 mg/kg. In a future study, a dose-dependent assay should be performed to assess the likelihood of an additional testicular protective effect. One limitation of this research is also that in vivo studies cannot be extrapolated to possible effect in clinics. More experiments therefore need to be conducted to extrapolate the study findings to humans.

CONCLUSION

The study results showed that, after testicular torsion (TT), the ER stress-related apoptotic pathway plays a pivotal role in testicular injury. Further studies of other experimental models of TT may prove that NAC is a useful agent as an adjunctive treatment in surgical repair in human cases.