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Radiotherapy is one of the important treatment strategies for localized prostate cancer. Conventional fractionated external beam radiotherapy is the standard dose-fraction regimen of radical radiotherapy for localized prostate cancer. In recent years, hypofractionated radiotherapy technique has been developed rapidly. The moderately hypofractionated radiotherapy has been considered as an alternative to conventional fractionated radiotherapy in conditional institutions. Increasing evidence has been obtained in the application of ultra-hypofractionated radiotherapy (also known as stereotactic body radiotherapy, SBRT) in patients with low-and intermediate-risk prostate cancer. However, the efficacy and safety of SBRT for high-risk prostate cancer have not been fully demonstrated. In this review, research progressess on the efficacy and safety of radical hypofractionated radiotherapy and the techniques of SBRT for prostate cancer were summarized.
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With aligned MR registration, the MR-Linac provides superior soft tissue resolution for prostate cancer. No fiducial markers or electromagnetic transponders insertion is needed to guarantee high-precision radiotherapy. The highly-recommended Adapt-To-Shape (ATS) workflow can resolve all the problems encountered during prostate cancer radiotherapy, including prostate volume changes and adjacent organs motion, both inter-fractionally and intra-fractionally. With all the above advantages, MR-Linac performs outstandingly than conventional linac in prostate cancer RT delivery, and probably helps us to reduce the CTV-PTV margin safely in the near future. Nevertheless, it is difficult to implement the ATS workflow in clinical practice. In this article, the standard ATS workflow for prostate cancer was summarized based on our own experience.
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Purpose To identify metabolites in humans that can be associated with the presence of malignant disturbances of the prostate. Methods In the present study, we selected male patients aged between 46 and 82 years who were considered at risk of prostate cancer due to elevated levels of prostate-specific antigen (PSA) or abnormal results on the digital rectal examination. All selected patients came from two university hospitals (Hospital Universitario del Valle and Clínica Rafael Uribe Uribe) and were divided into 2 groups: cancer (12 patients) and non-cancer (20 patients). Cancer was confirmed by histology, and none of the patients underwent any previous treatment. Standard protocols were applied to all the collected blood samples. The resulting plasma samples were kept at -80°C, and a profile of each one was acquired by nuclear magnetic resonance (NMR) using established experiments. Multivariate analyses were applied to this dataset, first to establish the quality of the data and identify outliers, and then, to model the data. Results We included 12 patients with cancer and 20 without it. Two patients were excluded due to contamination with ethanol. The remaining ones were used to build an Orthogonal Projections to Latent Structures Discriminant Analysis (OPLS-DA) model (including 15 non-cancer and 10 cancer patients), with acceptable discrimination (Q2 = 0.33). This model highlighted the role of lactate and lipids, with a positive association of these two metabolites and prostate cancer. Conclusions The primary discriminative metabolites between patients with and without prostate cancer were lactate and lipids. These might be the most reliable biomarkers to trace the development of cancer in the prostate.
Objetivo Identificar metabolitos en humanos que pueden estar asociados con la presencia de alteraciones malignas de la próstata. Métodos Se incluyeron muestras de pacientes masculinos entre 46 y 82 años y que se consideraron en riesgo de cáncer de próstata debido a la elevación del antígeno prostático específico (PSA) o el examen rectal anormal. Todos los pacientes seleccionados procedían de dos hospitales universitarios (Hospital Universitario del Valle y Clínica Rafael Uribe Uribe) y se dividieron en dos grupos: Oncológicos (12) vs no oncológicos (20). El cáncer fue confirmado por histología, y ninguno de ellos recibió tratamiento previo. Se aplicaron protocolos estándar a todas las muestras de sangre recolectadas. Las muestras de plasma resultantes se mantuvieron a −80°C y se adquirió un perfil de cada muestra mediante RMN. Se aplicaron análisis multivariantes a este conjunto de datos, primero para establecer la calidad de los datos e identificar valores atípicos, y para modelar los datos. Resultados Se incluyeron 12 pacientes con cáncer y 20 pacientes sin cáncer. Dos pacientes fueron excluidos por contaminación con etanol. Los restantes se utilizaron para construir un modelo OPLS-DA (15 pacientes no oncológicos y diez oncológicos), con una discriminación aceptable (Q2 = 0,33). Este modelo destacó el papel del lactato y los lípidos, encontrando una asociación positiva entre estos dos metabolitos y el cáncer de próstata. Conclusiones Los principales metabolitos discriminativos entre pacientes con cáncer de próstata versus no cáncer fueron el lactato y los lípidos. Estos podrían ser los biomarcadores más confiables para rastrear el desarrollo del cáncer en la próstata.
Subject(s)
Humans , Male , Prostate , Prostatic Neoplasms , Metabolomics , Magnetic Resonance Spectroscopy , Discriminant Analysis , Multivariate Analysis , Prostate-Specific Antigen , Lactic Acid , Digital Rectal Examination , Social DiscriminationABSTRACT
Introducción: El proceso de envejecimiento trae consigo cambios fisiológicos en las esferas orgánica y mental, que predisponen eventos fisiopatológicos, entre ellos el cáncer, entidad con repercusión significativa en el estado de salud del adulto mayor. Objetivo: Destacar la necesidad de los cuidados continuos para potenciar el estado de salud en el adulto mayor con cáncer de próstata. Métodos: Se confeccionó una comunicación breve a partir de un estudio preliminar con enfoque descriptivo de corte transversal, desde junio 2019 hasta febrero 2020, en el Hospital de Oncología María Curie, Camagüey, Cuba, donde se aplicó una encuesta sobre el nivel información de los cuidados continuos en oncología y los componentes de las teorías de Sor Callista Roy y Kristen M. Swanson en 16 enfermeros(as) participantes en el proyecto. Se ejecutó valoración del estado de salud, utilizando los instrumentos (Índice de Katz y escala de Lawton) en 34 adultos mayores con cáncer de próstata. Resultados: Fueron descritos niveles de información, mínimo aceptable e inaceptable en el personal encuestado. La valoración integral al adulto mayor con cáncer de próstata permitió conocer expresiones de dependencia a las actividades de la vida diaria e instrumentada. Conclusión: El estudio favoreció la preparación integral del personal de enfermería en la atención continuada del paciente oncológico. Además facilitó pautas que fortalecen la utilidad de la valoración integral para el proceso de los cuidados continuos del adulto mayor con cáncer de próstata, que permitan preservar conductas generadoras de salud biopsicosocial y potenciar su estado de salud(AU)
Introduction: The aging process brings about physiological changes, both organically and mentally, that may be the cause for pathophysiological events, including cancer, an entity with significant repercussions on the health status of the elderlies. Objective: To highlight the need for continuous care to enhance the health status of the elderlies with prostate cancer. Methods: A brief communication was made from a preliminary study with a descriptive cross-sectional approach, from June 2019 to February 2020, at María Curie Oncology Hospital, in Camagüey, Cuba, where a survey about the information level of continuous care in oncology and the components of the theories of Sister Callista Roy and Kristen M. Swanson was applied in sixteen nurses who participated in the project. Health status assessment was carried out, using the Katz index and Lawton scale in 34 older adults with prostate cancer. Results: Minimum ally acceptable and unacceptable levels of information were described in the surveyed personnel. The comprehensive assessment of the elderlies with prostate cancer allowed us to know expressions of dependence on the activities of daily and instrumented life. Conclusion: The study favored the comprehensive training of the nursing staff regarding ongoing care of cancer patients. In addition, it provided guidelines that strengthen the usefulness of comprehensive assessment for the process of continuous care of the elderlies with prostate cancer, so that these guidelines allow preserving behaviors that generate biopsychosocial health and enhance their health status(AU)
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Humans , Aged , Aged, 80 and over , Oncology Nursing/methods , Prostatic Neoplasms/epidemiology , Aging , Health Status , Epidemiology, Descriptive , Cross-Sectional Studies , Surveys and QuestionnairesABSTRACT
Objective:To evaluate the feasibility, safety and efficacy of the magnetic resonance imaging guided focused ultrasound surgery (MRgFUS) in the treatment of localized prostate cancer (PCa).Methods:The data of 5 patients treated by MRgFUS from August 2020 to June 2021 in our institution were retrospectively analyzed. The median age was 73 (58-80) years, with the median PSA of 7.34 (5.19-8.40) ng/ml, and a median prostate volume of 27.96 (21.50-37.91) ml. The median pretreatment international prostate symptom score (IPSS) was 13(0-18). Of the 3 patients with intention of erectile function preservation, the pretreatment international index of erectile function-15 (IIEF-15) score was 12, 23 and 3, respectively. All patients had histopathology-proven PCa of grade group ≤ International Society of Urological Pathology (ISUP) 3, pre-operative PSA level <20 ng/ml, and a clinical stage ≤T 2b. A total of 6 lesions was confirmed by biopsy, with 3 of ISUP grade group 3 and 3 of ISUP grade group 1. All 5 patients underwent MRgFUS which was guided by a real-time magnetic resonance imaging (MRI). PSA, MRI and repeated biopsy were conducted to monitor recurrence. Questionnaires consisted of IPSS, IIEF-15, and the International Consultation on Incontinence-questionnaire-Short Form (ICI-Q-SF) were recorded before and after MRgFUS to evaluate the impact on functional preservation. Results:A total of 5 patients received MRgFUS. In total, 5 of the 6 lesions were treated. 1 lesion unvisible on MRI was not clinically significant and was left untreated. The median time in MRI scanner was 190 (140-355) min, and the median sonication time was 64 (35-148) min with the median sonications of 8 (5-13). The median catheter indwelling time was 1 (1-8) days. No other adverse effects were reported. The PSA level of all 5 patients decreased, with the nadir PSA of 1.196 ng/ml, 4.398 ng/ml, 4.135 ng/ml, 1.562ng/ml and 1.350ng/ml, respectively. 4 of the patients had a PSA decrease over 50%. No PCa lesion was seen on MRI at 3-month follow-up visit. As for functional preservation, the post-MRgFUS IPSS declined compared with the baseline score, and the IPSS of last follow-up was 5(0-14). Of the 3 patients with intention to preserve the erectile function, the erectile function score of IIEF-15 were 12, 30 and 9 three months after the treatment, respectively. No incontinence occurred postoperatively.Conclusions:MRgFUS is a feasible and safe way for the treatment of low- to intermediate-risk localized PCa, with satisfactory performance on functional preservation and low incidence of complications. The oncological outcomes still need to be establised with longer follow-up time and larger sample studies.
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Objective:To establish a local effect model (LEM)-based rectal dose volume histogram (DVH) prediction model in prostate cancer patients treated with carbon ion therapy based on Japanese experience, aiming to provide reference for clinically reducing the incidence of rectal adverse reactions.Methods:The planning CT data of 76 patients with prostate cancer were collected. The microdosimetric kinetic model (MKM) was used for initial planning, and the LEM was selected to recalculate the biological dose based on the same fields to MKM. Then, the geometric features and DVH of the rectum were extracted from the LEM plans. The planning data of 61 cases were used to establish the prediction model with linear regression and the other 15 cases were used for validation.Results:The ratio of the overlapped volume between the rectum and the region of interest (ROI) expended from planning target volume by 1 cm along the left and right directions of the rectum could be proved to be the characteristic parameters for linear regression. The mean goodness-of-fit R2 of predicted and LEM plan-based DVH of 15 cases was 0.964. The results of predicted rectal adverse reactions based on predicted DVH were consistent with those of LEM plan-based DVH. Conclusions:The linear regression method used in this study can establish an accurate prediction model of rectal DVH, which may provide certain reference for reducing the incidence of rectal adverse reactions. Nevertheless, the findings remain to be further verified by clinical trials with larger sample size.
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RESUMO O uso de agrotóxicos na agricultura brasileira é um problema de saúde pública, dadas as contaminações no ambiente, em alimentos e as intoxicações resultantes do uso dessas substâncias. O objetivo deste artigo é investigar a distribuição espacial das áreas plantadas de lavouras e as taxas de mortalidade de alguns tipos de câncer: mama, colo do útero e próstata. Escolheram-se quatro estados brasileiros que possuem grande produção de commodities agrícolas a serem estudadas. Trata-se de um estudo ecológico de análise espacial conduzido com dados e informações do Sistema de Informação sobre Mortalidade (SIM) do Ministério da Saúde, por meio do qual elaboraram-se taxas de mortalidade para os referidos tipos de câncer, cujos óbitos tenham ocorrido entre 1996 e 2016. Há indícios de que existe correspondência entre as áreas de maior estimativa de uso de agrotóxicos Disruptores Endócrinos e o aumento das taxas de mortalidade pelos diferentes tipos de câncer.
ABSTRACT The use of agrochemicals in Brazilian agriculture is a public health problem, given the contamination of the environment, food and the poisoning resulting from the use of these substances. The objective of this article is to investigate the spatial distribution of planted crops area and mortality rates of some types of cancer: breast, cervix and prostate. Four Brazilian states were chosen that have large production of agricultural commodities to be studied. This is an ecological study of spatial analysis conducted with data and information from the Mortality Information System (SIM) of the Ministry of Health, and mortality rates were calculated for those types of cancer whose deaths occurred between 1996 and 2016. There are indications that there is a correspondence between the areas of higher estimation of the use of agrochemical Endocrine Disruptors and the increase of mortality rates by different types of cancer.
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ABSTRACT Purpose To evaluate the usefulness of natural killer cell activity (NKA) in diagnosing prostate cancer (PC). Materials and Methods The medical records of patients who underwent transrectal prostate biopsy (TRBx) at Korea University Ansan Hospital between May 2017 and December 2017 were retrospectively reviewed. NKA levels were measured using NK Vue® Tubes (ATgen, Sungnam, Korea). All blood samples were obtained at 8 AM on the day of biopsy. Patients with other malignancies, chronic inflammatory conditions, high prostate-specific antigen (PSA) level (>20ng/mL), or history of taking 5-alpha-reductase inhibitor or testosterone replacement therapy were excluded. Results A total of 102 patients who underwent TRBx for PC diagnosis were enrolled. Among them, 50 were diagnosed with PC. Significant differences in age and NKA level were observed between the PC and no-PC groups. Receiver operating characteristic (ROC) curve analysis showed that the optimal cut-off of NKA level for the prediction of PC was 500pg/dL, with a sensitivity of 68.0% and a specificity of 73.1%. In addition, NKA level (0.630) had the greatest area under the ROC curve compared to those for the ratio of total PSA to free PSA (0.597) and PSA density (0.578). Conclusions The results of this pilot study revealed that low NKA and high PSA levels were likely to be associated with a positive TRBx outcome. NKA detection was easy and improved the diagnostic accuracy of PC.
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Humans , Male , Aged , Prostatic Neoplasms/diagnosis , Killer Cells, Natural/metabolism , Prostate-Specific Antigen/blood , Prostatic Neoplasms , Prostatic Neoplasms/blood , Killer Cells, Natural/physiology , Biomarkers/metabolism , Biomarkers/blood , Pilot Projects , Retrospective Studies , ROC Curve , Sensitivity and Specificity , Image-Guided Biopsy , Middle AgedABSTRACT
Resumen: La resonancia magnética multiparamétrica (RMmp) de próstata ha tenido un desarrollo importante en los últimos años dado la alta prevalencia del cáncer de próstata y la necesidad de tener información imagenológica concreta para el correcto manejo de los pacientes urológicos. Otras técnicas de imágenes aportan información parcial sobre la morfología de la próstata, pero es la RMmp de próstata la técnica imagenológica que nos entrega mayor información, a través de secuencias morfológicas y funcionales, para detectar lesiones clínicamente significativas y disminuir el número de biopsias, predecir riesgo de agresividad de los tumores, estadificación local y ayudar al urólogo a realizar biopsias dirigidas cognitivas o por fusión RM/US. En este artículo se pretende mostrar casos representativos de errores frecuentes al momento de informar una resonancia magnética de próstata. Damos algunas recomendaciones para evitar estos errores y mejorar los informes radiológicos. Es común al comenzar a realizar informes de RMmp de próstata tener dudas sobre la correcta interpretación de los hallazgos. Ofrecemos a través de este articulo imágenes representativas de los principales errores en la búsqueda de patología neoplásica y algunas sugerencias para evitarlos. Desde el punto de vista académico se pueden dividir en pitfalls de condiciones anatómicas y patologías benignas que pueden simular un tumor. En el caso de pitfalls anatómicos mostramos casos referentes al estroma fibromuscular anterior hipertrófico, cápsula quirúrgica engrosada, plexo venoso peri-prostático, complejo neurovascular y pseudolesión posterior en zona periférica. Dentro de las condiciones benignas se encuentra la hiperplasia prostática benigna, procesos inflamatorios/infecciosos y otras condiciones que pueden simular tumor. Respecto a pitfalls relacionados con la hiperplasia prostática benigna podemos señalar hiperplasia de la zona de transición / central ("moustache-sign"), proliferación estromal en la zona de transición y nódulos adenomatosos ectópicos u extruidos en la zona periférica (ZP). Pitfalls inflamatorios/infecciosos corresponden a casos de prostatitis focal, prostatitis aguda, prostatitis con abscesos y prostatitis granulomatosa. Otros errores frecuentes de dificultad en la interpretación corresponden a casos de calcificaciones y hemorragia.
Abstract: Multiparameter magnetic resonance imaging (RMmp) of the prostate has had an important development in recent years given the high prevalence of prostate cancer and the need to have specific imaging information for the correct management of urological patients. Other imaging techniques provide partial information about the morphology of the prostate, but it is the mp-MRI of the prostate that gives us more information, through morphological and functional sequences, to detect clinically significant lesions and reduce the number of biopsies, predict risk of aggressiveness of the tumors, local staging and help the urologist to perform cognitive biopsies or by MR / US fusion. This article aims to show representative cases of frequent errors when reporting an MRI of the prostate. We give some recommendations to avoid these errors and improve radiological reports. It is common to start making mp-MRI of the prostate reports having doubts about the correct interpretation of the findings. We offer through this article representative images of the main errors in the search for neoplastic pathology and some suggestions to avoid them. From the academic point of view they can be divided into pitfalls of anatomical conditions and benign pathologies that can simulate a tumor. In the case of anatomical pitfalls, we show cases related to the hypertrophic anterior fibromuscular stroma, thickened surgical capsule, peri-prostatic venous plexus, neurovascular complex and posterior pseudo-injury in the peripheral area. Among the benign conditions is benign prostatic hyperplasia, inflammatory / infectious processes and other conditions that can simulate tumor. Regarding pitfalls related to benign prostatic hyperplasia, we can indicate hyperplasia of the transition / central zone ("mustache-sign"), stromal proliferation in the transition zone and ectopic or extruded adenomatous nodules in the peripheral zone. Inflammatory / infectious pitfalls correspond to cases of focal prostatitis, acute prostatitis, prostatitis with abscesses and granulomatous prostatitis. Other frequent errors of difficulty in interpretation correspond to cases of calcifications and hemorrhage.
Subject(s)
Humans , Prostate/diagnostic imaging , Prostatic Neoplasms/diagnostic imaging , Diagnostic Errors , Multiparametric Magnetic Resonance Imaging , Prostate/pathology , Prostatic Neoplasms/pathology , Diffusion Magnetic Resonance ImagingABSTRACT
Objective To evaluate the effect of setup errors upon the target area and the organs at risk (OAR) during radiotherapy for prostate cancer.Methods Twelve prostate cancer patients receiving treatment in the recent 1 year were randomly recruited in this study.The position of each patient was verified by using cone beam CT (CBCT) for 6-10 times during the treatment.In treatment planning system (TPS),the isocenter position was moved along the setup errors with averaging error value (Plan_A) and each CBCT value (Plan_F).The dose distribution was recalculated without changing the beam setting,weight factors and monitor units (MUs).The dose difference was statistically compared between the simulation and original plans (Plan_O).Results For clinical target volume (CTV) D95,there was a significant difference between Plan_A and Plan_O (P =0.008),whereas no significant difference was observed between Plan_F and Plan_O.There were significant differences between Plan_F and Plan_O,Plan_A and Plan_O (P=0.004,and 0.041) for the planned target volume (PTV) D95.For OAR,rectal V60,Dmax,left femoral V20,Dmax and right femoral Dmax significantly differed between Plan_F and Plan_O (P=0.026,0.015,0.041,0.049,0.003).However,only left femoral Dmax significantly differed between Plan_A and Plan_O (P=0.045).The movement in the superior-inferior (SI) direction was significantly correlated with the changes in the rectal V40,V50 and V60 and PTV D95 (r=-0.785,-0.887,-0.833,0.682).The movement in the anterior-posterior (AP) direction was significantly associated with the variations in the bladder V20,V30,V40,V50 and V60(r=-0.945,-0.823,-0.853,-0.818,-0.774).The evaluation indexes of all normal tissues in the re-plan could meet the clinical requirements.However,the volume of target prescription volume had different levels of deficit,and the deficit of Plan_F was greater than that of Plan_A.Conclusions The simulation results of averaging into the TPS underestimates the effect of daily setup errors on the dose distribution.The effect of setup errors on the dose distribution in target area is greater than that of normal tissues.Y-direction errors are more likely to cause the variations of the rectal and PTV dose,and the errors in the z-direction are inclined to cause the changes in the bladder dose.
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A 70-year-old male with chronic lymphocytic leukemia (CLL) 9 years ago initially presenting elevation of prostate specific antigen (PSA) was diagnosed with high-risk prostate cancer in March, 2018. He received 18F-FDG positron emission tomography/computed tomography (PET/CT), which showed mild FDG-avidity in swollen lymph nodes across the entire body, considering CLL. Then he underwent neoadjuvant androgen deprivation therapy for 1 month and then robot-assisted radical prostatectomy and biopsy of the right iliac vascular obturator lymph nodes. The prostate pathology was prostate cancer, and the pathology of lymph nodes was CLL. His serum PSA levels 1 month and 3 months after operation both reached the level of cure. For the patients with concomitant high-risk prostate cancer and CLL, PET/CT may be valuable in distinguishing whether the swollen lymph nodes were infiltrated by prostate cancer and guiding the lymphadenectomy.
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Purpose To explore the expression of bone morphogenetic protein-4 (BMP-4) in prostate cancer tissues and to analyze the effects of its down-regulation on proliferation and invasion of prostate cancer cells. Methods The expression of BMP-4 protein in prostate tissues of 58 patients with prostate cancer and 40 patients with benign prostatic hyperplasia (BPH) was detected by immunohistochemical En Vision method. The BMP-4 protein expression of different prostate cancer cells (LNcap, PC-3, Du145) and BPH was analyzed by Western blot.BMP-4 siRNA and control siRNA were transfected into LNcap respectively and then divided into three groups: untreated group, control siRNA group and BMP-4 siRNA group. Western blot was used to detect the expression levels of BMP-4 protein, MMP-2and MMP-9 in LNcap cells among the three groups. The proliferation of three groups was detected by CCK 8. The invasion ability of three groups was detected by Transwell chamber. Results The positive proportion of BMP-4 protein in prostate cancer tissues was higher than that in benign prostatic hyperplasia (P < 0.05) , and the expression level of BMP-4 protein in three kinds of prostate cancer cells was higher than that in BPH cell. The expression of BMP-4 protein in BMP-4 siRNA group was lower than that in untreated group and control siRNA group.The cell proliferation ability and cell invasion ability in BMP-4siRNA group were lower than those in untreated group and control siRNA group. The expression levels of MMP-2 and MMP-9proteins in BMP-4 siRNA group were lower than those in untreated group and control siRNA group. Conclusion BMP-4 is highly expressed in prostate cancer tissues and is associated with proliferation and invasion of prostate cancer cells, and it may become a potential therapeutic target for prostate cancer.
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Purpose To detect the expression of N-Myc and p53 in the tissues of prostate cancer (PCa) patients and to explore the relationship between them and their significance.Methods A total of 63 patients with PCa and 50 patients with benign prostatic hyperplasia (BPH) who underwent prostate surgery at the First Affiliated Hospital of Anhui Medical University were recruited in 2015-2016. The expression of N-Myc and p53 in pathological tissues were detected by immunohistochemistry of MaxVision method. Results The expression of N-Myc and p53 in PCa tissues was increased (P < 0.05). The expression of N-Myc and p53 in PCa tissues was correlated with bone metastases and TNM stage (P < 0.05), but not related to patient age, preoperative PSA level and other factors (P> 0.05). In addition, the expression of p53 was also correlated with Gleason score.Conclusion The high expression of N-Myc and p53 in PCa may involved in the malignant progression and metastasis of prostate cancer, and it is expected to become a new target for detecting PCa metastasis.
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Objective To assess the symptom burden and its predictive factors in patients with prostate cancer. Methods A cross-sectional study of 370 men with prostate cancer were conducted in the department of urology, Fudan University Shanghai Cancer Center. The questionnaire included a general questionnaire, Expanded Prostate Cancer Index Composite 26-item version (EPIC-26) and Hospital Anxiety and Depression Scale (HADS). Results The average score of EPIC-26 in patients with prostate cancer was 25.32±12.00. The sexual function (15.59±7.38) and endocrine disorder (4.09±3.70) scored higher in five domains. There were significant differences in symptom burden scores among different treatment methods (P<0.01). Multiple linear regression showed that endocrine therapy, anxiety, prostate specific antigen (PSA) and income were the influencing factors of symptom burden in this population, which could explain 49.3% of symptom burden. Conclusions The symptom burden of patients with prostate cancer is heavy, especially during endocrine therapy. Health care provider should focus on assessing the psychology of them. What′s more, it is important to develop the symptom management and psychological support, especially for patients with lower income and advanced patients.
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PURPOSE: The purpose of this study was to evaluate the association of androgen deprivation therapy (ADT) with cognitive dysfunction. MATERIALS AND METHODS: Using the National Health Insurance Service database of the entire Korean adult prostate cancer population (n=236,391), data on ADT and cognitive dysfunction between 2008 and 2015 were analyzed. We excluded patients previously diagnosed with cognitive dysfunction, dementia, or a cerebral event history. We tested the effect of ADT on the risk of cognitive dysfunction using propensity score–matched Cox proportional hazards regression models and Kaplan-Meier survival analysis. Our final cohort comprised of 35,401 individuals with prostate cancer, including 24,567 men (70.6%) who underwent ADT. RESULTS: During a mean follow-up period of 4.1 years, 4,741 patients were newly diagnosed with cognitive dysfunction. A statistically significant association was found between ADT and the risk of cognitive dysfunction (hazard ratio, 1.169; p=0.002). Meanwhile, age (≥ 70 years), diabetes, hypertension, cardiovascular history, and peripheral vascular disease were identified as factors that contribute to the increased risk of cognitive dysfunction. In contrast, the use of statins and aspirin was associated with a lower risk of cognitive dysfunction. Kaplan-Meier analysis demonstrated that patients aged 70 years or older who underwent ADT had the lowest cumulative probability of remaining cognitive dysfunction-free (log-rank p < 0.001). CONCLUSION: Our results revealed an association between the use of ADT for the treatment of prostate cancer and an increased risk of cognitive dysfunction in a nationwide population-based study. This finding should be further evaluated in prospective studies.
Subject(s)
Adult , Humans , Male , Aspirin , Cohort Studies , Dementia , Follow-Up Studies , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Hypertension , Kaplan-Meier Estimate , National Health Programs , Peripheral Vascular Diseases , Prospective Studies , Prostate , Prostatic NeoplasmsABSTRACT
Objective@#To assess the symptom burden and its predictive factors in patients with prostate cancer.@*Methods@#A cross-sectional study of 370 men with prostate cancer were conducted in the department of urology, Fudan University Shanghai Cancer Center. The questionnaire included a general questionnaire, Expanded Prostate Cancer Index Composite 26-item version (EPIC-26) and Hospital Anxiety and Depression Scale (HADS).@*Results@#The average score of EPIC-26 in patients with prostate cancer was 25.32±12.00. The sexual function (15.59±7.38) and endocrine disorder (4.09±3.70) scored higher in five domains. There were significant differences in symptom burden scores among different treatment methods (P < 0.01). Multiple linear regression showed that endocrine therapy, anxiety, prostate specific antigen (PSA) and income were the influencing factors of symptom burden in this population, which could explain 49.3% of symptom burden.@*Conclusions@#The symptom burden of patients with prostate cancer is heavy, especially during endocrine therapy. Health care provider should focus on assessing the psychology of them. What′s more, it is important to develop the symptom management and psychological support, especially for patients with lower income and advanced patients.
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A 70-year-old male with chronic lymphocytic leukemia (CLL) 9 years ago initially presenting elevation of prostate specific antigen (PSA) was diagnosed with high-risk prostate cancer in March, 2018. He received 18F-FDG positron emission tomography/computed tomography (PET/CT), which showed mild FDG-avidity in swollen lymph nodes across the entire body, considering CLL. Then he underwent neoadjuvant androgen deprivation therapy for 1 month and then robot-assisted radical prostatectomy and biopsy of the right iliac vascular obturator lymph nodes. The prostate pathology was prostate cancer, and the pathology of lymph nodes was CLL. His serum PSA levels 1 month and 3 months after operation both reached the level of cure. For the patients with concomitant high-risk prostate cancer and CLL, PET/CT may be valuable in distinguishing whether the swollen lymph nodes were infiltrated by prostate cancer and guiding the lymphadenectomy.
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Objective To systematically evaluate the clinical efficacy and safety between high-dose (74 to 80 Gy) and conventional-dose (64.0 to 70.2 Gy) conventionally fractionated external beam radiotherapy for stage T1b-4No-1M0 prostate cancer in this meta-analysis.Methods A literature search was performed in PubMea,ambasa,aochrane Librara,aeb of Scienca,aBa,aanfang Data,aNKI and Chongqing VIP to collect clinical trials on high-dose versus conventional-dose conventionally fractionated external beam radiotherapy of prostate cancer from the inception to July 1,2018.The included literatures were evaluated by Cochrane quality evaluation criteria and subject to meta-analysis by using Review Manager 5.3 statistical software.Results A total of 7 randomized controlled clinical trials involving 4 132 patients were included in the meta-analysis.The meta-analysis showed that the high-dose and conventional-dose groups yielded similar 10-year overall survival (RR=1.01,95％CI:0.96 to 1.07,P=0.64) and 10-year prostate cancer-specific survival (RR=1.01,95％CI:0.98 to 1.03,P=0.47).The biochemical failure rate in the high-dose group was significantly lower than that in the conventional-dose group (RR =0.78,95％CI:0.70 to 0.86,P＜0.01).Compared with the conventional-dose groua,ahe incidence of late grade ≥ 2 gastrointestinal and genitourinary adverse reactions (RR=1.48,95％CI:1.31 to 1.67,P＜0.01;RR=1.35,95％CI:1.06 to 1.73,P=0.02) was significantly higher in the high-dose group.Conclusion High-dose conventionally fractionated external beam radiotherapy has advantages in reducing the biochemical failure rate of patients with stage T1b-4N0-1M0 prostate cancer.Nevertheless,whether it can improve overall survival and prostate cancer-specific survival remains to be validated.High-dose radiotherapy also induce a higher incidence rate of late grade ≥ 2 gastrointestinal and genitourinary adverse reactions compared with conventional-dose radiotherapy.
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Objective To systematically evaluate the efficacy and safety of brachytherapy (BT) combined with external beam radiation therapy (EBRT) and EBRT alone for prostate cancer.Methods Databases including PubMed,Web of Science,Cochrane Library,CNKI,WanFang Data and VIP were searched from the inception to July 2018 to collect the clinical trials which comparatively analyzed the efficacy and safety between EBRT plus BT and EBRT alone for prostate cancer.According to the inclusion and exclusion criteria,data of the included studies were extracted and the methodological quality was evaluated.Then,a meta-analysis was performed using RevMan 5.3.Results Ten studies of 23 393 patients were included,in which 6 were randomized controlled trials (RCTs) and the other 4 were non-RCTs.The 3-year biochemical progression-free survival (b-PFS)[OR=2.03(95％CI:1.11 to 3.73),P=0.02] and the 5-year b-PFS of intermediate-risk patients[OR=2.27(95％CI:1.49 to 3.45),P＜0.01] in the EBRT+BT group were significantly higher compared with those in the EBRT group.The 3-and 5-year b-PFS,5-year overall survival and 5-year metastasis-free survival did not differ between two groups.in the incidence of ≥ grade 2 acute[OR=1.44(95％CI:1.11 to 1.38),P＜0.01] and chronic genitourinary adverse reactions [OR=3.06(95％CI:1.37 to 6.80),P＜0.01],≥ grade 3 acute[OR=1.75 (95％CI:1.14 to 2.69),P=0.01] and chronic genitourinary adverse reactions[OR=3.41(95％CI:2.42 to 4.82),P＜0.01] in the EBRT group were significantly lower than those in the EBRT+BT group.The incidence of gastrointestinal adverse reactions did not significantly differ between two groups.Conclusion Compared with EBRT alone,EBRT combined with BT can effectively improve the 3-and 5-year b-PFS,whereas increase the incidence of genitourinary adverse reactions for patients with intermediate-risk prostate cancer.
ABSTRACT
Objective To describe the frequency of mutations in DNA-repair genes in a southwestern Colombian population. Methods We have designed an observational study, including 162 people from all ages from southwest Colombia. We have extracted and collected their DNA in filters. We have immersed the DNA in a phosphate buffer along with DNeasy package (Thermo Fisher Scientific, Waltham, MA, USA). The preparation process was with the TruSeq Exome Library Prep (Illumina, Inc. San Diego, CA, USA), then the obtained libraries were normalized with TruSeq Rapid Exome (Illumina, Inc. San Diego, CA, USA). We sequenced the full exome and identified the variants associated with 12 genes (ataxia telangiectasia mutated [ATM], BRCA1 DNA repair associated [BRCA1], BRCA2 DNA repair associated [BRCA2], checkpoint kinase 2 [CHEK2], epithelial cell adhesion molecule [EPCAM], homeobox protein Hox-B13 [HOXB13], mutS homolog 1, 2 and 6 [MLH1, MSH2, MSH6], nibrin [NBN], PMS1 homolog 2, mismatch repair system component [PMS2], and tumor protein p53 [TP53]). Descriptive statistics were performed with the R software (The R Foundation for Statistical Computing, Vienna, Austria). Results A total of 7,315,466 pieces of data were sequenced in this population. The most frequently mutated genes were ATM (1,221 pieces of data; 13.2%), BRCA1 (1,178 pieces of data; 12.8%), BRCA2 (1,484 pieces of data; 16.12%), and NBN (965 pieces of data; 10.42%). The most common single nucleotide polymorphisms (SNPs) in these 12 genes were the following: BRCA2 (rs169547, rs206075, rs206076); ATM (rs659243, rs228589); TP53 (rs1625895, rs1042522, rs1642785); PMS2 (rs2228006, rs1805319); NBN (rs709816); and MSH6 (rs3136367) Conclusion The BRCA2, ATM, BRCA1 and NBN DNA-repair genes were the most frequently mutated in this southwestern Colombian Population
Objetivo Describir la frecuencia de las mutaciones en los genes de reparación del ADN en una población del suroccidente de Colombia. Métodos Diseñamos un estudio observacional que incluyó a 162 personas del suroccidente de Colombia de todas las edades. Hemos extraído y recogido el ADN en filtros. Los sumergimos en tampón fosfato junto con el paquete DNeasy (Thermo Fisher Scientific, Waltham, MA, EEUU). El proceso de preparación fue realizado con TruSeq Exome Library Prep (Illumina, Inc. San Diego, CA, EEUU); luego, las bibliotecas obtenidas se normalizaron con TruSeq Rapid Exome (Illumina, Inc. San Diego, CA, USA). Secuenciamos el exoma completo e identificamos las variantes asociadas a doce genes (ataxia telangiectasia mutated [ATM], BRCA1 DNA repair associated [BRCA1], BRCA2 DNA repair associated [BRCA2], checkpoint kinase 2 [CHEK2], epithelial cell adhesion molecule [EPCAM], homeobox protein Hox-B13 [HOXB13], mutS homolog 1, 2 and 6 [MLH1, MSH2, MSH6], nibrin [NBN], PMS1 homolog 2, mismatch repair system component [PMS2], y tumor protein p53 [TP53]). La estadística descriptiva se realizó en el programa R (The R Foundation for Statistical Computing, Viena, Austria). Resultados Un total de 7.315.466 datos fueron secuenciados en esta población. Los genes más frecuentemente mutados fueron el ATM, con 1.221 datos (13,2%), el BRCA1, con 1.178 datos (12,8%), el BRCA2, con 1.484 datos (16,12%) y el NBN, con 965 datos (10,42%). Los polimorfismos de un solo nucleótido (PSN) más comunes en estos 12 genes fueron los siguientes: BRCA2 (rs169547, rs206075, rs206076); ATM (rs659243, rs228589); TP53 (rs1625895, rs1042522, rs1642785); PMS2 (rs2228006, rs1805319); NBN (rs709816) y MSH6 (rs3136367) Conclusión Los genes de reparación de ADN BRCA2, ATM, BRCA1 NBN fueron los más frecuentemente mutados en esta población del suroccidente de Colombia.