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Wang N, Qu S, Kong W, Hua Q, Hong Z, Liu Z, Shi Y. Establishment and validation of novel predictive models to predict bone metastasis in newly diagnosed prostate adenocarcinoma based on single-photon emission computed tomography radiomics. Ann Nucl Med 2024:10.1007/s12149-024-01942-4. [PMID: 38822897 DOI: 10.1007/s12149-024-01942-4] [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: 01/15/2024] [Accepted: 05/12/2024] [Indexed: 06/03/2024]
Abstract
PURPOSE To establish and validate novel predictive models for predicting bone metastasis (BM) in newly diagnosed prostate adenocarcinoma (PCa) via single-photon emission computed tomography radiomics. METHOD In a retrospective review of the clinical single-photon emission computed tomography (SPECT) database, 176 patients (training set: n = 140; validation set: n = 36) who underwent SPECT/CT imaging and were histologically confirmed to have newly diagnosed PCa from June 2016 to June 2022 were enrolled. Radiomic features were extracted from the region of interest (ROI) in a targeted lesion in each patient. Clinical features, including age, total prostate-specific antigen (t-PSA), and Gleason grades, were included. Statistical tests were then employed to eliminate irrelevant and redundant features. Finally, four types of optimized models were constructed for the prediction. Furthermore, fivefold cross-validation was applied to obtain sensitivity, specificity, accuracy, and area under the curve (AUC) for performance evaluation. The clinical usefulness of the multivariate models was estimated through decision curve analysis (DCA). RESULTS A radiomics signature consisting of 27 selected features which were obtained by radiomics' LASSO treatment was significantly correlated with bone status (P < 0.01 for both training and validation sets). Collectively, the models showed good predictive efficiency. The AUC values ranged from 0.87 to 0.98 in four models. The AUC values of the human experts were 0.655 and 0.872 in the training and validation groups, respectively. Most radiomic models showed better diagnostic accuracy than human experts in the training and validation groups. DCA also demonstrated the superiority of the radiomics models compared to human experts. CONCLUSION Radiomics models are superior to humans in differentiating between benign bone and prostate cancer bone metastases; it can be used to facilitate personalized prediction of BM in newly diagnosed PCa patients.
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Affiliation(s)
- Ning Wang
- Shanghai Key Laboratory of Molecular Imaging, Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
- Department of Nuclear Medicine, the Second Affiliated Hospital of Soochow University, 215004, Jiangsu, Suzhou, China
| | - Shihui Qu
- Department of Nuclear Medicine, the Second Affiliated Hospital of Soochow University, 215004, Jiangsu, Suzhou, China
| | - Weiwei Kong
- Department of Nuclear Medicine, the Second Affiliated Hospital of Soochow University, 215004, Jiangsu, Suzhou, China
| | - Qian Hua
- Department of Nuclear Medicine, the Second Affiliated Hospital of Soochow University, 215004, Jiangsu, Suzhou, China
| | - Zhihui Hong
- Department of Nuclear Medicine, the Second Affiliated Hospital of Soochow University, 215004, Jiangsu, Suzhou, China
| | - Zengli Liu
- Department of Nuclear Medicine, the Second Affiliated Hospital of Soochow University, 215004, Jiangsu, Suzhou, China
| | - Yizhen Shi
- Department of Nuclear Medicine, the Second Affiliated Hospital of Soochow University, 215004, Jiangsu, Suzhou, China.
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Li G, Zhao R, Xie Z, Qu X, Duan Y, Zhu Y, Liang H, Tang D, Li Z, He W. Mining bone metastasis related key genes of prostate cancer from the STING pathway based on machine learning. Front Med (Lausanne) 2024; 11:1372495. [PMID: 38835789 PMCID: PMC11148254 DOI: 10.3389/fmed.2024.1372495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/29/2024] [Indexed: 06/06/2024] Open
Abstract
Background Prostate cancer (PCa) is the second most prevalent malignant tumor in male, and bone metastasis occurs in about 70% of patients with advanced disease. The STING pathway, an innate immune signaling mechanism, has been shown to play a key role in tumorigenesis, metastasis, and cancerous bone pain. Hence, exploring regulatory mechanism of STING in PCa bone metastasis will bring novel opportunities for treating PCa bone metastasis. Methods First, key genes were screened from STING-related genes (SRGs) based on random forest algorithm and their predictive performance was evaluated. Subsequently, a comprehensive analysis of key genes was performed to explore their roles in prostate carcinogenesis, metastasis and tumor immunity. Next, cellular experiments were performed to verify the role of RELA in proliferation and migration in PCa cells, meanwhile, based on immunohistochemistry, we verified the difference of RELA expression between PCa primary foci and bone metastasis. Finally, based on the key genes to construct an accurate and reliable nomogram, and mined targeting drugs of key genes. Results In this study, three key genes for bone metastasis were mined from SRGs based on the random forest algorithm. Evaluation analysis showed that the key genes had excellent prediction performance, and it also showed that the key genes played a key role in carcinogenesis, metastasis and tumor immunity in PCa by comprehensive analysis. In addition, cellular experiments and immunohistochemistry confirmed that overexpression of RELA significantly inhibited the proliferation and migration of PCa cells, and RELA was significantly low-expression in bone metastasis. Finally, the constructed nomogram showed excellent predictive performance in Receiver Operating Characteristic (ROC, AUC = 0.99) curve, calibration curve, and Decision Curve Analysis (DCA) curve; and the targeted drugs showed good molecular docking effects. Conclusion In sum, this study not only provides a new theoretical basis for the mechanism of PCa bone metastasis, but also provides novel therapeutic targets and novel diagnostic tools for advanced PCa treatment.
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Affiliation(s)
- Guiqiang Li
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Urology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Runhan Zhao
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhou Xie
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao Qu
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yingtao Duan
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yafei Zhu
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hao Liang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dagang Tang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Orthopedics, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Zefang Li
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Orthopedics, Qianjiang Hospital Affiliated with Chongqing University, Chongqing, China
| | - Weiyang He
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Perea-Bello AH, Trapero-Bertran M, Dürsteler C. Palliative Care Costs in Different Ambulatory-Based Settings: A Systematic Review. PHARMACOECONOMICS 2024; 42:301-318. [PMID: 38151673 PMCID: PMC10861396 DOI: 10.1007/s40273-023-01336-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Cost-of-illness studies in palliative care are of growing interest in health economics. There is no standard methodology to capture direct and non-direct healthcare and non-healthcare expenses incurred by health services, patients and their caregivers in the course of the ambulatory palliative care process. OBJECTIVE We aimed to describe the type of healthcare and non-healthcare expenses incurred by patients with cancer and non-cancer patients and their caregivers for palliative care in ambulatory-based settings and the methodology used to capture the data. METHODS We conducted a systematic review of studies on the costs of ambulatory-based palliative care in patients with cancer (breast, lung, colorectal) and non-cancer conditions (chronic heart failure, chronic obstructive pulmonary disease, dementia) found in six bibliographic databases (PubMed, EMBASE [via Ovid], Cochrane Database of Systematic Reviews, EconLit, the National Institute for Health Research Health Technology Assessment Database and the National Health Service Economic Evaluation Database at the University of York, and Google Scholar). The studies were published between January 2000 and December 2022. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology for study selection and assessed study quality using the Quality of Health Economic Studies instrument. The study was registered in PROSPERO (CRD42021250086). RESULTS Of 1434 identified references, 43 articles met the inclusion criteria. The primary data source was databases. More than half of the articles presented data from public healthcare systems (65.12%) were retrospective (60.47%), and entailed a bottom-up costing analysis (93.2%) made from a healthcare system perspective (53.49%). The sociodemographic characteristics of patients and families/caregivers were similar across the studies. Cost outcomes reports were heterogeneous; almost all of the studies collected data on direct healthcare costs (97.67%). The main driver of costs was inpatient care (55.81%), which increased during the end-of-life period. Nine studies (20.97%) recorded costs due to productivity losses for caregivers and three recorded such costs for patients. Caregiving costs were explored through an opportunity cost analysis in all cases, based on interviews conducted with and questionnaires administered to patients and caregivers, mainly via telephone calls (23.23%). CONCLUSIONS This systematic review reveals that studies on the costs of ambulatory-based palliative care are increasing. These studies are mostly conducted from a healthcare system perspective, which leaves out costs related to patients'/caregivers' economic burden. There is a need for prospective studies to assess this financial burden and evaluate, with strong evidence, the interventions and actions designed to improve the quality of life of palliative care patients. Future studies should propose cost calculation approaches using a societal perspective to better estimate the economic burden imposed on patients in ambulatory-based palliative care.
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Affiliation(s)
| | - Marta Trapero-Bertran
- Department of Economics and Business, Faculty of Law, Economics and Tourism, Universitat de Lleida, Lleida, Spain
| | - Christian Dürsteler
- Pain Medicine Section, Department of Anaesthesiology, Hospital Clínic de Barcelona, Barcelona, Spain
- Department of Surgery. Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
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4
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Sun J, Tian T, Wang N, Jing X, Qiu L, Cui H, Liu Z, Liu J, Yan L, Li D. Pretreatment level of serum sialic acid predicts both qualitative and quantitative bone metastases of prostate cancer. Front Endocrinol (Lausanne) 2024; 15:1338420. [PMID: 38384968 PMCID: PMC10880016 DOI: 10.3389/fendo.2024.1338420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/18/2024] [Indexed: 02/23/2024] Open
Abstract
Background Recently, serum sialic acid (SA) has emerged as a distinct prognostic marker for prostate cancer (PCa) and bone metastases, warranting differential treatment and prognosis for low-volume (LVD) and high-volume disease (HVD). In clinical settings, evaluating bone metastases can prove advantageous. Objectives We aimed to establish the correlation between SA and both bone metastasis and HVD in newly diagnosed PCa patients. Methods We conducted a retrospective analysis of 1202 patients who received a new diagnosis of PCa between November 2014 and February 2021. We compared pretreatment SA levels across multiple groups and investigated the associations between SA levels and the clinical parameters of patients. Additionally, we compared the differences between HVD and LVD. We utilized several statistical methods, including the non-parametric Mann-Whitney U test, Spearman correlation, receiver operating characteristic (ROC) curve analysis, and logistic regression. Results The results indicate that SA may serve as a predictor of bone metastasis in patients with HVD. ROC curve analysis revealed a cut-off value of 56.15 mg/dL with an area under the curve of 0.767 (95% CI: 0.703-0.832, P < 0.001) for bone metastasis versus without bone metastasis and a cut-off value of 65.80 mg/dL with an area under the curve of 0.766 (95% CI: 0.644-0.888, P = 0.003) for HVD versus LVD. Notably, PCa patients with bone metastases exhibited significantly higher SA levels than those without bone metastases, and HVD patients had higher SA levels than LVD patients. In comparison to the non-metastatic and LVD cohorts, the cohort with HVD exhibited higher levels of alkaline phosphatase (AKP) (median, 122.00 U/L), fibrinogen (FIB) (median, 3.63 g/L), and prostate-specific antigen (PSA) (median, 215.70 ng/mL), as well as higher Gleason scores (> 7). Multivariate logistic regression analysis demonstrated that an SA level of > 56.15 mg/dL was independently associated with the presence of bone metastases in PCa patients (OR = 2.966, P = 0.018), while an SA level of > 65.80 mg/dL was independently associated with HVD (OR = 1.194, P = 0.048). Conclusion The pretreatment serum SA level is positively correlated with the presence of bone metastases.
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Affiliation(s)
- Jingtao Sun
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
| | - Tian Tian
- Respiratory and Critical Care Medicine Department, Qilu Hospital of Shandong University, Jinan, China
| | - Naiqiang Wang
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
| | - Xuehui Jing
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
- Department of Urology, Yucheng People’s Hospital, Dezhou, China
| | - Laiyuan Qiu
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
| | - Haochen Cui
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
| | - Zhao Liu
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
| | - Jikai Liu
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
| | - Lei Yan
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
| | - Dawei Li
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
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Kendrick J, Francis RJ, Hassan GM, Rowshanfarzad P, Ong JS, Jeraj R, Barry N, Hagan T, Ebert MA. Prospective inter- and intra-tracer repeatability analysis of radiomics features in [ 68Ga]Ga-PSMA-11 and [ 18F]F-PSMA-1007 PET scans in metastatic prostate cancer. Br J Radiol 2023; 96:20221178. [PMID: 37751168 PMCID: PMC10646662 DOI: 10.1259/bjr.20221178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 07/14/2023] [Accepted: 08/25/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVE This study aimed to quantify both the intra- and intertracer repeatability of lesion-level radiomics features in [68Ga]Ga-prostate-specific membrane antigen (PSMA)-11 and [18F]F-PSMA-1007 positron emission tomography (PET) scans. METHODS Eighteen patients with metastatic prostate cancer (mPCa) were prospectively recruited for the study and randomised to one of three test-retest groups: (i) intratracer [68Ga]Ga-PSMA-11 PET, (ii) intratracer [18F]F-PSMA-1007 PET or (iii) intertracer between [68Ga]Ga-PSMA-11 and [18F]F-PSMA-1007 PET. Four conventional PET metrics (standardised uptake value (SUV)max, SUVmean, SUVtotal and volume) and 107 radiomics features were extracted from 75 lesions and assessed using the repeatability coefficient (RC) and the ICC. Radiomic feature repeatability was also quantified after the application of 16 filters to the PET image. RESULTS Test-retest scans were taken a median of 5 days apart (range: 2-7 days). SUVmean demonstrated the lowest RC limits of the conventional features, with RCs of 7.9%, 14.2% and 24.7% for the [68Ga]Ga-PSMA-11 PET, [18F]F-PSMA-1007 PET, and intertracer groups, respectively. 69%, 66% and 9% of all radiomics features had good or excellent ICC values (ICC ≥ 0.75) for the same groups. Feature repeatability therefore diminished considerably for the intertracer group relative to intratracer groups. CONCLUSION In this study, robust biomarkers for each tracer group that can be used in subsequent clinical studies were identified. Overall, the repeatability of conventional and radiomic features were found to be substantially lower for the intertracer group relative to both intratracer groups, suggesting that assessing patient response quantitatively should be done using the same radiotracer where possible. ADVANCES IN KNOWLEDGE Intertracer biomarker repeatability limits are significantly larger than intratracer limits.
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Affiliation(s)
- Jake Kendrick
- School of Physics, Mathematics and Computing, University of Western Australia, Perth, Australia
| | | | - Ghulam Mubashar Hassan
- School of Physics, Mathematics and Computing, University of Western Australia, Perth, Australia
| | - Pejman Rowshanfarzad
- School of Physics, Mathematics and Computing, University of Western Australia, Perth, Australia
| | - Jeremy S.L. Ong
- Department of Nuclear Medicine, Fiona Stanley Hospital, Murdoch, Australia
| | | | - Nathaniel Barry
- School of Physics, Mathematics and Computing, University of Western Australia, Perth, Australia
| | - Tammy Hagan
- Department of Nuclear Medicine, Sir Charles Gairdner Hospital, Perth, Australia
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Holzgreve A, Unterrainer M, Calais J, Adams T, Oprea-Lager DE, Goffin K, Lopci E, Unterrainer LM, Kramer KKM, Schmidt-Hegemann NS, Casuscelli J, Stief CG, Ricke J, Bartenstein P, Kunz WG, Mehrens D. Is PSMA PET/CT cost-effective for the primary staging in prostate cancer? First results for European countries and the USA based on the proPSMA trial. Eur J Nucl Med Mol Imaging 2023; 50:3750-3754. [PMID: 37428216 PMCID: PMC10547650 DOI: 10.1007/s00259-023-06332-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/04/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE The proPSMA trial at ten Australian centers demonstrated increased sensitivity and specificity for PSMA PET/CT compared to conventional imaging regarding metastatic status in primary high-risk prostate cancer patients. A cost-effectiveness analysis showed benefits of PSMA PET/CT over conventional imaging for the Australian setting. However, comparable data for other countries are lacking. Therefore, we aimed to verify the cost-effectiveness of PSMA PET/CT in several European countries as well as the USA. METHODS Clinical data on diagnostic accuracy were derived from the proPSMA trial. Costs for PSMA PET/CT and conventional imaging were taken from reimbursements of national health systems and individual billing information of selected centers in Belgium, Germany, Italy, the Netherlands, and the USA. For comparability, scan duration and the decision tree of the analysis were adopted from the Australian cost-effectiveness study. RESULTS In contrast to the Australian setting, PSMA PET/CT was primarily associated with increased costs in the studied centers in Europe and the USA. Mainly, the scan duration had an impact on the cost-effectiveness. However, costs for an accurate diagnosis using PSMA PET/CT seemed reasonably low compared to the potential consequential costs of an inaccurate diagnosis. CONCLUSION We assume that the use of PSMA PET/CT is appropriate from a health economic perspective, but this will need to be verified by a prospective evaluation of patients at initial diagnosis.
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Affiliation(s)
- Adrien Holzgreve
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany.
| | - Marcus Unterrainer
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany
- Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Jérémie Calais
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, UCLA, California, Los Angeles, USA
| | - Thaiza Adams
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, UCLA, California, Los Angeles, USA
| | - Daniela E Oprea-Lager
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Karolien Goffin
- Division of Nuclear Medicine, University Hospital Leuven and KU Leuven, Leuven, Belgium
| | - Egesta Lopci
- Nuclear Medicine Department, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy
| | - Lena M Unterrainer
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, UCLA, California, Los Angeles, USA
| | - Kristina K M Kramer
- Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany
| | | | | | - Christian G Stief
- Department of Urology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Wolfgang G Kunz
- Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Dirk Mehrens
- Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany
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Zhang K, Yin W, Ma L, Liu Z, Li Q. HSPB8 facilitates prostate cancer progression via activating the JAK/STAT3 signaling pathway. Biochem Cell Biol 2023; 101:1-11. [PMID: 36318825 DOI: 10.1139/bcb-2022-0205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Prostate cancer (PC) is a clinically and biologically heterogeneous disease that lacks effective treatment. Heat shock protein B8 (HSPB8) is an important factor in the progression of various types of cancer. However, the clinical significance and biological role of HSPB8 in PC are still unclear. In this study, we determined HSPB8 expression in PC tissues by immunohistochemical staining and explored the in vitro functions of HSPB8 using HSPB8 knockdown DU145 and LNcap PC cell lines. The in vivo effect of HSPB8 was explored by a subcutaneous xenograft mice model. The human phospho-kinase array and signal transducer and activator of transcription (STAT) 3 activator were utilized to explore the potential mechanism of HSPB8-induced PC progression. As a result, we found that HSPB8 was abundantly expressed in PC tissues and cell lines. HSPB8 knockdown inhibited cell proliferation and migration, promoted apoptosis and cycle repression, as well as weakened tumorigenesis ability. Mechanistically, we demonstrated that HSPB8 facilitates the malignant phenotypes of PC by activating the Janus kinase/STAT3 signaling pathway. These results proposed that HSPB8 seems to be an attractive therapeutic target for PC patients.
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Affiliation(s)
- Kan Zhang
- Department of urinary surgery, Ningbo First Hospital, No.59, Liuting Street, Haishu District, Ningbo, Zhejiang Province 315000, China
| | - Weiqi Yin
- Department of urinary surgery, Ningbo First Hospital, No.59, Liuting Street, Haishu District, Ningbo, Zhejiang Province 315000, China
| | - Luping Ma
- Department of urinary surgery, First Affiliated Hospital School of Medicine, Shihezi University, No.107, North 2nd Road, Shihezi, Xinjiang Province 832008, China
| | - Zhili Liu
- Department of urinary surgery, First Affiliated Hospital School of Medicine, Shihezi University, No.107, North 2nd Road, Shihezi, Xinjiang Province 832008, China
| | - Qiang Li
- Department of urinary surgery, First Affiliated Hospital School of Medicine, Shihezi University, No.107, North 2nd Road, Shihezi, Xinjiang Province 832008, China
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Pereira-Salgado A, Anton A, Franchini F, Mahar RK, Kwan EM, Wong S, Shapiro J, Weickhardt A, Azad AA, Spain L, Gunjur A, Torres J, Parente P, Parnis F, Goh J, Steer C, Brown S, Gibbs P, Tran B, IJzerman M. Real-world clinical outcomes and cost estimates of metastatic castration-resistant prostate cancer treatment: does sequencing of taxanes and androgen receptor-targeted agents matter? Expert Rev Pharmacoecon Outcomes Res 2023; 23:231-239. [PMID: 36541133 DOI: 10.1080/14737167.2023.2161048] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Health economic outcomes of real-world treatment sequencing of androgen receptor-targeted agents (ARTA) and docetaxel (DOC) remain unclear. MATERIAL AND METHODS Data from the electronic Castration-resistant Prostate cancer Australian Database (ePAD) were analyzed including median overall survival (mOS) and median time-to-treatment failure (mTTF). Mean total costs (mTC) and incremental cost-effectiveness ratios (ICER) of treatment sequences were estimated using the average sample method and Zhao and Tian estimator. RESULTS Of 752 men, 441 received ARTA, 194 DOC, and 175 both sequentially. Of participants treated with both, first-line DOC followed by ARTA was the more common sequence (n = 125, 71%). mOS for first-line ARTA was 8.38 years (95% CI: 3.48, not-estimated) vs. 3.29 years (95% CI: 2.92, 4.02) for DOC. mTTF was 15.7 months (95% CI: 14.2, 23.7) for the ARTA-DOC sequence and 18.2 months (95% CI: 16.2, 23.2) for DOC-ARTA. In first-line, ARTA cost an additional $13,244 per mTTF month compared to DOC. In second-line, ARTA cost $6726 per mTTF month. The DOC-ARTA sequence saved $2139 per mTTF compared to ARTA-DOC, though not statistically significant. CONCLUSION ICERs show ARTA had improved clinical benefit compared to DOC but at higher cost. There were no significant cost differences between combined sequences.
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Affiliation(s)
- Amanda Pereira-Salgado
- Centre for Cancer Research and Centre for Health Policy, Faculty of Medicine, Dentistry and Health Sciences, the University of Melbourne, Melbourne, Australia.,Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Angelyn Anton
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia.,Department of Personalised Medicine, Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia.,Department of Cancer Services, Eastern Health, Melbourne, Australia
| | - Fanny Franchini
- Centre for Cancer Research and Centre for Health Policy, Faculty of Medicine, Dentistry and Health Sciences, the University of Melbourne, Melbourne, Australia.,Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.,Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Robert K Mahar
- Centre for Cancer Research and Centre for Health Policy, Faculty of Medicine, Dentistry and Health Sciences, the University of Melbourne, Melbourne, Australia.,Biostatistics Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.,Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Edmond M Kwan
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia.,Department of Medical Oncology, Monash Health, Melbourne, Australia
| | | | | | - Andrew Weickhardt
- Olivia Newton John Cancer Wellness and Research Centre, Melbourne, Australia
| | - Arun A Azad
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Lavinia Spain
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia.,Department of Cancer Services, Eastern Health, Melbourne, Australia
| | - Ashray Gunjur
- Olivia Newton John Cancer Wellness and Research Centre, Melbourne, Australia
| | | | - Phillip Parente
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia.,Department of Cancer Services, Eastern Health, Melbourne, Australia
| | - Francis Parnis
- Adelaide Cancer Centre, Adelaide, Australia.,University of Adelaide, Adelaide, Australia
| | - Jeffrey Goh
- Royal Brisbane and Women's Hospital, Brisbane, Australia.,University of Queensland, St Lucia, Australia
| | - Christopher Steer
- Border Medical Oncology, Albury Wodonga Regional Cancer Centre, Albury, Australia.,University of New South Wales, Rural Clinical School, Albury Campus, Albury, Australia
| | | | - Peter Gibbs
- Department of Personalised Medicine, Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia.,Western Health, Melbourne, Australia
| | - Ben Tran
- Department of Personalised Medicine, Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia.,Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Maarten IJzerman
- Centre for Cancer Research and Centre for Health Policy, Faculty of Medicine, Dentistry and Health Sciences, the University of Melbourne, Melbourne, Australia.,Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.,Peter MacCallum Cancer Centre, Melbourne, Australia
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9
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Kendrick J, Francis RJ, Hassan GM, Rowshanfarzad P, Ong JSL, Ebert MA. Fully automatic prognostic biomarker extraction from metastatic prostate lesion segmentations in whole-body [ 68Ga]Ga-PSMA-11 PET/CT images. Eur J Nucl Med Mol Imaging 2022; 50:67-79. [PMID: 35976392 DOI: 10.1007/s00259-022-05927-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/01/2022] [Indexed: 12/17/2022]
Abstract
PURPOSE This study aimed to develop and assess an automated segmentation framework based on deep learning for metastatic prostate cancer (mPCa) lesions in whole-body [68Ga]Ga-PSMA-11 PET/CT images for the purpose of extracting patient-level prognostic biomarkers. METHODS Three hundred thirty-seven [68Ga]Ga-PSMA-11 PET/CT images were retrieved from a cohort of biochemically recurrent PCa patients. A fully 3D convolutional neural network (CNN) is proposed which is based on the self-configuring nnU-Net framework, and was trained on a subset of these scans, with an independent test set reserved for model evaluation. Voxel-level segmentation results were assessed using the dice similarity coefficient (DSC), positive predictive value (PPV), and sensitivity. Sensitivity and PPV were calculated to assess lesion level detection; patient-level classification results were assessed by the accuracy, PPV, and sensitivity. Whole-body biomarkers total lesional volume (TLVauto) and total lesional uptake (TLUauto) were calculated from the automated segmentations, and Kaplan-Meier analysis was used to assess biomarker relationship with patient overall survival. RESULTS At the patient level, the accuracy, sensitivity, and PPV were all > 90%, with the best metric being the PPV (97.2%). PPV and sensitivity at the lesion level were 88.2% and 73.0%, respectively. DSC and PPV measured at the voxel level performed within measured inter-observer variability (DSC, median = 50.7% vs. second observer = 32%, p = 0.012; PPV, median = 64.9% vs. second observer = 25.7%, p < 0.005). Kaplan-Meier analysis of TLVauto and TLUauto showed they were significantly associated with patient overall survival (both p < 0.005). CONCLUSION The fully automated assessment of whole-body [68Ga]Ga-PSMA-11 PET/CT images using deep learning shows significant promise, yielding accurate scan classification, voxel-level segmentations within inter-observer variability, and potentially clinically useful prognostic biomarkers associated with patient overall survival. TRIAL REGISTRATION This study was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12615000608561) on 11 June 2015.
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Affiliation(s)
- Jake Kendrick
- School of Physics, Mathematics and Computing, University of Western Australia, Perth, WA, Australia.
| | - Roslyn J Francis
- Medical School, University of Western Australia, Crawley, WA, Australia.,Department of Nuclear Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Ghulam Mubashar Hassan
- School of Physics, Mathematics and Computing, University of Western Australia, Perth, WA, Australia
| | - Pejman Rowshanfarzad
- School of Physics, Mathematics and Computing, University of Western Australia, Perth, WA, Australia
| | - Jeremy S L Ong
- Department of Nuclear Medicine, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Martin A Ebert
- School of Physics, Mathematics and Computing, University of Western Australia, Perth, WA, Australia.,Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia.,5D Clinics, Claremont, WA, Australia
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10
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Liu X, Zhang Y, Wu X, Xu F, Ma H, Wu M, Xia Y. Targeting Ferroptosis Pathway to Combat Therapy Resistance and Metastasis of Cancer. Front Pharmacol 2022; 13:909821. [PMID: 35847022 PMCID: PMC9280276 DOI: 10.3389/fphar.2022.909821] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/20/2022] [Indexed: 01/18/2023] Open
Abstract
Ferroptosis is an iron-dependent regulated form of cell death caused by excessive lipid peroxidation. This form of cell death differed from known forms of cell death in morphological and biochemical features such as apoptosis, necrosis, and autophagy. Cancer cells require higher levels of iron to survive, which makes them highly susceptible to ferroptosis. Therefore, it was found to be closely related to the progression, treatment response, and metastasis of various cancer types. Numerous studies have found that the ferroptosis pathway is closely related to drug resistance and metastasis of cancer. Some cancer cells reduce their susceptibility to ferroptosis by downregulating the ferroptosis pathway, resulting in resistance to anticancer therapy. Induction of ferroptosis restores the sensitivity of drug-resistant cancer cells to standard treatments. Cancer cells that are resistant to conventional therapies or have a high propensity to metastasize might be particularly susceptible to ferroptosis. Some biological processes and cellular components, such as epithelial–mesenchymal transition (EMT) and noncoding RNAs, can influence cancer metastasis by regulating ferroptosis. Therefore, targeting ferroptosis may help suppress cancer metastasis. Those progresses revealed the importance of ferroptosis in cancer, In order to provide the detailed molecular mechanisms of ferroptosis in regulating therapy resistance and metastasis and strategies to overcome these barriers are not fully understood, we described the key molecular mechanisms of ferroptosis and its interaction with signaling pathways related to therapy resistance and metastasis. Furthermore, we summarized strategies for reversing resistance to targeted therapy, chemotherapy, radiotherapy, and immunotherapy and inhibiting cancer metastasis by modulating ferroptosis. Understanding the comprehensive regulatory mechanisms and signaling pathways of ferroptosis in cancer can provide new insights to enhance the efficacy of anticancer drugs, overcome drug resistance, and inhibit cancer metastasis.
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Affiliation(s)
- Xuan Liu
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Yiqian Zhang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Xuyi Wu
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province/Rehabilitation Medicine Research Institute, Chengdu, China
| | - Fuyan Xu
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Hongbo Ma
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Mengling Wu
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Xia
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province/Rehabilitation Medicine Research Institute, Chengdu, China
- *Correspondence: Yong Xia,
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11
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Kendrick J, Francis R, Hassan GM, Rowshanfarzad P, Jeraj R, Kasisi C, Rusanov B, Ebert M. Radiomics for Identification and Prediction in Metastatic Prostate Cancer: A Review of Studies. Front Oncol 2021; 11:771787. [PMID: 34790581 PMCID: PMC8591174 DOI: 10.3389/fonc.2021.771787] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/11/2021] [Indexed: 12/21/2022] Open
Abstract
Metastatic Prostate Cancer (mPCa) is associated with a poor patient prognosis. mPCa spreads throughout the body, often to bones, with spatial and temporal variations that make the clinical management of the disease difficult. The evolution of the disease leads to spatial heterogeneity that is extremely difficult to characterise with solid biopsies. Imaging provides the opportunity to quantify disease spread. Advanced image analytics methods, including radiomics, offer the opportunity to characterise heterogeneity beyond what can be achieved with simple assessment. Radiomics analysis has the potential to yield useful quantitative imaging biomarkers that can improve the early detection of mPCa, predict disease progression, assess response, and potentially inform the choice of treatment procedures. Traditional radiomics analysis involves modelling with hand-crafted features designed using significant domain knowledge. On the other hand, artificial intelligence techniques such as deep learning can facilitate end-to-end automated feature extraction and model generation with minimal human intervention. Radiomics models have the potential to become vital pieces in the oncology workflow, however, the current limitations of the field, such as limited reproducibility, are impeding their translation into clinical practice. This review provides an overview of the radiomics methodology, detailing critical aspects affecting the reproducibility of features, and providing examples of how artificial intelligence techniques can be incorporated into the workflow. The current landscape of publications utilising radiomics methods in the assessment and treatment of mPCa are surveyed and reviewed. Associated studies have incorporated information from multiple imaging modalities, including bone scintigraphy, CT, PET with varying tracers, multiparametric MRI together with clinical covariates, spanning the prediction of progression through to overall survival in varying cohorts. The methodological quality of each study is quantified using the radiomics quality score. Multiple deficits were identified, with the lack of prospective design and external validation highlighted as major impediments to clinical translation. These results inform some recommendations for future directions of the field.
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Affiliation(s)
- Jake Kendrick
- School of Physics, Mathematics and Computing, University of Western Australia, Perth, WA, Australia
| | - Roslyn Francis
- Medical School, University of Western Australia, Crawley, WA, Australia
- Department of Nuclear Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Ghulam Mubashar Hassan
- School of Physics, Mathematics and Computing, University of Western Australia, Perth, WA, Australia
| | - Pejman Rowshanfarzad
- School of Physics, Mathematics and Computing, University of Western Australia, Perth, WA, Australia
| | - Robert Jeraj
- Department of Medical Physics, University of Wisconsin, Madison, WI, United States
- Faculty of Mathematics and Physics, University of Ljubljana, Ljubljana, Slovenia
| | - Collin Kasisi
- Department of Nuclear Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Branimir Rusanov
- School of Physics, Mathematics and Computing, University of Western Australia, Perth, WA, Australia
| | - Martin Ebert
- School of Physics, Mathematics and Computing, University of Western Australia, Perth, WA, Australia
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia
- 5D Clinics, Claremont, WA, Australia
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12
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Xiong K, Wang G, Peng T, Zhou F, Chen S, Liu W, Ju L, Xiao Y, Qian K, Wang X. The cholesterol esterification inhibitor avasimibe suppresses tumour proliferation and metastasis via the E2F-1 signalling pathway in prostate cancer. Cancer Cell Int 2021; 21:461. [PMID: 34461908 PMCID: PMC8407011 DOI: 10.1186/s12935-021-02175-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/24/2021] [Indexed: 02/08/2023] Open
Abstract
Background New effective drugs for prostate cancer (PCa) treatment are urgently needed. Avasimibe was recently identified as a promising drug for anticancer therapies. The main purpose of this study was to explore the effects and the underlying mechanisms of avasimibe in prostate cancer. Methods In this study, MTT and clonogenic survival assays were performed to detect cell proliferation after avasimibe treatment. The effect of avasimibe on cell migration was measured by wound healing and transwell migration assays. Cell cycle distribution and apoptosis were detected by flow cytometry. Immunofluorescence staining and western blot analysis were used to detect the expression of cell cycle-related proteins and epithelial-mesenchymal transition (EMT)-related proteins. In vivo, the antitumour effects of avasimibe were evaluated using a xenograft model and pulmonary metastasis model. Results The study found that avasimibe suppresses tumour growth and triggers G1 phase arrest. Moreover, the expression of the cell cycle-related proteins CDK2/4/6, Cyclin D1 and Cyclin A1 + A2 was significantly increased and p21 expression was decreased after avasimibe treatment. The migration of PCa cells was attenuated after treatment with avasimibe, followed by the downregulation of the expression of the EMT-related proteins N-cadherin, β-catenin, vimentin, Snail and MMP9 and upregulation of E-cadherin expression. Moreover, E2F-1 was elevated after treatment with avasimibe. After knockdown of E2F-1 expression, the inhibition of cell proliferation and migration caused by avasimibe was significantly recovered. The results of the xenograft model showed that avasimibe suppressed tumour growth in vivo. Immunofluorescence staining revealed lower levels of Ki67 and higher levels of E2F-1 in tumour tissues of the avasimibe group than those of the control group. A pulmonary metastasis model also confirmed the inhibition of PCa metastasis by avasimibe. The number of lung metastatic foci in the avasimibe group was significantly decreased compared with that in the control group. Conclusions Our results suggest that avasimibe can suppress tumour proliferation and metastasis via the E2F-1 signalling pathway. These findings demonstrate the potential of avasimibe as a new effective drug for PCa treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s12935-021-02175-5.
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Affiliation(s)
- Kangping Xiong
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Gang Wang
- Department of Biological Repositories, Zhongnan Hospital of Wuhan University, Wuhan, China.,Human Genetic Resource Preservation Center of Hubei Province, Wuhan, China.,Human Genetic Resource Preservation Center of Wuhan University, Wuhan, China.,Laboratory of Precision Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.,Wuhan Research Center for Infectious Diseases and Cancer, Chinese Academy of Medical Sciences, Wuhan, China
| | - Tianchen Peng
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Fenfang Zhou
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Siming Chen
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wei Liu
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Lingao Ju
- Department of Biological Repositories, Zhongnan Hospital of Wuhan University, Wuhan, China.,Human Genetic Resource Preservation Center of Hubei Province, Wuhan, China.,Human Genetic Resource Preservation Center of Wuhan University, Wuhan, China.,Laboratory of Precision Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.,Wuhan Research Center for Infectious Diseases and Cancer, Chinese Academy of Medical Sciences, Wuhan, China
| | - Yu Xiao
- Department of Biological Repositories, Zhongnan Hospital of Wuhan University, Wuhan, China.,Human Genetic Resource Preservation Center of Hubei Province, Wuhan, China.,Human Genetic Resource Preservation Center of Wuhan University, Wuhan, China.,Laboratory of Precision Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.,Wuhan Research Center for Infectious Diseases and Cancer, Chinese Academy of Medical Sciences, Wuhan, China
| | - Kaiyu Qian
- Department of Biological Repositories, Zhongnan Hospital of Wuhan University, Wuhan, China. .,Human Genetic Resource Preservation Center of Hubei Province, Wuhan, China. .,Human Genetic Resource Preservation Center of Wuhan University, Wuhan, China. .,Wuhan Research Center for Infectious Diseases and Cancer, Chinese Academy of Medical Sciences, Wuhan, China.
| | - Xinghuan Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China. .,Wuhan Research Center for Infectious Diseases and Cancer, Chinese Academy of Medical Sciences, Wuhan, China. .,Medical Research Institute, Wuhan University, Wuhan, China.
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13
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Pereira-Salgado A, Kwan EM, Tran B, Gibbs P, De Bono J, IJzerman M. Systematic Review of Efficacy and Health Economic Implications of Real-world Treatment Sequencing in Prostate Cancer: Where Do the Newer Agents Enzalutamide and Abiraterone Fit in? Eur Urol Focus 2021; 7:752-763. [DOI: 10.1016/j.euf.2020.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 02/11/2020] [Accepted: 03/04/2020] [Indexed: 11/30/2022]
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14
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Moussa M, Papatsoris A, Sryropoulou D, Chakra MA, Dellis A, Tzelves L. A pharmacoeconomic evaluation of pharmaceutical treatment options for prostate cancer. Expert Opin Pharmacother 2021; 22:1685-1728. [PMID: 34076542 DOI: 10.1080/14656566.2021.1925647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Prostate cancer is one of the most common neoplasms in men. For many years the mainstay of treatment was androgen deprivation therapy, but during last decade many novel agents have emerged, accompanied by increased costs for healthcare systems. AREAS COVERED In this literature review, the authors provide a pharmacoeconomic review of several pharmaceutical agents used in several disease stages, by summarizing evidence from cost-analysis, cost-effectiveness, cost-utility, cost-saving, cost-benefit and budgetary impact analysis studies. EXPERT OPINION The rapid development of therapeutic agents for prostate cancer has put a great budgetary burden on healthcare systems, since these drugs are prolonging survival and improving quality of life . Since existing data are now mature enough from a number of clinical trials with long-term follow-up, policy makers should propose not only the most clinically effective but also the most cost-effective agents, in order for every patient to gain access at least to some of these therapies. Docetaxel addition seems to be a cost-effective option, when compared to both abiraterone and enzalutamide (due to costs related to acquisition and side effects). Cabazitaxel is a strong candidate after docetaxel failure, while both denosumab and bisphosphonates are cost-effective for reducing skeletal-related events in metastatic disease.
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Affiliation(s)
- Mohamad Moussa
- Department of Urology, Al Zahraa Hospital, University Medical Center, Lebanese University, Beirut, Lebanon
| | - Athanasios Papatsoris
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Mohamed Abou Chakra
- Department of Urology, Al Zahraa Hospital, University Medical Center, Lebanese University, Beirut, Lebanon
| | - Athanasios Dellis
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece.,Department of Surgery, School of Medicine, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Lazaros Tzelves
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
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15
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Kreis K, Horenkamp-Sonntag D, Schneider U, Zeidler J, Glaeske G, Weissbach L. Treatment-Related Healthcare Costs of Metastatic Castration-Resistant Prostate Cancer in Germany: A Claims Data Study. PHARMACOECONOMICS - OPEN 2021; 5:299-310. [PMID: 32474839 PMCID: PMC8160066 DOI: 10.1007/s41669-020-00219-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
PURPOSE Treatments for patients with metastatic castration-resistant prostate cancer (mCRPC) have expanded rapidly. They include the chemotherapies docetaxel and cabazitaxel, hormonal drugs abiraterone and enzalutamide, and best supportive care (BSC). Cabazitaxel has proven to be the last life-prolonging option, associated with a significant risk of serious adverse events. Given the lack of real-world evidence, we aimed to compare healthcare resource utilization (HRU) and costs in patients with mCRPC treated with cabazitaxel, docetaxel, abiraterone, enzalutamide, and BSC. METHODS We used 2014-2017 claims data from a large German statutory health insurance fund, the Techniker Krankenkasse, to identify patients with mCRPC. Patient allocation to individual therapy regimens was based on clinical knowledge and included therapy cycles, duration of therapy, and continuous treatment. The study period lasted from the first claim until death, the end of data availability, a drug switch, or discontinuation of therapy, whichever came first. Multivariate regression models were used to compare monthly all-cause and mCRPC-related HRU and costs across cohorts by adjusting for baseline covariates (including age and comorbidities). RESULTS The 3944 identified patients with mCRPC initiated treatment with cabazitaxel (n = 240), docetaxel (n = 539), abiraterone (n = 486), enzalutamide (n = 351), or BSC (n = 2328). In most domains, HRU was highest in the cabazitaxel cohort and lowest in the BSC group. Accordingly, the highest all-cause and mCRPC-related costs per month, respectively, were observed in patients receiving cabazitaxel (€7631/€6343), followed by abiraterone (€5226/€4579), enzalutamide (€5079/€4416), docetaxel (€2392/€1580), and BSC (€959/€438). Cost variations were mostly attributable to drugs, inpatient treatment, and sick leave payments. CONCLUSION mCRPC treatment imposes a high economic burden on statutory health insurance. Cabazitaxel is associated with substantially higher expenses, resulting from higher drug costs and a greater need for inpatient treatment. As mCRPC continues to be incurable, decision makers and clinician leaders should carefully evaluate public access to innovative agents and optimal treatment strategies.
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Affiliation(s)
- Kristine Kreis
- Center for Health Economics Research Hannover (CHERH), Gottfried Wilhelm Leibniz Universität Hannover, Otto-Brenner-Straße 7, 30159, Hannover, Germany.
| | - Dirk Horenkamp-Sonntag
- Versorgungsmanagement, Techniker Krankenkasse, Bramfelder Straße 140, 22305, Hamburg, Germany
| | - Udo Schneider
- Versorgungsmanagement, Techniker Krankenkasse, Bramfelder Straße 140, 22305, Hamburg, Germany
| | - Jan Zeidler
- Center for Health Economics Research Hannover (CHERH), Gottfried Wilhelm Leibniz Universität Hannover, Otto-Brenner-Straße 7, 30159, Hannover, Germany
| | - Gerd Glaeske
- Forschungszentrum Ungleichheit und Sozialpolitik, Universität Bremen - SOCIUM, Mary-Somerville-Str. 5, 28359, Bremen, Germany
| | - Lothar Weissbach
- Gesundheitsforschung für Männer gGmbH, Muthesiusstr. 7, 12163, Berlin, Germany
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16
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Anderson PT, Rowe NE. Current attitudes of Canadian urologists towards surgical castration in the treatment of prostate cancer. Can Urol Assoc J 2021. [PMID: 33119504 DOI: 10.5489/cuaj.6834)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Affiliation(s)
- Patrick T Anderson
- Department of Surgery, Division of Urology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Neal E Rowe
- Department of Surgery, Division of Urology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
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17
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de Feria Cardet RE, Hofman MS, Segard T, Yim J, Williams S, Francis RJ, Frydenberg M, Lawrentschuk N, Murphy DG, De Abreu Lourenco R. Is Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography Imaging Cost-effective in Prostate Cancer: An Analysis Informed by the proPSMA Trial. Eur Urol 2021; 79:413-418. [PMID: 33341285 DOI: 10.1016/j.eururo.2020.11.043] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 11/28/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Before integrating prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) into routine care, it is important to assess if the benefits justify the differences in resource use. OBJECTIVE To determine the cost-effectiveness of PSMA-PET/CT when compared with conventional imaging. DESIGN, SETTING, AND PARTICIPANTS A cost-effectiveness analysis was developed using data from the proPSMA study. proPSMA included patients with high-risk prostate cancer assigned to conventional imaging or 68Ga-PSMA-11 PET/CT with planned health economics data collected. The cost-effectiveness analysis was conducted from an Australian societal perspective. INTERVENTION 68Ga-PSMA-11 PET/CT compared with conventional imaging (CT and bone scan). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome from proPSMA was diagnostic accuracy (nodal and distant metastases). This informed a decision tree analysis of the cost per accurate diagnosis. RESULTS AND LIMITATIONS The estimated cost per scan for PSMA PET/CT was AUD$1203, which was less than the conventional imaging cost at AUD$1412. PSMA PET/CT was thus dominant, having both better accuracy and a lower cost. This resulted in a cost of AUD$959 saved per additional accurate detection of nodal disease, and AUD$1412 saved for additional accurate detection of distant metastases. The results were most sensitive to variations in the number of men scanned for each 68Ga-PSMA-11 production run. Subsequent research is required to assess the long-term costs and benefits of PSMA PET/CT-directed care. CONCLUSIONS PSMA PET/CT has lower direct comparative costs and greater accuracy compared to conventional imaging for initial staging of men with high-risk prostate cancer. This provides a compelling case for adopting PSMA PET/CT into clinical practice. PATIENT SUMMARY The proPSMA study demonstrated that prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) better detects disease that has spread beyond the prostate compared with conventional imaging. Our analysis shows that PSMA PET/CT is also less costly than conventional imaging for the detection of disease spread. This research was presented at the European Association of Nuclear Medicine Scientific Meeting in October 2020.
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Affiliation(s)
- Rafael E de Feria Cardet
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
| | - Michael S Hofman
- Prostate Cancer Theranostics and Imaging Centre of Excellence, Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | | | - Jackie Yim
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
| | - Scott Williams
- Prostate Cancer Theranostics and Imaging Centre of Excellence, Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia; Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Camperdown, Australia; Department of Medicine, University of Queensland, Brisbane, Australia
| | - Roslyn J Francis
- Sir Charles Gairdner Hospital, Perth, Australia; School of Medicine and Pharmacology, University of Western Australia, Crawley, Australia
| | - Mark Frydenberg
- Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Cabrini Institute, Cabrini Health, Malvern, Australia
| | - Nathan Lawrentschuk
- Prostate Cancer Theranostics and Imaging Centre of Excellence, Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Surgery, University of Melbourne and Royal Melbourne Hospital, Melbourne, Australia; EJ Whitten Prostate Cancer Research Centre, Epworth Healthcare, Melbourne, Australia; Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Declan G Murphy
- Prostate Cancer Theranostics and Imaging Centre of Excellence, Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia; Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia.
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Juzeniene A, Stenberg VY, Bruland ØS, Larsen RH. Preclinical and Clinical Status of PSMA-Targeted Alpha Therapy for Metastatic Castration-Resistant Prostate Cancer. Cancers (Basel) 2021; 13:779. [PMID: 33668474 PMCID: PMC7918517 DOI: 10.3390/cancers13040779] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/07/2021] [Accepted: 02/08/2021] [Indexed: 12/14/2022] Open
Abstract
Bone, lymph node, and visceral metastases are frequent in castrate-resistant prostate cancer patients. Since such patients have only a few months' survival benefit from standard therapies, there is an urgent need for new personalized therapies. The prostate-specific membrane antigen (PSMA) is overexpressed in prostate cancer and is a molecular target for imaging diagnostics and targeted radionuclide therapy (theragnostics). PSMA-targeted α therapies (PSMA-TAT) may deliver potent and local radiation more selectively to cancer cells than PSMA-targeted β- therapies. In this review, we summarize both the recent preclinical and clinical advances made in the development of PSMA-TAT, as well as the availability of therapeutic α-emitting radionuclides, the development of small molecules and antibodies targeting PSMA. Lastly, we discuss the potentials, limitations, and future perspectives of PSMA-TAT.
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Affiliation(s)
- Asta Juzeniene
- Department of Radiation Biology, Institute for Cancer Research, Norwegian Radium Hospital, Oslo University Hospital, Montebello, 0379 Oslo, Norway;
| | - Vilde Yuli Stenberg
- Department of Radiation Biology, Institute for Cancer Research, Norwegian Radium Hospital, Oslo University Hospital, Montebello, 0379 Oslo, Norway;
- Nucligen, Ullernchausséen 64, 0379 Oslo, Norway;
- Institute for Clinical Medicine, University of Oslo, Box 1171 Blindern, 0318 Oslo, Norway;
| | - Øyvind Sverre Bruland
- Institute for Clinical Medicine, University of Oslo, Box 1171 Blindern, 0318 Oslo, Norway;
- Department of Oncology, Norwegian Radium Hospital, Oslo University Hospital, 0379 Oslo, Norway
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Luo F, Han J, Chen Y, Yang K, Zhang Z, Li J. Lamin B1 promotes tumor progression and metastasis in primary prostate cancer patients. Future Oncol 2021; 17:663-673. [PMID: 33112662 DOI: 10.2217/fon-2020-0825] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Aims: To determine the role of lamin B1 (LMNB1) in the progression and metastasis of primary prostate cancer (PC). Patients & methods: Two PC cohorts were used to investigate the clinical relationship between LMNB1 expression and tumor progression and metastasis. Results: The qRT-PCR results revealed that LMNB1 expression was markedly increased in patients with aggressive features and was associated with worse prognosis. Logistic regression analyses indicated that LMNB1 expression is an independent risk factor for distant metastasis. Kaplan-Meier analysis showed that increased LMNB1 levels were related to poor disease-free survival in the primary PC cohort. Conclusion: This study reveals that upregulation of LMNB1 is associated with cancer metastasis and poor survival outcomes in primary PC patients.
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Affiliation(s)
- Fei Luo
- Department of Urology, Tianjin Union Medical Center, Tianjin 300121, China
| | - Jiaxi Han
- Department of Urology, Tianjin Union Medical Center, Tianjin 300121, China
| | - Yatong Chen
- Department of Urology, Tianjin Union Medical Center, Tianjin 300121, China
| | - Kuo Yang
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin 300211, China
| | - Zhihua Zhang
- Department of Urology, Tianjin Union Medical Center, Tianjin 300121, China
| | - Jian Li
- Department of Urology, Tianjin Union Medical Center, Tianjin 300121, China
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20
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Anderson PT, Rowe NE. Current attitudes of Canadian urologists towards surgical castration in the treatment of prostate cancer. Can Urol Assoc J 2020; 15:E281-E285. [PMID: 33119504 DOI: 10.5489/cuaj.6834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Patrick T Anderson
- Department of Surgery, Division of Urology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Neal E Rowe
- Department of Surgery, Division of Urology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
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21
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Yuan P, Ling L, Fan Q, Gao X, Sun T, Miao J, Yuan X, Liu J, Liu B. A four-gene signature associated with clinical features can better predict prognosis in prostate cancer. Cancer Med 2020; 9:8202-8215. [PMID: 32924329 PMCID: PMC7643642 DOI: 10.1002/cam4.3453] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 08/20/2020] [Accepted: 08/22/2020] [Indexed: 01/09/2023] Open
Abstract
Prostate cancer (PCa) is one of the most deadly urinary tumors in men globally, and the 5‐year over survival is poor due to metastasis of tumor. It is significant to explore potential biomarkers for early diagnosis and personalized therapy of PCa. In the present study, we performed an integrated analysis based on multiple microarrays in the Gene Expression Omnibus (GEO) dataset and obtained differentially expressed genes (DEGs) between 510 PCa and 259 benign issues. The weighted correlation network analysis indicated that prognostic profile was the most relevant to DEGs. Then, univariate and multivariate COX regression analyses were conducted and four prognostic genes were obtained to establish a four‐gene prognostic model. And the predictive effect and expression profiles of the four genes were well validated in another GEO dataset, The Cancer Genome Atlas and the Human Protein Atlas datasets. Furthermore, combination of four‐gene model and clinical features was analyzed systematically to guide the prognosis of patients with PCa to a largest extent. In summary, our findings indicate that four genes had important prognostic significance in PCa and combination of four‐gene model and clinical features could achieve a better prediction to guide the prognosis of patients with PCa.
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Affiliation(s)
- Penghui Yuan
- Department of Urology Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Le Ling
- Department of Urology Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qing Fan
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xintao Gao
- Department of Urology Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Taotao Sun
- Department of Urology Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianping Miao
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xianglin Yuan
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jihong Liu
- Department of Urology Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Liu
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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22
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Sariisik E, Zistl D, Docheva D, Schilling AF, Benoit M, Sudhop S, Clausen-Schaumann H. Inadequate tissue mineralization promotes cancer cell attachment. PLoS One 2020; 15:e0237116. [PMID: 32857787 PMCID: PMC7454967 DOI: 10.1371/journal.pone.0237116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/20/2020] [Indexed: 01/13/2023] Open
Abstract
Bone metastases are a frequent complication in prostate cancer, and several studies have shown that vitamin D deficiency promotes bone metastases. However, while many studies focus on vitamin D’s role in cell metabolism, the effect of chronically low vitamin D levels on bone tissue, i.e. insufficient mineralization of the tissue, has largely been ignored. To investigate, whether poor tissue mineralization promotes cancer cell attachment, we used a fluorescence based adhesion assay and single cell force spectroscopy to quantify the adhesion of two prostate cancer cell lines to well-mineralized and demineralized dentin, serving as biomimetic bone model system. Adhesion rates of bone metastases-derived PC3 cells increased significantly on demineralized dentin. Additionally, on mineralized dentin, PC3 cells adhered mainly via membrane anchored surface receptors, while on demineralized dentin, they adhered via cytoskeleton-anchored transmembrane receptors, pointing to an interaction via exposed collagen fibrils. The adhesion rate of lymph node derived LNCaP cells on the other hand is significantly lower than that of PC3 and not predominately mediated by cytoskeleton-linked receptors. This indicates that poor tissue mineralization facilitates the adhesion of invasive cancer cells by the exposure of collagen and emphasizes the disease modifying effect of sufficient vitamin D for cancer patients.
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Affiliation(s)
- Ediz Sariisik
- Center for Applied Tissue Engineering and Regenerative Medicine (CANTER), Munich University of Applied Sciences, Munich, Germany
- Chair of Applied Physics, Ludwig-Maximilians-Universität, Munich, Germany
- Center for NanoScience, Ludwig-Maximilians-Universität, Munich, Germany
| | - Domenik Zistl
- Center for Applied Tissue Engineering and Regenerative Medicine (CANTER), Munich University of Applied Sciences, Munich, Germany
| | - Denitsa Docheva
- Center for Applied Tissue Engineering and Regenerative Medicine (CANTER), Munich University of Applied Sciences, Munich, Germany
- Department of Trauma Surgery, Experimental Trauma Surgery, University Regensburg Medical Centre, Regensburg, Germany
| | - Arndt F. Schilling
- Center for Applied Tissue Engineering and Regenerative Medicine (CANTER), Munich University of Applied Sciences, Munich, Germany
- Clinic for Trauma Surgery, Orthopaedics, and Plastic Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Martin Benoit
- Center for Applied Tissue Engineering and Regenerative Medicine (CANTER), Munich University of Applied Sciences, Munich, Germany
- Chair of Applied Physics, Ludwig-Maximilians-Universität, Munich, Germany
- Center for NanoScience, Ludwig-Maximilians-Universität, Munich, Germany
| | - Stefanie Sudhop
- Center for Applied Tissue Engineering and Regenerative Medicine (CANTER), Munich University of Applied Sciences, Munich, Germany
- Center for NanoScience, Ludwig-Maximilians-Universität, Munich, Germany
- * E-mail:
| | - Hauke Clausen-Schaumann
- Center for Applied Tissue Engineering and Regenerative Medicine (CANTER), Munich University of Applied Sciences, Munich, Germany
- Center for NanoScience, Ludwig-Maximilians-Universität, Munich, Germany
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23
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Jeong SH, Raman JD. Impact of the evolving United States Preventative Services Task Force policy statements on incidence and distribution of prostate cancer over 15 years in a statewide cancer registry. Prostate Int 2020; 9:12-17. [PMID: 33912509 PMCID: PMC8053697 DOI: 10.1016/j.prnil.2020.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/04/2020] [Accepted: 06/16/2020] [Indexed: 12/12/2022] Open
Abstract
Background The United States Preventative Services Task Force (USPSTF) guideline on Prostate Specific Antigen (PSA)-based prostate cancer screening evolved both in 2008 (Grade I for men < 75 years and Grade D for men > 75 years) and in 2012 (Grade D for all ages). Materials and methods A statewide cancer registry operated by the Pennsylvania Department of Health was accessed to analyze over a 15-year period prostate cancer rates across different categories including age, stage, and geographic distribution. Results Local prostate cancer rates decreased significantly when comparing before and after USPSTF's guideline changes: 2002-2008 vs. 2009-2012 vs. 2013-2016 (p < 0.005). Conversely, the distant cancer rates increased significantly in Caucasian men (but not in African American men) (p = 0.0078). In age group analysis, distant cancer rates increased significantly in all age ranges, most notably in younger men (50-59 years). No observed difference in the trend of distant cancer rates when considering rural versus urban counties. Conclusions Incident prostate cancer cases diagnosed in Pennsylvania have decreased over the past 15 years with a recent rise in distant carcinomas potentially attributable to the USPSTF recommendations against PSA-based screening. Although the USPSTF revised their PSA-based prostate cancer screening guideline in 2018 (Grade C for men 55-69 years and Grade D for men > 70 years), the implications of the aforementioned observations on mortality outcomes merit further follow-up.
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Affiliation(s)
- Seong H Jeong
- The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Jay D Raman
- Division of Urology, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
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24
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Ye J, Gao M, Guo X, Zhang H, Jiang F. Breviscapine suppresses the growth and metastasis of prostate cancer through regulating PAQR4-mediated PI3K/Akt pathway. Biomed Pharmacother 2020; 127:110223. [PMID: 32413672 DOI: 10.1016/j.biopha.2020.110223] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/27/2020] [Accepted: 04/30/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Prostate cancer, one of the most frequently diagnosed tumors of men, leads to poor quality of life. Previous studies have shown that breviscapine (BRE) exerts therapeutic activity in malignant tumors. However, the role and mechanism of BRE exhibit an anti-tumor effect on prostate cancer are largely unknown. METHODS The mRNA and protein levels in prostate cancer tissues and cell lines were measured using RT-qPCR, western blot, and immunohistochemical staining, respectively. Cell proliferation, invasion, and migration in both PC3 and DU145 cells were evaluated using CCK-8 and Transwell assay. The effect of BRE on cell proliferation and metastasis by regulating the PAQR4-mediated PI3K/Akt pathway in vitro and in vivo was determined. RESULTS PAQR4 was significantly overexpressed in prostate cancer tissues and cell lines, which was positively correlated with poor prognosis. Knockdown of PAQR4 inhibited the proliferation, invasion, migration, and epithelial-mesenchymal transition (EMT) of both PC3 and DU145 cells. Mechanistically, BRE treatment significantly suppressed the malignant biological behavior of both prostate cancer cells by downregulating PAQR4 and blocking the PI3K/Akt pathway. In vivo experiments, BRE administration remarkably inhibited tumor growth and metastasis in a xenograft model of prostate cancer. CONCLUSION Our findings revealed that BRE exerts anti-tumor and anti-metastasis roles in prostate cancer by inhibiting PAQR4-mediated PI3K/Akt pathway, which provides a new therapeutic agent for prostate cancer clinical treatment.
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Affiliation(s)
- Jiwei Ye
- Department of Urology, Nanyang Second People's Hospital of Henan Province, Nanyang, 473000, Henan, China.
| | - Mingquan Gao
- Sichuan Cancer Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610041, Sichuan, China.
| | - Xinwu Guo
- Department of Urology, Nanyang Second People's Hospital of Henan Province, Nanyang, 473000, Henan, China.
| | - Henan Zhang
- Institute of Edible Fungi, Shanghai Academy of Agricultural Sciences, National Engineering Research Center of Edible Fungi, Key Laboratory of Edible Fungi Resources and Utilization (South), Ministry of Agriculture, Shanghai, 201403, China.
| | - Fuchun Jiang
- Department of Pharmaceutical Botany, School of Pharmacy, The Second Military Medical University, Shanghai, 200433, China.
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25
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Rodin D, Chien AT, Ellimoottil C, Nguyen PL, Kakani P, Mossanen M, Rosenthal M, Landrum MB, Sinaiko AD. Physician and facility drivers of spending variation in locoregional prostate cancer. Cancer 2020; 126:1622-1631. [PMID: 31977081 DOI: 10.1002/cncr.32719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 10/11/2019] [Accepted: 12/07/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND Prostate cancer is the most common male cancer, with a wide range of treatment options. Payment reform to reduce unnecessary spending variation is an important strategy for reducing waste, but its magnitude and drivers within prostate cancer are unknown. METHODS In total, 38,971 men aged ≥66 years with localized prostate cancer who were enrolled in Medicare fee-for-service and were included in the Surveillance, Epidemiology, and End Results-Medicare database from 2009 to 2014 were included. Multilevel linear regression with physician and facility random effects was used to examine the contributions of urologists, radiation oncologists, and their affiliated facilities to variation in total patient spending in the year after diagnosis within geographic region. The authors assessed whether spending variation was driven by patient characteristics, disease risk, or treatments. Physicians and facilities were sorted into quintiles of adjusted patient-level spending, and differences between those that were high-spending and low-spending were examined. RESULTS Substantial variation in spending was driven by physician and facility factors. Differences in cancer treatment modalities drove more variation across physicians than differences in patient and disease characteristics (72% vs 2% for urologists, 20% vs 18% for radiation oncologists). The highest spending physicians spent 46% more than the lowest and had more imaging tests, inpatient care, and radiotherapy spending. There were no differences across spending quintiles in the use of robotic surgery by urologists or the use of brachytherapy by radiation oncologists. CONCLUSIONS Significant differences were observed for patients with similar demographics and disease characteristics. This variation across both physicians and facilities suggests that efforts to reduce unnecessary spending must address decision making at both levels.
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Affiliation(s)
- Danielle Rodin
- Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Alyna T Chien
- Department of Medicine, Division of General Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Chad Ellimoottil
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | - Pragya Kakani
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Matthew Mossanen
- Division of Urology, Brigham and Women's Hospital, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Meredith Rosenthal
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Mary Beth Landrum
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Anna D Sinaiko
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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26
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Nieder C, Dalhaug A, Haukland E. Is there a seasonal variation of survival after systemic chemotherapy for metastatic castration-resistant prostate cancer in a rural part of North Norway? Int J Circumpolar Health 2020; 79:1742520. [PMID: 32191614 PMCID: PMC7144237 DOI: 10.1080/22423982.2020.1742520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The winter darkness or polar night induces endocrine and metabolic mechanisms, which might reduce the efficacy of cancer treatment and thus contribute to shorter survival. Moreover, season-and weather-related treatment delays and irregularities might also cause reduced efficacy of anti-cancer drugs. Therefore, this study evaluated the prognostic impact of timing of chemotherapy (start during winter darkness or outside of this season), in terms of overall survival, in patients with metastatic castration-resistant prostate cancer (MCRPC) who received oncology care at the Nordland hospital Bodø. The study included 111 patients treated with first-line docetaxel chemotherapy for MCRPC. Twenty patients (18%) started their treatment during winter darkness (arbitrarily defined as ±4 weeks around 21 December). In unadjusted univariate analysis, survival was shorter in this group (median 10.2 vs. 18.9 months, p = 0.055). However, not all baseline parameters were equally distributed between the two groups. In multivariable-adjusted Cox regression analysis accounting for several confounding variables, only one factor was statistically significant: pre-chemotherapy serum lactate dehydrogenase level (a surrogate marker of disease burden). Thus, the present results suggest that seasonal variation is not a major contributor to the diverging survival outcomes observed after docetaxel chemotherapy.
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Affiliation(s)
- Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, UiT- the Arctic University of Norway, Tromsø, Norway
| | - Astrid Dalhaug
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, UiT- the Arctic University of Norway, Tromsø, Norway
| | - Ellinor Haukland
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, UiT- the Arctic University of Norway, Tromsø, Norway
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27
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Nieder C, Dalhaug A, Haukland E. Feasibility and efficacy of sequential systemic therapy for metastatic castration-resistant prostate cancer in a rural health care setting. Scand J Urol 2020; 54:110-114. [PMID: 32091322 DOI: 10.1080/21681805.2020.1730435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Aim: The aim of this study was to evaluate the feasibility and efficacy, in terms of overall survival, of sequential systemic therapy in patients with metastatic castration-resistant prostate cancer (MCRPC) who lived in Nordland County, Norway, a large region with a challenging geography, yet only one department of oncology located in the main city, Bodø.Patients and methods: Overall 77 patients who had received at least 2 lines of treatment were included in this retrospective study.Results: Management included docetaxel in 69 patients (90%), often prescribed in first line. Only 12 patients (16%) started their treatment with a sequence of two endocrine drugs (enzalutamide or abiraterone acetate). Thirty-two patients (42%) were not eligible for treatment beyond second line, while 31 (40%) received 3 lines, and 14 (18%) more than 3 lines (for example cabazitaxel or Ra-223). Distance to the department of oncology did not predict for treatment with more than 2 lines. Only two factors were statistically significant: age <75 years and not initiating treatment with two lines of endocrine drugs. Survival increased with increasing number of lines of treatment. None of the five individual drugs available to these patients was significantly associated with survival.Conclusions: There was no indication toward under-treatment with systemic therapy among patients from the distant regions. Sequential treatment was feasible and survival increased with each additional line.
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Affiliation(s)
- Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Astrid Dalhaug
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Ellinor Haukland
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
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28
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Nieder C, Dalhaug A, Haukland E, Norum J. Management of patients with metastatic prostate cancer (mPC) in a rural part of North Norway with a scattered population: does living near the department of oncology translate into a different pattern of care and survival? Int J Circumpolar Health 2020; 78:1620086. [PMID: 31120400 PMCID: PMC6534221 DOI: 10.1080/22423982.2019.1620086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The goal of the Norwegian Ministry of Health and Care Services is to offer an equal health-care service with the same outcomes wherever people are living within the country. The aim of this study was to evaluate whether this was true for patients diagnosed with metastatic prostate cancer (mPC) and living in Nordland County, a region with a challenging geography and climate and having, several small and remote communities and only 1 department of oncology. The latter is located in the main city, Bodø. We also compared a subgroup living in communities having lower average annual income (less than NOK 240,000 (equivalent to USD 28,600)) with patients living in Bodø (NOK 285,000 (USD 33,900)). Overall 288 patients were included and stratified into 3 subgroups (favourable distance and income, unfavourable distance and income, and unfavourable distance and favourable income). No statistically significant differences were observed regarding patient characteristics. There was no indication towards under-treatment among patients from the distant regions or the lower income region. Given that disparities were not observed, it was not surprising to see comparable survival outcomes (p=0.35). In conclusion, these results suggest that the health-care system in Nordland County successfully delivers state-of-the-art oncology care to patients with mPC.
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Affiliation(s)
- Carsten Nieder
- a Department of Oncology and Palliative Medicine , Nordland Hospital , Bodø , Norway.,b Department of Clinical Medicine, Faculty of Health Sciences , UiT- The Arctic University of Norway , Tromsø , Norway
| | - Astrid Dalhaug
- a Department of Oncology and Palliative Medicine , Nordland Hospital , Bodø , Norway.,b Department of Clinical Medicine, Faculty of Health Sciences , UiT- The Arctic University of Norway , Tromsø , Norway
| | - Ellinor Haukland
- a Department of Oncology and Palliative Medicine , Nordland Hospital , Bodø , Norway.,b Department of Clinical Medicine, Faculty of Health Sciences , UiT- The Arctic University of Norway , Tromsø , Norway
| | - Jan Norum
- b Department of Clinical Medicine, Faculty of Health Sciences , UiT- The Arctic University of Norway , Tromsø , Norway.,c Department of Surgery , Finnmark Hospital , Hammerfest , Norway
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29
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Zhao F, Wang J, Chen M, Chen D, Ye S, Li X, Chen X, Ren G, Yan S. Sites of synchronous distant metastases and prognosis in prostate cancer patients with bone metastases at initial diagnosis: a population-based study of 16,643 patients. Clin Transl Med 2019; 8:30. [PMID: 31784868 PMCID: PMC6884608 DOI: 10.1186/s40169-019-0247-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 11/19/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Bone is a preferential site for prostate cancer (PCa) metastasis. However, sites of synchronous distant metastases in PCa patients with bone metastases at initial diagnosis and their impacts on prognosis are still unclear, limiting our ability to better stratify and treat the patients. In this study, we examined the sites of synchronous extra-skeletal metastases in de novo PCa patients with bone metastases and their associated prognoses. METHODS In total, 16,643 de novo PCa patients with bone metastases from the SEER database were included. After stratification of metastatic sites (bone, lung, liver, and brain) and treatment modalities, overall survival (OS) and independent predictors of OS, were analyzed. RESULTS Lung was the most frequent site of synchronous metastases, followed by liver, while brain metastases were relatively uncommon. Patients with bone-only metastases showed the longest mean survival time (35.87 months, p < 0.001), followed by patients with bone and lung metastases (30.74 months, p < 0.001). Patients with bone and liver metastases had the shortest mean survival time (17.39 months, p < 0.001). Age > 70 years, unmarried status, high tumor grade, prostate-specific antigen (PSA) > 50 ng/ml, and Gleason score ≥ 8 were associated with poor OS (all p < 0.01). Asian or Pacific Islander ethnic background was associated with a favorable OS (all p < 0.01). Chemotherapy improved OS in patients without brain metastases (all p < 0.05). For patients with bone-only metastases, radical prostatectomy (RP) (HR, 0.339; 95% CI 0.231-0.495; p < 0.001), brachytherapy (BT) (HR, 0.567; 95% CI 0.388-0.829; p = 0.003), and chemotherapy (HR, 0.850; 95% CI 0.781-0.924; p < 0.001) were associated with prolonged OS. CONCLUSIONS Age, race, tumor grade, PSA, Gleason score, sites of synchronous extra-skeletal metastases, as well as treatment modalities affected OS in newly diagnosed PCa patients with bone metastases. Synchronous liver metastases were associated with poor OS. Chemotherapy improved OS in patients without brain metastases. RP and BT improved OS in patients with bone-only metastases. Further investigation is warranted to validate these findings.
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Affiliation(s)
- Feng Zhao
- Department of Radiation Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, People's Republic of China.
| | - Jili Wang
- Graduate School, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Meiqin Chen
- Graduate School, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Danni Chen
- Department of Radiation Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Sunyi Ye
- Department of Urology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Xinke Li
- Department of Radiation Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Xin Chen
- Institute of Pharmaceutical Biotechnology and the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310058, Zhejiang, People's Republic of China
| | - Guoping Ren
- Department of Pathology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, People's Republic of China.
| | - Senxiang Yan
- Department of Radiation Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, People's Republic of China.
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30
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Zhang X. Interactions between cancer cells and bone microenvironment promote bone metastasis in prostate cancer. Cancer Commun (Lond) 2019; 39:76. [PMID: 31753020 PMCID: PMC6873445 DOI: 10.1186/s40880-019-0425-1] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 11/13/2019] [Indexed: 12/26/2022] Open
Abstract
Bone metastasis is the leading cause of death in prostate cancer patients, for which there is currently no effective treatment. Since the bone microenvironment plays an important role in this process, attentions have been directed to the interactions between cancer cells and the bone microenvironment, including osteoclasts, osteoblasts, and bone stromal cells. Here, we explained the mechanism of interactions between prostate cancer cells and metastasis-associated cells within the bone microenvironment and further discussed the recent advances in targeted therapy of prostate cancer bone metastasis. This review also summarized the effects of bone microenvironment on prostate cancer metastasis and the related mechanisms, and provides insights for future prostate cancer metastasis studies.
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Affiliation(s)
- Xiangyu Zhang
- Department of Pathology, Jining First People's Hospital, Jining Medical University, No. 6 Jiankang Road, Jining, 272000, Shandong, P. R. China.
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31
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Abstract
Ketoconazole is a nonselective steroid 17α-hydroxylase/17,20 lyase (CYP17A1) inhibitor that has been used, off-label, as a second-line therapy for castration-resistant prostate cancer (CRPC). The drug has shown clinical efficacy without survival benefit. Despite not improving survival, ketoconazole has beneficial characteristics, such as its low cost, a relatively favourable toxicity profile compared with chemotherapy, and its efficacy both before and after chemotherapy. The approval of several new, highly effective treatments, including abiraterone acetate, enzalutamide, and apalutamide, warrants re-evaluation of the role of ketoconazole and other classic agents in achieving the optimal timing and sequencing of available agents to prolong survival and maintain patients' quality of life. In the current CRPC treatment landscape, we believe that ketoconazole can be considered in patients with nonmetastatic CRPC and in those with metastatic CRPC who do not respond to, tolerate, or have access to chemotherapy and other standard therapeutic options.
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Affiliation(s)
- Vaibhav Patel
- Division of Hematology and Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Bobby Liaw
- Division of Hematology and Oncology, Department of Medicine, The Mount Sinai Hospital, Mount Sinai Beth Israel, New York, NY, USA
| | - William Oh
- Division of Hematology and Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Dizdar O, Guven DC, Guner G, Erman M, Hayran M. Gleason score and docetaxel response in advanced hormone-sensitive prostate cancer: The lower the better. JOURNAL OF ONCOLOGICAL SCIENCES 2019. [DOI: 10.1016/j.jons.2019.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Hu Y, Wu Q, Gao J, Zhang Y, Wang Y. A meta-analysis and The Cancer Genome Atlas data of prostate cancer risk and prognosis using epithelial cell adhesion molecule (EpCAM) expression. BMC Urol 2019; 19:67. [PMID: 31324239 PMCID: PMC6642570 DOI: 10.1186/s12894-019-0499-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/09/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Epithelial cell adhesion molecule (EpCAM) expression has been reported in many types of cancer, including prostate cancer (PCa). However, the role of EpCAM expression remains inconsistent. We conducted a meta-analysis to assess the clinicopathological and prognostic significance of EpCAM expression in PCa. METHODS Publications were searched online using electronic databases. The available data were obtained from The Cancer Genome Atlas (TCGA). The odds ratios (ORs) or hazard ratios (HRs) with their 95% confidence intervals (CIs) were calculated. RESULTS We identified seven studies in which immunohistochemistry was used and that included 871 prostatic tissue samples. EpCAM expression was significantly higher in PCa samples than in benign and normal tissue samples (OR = 77.93, P = 0.002; OR = 161.61, P < 0.001; respectively). No correlation of EpCAM overexpression with pT stage and lymph node metastasis was observed; however, EpCAM overexpression showed a significant correlation with Gleason score (OR = 0.48, P = 0.012) and bone metastasis (OR = 145.80, P < 0.001). Furthermore, TCGA data showed that EpCAM overexpression was not closely correlated with age, pT stage, lymph node metastasis, number of lymph node, prostate-specific antigen level, Gleason score, biochemical recurrence, and overall survival. Based on multivariate Cox proportional-hazards regression analysis, a significant correlation was observed between EpCAM overexpression and 5-year worse biochemical recurrence free-survival. CONCLUSIONS EpCAM overexpression may be correlated with the development of bone metastasis and worse biochemical recurrence free-survival of PCa. Further studies are needed to verify these findings.
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Affiliation(s)
- Yu Hu
- Department of Pathology, China-Japan Union Hospital, Jilin University, Changchun, Jilin, China
| | - Qiong Wu
- Department of Pathology, China-Japan Union Hospital, Jilin University, Changchun, Jilin, China
| | - Jialin Gao
- Department of Urology, The First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, 130021, Jilin, China
| | - Yongrui Zhang
- Department of Urology, The First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, 130021, Jilin, China
| | - Yuantao Wang
- Department of Urology, The First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, 130021, Jilin, China.
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Nieder C, Dalhaug A, Pawinski A. Contribution of Serum Biomarkers to Prognostic Assessment in Patients With Oligometastatic Prostate Cancer. In Vivo 2019; 33:465-468. [PMID: 30804126 DOI: 10.21873/invivo.11495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 11/22/2018] [Accepted: 11/28/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND/AIM The aim of this study was to analyze the prognostic impact of biomarkers, such as serum lactate dehydrogenase (LDH), in patients with oligometastatic castration-resistant prostate cancer, arbitrarily defined as a maximum of five metastatic lesions. PATIENTS AND METHODS This was a retrospective single-institution analysis. Overall 34 patients were included, all of whom received first-line docetaxel without ablative local treatment. RESULTS Twelve patients (35%) had elevated LDH (≥255 U/l). Their median survival was significantly shorter than that of patients with normal LDH. Due to an interaction with other biomarkers, multivariate Cox regression analysis was performed. The latter showed that serum hemoglobin was the only significant predictor of survival. CONCLUSION Correct diagnosis of oligometastatic disease is not trivial, because all radiological modalities are limited by certain thresholds for detection of small metastases. Serum biomarkers may reflect the total burden of malignant disease. However, this relatively small study did not clearly demonstrate that elevation of LDH may be useful for clinical decision-making, e.g. in terms of adding local treatment for all sites of metastatic spread.
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Affiliation(s)
- Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway .,Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Astrid Dalhaug
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway
| | - Adam Pawinski
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway
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De Abreu Lourenco R, Williams SG. Building an Understanding of the Value of Docetaxel Plus Hormone Therapy in Prostate Cancer: An Ever-growing Evidence Base. Eur Urol Oncol 2019; 1:459-460. [PMID: 31158088 DOI: 10.1016/j.euo.2018.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 10/09/2018] [Indexed: 10/27/2022]
Affiliation(s)
| | - Scott G Williams
- Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Australia
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Aguiar PN, Tan PS, Simko S, Barreto CMN, Gutierres BDS, del Giglio A, Lopes GDL. Cost-effectiveness analysis of abiraterone, docetaxel or placebo plus androgen deprivation therapy for hormone-sensitive advanced prostate cancer. EINSTEIN-SAO PAULO 2019; 17:eGS4414. [PMID: 30843996 PMCID: PMC6394999 DOI: 10.31744/einstein_journal/2019gs4414] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 06/24/2018] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To evaluate the cost-effectiveness of the addition of chemotherapy or abiraterone to androgen deprivation. METHODS We developed an analytical model to determine the cost-effectiveness of the addition of docetaxel or abiraterone versus androgen deprivation therapy alone. Direct and indirect costs were included in the model. The effects were expressed in Quality-Adjusted Life Years adjusted for side effects. RESULTS Compared to androgen deprivation therapy alone, the addition of chemotherapy and of abiraterone generated 0.492 and 0.999, respectively, in Quality-Adjusted Life Years. Abiraterone led to a Quality-Adjusted Life Years gain of 0.506 compared to docetaxel. The incremental costs per Quality-Adjusted Life Years were R$ 133.649,22 for docetaxel, R$ 330.828,70 for abiraterone and R$ 571.379,42 for abiraterone compared to docetaxel, respectively. CONCLUSION The addition of chemotherapy to androgen deprivation therapy is more cost-effective than the addition of abiraterone to androgen deprivation therapy. However, discounts on abiraterone cost might improve cost-effectiveness.
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Affiliation(s)
- Pedro Nazareth Aguiar
- Faculdade de Medicina do ABC, Santo André, SP, Brazil
- Americas Centro de Oncologia Integrado, São Paulo, SP, Brazil
| | - Pui San Tan
- University of Oxford, Oxford, England, United Kingdom
| | - Sarah Simko
- School of Medicine, Universidade de Miami, Florida, FL, United States
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De Abreu Lourenco R, Williams S. Health Technology Assessment and Health Care Utilisation in the Management of Early Prostate Cancer. Eur Urol Focus 2018; 5:134-136. [PMID: 30551978 DOI: 10.1016/j.euf.2018.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/05/2018] [Accepted: 11/19/2018] [Indexed: 12/24/2022]
Abstract
Health technology assessment (HTA) is a key tool used to allocate health care funding. A critical aspect of HTA is the performance of economic evaluations that compare the costs and outcomes for competing therapies; these typically rely on data from clinical trials. For early prostate cancer, this represents a challenge, as long-term survival and quality-of-life effects-key outcomes in such evaluations-may require a decade or more of follow-up. Thus, identification of early or intermediate measures of benefit is critical. Systematic reviews of economic evaluations in prostate cancer show that understanding the links between intermediate and final outcomes is important for confidence in assessments of what represents value for money. This highlights the importance of efforts to identify and validate intermediate clinical endpoints for use in determining clinical benefit, and hence value for money, in early prostate cancer. PATIENT SUMMARY: As the costs of providing care rise, the challenge is to ensure that we achieve value for money. In this brief review, we note the importance of clinical trial data in understanding what represents value for money and we highlight current efforts to identify measures that can be used to make decisions on treatment funding sooner.
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Affiliation(s)
- Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia.
| | - Scott Williams
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
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Grochtdreis T, König HH, Dobruschkin A, von Amsberg G, Dams J. Cost-effectiveness analyses and cost analyses in castration-resistant prostate cancer: A systematic review. PLoS One 2018; 13:e0208063. [PMID: 30517165 PMCID: PMC6281264 DOI: 10.1371/journal.pone.0208063] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 11/09/2018] [Indexed: 12/19/2022] Open
Abstract
Background Treatment of metastatic prostate cancer is associated with high personal and economic burden. Recently, new treatment options for castration-resistant prostate cancer became available with promising survival advantages. However, cost-effectiveness of those new treatment options is sometimes ambiguous or given only under certain circumstances. The aim of this study was to systematically review studies on the cost-effectiveness of treatments and costs of castration-resistant prostate cancer (CRPC) and metastasizing castration-resistant prostate cancer (mCRPC) on their methodological quality and the risk of bias. Methods A systematic literature search was performed in the databases PubMed, CINAHL Complete, the Cochrane Library and Web of Science Core Collection for costs-effectiveness analyses, model-based economic evaluations, cost-of-illness analyses and budget impact analyses. Reported costs were inflated to 2015 US$ purchasing power parities. Quality assessment and risk of bias assessment was performed using the Consolidated Health Economic Evaluation Reporting Standards checklist and the Bias in Economic Evaluations checklist, respectively. Results In total, 38 articles were identified by the systematic literature search. The methodological quality of the included studies varied widely, and there was considerable risk of bias. The cost-effectiveness treatments for CRPC and mCRPC was assessed with incremental cost-effectiveness ratios ranging from dominance for mitoxantrone to $562,328 per quality-adjusted life year gained for sipuleucel-T compared with prednisone alone. Annual costs for the treatment of castration-resistant prostate cancer ranged from $3,067 to $77,725. Conclusion The cost-effectiveness of treatments of CRPC strongly depended on the willingness to pay per quality-adjusted life year gained/life-year saved throughout all included costs-effectiveness analyses and model-based economic evaluations. High-quality cost-effectiveness analyses based on randomized controlled trials are needed in order to make informed decisions on the management of castration-resistant prostate cancer and the resulting financial impact on the healthcare system.
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Affiliation(s)
- Thomas Grochtdreis
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Dobruschkin
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gunhild von Amsberg
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald-Tumorzentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Judith Dams
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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39
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Consensus Statement on Circulating Biomarkers for Advanced Prostate Cancer. Eur Urol Oncol 2018; 1:151-159. [DOI: 10.1016/j.euo.2018.02.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 02/20/2018] [Indexed: 12/28/2022]
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40
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Nieder C, Haukland E, Pawinski A, Norum J. Seven-month prostate-specific antigen (PSA) is prognostic in patients with prostate cancer initially diagnosed with distant metastases. Med Oncol 2018; 35:46. [PMID: 29508104 DOI: 10.1007/s12032-018-1110-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 02/27/2018] [Indexed: 02/07/2023]
Abstract
Recent research suggests that prostate-specific antigen (PSA) ≤ 0.2 ng/dl at 7 months is prognostic for better survival with androgen deprivation therapy for metastatic hormone-sensitive prostate cancer regardless of chemotherapy with docetaxel. These results were derived from a group of clinical trial participants. Therefore, we performed a confirmatory analysis in patients treated outside of trials. Furthermore, we limited inclusion to those who presented with metastases at the initial diagnosis of prostate cancer (synchronous metastases). A retrospective analysis of a comprehensive regional database was performed. The oncology care in this region (Nordland County, Northern Norway) was provided by one center. Patients who were diagnosed between January 01, 2004 and December 31, 2016 were included. Of 101 patients, 90 were alive at 7 months and had their PSA value measured. Their median age was 68.5 years. Only six patients (7%) achieved PSA ≤ 0.2 ng/dl at 7 months. The median value was 4.05 ng/dl. Median overall survival was shortest in patients with PSA > 4.0 ng/dl (22 months). For patients with PSA between 0.3 and 4.0 ng/dl, median survival was 54 months (p = 0.0001). No further increase was seen in the small group with lower PSA. Statistical significance was also found for a cutoff of ≤ 1.0 ng/dl (55 vs. 32 months). PSA at 7 months predicts overall survival. Given that only 7% of patients achieved PSA ≤ 0.2 ng/dl, confirmation of this particular cutoff requires additional studies in other populations.
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Affiliation(s)
- Carsten Nieder
- Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, 9037, Tromsö, Norway. .,Department of Oncology and Palliative Medicine, Nordland Hospital Trust, 8092, Bodø, Norway.
| | - Ellinor Haukland
- Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, 9037, Tromsö, Norway.,Department of Oncology and Palliative Medicine, Nordland Hospital Trust, 8092, Bodø, Norway
| | - Adam Pawinski
- Department of Oncology and Palliative Medicine, Nordland Hospital Trust, 8092, Bodø, Norway
| | - Jan Norum
- Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, 9037, Tromsö, Norway.,Department of Surgery, Finnmark Hospital Trust, Hammerfest, 9600, Norway
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