RESUMO
Introduction: Studies directly comparing the different combination therapies offered to men with metastatic castration sensitive prostate cancer (mCSPC), are not available yet. This study was designed using the network meta-analysis (NMA) framework to provide a comparison of the different available options for the treatment of men with mCSPC. Methods: A systematic search was performed and the prospective randomized controlled trials reporting the overall survival (OS) or failure-free survival (FFS) were selected for review. A total of 14 studies were included in the NMA. Results: The addition of abiraterone, apalutamide, docetaxel, and docetaxel with zoledronic acid to the androgen deprivation therapy (ADT) demonstrated a significant improvement in the OS. In indirect comparison, abiraterone had a higher impact on the OS as compared to docetaxel (hazard ratio [HR]: 1.21, 95% confidence interval [CI]: 1.0-1.46) and docetaxel with zoledronic acid (HR: 1.31, 95% CI: 1.05-1.63) but not apalutamide. Furthermore, apalutamide was not different than docetaxel or docetaxel with zoledronic acid. There was a significant improvement in the FFS with the combination of abiraterone, apalutamide, docetaxel (HR: 0.61, 95% CI: 0.46-0.81), docetaxel with zoledronic acid (HR: 0.62, 95% CI: 0.43-0.9), and enzalutamide (HR: 0.39, 95% CI: 0.25-0.61) as compared to the ADT alone. Similar to the indirect comparison of OS, abiraterone outperformed docetaxel (HR: 1.66, 95% CI: 1.12-2.47), docetaxel with zoledronic acid (HR: 1.69, 95% CI: 1.06-2.68), and enzalutamide (HR: 1.06, 95% CI: 0.63-1.80), but not apalutamide in terms of impact on the FFS. Conclusion: Overall, abiraterone demonstrated better OS and FFS outcomes as compared to all the other combination strategies in this NMA.
Assuntos
Transtornos de Deglutição/etiologia , Doenças do Esôfago/complicações , Tuberculose Gastrointestinal/complicações , Tuberculose dos Linfonodos/complicações , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Doenças do Esôfago/diagnóstico , Feminino , Granuloma de Células Gigantes/complicações , Granuloma de Células Gigantes/diagnóstico , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Tuberculose Gastrointestinal/diagnóstico , Tuberculose dos Linfonodos/diagnósticoAssuntos
Histoplasma/isolamento & purificação , Histoplasmose/complicações , Síndrome de Job/complicações , Doenças Retais/complicações , Reto/microbiologia , Biópsia , Pré-Escolar , Colonoscopia , Diagnóstico Diferencial , Feminino , Histoplasmose/diagnóstico , Histoplasmose/microbiologia , Humanos , Doenças Retais/diagnóstico , Doenças Retais/microbiologia , Reto/patologiaRESUMO
Combined penoscrotal incarceration is rarely reported in the literature. It is a urological emergency. Depending on the nature of the constricting object, duration of constriction, and with no defined treatment methods, inventiveness is usually required in removing difficult objects. This is a report of a penoscrotal incarceration by four closed steel rings, treated in Northern Ireland with a few minor points reiterated.
