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Pembroke L, Sherman KA, Dhillon HM, Francis H, Gillatt D, Gurney H. Online Group Cognitive Rehabilitation Program for Prostate Cancer Survivors: Development Using Codesign and the Theoretical Domains Framework. Semin Oncol Nurs 2024; 40:151695. [PMID: 39054190 DOI: 10.1016/j.soncn.2024.151695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 06/19/2024] [Accepted: 06/21/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVES This study aimed to describe the adaptation of a group cognitive rehabilitation program for prostate cancer survivors (PCS) via telehealth delivery using a codesign approach with PCS experiencing cancer-related cognitive impairment. The Theoretical Domains Framework (TDF) also informed the intervention development. METHODS Intervention development consisted of three steps: 1) Adapting an existing cancer-related cognitive rehabilitation program for PCS; 2) Conducting a codesign focus group workshop to gather feedback that was analyzed using a template approach; and 3) Incorporation of consumer feedback to refine the program for future piloting in PCS. Components of the finalized intervention were mapped onto the TDF domains. RESULTS Six PCS were involved in the codesign focus group workshop, providing feedback on program structure, the topics and its order, and rehabilitation activities. A manualized four-week online group cognitive rehabilitation program titled "Promoting Cognitive Wellbeing in Prostate Cancer Survivors (ProCog)" was developed. Four sessions of 2-hours' duration were designed exploring: cognitive/brain functions; the impact of cancer treatments and ageing; the relationship between thoughts, feelings and behaviors; values-based goal-setting; and skills/strategies to manage fatigue and improve attention, memory, aspects of executive functioning, and emotional functioning. CONCLUSIONS Consumer input and guidance from the TDF ensures a robust development process for the online ProCog intervention, designed for and with PCS experiencing cognitive difficulties. As an important initial step before piloting, this adaptation and development process ensures that ProCog addresses consumer needs and preferences and targets factors increasing behavior change. IMPLICATIONS FOR NURSING PRACTICE This research raises awareness of possible cancer-related cognitive impairments in prostate cancer survivors and strategies for rehabilitation. ProCog is an accessible online intervention that nurses can use to refer patients needing cognitive rehabilitation.
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Affiliation(s)
- Lorna Pembroke
- Lifespan Health and Wellbeing Research Centre, Macquarie University, New South Wales, Australia; School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University & Macquarie University Hospital, New South Wales, Australia.
| | - Kerry A Sherman
- Lifespan Health and Wellbeing Research Centre, Macquarie University, New South Wales, Australia; School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University & Macquarie University Hospital, New South Wales, Australia
| | - Haryana M Dhillon
- Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, Faculty of Science, University of Sydney, New South Wales, Australia; Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, University of Sydney, New South Wales, Australia
| | - Heather Francis
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University & Macquarie University Hospital, New South Wales, Australia
| | - David Gillatt
- Macquarie University Urology Clinic, Faculty of Medicine and Health Sciences, Macquarie, University & Macquarie University Hospital, New South Wales, Australia
| | - Howard Gurney
- Macquarie University Clinical Trials Unit (CTU), Faculty of Medicine and Health Sciences, Macquarie University & Macquarie University Hospital, New South Wales, Australia
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Coelingh Bennink HJT, Prowse A, Egberts JFM, Debruyne FMJ, Huhtaniemi IT, Tombal B. The Loss of Estradiol by Androgen Deprivation in Prostate Cancer Patients Shows the Importance of Estrogens in Males. J Endocr Soc 2024; 8:bvae107. [PMID: 38883397 PMCID: PMC11177789 DOI: 10.1210/jendso/bvae107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Indexed: 06/18/2024] Open
Abstract
The role of estradiol (E2; an estrogen) in men needs to be more appreciated. In this review, we address the clinical situations that allow the study of the clinical consequences of E2 deficiency in men and discuss the effects of restoration of levels of this reproductive steroid hormone. In men with advanced prostate cancer (PCa) undergoing androgen deprivation therapy (ADT), E2 is suppressed along with testosterone, leading to side effects affecting the quality of life. These include hot flashes, arthralgia, fatigue, mood changes, cognition problems, weight gain, bone loss, and increased risk of cardiovascular disease. Transdermal E2 alone for ADT has shown equivalent testosterone suppression compared to gonadotropin-releasing hormone (GnRH) agonists while also preventing estrogen-deficiency side effects, including hot flashes and bone loss. Co-treatment of ADT with fetal estrogen estetrol (E4) has shown significant improvements of estrogen-deficiency symptoms. These observations emphasize the need to raise awareness of the importance of estrogens in men among clinicians and the lay public.
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Affiliation(s)
| | - Amanda Prowse
- Terminal 4 Communications, 1217 SK Hilversum, The Netherlands
| | - Jan F M Egberts
- Terminal 4 Communications, 1217 SK Hilversum, The Netherlands
| | | | - Ilpo T Huhtaniemi
- Institute of Reproductive and Developmental Biology, Imperial College London, London SW7 2AZ, UK
| | - Bertrand Tombal
- Division of Urology, University Clinic Saint-Luc, 1200 Brussels, Belgium
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Singh M, Agarwal V, Pancham P, Jindal D, Agarwal S, Rai SN, Singh SK, Gupta V. A Comprehensive Review and Androgen Deprivation Therapy and Its Impact on Alzheimer's Disease Risk in Older Men with Prostate Cancer. Degener Neurol Neuromuscul Dis 2024; 14:33-46. [PMID: 38774717 PMCID: PMC11108066 DOI: 10.2147/dnnd.s445130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 05/03/2024] [Indexed: 05/24/2024] Open
Abstract
Prostate cancer (PCa) is one of the most prevalent malignancies affecting males worldwide. Despite reductions in mortality rates due to advances in early identification and treatment methods, PCa remains a major health concern. Recent research has shed light on a possible link between PCa and Alzheimer's disease (AD), which is a significant neurological ailment that affects older males all over the world. Androgen deprivation therapy (ADT), a cornerstone therapeutic method used in conjunction with radiation and palliative care in advanced metastatic PCa cases, is critical for disease management. Evidence reveals a relationship between ADT and cognitive impairment. Hormonal manipulation may cause long-term cognitive problems through processes such as amyloid beta (Aβ) aggregation and neurofibrillary tangles (NFTs). Fluctuations in basal androgen levels can upset the delicate balance of genes that are sensitive to androgen levels, contributing to cognitive impairment. This detailed review dives into the various aspects of PCa aetiology and its relationship with cognitive decline. It investigates the discovery of particular biomarkers, as well as microRNAs (miRNAs), which play important roles in pathogenic progression. The review attempts to identify potential biomarkers associated with ADT-induced cerebral changes, including Aβ oligomer buildup, NFT formation, and tauopathy, which can contribute to early-onset dementia and cognitive impairment. Besides it further aims to provide insights into innovative diagnostic and therapeutic avenues for alleviating PCa and ADT-related cognitive sequelae by unravelling these complicated pathways and molecular mechanisms.
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Affiliation(s)
- Manisha Singh
- Faculty of Health, Graduate School of Health, University of Technology Sydney, Sydney, Australia
- ARCCIM, School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
- Department of Biotechnology, Jaypee Institute of Information Technology (JIIT) Noida, Noida, Uttar Pradesh, India
| | - Vinayak Agarwal
- Department of Biotechnology, Jaypee Institute of Information Technology (JIIT) Noida, Noida, Uttar Pradesh, India
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Pranav Pancham
- Department of Biotechnology, Jaypee Institute of Information Technology (JIIT) Noida, Noida, Uttar Pradesh, India
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Divya Jindal
- Department of Biotechnology, Jaypee Institute of Information Technology (JIIT) Noida, Noida, Uttar Pradesh, India
- Indian Institute of Technology Bombay Monash Research Academy, Mumbai, India
| | - Shriya Agarwal
- Department of Biotechnology, Jaypee Institute of Information Technology (JIIT) Noida, Noida, Uttar Pradesh, India
- Department of Molecular Science, School of Natural Sciences, Macquarie University, Sydney, Australia
| | - Sachchida Nand Rai
- Centre of Experimental Medicine and Surgery (CEMS), Institute of Medical Sciences (IMS), Banaras Hindu University (BHU), Varanasi, Uttar Pradesh, 221005, India
| | - Santosh Kumar Singh
- Centre of Experimental Medicine and Surgery (CEMS), Institute of Medical Sciences (IMS), Banaras Hindu University (BHU), Varanasi, Uttar Pradesh, 221005, India
| | - Vivek Gupta
- Macquarie Medical School, Macquarie University, Sydney, Australia
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Pembroke L, Sherman KA, Francis H, Dhillon HM, Gurney H, Gillatt D. Psychosocial Factors Associated with Cognitive Function in Prostate Cancer Survivors on Hormonal Treatments: A Systematic Review. Neuropsychol Rev 2024:10.1007/s11065-024-09639-1. [PMID: 38642173 DOI: 10.1007/s11065-024-09639-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 03/07/2024] [Indexed: 04/22/2024]
Abstract
Hormonal treatments (HT) for prostate cancer (e.g., androgen deprivation therapy) yield clinical and survival benefits, yet adverse cognitive changes may be a side effect. Since psychosocial factors are largely modifiable, interventions targeting these factors may help mitigate these adverse cognitive effects. This systematic review aimed to identify a range of psychosocial factors associated with cognitive function in individuals with prostate cancer undergoing HT and to determine whether these factors mitigate or exacerbate this effect. Applying PRISMA guidelines, a comprehensive search of relevant databases conducted in September 2023 using terms related to prostate cancer, hormone therapy, and cognitive outcomes was undertaken. The search yielded 694 unique abstracts, with 11 studies included for analysis examining the relationship between cognitive function and the following psychosocial factors: psychological distress, fatigue, insomnia, and coping processes. Findings were mixed with only two studies reporting significant associations between cognitive performance with fatigue and depression. Three studies that included measures of perceived cognitive function identified associations with depression, anxiety, fatigue, insomnia, illness threat appraisals, and coping styles. However, no studies found evidence for an association between self-reported and objective measures of cognitive functioning. Evidence regarding the association of interpersonal factors is lacking. Moreover, whether these factors mitigate or exacerbate the effect of HT on cognitive function still needs to be determined. Overall, the research exploring the association between psychosocial factors and cognitive function in prostate cancer survivors undergoing HT is still in its infancy. Further research is required to optimize the implementation of neuropsychological interventions for prostate cancer survivors.
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Affiliation(s)
- Lorna Pembroke
- Lifespan Health and Wellbeing Research Centre, Macquarie University, Macquarie Park, NSW, 2109, Australia
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University & Macquarie University Hospital, Macquarie Park, NSW, 2109, Australia
| | - Kerry A Sherman
- Lifespan Health and Wellbeing Research Centre, Macquarie University, Macquarie Park, NSW, 2109, Australia.
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University & Macquarie University Hospital, Macquarie Park, NSW, 2109, Australia.
| | - Heather Francis
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University & Macquarie University Hospital, Macquarie Park, NSW, 2109, Australia
| | - Haryana M Dhillon
- Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW, 2006, Australia
- Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Howard Gurney
- Faculty of Medicine, Health and Health Sciences, Macquarie University Clinical Trials Unit (CTU), Macquarie University & Macquarie University Hospital, Macquarie Park, NSW, 2109, Australia
| | - David Gillatt
- Faculty of Medicine, Health and Health Sciences, Macquarie, Macquarie University Urology Clinic, University & Macquarie University Hospital, Macquarie Park, NSW, 2109, Australia
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Cowan BA, Olivier K, Tombal B, Wefel JS. Treatment-Related Cognitive Impairment in Patients with Prostate Cancer: Patients' Real-World Insights for Optimizing Outcomes. Adv Ther 2024; 41:476-491. [PMID: 37979089 PMCID: PMC10838823 DOI: 10.1007/s12325-023-02721-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/26/2023] [Indexed: 11/19/2023]
Abstract
Cognitive impairment (CI) is an issue that needs to be at the forefront of unmet healthcare needs in patients with prostate cancer (PCa) as it can negatively impact quality of life during long-term care. CI in patients with prostate cancer is thought to be influenced by treatment, androgen deprivation therapy (ADT), and novel androgen receptor (AR) pathway inhibitors in particular; however, current understanding is limited on how treatment affects cognition. Additionally, the experience of patients with CI who are receiving PCa treatment is not well understood or represented in clinical literature, which is a barrier to optimal patient outcomes in managing prostate cancer treatment-related cognitive impairment (PCa-TRCI). To help understand the patient journey and elucidate management gaps in PCa-TRCI, an international roundtable of healthcare provider and patient panelists was convened. The panelists focused on four key topic areas: (1) the patient experience when afflicted with, or at risk of, PCa-TRCI, (2) the physical, emotional, and social impact of CI on patients' quality of life (QoL), (3) the challenges that patients with PCa-TRCI face, and their impact on clinical decision-making, and (4) ways in which managing PCa-TRCI should evolve to improve patient outcomes. The purpose of the roundtable was to include patients in a direct discussion with healthcare providers (HCPs) regarding the patient journey and highlight real-world evidence of areas where patient outcomes could be improved in the absence of clinical evidence. The resulting discussion highlighted important healthcare gaps for patients with, and at risk of, PCa-TRCI and offered potential solutions as a roadmap to effective medicine.
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Affiliation(s)
| | - Kara Olivier
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Bertrand Tombal
- Division of Urology at the Université catholique de Louvain, Ottignies-Louvain-la-Neuve, Belgium
| | - Jeffrey S Wefel
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Neerhut T, Shin BNH, Rhee H, Chung E. A review of the objective cognitive function measurements in males receiving hormonal therapy for prostate cancer. Investig Clin Urol 2023; 64:521-540. [PMID: 37932563 PMCID: PMC10630686 DOI: 10.4111/icu.20230103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 06/26/2023] [Accepted: 08/21/2023] [Indexed: 11/08/2023] Open
Abstract
PURPOSE Prostate cancer (PC) is more common in the older population and the use of hormonal therapy in PC can increase medical frailty and cognitive decline. This narrative review examines the impact of androgen deprivation therapies (ADTs) and next-generational hormonal therapies (NGHT) on cognitive function outcomes amongst patients with hormone-sensitive or castrate-resistant PC. MATERIALS AND METHODS Six electronic databases were searched from January 2000 to June 2022 for quantitative studies to evaluate the impacts of hormonal therapies (ADT, combined androgen blockade, and NGHT) on cognitive functions in men with PC. RESULTS Of the 36 studies identified, 20 studies reported no effect of hormonal therapies on any cognitive domain while 16 studies found possible declines in at least one domain. The domains assessed were highly variable and objective assessment measurements were not standardized or widely adopted. While the results have been inconsistent, a relationship between declining androgen levels and poorer performances in the visuospatial and visual memory domains has been highlighted. It was not possible to distinguish the degree of cognitive parameter changes between the populations of hormone-sensitive and castrate-resistant PC. CONCLUSIONS While the exact impact of ADT and NGHT on cognitive function in men with PC remains controversial, appropriate care should be undertaken especially in older and frail individuals, specifically in those with progressive or established visuospatial or visual memory deficits.
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Affiliation(s)
- Thomas Neerhut
- Department of Urology, Princess Alexandra Hospital Brisbane QLD Australia, The University of Queensland, Brisbane, QLD, Australia
| | - Brian Ng Hung Shin
- Department of Urology, Princess Alexandra Hospital Brisbane QLD Australia, The University of Queensland, Brisbane, QLD, Australia
| | - Handoo Rhee
- Department of Urology, Princess Alexandra Hospital Brisbane QLD Australia, The University of Queensland, Brisbane, QLD, Australia
| | - Eric Chung
- Department of Urology, Princess Alexandra Hospital Brisbane QLD Australia, The University of Queensland, Brisbane, QLD, Australia
- AndroUrology Centre, Brisbane, QLD, Australia.
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Saleem A, Shah SIA, Mangar SA, Coello C, Wall MB, Rizzo G, Jones T, Price PM. Cognitive Dysfunction in Patients Treated with Androgen Deprivation Therapy: A Multimodality Functional Imaging Study to Evaluate Neuroinflammation. Prostate Cancer 2023; 2023:6641707. [PMID: 37885823 PMCID: PMC10599921 DOI: 10.1155/2023/6641707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 07/14/2023] [Accepted: 10/05/2023] [Indexed: 10/28/2023] Open
Abstract
Background Androgen deprivation therapy (ADT) for prostate cancer is implicated as a possible cause of cognitive impairment (CI). CI in dementia and Alzheimer's disease is associated with neuroinflammation. In this study, we investigated a potential role of neuroinflammation in ADT-related CI. Methods Patients with prostate cancer on ADT for ≥3 months were categorized as having ADT-emergent CI or normal cognition (NC) based on self-report at interview. Neuroinflammation was evaluated using positron emission tomography (PET) with the translocator protein (TSPO) radioligand [11C]-PBR28. [11C]-PBR28 uptake in various brain regions was quantified as standardized uptake value (SUVR, normalized to cerebellum) and related to blood oxygen level-dependent functional magnetic resonance imaging (BOLD-fMRI) choice-reaction time task (CRT) activation maps. Results Eleven patients underwent PET: four with reported CI (rCI), six with reported NC (rNC), and one status unrecorded. PET did not reveal any between-group differences in SUVR regionally or globally. There was no difference between groups on brain activation to the CRT. Regardless of the reported cognitive status, there was strong correlation between PET-TSPO signal and CRT activation in the hippocampus, amygdala, and medial cortex. Conclusions We found no difference in neuroinflammation measured by PET-TSPO between patients with rCI and rNC. However, we speculate that the strong correlation between TSPO uptake and BOLD-fMRI activation in brain regions involved in memory and known to have high androgen-receptor expression mediating plasticity (hippocampus and amygdala) might reflect inflammatory effects of ADT with compensatory upregulated/increased synaptic functions. Further studies of this imaging readout are warranted to investigate ADT-related CI.
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Affiliation(s)
- Azeem Saleem
- Invicro, Burlington Danes Building, Imperial College London, Hammersmith Hospital, Du Cane Road, London, UK
- Hull York Medical School, University of Hull, Cottingham Road, Hull HU6 7RX, UK
| | - Syed Imran Ali Shah
- Department of Surgery and Cancer, Imperial College, London, UK
- Department of Biochemistry, CMH Lahore Medical College & Institute of Dentistry, Lahore, Pakistan
| | | | - Christopher Coello
- Invicro, Burlington Danes Building, Imperial College London, Hammersmith Hospital, Du Cane Road, London, UK
| | - Matthew B. Wall
- Invicro, Burlington Danes Building, Imperial College London, Hammersmith Hospital, Du Cane Road, London, UK
| | - Gaia Rizzo
- Invicro, Burlington Danes Building, Imperial College London, Hammersmith Hospital, Du Cane Road, London, UK
- Division of Brain Sciences, Imperial College London, London, UK
| | - Terry Jones
- Department of Radiology, University of California Davis Medical Center, Davis, California, USA
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Mirmoeeni S, Azari Jafari A, Shah M, Salemi F, Hashemi SZ, Seifi A. The Clinical, Diagnostic, Therapeutic, and Prognostic Characteristics of Brain Metastases in Prostate Cancer: A Systematic Review. Prostate Cancer 2022; 2022:5324600. [PMID: 36474619 PMCID: PMC9719815 DOI: 10.1155/2022/5324600] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 08/19/2023] Open
Abstract
AIM Prostate cancer (PCa) is the second most common nonskin malignancy and the second most common cause of cancer-related deaths in men. The most common site of metastasis in PCa is the axial skeleton which may lead to back pain or pathological fractures. Hematogenous spread to the brain and involvement of the central nervous system (CNS) are a rare occurrence. However, failed androgen deprivation therapy (ADT) may facilitate such a spread resulting in an advanced metastatic stage of PCa, which carries a poor prognosis. METHODS In this systematic review, we searched the PubMed, Scopus, and Web of Science online databases based on the PRISMA guideline and used all the medical subject headings (MeSH) in terms of the following search line: ("Brain Neoplasms" OR "Central Nervous System Neoplasms") and ("Prostatic Neoplasms" OR "Prostate"). Related studies were identified and reviewed. RESULTS A total of 59 eligible studies (902 patients) were included in this systematic review. In order to gain a deeper understanding, we extracted and presented the data from included articles based on clinical manifestations, diagnostic methods, therapeutic approaches, and prognostic status of PCa patients having BMs. CONCLUSION We have demonstrated the current knowledge regarding the mechanism, clinical manifestations, diagnostic methods, therapeutic approaches, and prognosis of BMs in PCa. These data shed more light on the way to help clinicians and physicians to understand, diagnose, and manage BMs in PCa patients better.
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Affiliation(s)
| | | | - Muffaqam Shah
- Deccan College of Medical Sciences, P.O. Kanchanbagh, DMRL ‘X' Road, Santhosh Nagar, Hyderabad 500058, Telangana, India
| | - Fateme Salemi
- School of Medicine, Islamic Azad University of Medical Sciences, Yazd, Iran
| | - Seyedeh Zohreh Hashemi
- Researcher at the Research Center of Tehran University of Medical Sciences, Pharmacology Department, Tehran, Iran
| | - Ali Seifi
- Department of Neurosurgery, Division of Neuro Critical Care, University of Texas Health Science Center at San Antonio School of Medicine, San Antonio, TX, USA
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Russell N, Allebone J, Dandash O, Hoermann R, Cheung AS, Zajac JD, Handelsman DJ, Kanaan RA, Grossmann M. Effect of estradiol on cognition in men undergoing androgen deprivation therapy: A randomized placebo-controlled trial. Clin Endocrinol (Oxf) 2022; 97:622-633. [PMID: 35150156 DOI: 10.1111/cen.14689] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/23/2022] [Accepted: 02/06/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Roles for estradiol in modulating cognition in men remain uncertain. We assessed the isolated effects of estradiol on cognition in men in the absence of testosterone. DESIGN Randomized trial of transdermal estradiol 0.9 mg daily, or matched placebo, for 6 months, hypothesizing that estradiol would improve verbal learning, verbal memory, and spatial problem solving over time. PATIENTS Men receiving androgen deprivation therapy (ADT) for prostate cancer. MEASUREMENTS Cognition was assessed by a tablet-based cognitive battery (Cogstate) at baseline, Month 1, Month 3, and Month 6. Anxiety and depression symptoms were assessed using the Hospital Anxiety and Depression Scale. RESULTS Seventy-eight participants were randomized. Baseline mean scores were 21.0 (standard deviation [SD] 4.1) for the International Shopping List test (ISL), assessing verbal learning and memory (higher scores better), and 60.4 (SD 19.5) for the Groton Maze Learning test (GML), assessing spatial problem solving (lower scores better). There was no significant difference in performance over time for the estradiol group versus the placebo group for the ISL, mean adjusted difference (MAD) 0.7 (95% confidence interval [CI] -1.2 to 2.5), p = .36, or the GML, MAD -3.2 (95% CI -12.0 to 5.6), p = 0.53. There was no significant difference between groups over time in performance in any other cognitive domain, or on depression or anxiety scores. CONCLUSIONS We found no major effects of estradiol on cognition in men with castrate testosterone concentrations. Although the cognitive effects of ADT are debated, this study suggests that any such effects are unlikely to be prevented by the administration of estradiol.
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Affiliation(s)
- Nicholas Russell
- Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Australia
- Department of Endocrinology, Austin Health, Heidelberg, Australia
| | - James Allebone
- Department of Psychiatry, Austin Health, The University of Melbourne, Heidelberg, Australia
| | - Orwa Dandash
- Department of Psychiatry, Austin Health, The University of Melbourne, Heidelberg, Australia
| | - Rudolf Hoermann
- Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Australia
| | - Ada S Cheung
- Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Australia
- Department of Endocrinology, Austin Health, Heidelberg, Australia
| | - Jeffrey D Zajac
- Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Australia
- Department of Endocrinology, Austin Health, Heidelberg, Australia
| | - David J Handelsman
- Department of Andrology, ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Richard A Kanaan
- Department of Psychiatry, Austin Health, The University of Melbourne, Heidelberg, Australia
| | - Mathis Grossmann
- Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Australia
- Department of Endocrinology, Austin Health, Heidelberg, Australia
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Lipp HP, Wolfer DP. Behavior is movement only but how to interpret it? Problems and pitfalls in translational neuroscience-a 40-year experience. Front Behav Neurosci 2022; 16:958067. [PMID: 36330050 PMCID: PMC9623569 DOI: 10.3389/fnbeh.2022.958067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/07/2022] [Indexed: 09/19/2023] Open
Abstract
Translational research in behavioral neuroscience seeks causes and remedies for human mental health problems in animals, following leads imposed by clinical research in psychiatry. This endeavor faces several problems because scientists must read and interpret animal movements to represent human perceptions, mood, and memory processes. Yet, it is still not known how mammalian brains bundle all these processes into a highly compressed motor output in the brain stem and spinal cord, but without that knowledge, translational research remains aimless. Based on some four decades of experience in the field, the article identifies sources of interpretation problems and illustrates typical translational pitfalls. (1) The sensory world of mice is different. Smell, hearing, and tactile whisker sensations dominate in rodents, while visual input is comparatively small. In humans, the relations are reversed. (2) Mouse and human brains are equated inappropriately: the association cortex makes up a large portion of the human neocortex, while it is relatively small in rodents. The predominant associative cortex in rodents is the hippocampus itself, orchestrating chiefly inputs from secondary sensorimotor areas and generating species-typical motor patterns that are not easily reconciled with putative human hippocampal functions. (3) Translational interpretation of studies of memory or emotionality often neglects the ecology of mice, an extremely small species surviving by freezing or flight reactions that do not need much cognitive processing. (4) Further misinterpretations arise from confounding neuronal properties with system properties, and from rigid mechanistic thinking unaware that many experimentally induced changes in the brain do partially reflect unpredictable compensatory plasticity. (5) Based on observing hippocampal lesion effects in mice indoors and outdoors, the article offers a simplistic general model of hippocampal functions in relation to hypothalamic input and output, placing hypothalamus and the supraspinal motor system at the top of a cerebral hierarchy. (6) Many translational problems could be avoided by inclusion of simple species-typical behaviors as end-points comparable to human cognitive or executive processing, and to rely more on artificial intelligence for recognizing patterns not classifiable by traditional psychological concepts.
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Affiliation(s)
- Hans-Peter Lipp
- Institute of Evolutionary Medicine, University of Zürich, Zürich, Switzerland
| | - David P. Wolfer
- Faculty of Medicine, Institute of Anatomy, University of Zürich, Zürich, Switzerland
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zürich, Zürich, Switzerland
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11
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Branigan GL, Torrandell‐Haro G, Soto M, Gelmann EP, Vitali F, Rodgers KE, Brinton RD. Androgen-targeting therapeutics mitigate the adverse effect of GnRH agonist on the risk of neurodegenerative disease in men treated for prostate cancer. Cancer Med 2022; 11:2687-2698. [PMID: 35293700 PMCID: PMC9249980 DOI: 10.1002/cam4.4650] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/18/2022] [Accepted: 02/23/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Prostate cancer and multiple neurodegenerative diseases (NDD) share an age-associated pattern of onset. Therapy of prostate cancer is known to impact cognitive function. The objective of this study was to determine the impact of multiple classes of androgen-targeting therapeutics (ATT) on the risk of NDD. METHODS A retrospective cohort study of men aged 45 and older with prostate within the US-based Mariner claims data set between January 1 and 27, 2021. A propensity score approach was used to minimize measured and unmeasured selection bias. Disease risk was determined using Kaplan-Meier survival analyses. RESULTS Of the 1,798,648 men with prostate cancer, 209,722 met inclusion criteria. Mean (SD) follow-up was 6.4 (1.8) years. In the propensity score-matched population, exposure to ATT was associated with a minimal increase in NDD incidence (relative risk [RR], 1.07; 95% CI, 1.05-1.10; p < 0.001). However, GnRH agonists alone were associated with significantly increased NDD risk (RR, 1.47; 95% CI, 1.30-1.66; p <0.001). Abiraterone, commonly administered with GnRH agonists and low-dose prednisone, was associated with a significantly decreased risk (RR, 0.77; 95% CI, 0.68-0.87; p < 0.001) of any NDD. CONCLUSIONS Among patients with prostate cancer, GnRH agonist exposure was associated with an increased NDD risk. Abiraterone acetate reduced the risks of Alzheimer's disease and Parkinson's disease conferred by GnRH agonists, whereas the risk for ALS was reduced by androgen receptor inhibitors. Outcomes of these analyses contribute to addressing controversies in the field and indicate that GnRH agonism may be a predictable instigator of risk for NDD with opportunities for risk mitigation in combination with another ATT.
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Affiliation(s)
- Gregory L. Branigan
- Center for Innovation in Brain ScienceUniversity of ArizonaTucsonArizonaUSA
- Department of PharmacologyUniversity of Arizona College of MedicineTucsonArizonaUSA
- Medical Scientist Training ProgramUniversity of Arizona College of MedicineTucsonArizonaUSA
| | - Georgina Torrandell‐Haro
- Center for Innovation in Brain ScienceUniversity of ArizonaTucsonArizonaUSA
- Department of PharmacologyUniversity of Arizona College of MedicineTucsonArizonaUSA
| | - Maira Soto
- Center for Innovation in Brain ScienceUniversity of ArizonaTucsonArizonaUSA
| | - Edward P. Gelmann
- Department of Medicine, Division of Hematology and OncologyUniversity of Arizona College of Medicine and University of Arizona Cancer CenterTucsonArizonaUSA
| | - Francesca Vitali
- Center for Innovation in Brain ScienceUniversity of ArizonaTucsonArizonaUSA
- Department of NeurologyUniversity of Arizona College of MedicineTucsonArizonaUSA
- Center for Biomedical Informatics and BiostatisticsUniversity of ArizonaTucsonArizonaUSA
| | - Kathleen E. Rodgers
- Center for Innovation in Brain ScienceUniversity of ArizonaTucsonArizonaUSA
- Department of PharmacologyUniversity of Arizona College of MedicineTucsonArizonaUSA
| | - Roberta Diaz Brinton
- Center for Innovation in Brain ScienceUniversity of ArizonaTucsonArizonaUSA
- Department of PharmacologyUniversity of Arizona College of MedicineTucsonArizonaUSA
- Department of NeurologyUniversity of Arizona College of MedicineTucsonArizonaUSA
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12
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Chaudhary S, Roy A, Summers C, Zhornitsky S, Ahles T, Li CSR, Chao HH. Hypothalamic connectivities predict individual differences in ADT-elicited changes in working memory and quality of life in prostate cancer patients. Sci Rep 2022; 12:9567. [PMID: 35688928 PMCID: PMC9187668 DOI: 10.1038/s41598-022-13361-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 05/24/2022] [Indexed: 11/09/2022] Open
Abstract
Androgen deprivation therapy (ADT) has been associated with adverse effects on cognition. However, we currently lack understanding of the neurobiology and prognostic markers of these effects. Given that ADT acts via the hypothalamus-pituitary-gonadal axis, we assessed whether baseline hypothalamic resting state functional connectivity (rsFC) could predict changes in working memory and quality of life in prostate cancer patients following androgen deprivation. In a prospective observational study, 28 men with non-metastatic prostate cancer receiving ADT and 38 patients not receiving ADT (controls), matched in age, years of education and Montreal Cognitive Assessment score, participated in brain imaging at baseline, and N-back task and quality-of-life (QoL) assessments at baseline and at 6 months follow-up. Imaging data were processed with published routines and evaluated at a corrected threshold. ADT and control groups did not differ in N-back performance or QoL across time points. In ADT, the changes in 0-back correct response rate (follow-up-baseline) were correlated with baseline hypothalamus-precentral gyrus rsFC; the changes in 1-back correct response rate and reaction time were each correlated with hypothalamus-middle frontal gyrus and superior parietal lobule rsFC. The changes in physical well-being subscore of QoL were correlated with baseline hypothalamus-anterior cingulate and cuneus rsFC. The hypothalamus rsFCs predicted N-back and QoL change with an area under the receiver operating characteristic curve of 0.93 and 0.73, respectively. Baseline hypothalamus-frontoparietal and salience network rsFC's predict inter-subject variations in the changes in working-memory and QoL following 6 months of ADT. Whether and how hypothalamic rsFCs may predict the cognitive and QoL effects with longer-term ADT remain to be investigated.
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Affiliation(s)
- Shefali Chaudhary
- Department of Psychiatry, Yale University School of Medicine, CMHC S110, 34 Park Street, New Haven, CT, 06519, USA.
| | - Alicia Roy
- Cancer Center, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Christine Summers
- Cancer Center, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Simon Zhornitsky
- Department of Psychiatry, Yale University School of Medicine, CMHC S110, 34 Park Street, New Haven, CT, 06519, USA
| | - Tim Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chiang-Shan R Li
- Department of Psychiatry, Yale University, New Haven, CT, 06520, USA
- Department of Neuroscience, Yale University, New Haven, CT, 06520, USA
- Interdepartmental Neuroscience Program, Yale University School of Medicine, Yale University, New Haven, CT, 06520, USA
- Wu Tsai Institute, Yale University, New Haven, CT, 06520, USA
| | - Herta H Chao
- Cancer Center, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA.
- Department of Medicine and Yale Comprehensive Cancer Center, Yale University School of Medicine, New Haven, CT, 06519, USA.
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13
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Reiss AB, Saeedullah U, Grossfeld DJ, Glass AD, Pinkhasov A, Katz AE. Prostate cancer treatment and the relationship of androgen deprivation therapy to cognitive function. Clin Transl Oncol 2021; 24:733-741. [PMID: 34743290 DOI: 10.1007/s12094-021-02727-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/23/2021] [Indexed: 02/01/2023]
Abstract
Prostate cancer is the second most common form of cancer in men. For advanced, high risk prostate cancer, androgen deprivation therapy (ADT) is the preferred treatment and can induce remission, but resistance to ADT brings biochemical recurrence and progression of cancer. ADT brings adverse effects such as erectile dysfunction, decreased libido, and diminished physical strength. It is estimated that between 25 and 50% of men on ADT manifest some form of cognitive dysfunction that may be self-reported or reported by a family member. There is concern that impaired cognitive function with ADT is due to loss of testosterone support. Testosterone and its metabolites are known to possess neuroprotective properties. While a direct causal relationship between ADT and cognitive decline in prostate cancer patients has not been established, this review describes the controversy surrounding the possible connection between ADT and neurocognitive deterioration. The cellular and molecular mechanisms believed to underlie the protection of neuronal integrity by androgens are discussed. Results from animal models and human clinical studies are presented. Finally, we call attention to lifestyle modifications that may minimize cognitive issues in prostate cancer patients.
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Affiliation(s)
- A B Reiss
- Biomedical Research Institute, NYU Long Island School of Medicine, 101 Mineola Boulevard, Suite 4-004, Mineola, NY, 11501, USA.
| | - U Saeedullah
- Biomedical Research Institute, NYU Long Island School of Medicine, 101 Mineola Boulevard, Suite 4-004, Mineola, NY, 11501, USA
| | - D J Grossfeld
- Biomedical Research Institute, NYU Long Island School of Medicine, 101 Mineola Boulevard, Suite 4-004, Mineola, NY, 11501, USA
| | - A D Glass
- Biomedical Research Institute, NYU Long Island School of Medicine, 101 Mineola Boulevard, Suite 4-004, Mineola, NY, 11501, USA
| | - A Pinkhasov
- Biomedical Research Institute, NYU Long Island School of Medicine, 101 Mineola Boulevard, Suite 4-004, Mineola, NY, 11501, USA
| | - A E Katz
- Biomedical Research Institute, NYU Long Island School of Medicine, 101 Mineola Boulevard, Suite 4-004, Mineola, NY, 11501, USA
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14
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Tinajero-Díaz E, Salado-Leza D, Gonzalez C, Martínez Velázquez M, López Z, Bravo-Madrigal J, Knauth P, Flores-Hernández FY, Herrera-Rodríguez SE, Navarro RE, Cabrera-Wrooman A, Krötzsch E, Carvajal ZYG, Hernández-Gutiérrez R. Green Metallic Nanoparticles for Cancer Therapy: Evaluation Models and Cancer Applications. Pharmaceutics 2021; 13:1719. [PMID: 34684012 PMCID: PMC8537602 DOI: 10.3390/pharmaceutics13101719] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/29/2021] [Accepted: 10/05/2021] [Indexed: 12/15/2022] Open
Abstract
Metal-based nanoparticles are widely used to deliver bioactive molecules and drugs to improve cancer therapy. Several research works have highlighted the synthesis of gold and silver nanoparticles by green chemistry, using biological entities to minimize the use of solvents and control their physicochemical and biological properties. Recent advances in evaluating the anticancer effect of green biogenic Au and Ag nanoparticles are mainly focused on the use of conventional 2D cell culture and in vivo murine models that allow determination of the half-maximal inhibitory concentration, a critical parameter to move forward clinical trials. However, the interaction between nanoparticles and the tumor microenvironment is not yet fully understood. Therefore, it is necessary to develop more human-like evaluation models or to improve the existing ones for a better understanding of the molecular bases of cancer. This review provides recent advances in biosynthesized Au and Ag nanoparticles for seven of the most common and relevant cancers and their biological assessment. In addition, it provides a general idea of the in silico, in vitro, ex vivo, and in vivo models used for the anticancer evaluation of green biogenic metal-based nanoparticles.
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Affiliation(s)
- Ernesto Tinajero-Díaz
- Departament d’Enginyeria Química, Universitat Politècnica de Catalunya, ETSEIB, Diagonal 647, 08028 Barcelona, Spain;
- Biotecnología Médica y Farmacéutica, Centro de Investigación y Asistencia en Tecnología y Diseño del Estado de Jalisco, A.C., Av. Normalistas 800, Col. Colinas de La Normal, Guadalajara 44270, Mexico; (M.M.V.); (J.B.-M.); (F.Y.F.-H.); (S.E.H.-R.)
| | - Daniela Salado-Leza
- Facultad de Ciencias Químicas, Universidad Autónoma de San Luis Potosí, Av. Dr. Manuel Nava, Zona Universitaria, San Luis Potosí 78210, Mexico; (D.S.-L.); (C.G.)
- Cátedras CONACyT, México City 03940, Mexico
| | - Carmen Gonzalez
- Facultad de Ciencias Químicas, Universidad Autónoma de San Luis Potosí, Av. Dr. Manuel Nava, Zona Universitaria, San Luis Potosí 78210, Mexico; (D.S.-L.); (C.G.)
| | - Moisés Martínez Velázquez
- Biotecnología Médica y Farmacéutica, Centro de Investigación y Asistencia en Tecnología y Diseño del Estado de Jalisco, A.C., Av. Normalistas 800, Col. Colinas de La Normal, Guadalajara 44270, Mexico; (M.M.V.); (J.B.-M.); (F.Y.F.-H.); (S.E.H.-R.)
| | - Zaira López
- Centro Universitario de la Ciénega, Cell Biology Laboratory, Universidad de Guadalajara, Av. Universidad 1115, Ocotlán 47810, Mexico; (Z.L.); (P.K.)
| | - Jorge Bravo-Madrigal
- Biotecnología Médica y Farmacéutica, Centro de Investigación y Asistencia en Tecnología y Diseño del Estado de Jalisco, A.C., Av. Normalistas 800, Col. Colinas de La Normal, Guadalajara 44270, Mexico; (M.M.V.); (J.B.-M.); (F.Y.F.-H.); (S.E.H.-R.)
| | - Peter Knauth
- Centro Universitario de la Ciénega, Cell Biology Laboratory, Universidad de Guadalajara, Av. Universidad 1115, Ocotlán 47810, Mexico; (Z.L.); (P.K.)
| | - Flor Y. Flores-Hernández
- Biotecnología Médica y Farmacéutica, Centro de Investigación y Asistencia en Tecnología y Diseño del Estado de Jalisco, A.C., Av. Normalistas 800, Col. Colinas de La Normal, Guadalajara 44270, Mexico; (M.M.V.); (J.B.-M.); (F.Y.F.-H.); (S.E.H.-R.)
| | - Sara Elisa Herrera-Rodríguez
- Biotecnología Médica y Farmacéutica, Centro de Investigación y Asistencia en Tecnología y Diseño del Estado de Jalisco, A.C., Av. Normalistas 800, Col. Colinas de La Normal, Guadalajara 44270, Mexico; (M.M.V.); (J.B.-M.); (F.Y.F.-H.); (S.E.H.-R.)
| | - Rosa E. Navarro
- Departamento de Biología Celular y Desarrollo, Instituto de Fisiología Celular, Universidad Nacional Autónoma de México, Circuito Exterior s/n, Ciudad Universitaria, México City 04510, Mexico;
| | - Alejandro Cabrera-Wrooman
- Centro Nacional de Investigación y Atención de Quemados, Laboratory of Connective Tissue, Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, México City 14389, Mexico; (A.C.-W.); (E.K.)
| | - Edgar Krötzsch
- Centro Nacional de Investigación y Atención de Quemados, Laboratory of Connective Tissue, Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, México City 14389, Mexico; (A.C.-W.); (E.K.)
| | - Zaira Y. García Carvajal
- Biotecnología Médica y Farmacéutica, Centro de Investigación y Asistencia en Tecnología y Diseño del Estado de Jalisco, A.C., Av. Normalistas 800, Col. Colinas de La Normal, Guadalajara 44270, Mexico; (M.M.V.); (J.B.-M.); (F.Y.F.-H.); (S.E.H.-R.)
| | - Rodolfo Hernández-Gutiérrez
- Biotecnología Médica y Farmacéutica, Centro de Investigación y Asistencia en Tecnología y Diseño del Estado de Jalisco, A.C., Av. Normalistas 800, Col. Colinas de La Normal, Guadalajara 44270, Mexico; (M.M.V.); (J.B.-M.); (F.Y.F.-H.); (S.E.H.-R.)
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15
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Buskbjerg CR, Amidi A, Buus S, Gravholt CH, Hadi Hosseini SM, Zachariae R. Androgen deprivation therapy and cognitive decline-associations with brain connectomes, endocrine status, and risk genotypes. Prostate Cancer Prostatic Dis 2021; 25:208-218. [PMID: 34088994 DOI: 10.1038/s41391-021-00398-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/30/2021] [Accepted: 05/19/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Evidence suggests that prostate cancer (PC) patients undergoing androgen deprivation therapy (ADT) are at risk for cognitive decline (CD), but the underlying mechanisms are less clear. In the present study, changes in cognitive performance and structural brain connectomes in PC patients undergoing ADT were assessed, and associations of cognitive changes with endocrine status and risk genotypes were explored. METHODS Thirty-seven PC patients underwent cognitive assessment, structural MRI, and provided blood samples prior to ADT and after 6 months of treatment. Twenty-seven age- and education-matched healthy controls (HCs) underwent the same assessments. CD was determined using a standardized regression-based approach and defined as z-scores ≤ -1.64. Changes in brain connectomes were evaluated using graph theory. Associations of CD with testosterone levels and genotypes (APOE, COMT, BDNF) were explored. RESULTS Compared with HCs, PC patients demonstrated reduced testosterone levels (p < 0.01) and higher rates of decline for 13 out of 15 cognitive outcomes, with three outcomes related to two cognitive domains, i.e., verbal memory and visuospatial learning and memory, reaching statistical significance (p ≤ 0.01-0.04). Testosterone level changes did not predict CD. COMT Met homozygote PC patients evidenced larger reductions in visuospatial memory compared with Val carriers (p = 0.02). No between-group differences were observed in brain connectomes across time, and no effects were found of APOE and BDNF. CONCLUSIONS Our results indicate that PC patients undergoing ADT may evidence CD, and that COMT Met homozygotes may be at increased risk of CD. The results did not reveal changes in brain connectomes or testosterone levels as underlying mechanisms. More research evaluating the role of ADT-related disruption of the dynamics of the hypothalamic-pituitary-gonadal axis is needed.
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Affiliation(s)
- Cecilie R Buskbjerg
- Unit for Psychooncology and Health Psychology, Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark.
| | - Ali Amidi
- Unit for Psychooncology and Health Psychology, Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
| | - Simon Buus
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Claus H Gravholt
- Department of Endocrinology, Aarhus University Hospital, Aarhus, Denmark.,Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - S M Hadi Hosseini
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA, USA
| | - Robert Zachariae
- Unit for Psychooncology and Health Psychology, Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark.,Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
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16
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Zhang T, Chen X, Sun L, Guo X, Cai T, Wang J, Zeng Y, Ma J, Ding X, Xie Z, Niu L, Zhang M, Tao N, Yang F. Proteomics reveals the function reverse of MPSSS-treated prostate cancer-associated fibroblasts to suppress PC-3 cell viability via the FoxO pathway. Cancer Med 2021; 10:2509-2522. [PMID: 33704935 PMCID: PMC7982613 DOI: 10.1002/cam4.3825] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/21/2021] [Indexed: 01/10/2023] Open
Abstract
Prostate cancer‐associated fibroblasts (prostate CAFs) are essential components of the tumor microenvironment and can promote tumor progression through their immunosuppressive functions. MPSSS, a novel polysaccharide purified from Lentinus edodes, has been reported to have anti‐tumor activity. MPSSS could also inhibit the immunosuppressive function of prostate CAFs, which has been demonstrated through that the secretome of MPSSS‐treated prostate CAFs could inhibit the proliferation of T cells. However, how the secretome of MPSSS‐treated prostate CAFs influence prostate cancer progression is still unclear. Interestingly, we found that the low molecular weight (3–100kD) secretome of prostate CAFs (lmwCAFS) could promote the growth of PC‐3 cells, while that of MPSSS‐treated prostate CAFs (MT‐lmwCAFS) could inhibit their growth. We carried out comparative secretomic analysis of lmwCAFS and MT‐lmwCAFS to identify functional molecules that inhibit the growth of PC‐3 cells, and proteomic analysis of lmwCAFS‐treated PC‐3 cells and MT‐lmwCAFS‐treated PC‐3 cells to investigate the underlying molecular mechanism. These analyses suggest that TGF‐β3 from MT‐lmwCAFS may inhibit the growth of PC‐3 cells. The validated experiments revealed that TGF‐β3 from MT‐lmwCAFS activated p21 expression in PC‐3 cells by regulating the FoxO pathway thereby inducing G0/G1 cell cycle arrest of PC‐3 cells. Overall, our data demonstrated that MPSSS reversed the ability of prostate CAFs to suppress the cell viability of PC‐3 cells, which might provide a potential therapeutic strategy to prevent prostate cancer progression.
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Affiliation(s)
- Tingting Zhang
- Key Laboratory of Protein and Peptide Pharmaceuticals & Laboratory of Proteomics, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Xiulan Chen
- Key Laboratory of Protein and Peptide Pharmaceuticals & Laboratory of Proteomics, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Lang Sun
- Key Laboratory of Protein and Peptide Pharmaceuticals & Laboratory of Proteomics, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Xiaojing Guo
- Key Laboratory of Protein and Peptide Pharmaceuticals & Laboratory of Proteomics, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Tanxi Cai
- Key Laboratory of Protein and Peptide Pharmaceuticals & Laboratory of Proteomics, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Jifeng Wang
- Key Laboratory of Protein and Peptide Pharmaceuticals & Laboratory of Proteomics, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | - Yanqiong Zeng
- School of Basic Medical Sciences of Southwest Medical University, Luzhou, China
| | - Jing Ma
- Key Laboratory of Protein and Peptide Pharmaceuticals & Laboratory of Proteomics, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Xiang Ding
- Key Laboratory of Protein and Peptide Pharmaceuticals & Laboratory of Proteomics, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Zhensheng Xie
- Key Laboratory of Protein and Peptide Pharmaceuticals & Laboratory of Proteomics, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Lili Niu
- Key Laboratory of Protein and Peptide Pharmaceuticals & Laboratory of Proteomics, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Mengmeng Zhang
- Key Laboratory of Protein and Peptide Pharmaceuticals & Laboratory of Proteomics, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | - Ning Tao
- Key Laboratory of Protein and Peptide Pharmaceuticals & Laboratory of Proteomics, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Fuquan Yang
- Key Laboratory of Protein and Peptide Pharmaceuticals & Laboratory of Proteomics, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
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17
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Analysis of Brain Functions in Men with Prostate Cancer under Androgen Deprivation Therapy: A One-Year Longitudinal Study. Life (Basel) 2021; 11:life11030227. [PMID: 33802213 PMCID: PMC8000211 DOI: 10.3390/life11030227] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/07/2021] [Accepted: 03/09/2021] [Indexed: 12/24/2022] Open
Abstract
The relationship between cognitive decline and androgen deprivation therapy (ADT) under luteinizing hormone-releasing hormone (LHRH) analogues is unclear, and there is a scarcity of longitudinal studies considering the interaction between cognition, depressive symptoms and sleep quality in men with prostate cancer (PCa) treated with ADT. This study aimed to determine if there were differences in the scores obtained in cognitive assessment, depressive symptoms, and sleep quality after one year of ADT and determine the interrelations between sleep, mood, and cognitive status. A prospective longitudinal observational study was designed, in which a cohort of men (mean age was 70.8 years) newly treated with androgen-deprivation therapy was assessed in the first six months of treatment and 12 months later. Analysis of cognitive function by the Mini-Mental State Examination (MMSE) scores indicated a significant (p < 0.05) increase after one year of treatment and by the Brief Scale for Cognitive Evaluation (BCog) scores indicated no changes in the scores before and after one year of treatment. Analysis of depressive symptoms with the Geriatric Depression Scale and sleep quality with the Athens Insomnia Scale (AIS) scores showed significant (p < 0.05) changes after one year of treatment with ADT, with men describing more depressive symptoms and more sleep disturbances. No statistically significant differences were found in the cognitive performance between men with impaired sleep or depression results and those without them. Our study showed no clinical evidence of the relationship between ADT under luteinizing hormone-releasing hormone (LHRH) analogues and cognitive deterioration in 1-year follow-up, but there are impairments in the sleep quality in men with PCa undergoing ADT and an increase in depressive symptoms which has important implications for clinicians as they would impair quality of life and adherence to treatment.
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18
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Danielak D. Vortioxetine in management of major depressive disorder - a favorable alternative for elderly patients? Expert Opin Pharmacother 2021; 22:1167-1177. [PMID: 33650935 DOI: 10.1080/14656566.2021.1880567] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Introduction: Depressive disorders are common in older patients, and their prevalence may reach up to 17.1%. Though for older adults, the initial recommended treatment is either life-review treatment or group cognitive-behavioral therapy, a combination of pharmacotherapy with interpersonal psychotherapy is also an option. There are many classes of antidepressants, and some meta-analyses suggest that the efficacy of different antidepressant groups is similar. Therefore, depression treatment in an elderly patient should consider preference, safety, and tolerability. Most reports suggest that SSRIs, such as citalopram, escitalopram, or sertraline, should be proposed as first-time medications.Areas covered: This article discusses the pharmacokinetic and pharmacodynamic properties of vortioxetine, emphasizing the observed differences, benefits, and risks for older patients. Vortioxetine - a multimodal antidepressant drug - was shown to be effective against major depressive disorders in both double-blinded, placebo-controlled trials and open-label studies.Expert opinion: Compared with commonly used antidepressants, vortioxetine appears to have unique properties that may be beneficial for elderly patients. Not only does it enhance cognitive function, but it also has a favorable safety profile.
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Affiliation(s)
- Dorota Danielak
- Department of Physical Pharmacy and Pharmacokinetics, Poznan University of Medical Sciences, Poznań, Poland
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19
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Shim M, Bang WJ, Oh CY, Lee YS, Cho JS. Androgen deprivation therapy and risk of cognitive dysfunction in men with prostate cancer: is there a possible link? Prostate Int 2021; 10:68-74. [PMID: 35510099 PMCID: PMC9042678 DOI: 10.1016/j.prnil.2021.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 02/19/2021] [Accepted: 02/26/2021] [Indexed: 02/02/2023] Open
Abstract
The expansion of the indication to use androgen deprivation therapy (ADT) to treat patients with advanced or metastatic prostate cancer has dramatically increased over the recent decades, resulting in the progress of patients’ survival. However, chronic health implications can become more apparent as the number of long-term cancer survivors is expected to be increased along with the adverse effect of ADT. In particular, interest in investigating ADT, especially luteinizing hormone-releasing hormone (LHRH) agonist association with cognitive dysfunction has been growing. Previous studies in animals and humans suggest that the level of androgen decreases with age and that cognitive decline occurs with decreases in androgen. Correspondingly, some of the extensive studies using common neurocognitive tests have shown that LHRH agonists may affect specific domains of cognitive function (e.g., visuospatial abilities and executive function). However, the results from these studies have not consistently demonstrated the association because of its intrinsic limitations. Large-scale studies based on electronic databases have also failed to show consistent results to make decisive conclusions because of its heterogeneity, complexity of covariates, and possible risk of biases. Thus, this review article summarizes key findings and discusses the results of several studies investigating the ADT association with cognitive dysfunction and risk of dementia from various perspectives.
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Araujo N, Morais S, Costa AR, Braga R, Carneiro AF, Cruz VT, Ruano L, Oliveira J, Figueiredo LP, Pereira S, Lunet N. Cognitive decline in patients with prostate cancer: study protocol of a prospective cohort, NEON-PC. BMJ Open 2021; 11:e043844. [PMID: 33589462 PMCID: PMC7887367 DOI: 10.1136/bmjopen-2020-043844] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/23/2020] [Accepted: 01/12/2021] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Prostate cancer is the most prevalent oncological disease among men in industrialised countries. Despite the high survival rates, treatments are often associated with adverse effects, including metabolic and cardiovascular complications, sexual dysfunction and, to a lesser extent, cognitive decline. This study was primarily designed to evaluate the trajectories of cognitive performance in patients with prostate cancer, and to quantify the impact of the disease and its treatments on the occurrence of cognitive decline. METHODS Participants will be recruited from two main hospitals providing care to approximately half of the patients with prostate cancer in Northern Portugal (Portuguese Institute of Oncology of Porto and São João Hospital Centre), and will comprise a cohort of recently diagnosed patients with prostate cancer proposed for different treatment plans, including: (1) radical prostatectomy; (2) brachytherapy and/or radiotherapy; (3) radiotherapy in combination with androgen deprivation therapy and (4) androgen deprivation therapy (with or without chemotherapy). Recruitment began in February 2018 and is expected to continue until the first semester of 2021. Follow-up evaluations will be conducted at 1, 3, 5, 7 and 10 years. Sociodemographic, behavioural and clinical characteristics, anxiety and depression, health literacy, health status, quality of life, and sleep quality will be assessed. Blood pressure and anthropometrics will be measured, and a fasting blood sample will be collected. Participants' cognitive performance will be evaluated before treatments and throughout follow-up (Montreal Cognitive Assessment and Cube Test as well as Brain on Track for remote monitoring). All participants suspected of cognitive impairment will undergo neuropsychological tests and clinical observation by a neurologist. ETHICS AND DISSEMINATION The study was approved by the Ethics Committee of the hospitals involved. All participants will provide written informed consent, and study procedures will be developed to ensure data protection and confidentiality. Results will be disseminated through publication in peer-reviewed journals and presentation in scientific meetings.
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Affiliation(s)
- Natalia Araujo
- EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | - Samantha Morais
- EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Ana Rute Costa
- EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | - Raquel Braga
- EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
- USF Lagoa, Unidade Local de Saúde de Matosinhos EPE, Senhora da Hora, Portugal
| | - Ana Filipa Carneiro
- Serviço de Oncologia, Instituto Português de Oncologia do Porto Francisco Gentil, EPE, Porto, Portugal
| | - Vitor Tedim Cruz
- EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
- Serviço de Neurologia, Unidade Local de Saúde de Matosinhos EPE, Senhora da Hora, Portugal
| | - Luis Ruano
- EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
- Serviço de Neurologia, Centro Hospitalar de Entre o Douro e Vouga EPE, Santa Maria da Feira, Portugal
| | - Jorge Oliveira
- Serviço de Urologia, Instituto Português de Oncologia do Porto Francisco Gentil, EPE, Porto, Portugal
| | - Luis Pacheco Figueiredo
- Instituto de Investigação em Ciências da Vida e Saúde, Escola de Medicina da Universidade do Minho, Braga, Portugal
- Serviço de Urologia, Centro Hospitalar de São João EPE, Porto, Portugal
| | - Susana Pereira
- EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
- Serviço de Neurologia, Instituto Português de Oncologia do Porto Francisco Gentil, EPE, Porto, Portugal
| | - Nuno Lunet
- EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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Lee HH, Park S, Joung JY, Kim SH. How Does Androgen Deprivation Therapy Affect Mental Health including Cognitive Dysfunction in Patients with Prostate Cancer? World J Mens Health 2020; 39:598-605. [PMID: 32777867 PMCID: PMC8443997 DOI: 10.5534/wjmh.200092] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/25/2020] [Accepted: 07/03/2020] [Indexed: 11/29/2022] Open
Abstract
Androgen deprivation therapy (ADT) is used to block the release of androgen in prostate cancer to promote the regression of cancer cells, and hence, disease progression. Its indication has been widened from the metastatic setting to the localized setting in prostate cancer. Long-term ADT for suppressing androgen release leads to a rapid decrease in androgen, termed as andropause, resulting in several dose and duration dependent adverse effects, including cognitive dysfunction such as dementia. Many retrospective and prospective studies, as well as meta-analyses, have attempted to confirm the crucial relationship between ADT and cognitive dysfunction, but pro and contrary opinions regarding this issue are ongoing owing to the absence of randomized controlled trials. Additionally, several recent studies have suggested the negative effects of dose- and duration-dependent ADT on cognitive dysfunction, especially in 40–65-year-old patients with prostate cancer, who are currently active workers in the society. This review article discusses several studies examining the influence of ADT on mental health based on diverse significant perspectives, especially cognitive dysfunction.
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Affiliation(s)
- Hyung Ho Lee
- Department Urology, Urological Cancer Center, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Sahyun Park
- Department Urology, Urological Cancer Center, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Jae Young Joung
- Department Urology, Urological Cancer Center, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Sung Han Kim
- Department Urology, Urological Cancer Center, Research Institute and Hospital of National Cancer Center, Goyang, Korea.
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Cheng L, Yue CF, Wang Y, Cao HF, Dong JF, Dong LX, Chen DY. Can docetaxel combined prednisone effectively treat hormone refractory prostate cancer?: A protocol of systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e20367. [PMID: 32481418 DOI: 10.1097/md.0000000000020367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Previous studies have reported that docetaxel combined prednisone (DP) has been used for the treatment of patients with hormone refractory prostate cancer (HRPC). However, its results are still inconsistent. Therefore, this study will synthesize the latest evidence of the efficacy and safety of DP for the treatment of patients with HRPC. METHODS Cochrane Library, PUBMED, EMBASE, Web of Science, CINAHL, CBM, and CNKI will be searched to identify randomized controlled trials published from their inception to the March 1, 2020, irrespective language and publication time restrictions. We will calculate the pooled effects of dichotomous outcomes as risk ratio and 95% confidence intervals, and that of continuous outcomes as standardized mean difference or mean difference and 95% confidence intervals. Study quality will be assessed using Cochrane risk of bias, and quality of evidence for main outcome will be evaluated using Grading of Recommendations Assessment Development and Evaluation. Statistical analysis will be performed using RevMan 5.3 software. RESULTS This study will appraise the efficacy and safety of DP for the treatment of patients with HRPC. The primary outcome includes overall survival, and the secondary outcomes comprise of progression-free survival, prostate-specific antigen response rate, duration of prostate-specific antigen response, objective tumor response rate, disease-free survival, quality of life, and adverse events. CONCLUSION The results of this study may provide helpful evidence of DP for the treatment of patients with HRPC.Systematic review registration: INPLASY202040112.
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Affiliation(s)
| | - Cai-Fang Yue
- Department of Critical Care Medicine, The First Affiliated Hospital of Jiamusi University
| | | | | | - Jian-Feng Dong
- Department of Pathology, Jiamusi Anorectal Hospital, Jiamusi, China
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