Prostate cancer screening in Europe and Asia

UFO registry: final analysis of baseline data from patients with advanced prostate cancer in Asia

Background

The incidence of prostate cancer (PC) is increasing in Asian countries. The epidemiology of PC, its treatment including the use of novel therapeutic options, impacts on quality of life, and clinical outcomes of patients with PC in Asia, are not well documented.

Objectives

To describe the demographic and disease features of the full cohort of patients enrolled in the United in Fight against prOstate cancer (UFO) registry.

Design

The UFO registry was a multi-national, longitudinal, observational study of patients with PC presenting to participating tertiary care hospitals in eight Asian countries/regions.

Methods

Patients with high-risk localized PC (HRL), non-metastatic biochemically recurrent, or metastatic PC were consecutively enrolled from September 14, 2015 until September 1, 2020 and followed for up to 5 years.

Results

Among the full cohort of 3635 patients, 425 had HRL, 389 had non-metastatic biochemically recurrent, and 2821 had metastatic PC. Median follow-up time was 4.2, 4.2, and 2.6 years, respectively. At first diagnosis, the mean age ranged from 65.7 to 69.1 years, 38.5% had extra-capsular tumor extension, 34.0% had regional lymph node metastases, and 65.1% had distant metastases. Quality-of-life scores at enrollment were significantly worse in patients with metastatic disease. Decisions to start therapy were mainly driven by treatment guidelines and disease progression. The decision to discontinue hormonal therapy was often due to disease progression. Few patients received novel hormonal therapies despite their availability.

Conclusion

The UFO registry provides a detailed, contemporary picture of the characteristics, treatment, and outcomes of patients with PC in Asia. There is an unmet medical need to improve access to novel agents in Asia, aiming to improve quality of life and clinical outcomes.

Trial registration

Clinicaltrials.gov Identifier: NCT02546908, Registry Identifier: NOPRODPCR4001.

Prediction of high-risk prostate cancer based on the habitat features of biparametric magnetic resonance and the omics features of contrast-enhanced ultrasound

Rationale and objectives

To predict high-risk prostate cancer (PCa) by combining the habitat features of biparametric magnetic resonance imaging (bp-MRI) with the omics features of contrast-enhanced ultrasound (CEUS).

Materials and methods

This study retrospectively collected patients with PCa confirmed by histopathology from January 2020 to June 2023. All patients underwent bp-MRI and CEUS of the prostate, followed by a targeted and transrectal systematic prostate biopsy. The cases were divided into the intermediate-low-risk group (Gleason score ≤7, n = 59) and high-risk group (Gleason score ≥8, n = 33). Radiomics prediction models, namely, MRI_habitat, CEUS_intra, and MRI-CEUS models, were developed based on the habitat features of bp-MRI, the omics features of CEUS, and a merge of features of the two, respectively. Predicted probabilities, called radscores, were then obtained. Clinical-radiological indicators were screened to construct clinic models, which generated clinic scores. The omics-clinic model was constructed by combining the radscore of MRI-CEUS and the clinic score. The predictive performance of all the models was evaluated using the receiver operating characteristic curve.

Results

The area under the curve (AUC) values of the MRI-CEUS model were 0.875 and 0.842 in the training set and test set, respectively, which were higher than those of the MR_habitat (training set: 0.846, test set: 0.813), CEUS_intra (training set: 0.801, test set: 0.743), and clinic models (training set: 0.722, test set: 0.611). The omics-clinic model achieved a higher AUC (train set: 0.986, test set: 0.898).

Conclusions

The combination of the habitat features of bp-MRI and the omics features of CEUS can help predict high-risk PCa.

Deep-learning-based segmentation using individual patient data on prostate cancer radiation therapy

PURPOSE

Organ-at-risk segmentation is essential in adaptive radiotherapy (ART). Learning-based automatic segmentation can reduce committed labor and accelerate the ART process. In this study, an auto-segmentation model was developed by employing individual patient datasets and a deep-learning-based augmentation method for tailoring radiation therapy according to the changes in the target and organ of interest in patients with prostate cancer.

METHODS

Two computed tomography (CT) datasets with well-defined labels, including contoured prostate, bladder, and rectum, were obtained from 18 patients. The labels of the CT images captured during radiation therapy (CT2nd) were predicted using CT images scanned before radiation therapy (CT1st). From the deformable vector fields (DVFs) created by using the VoxelMorph method, 10 DVFs were extracted when each of the modified CT and CT2nd images were deformed and registered to the fixed CT1st image. Augmented images were acquired by utilizing 110 extracted DVFs and spatially transforming the CT1st images and labels. An nnU-net autosegmentation network was trained by using the augmented images, and the CT2nd label was predicted. A patient-specific model was created for 18 patients, and the performances of the individual models were evaluated. The results were evaluated by employing the Dice similarity coefficient (DSC), average Hausdorff distance, and mean surface distance. The accuracy of the proposed model was compared with those of models trained with large datasets.

RESULTS

Patient-specific models were developed successfully. For the proposed method, the DSC values of the actual and predicted labels for the bladder, prostate, and rectum were 0.94 ± 0.03, 0.84 ± 0.07, and 0.83 ± 0.04, respectively.

CONCLUSION

We demonstrated the feasibility of automatic segmentation by employing individual patient datasets and image augmentation techniques. The proposed method has potential for clinical application in automatic prostate segmentation for ART.

From Sea to Science: Coral Aquaculture for Sustainable Anticancer Drug Development

Marine natural products offer immense potential for drug development, but the limited supply of marine organisms poses a significant challenge. Establishing aquaculture presents a sustainable solution for this challenge by facilitating the mass production of active ingredients while reducing our reliance on wild populations and harm to local environments. To fully utilize aquaculture as a source of biologically active products, a cell-free system was established to target molecular components with protein-modulating activity, including topoisomerase II, HDAC, and tubulin polymerization, using extracts from aquaculture corals. Subsequent in vitro studies were performed, including MTT assays, flow cytometry, confocal microscopy, and Western blotting, along with in vivo xenograft models, to verify the efficacy of the active extracts and further elucidate their cytotoxic mechanisms. Regulatory proteins were clarified using NGS and gene modification techniques. Molecular docking and SwissADME assays were performed to evaluate the drug-likeness and pharmacokinetic and medicinal chemistry-related properties of the small molecules. The extract from Lobophytum crassum (LCE) demonstrated potent broad-spectrum activity, exhibiting significant inhibition of tubulin polymerization, and showed low IC50 values against prostate cancer cells. Flow cytometry and Western blotting assays revealed that LCE induced apoptosis, as evidenced by the increased expression of apoptotic protein-cleaved caspase-3 and the populations of early and late apoptotic cells. In the xenograft tumor experiments, LCE significantly suppressed tumor growth and reduced the tumor volume (PC3: 43.9%; Du145: 49.2%) and weight (PC3: 48.8%; Du145: 7.8%). Additionally, LCE inhibited prostate cancer cell migration, and invasion upregulated the epithelial marker E-cadherin and suppressed EMT-related proteins. Furthermore, LCE effectively attenuated TGF-β-induced EMT in PC3 and Du145 cells. Bioactivity-guided fractionation and SwissADME validation confirmed that LCE's main component, 13-acetoxysarcocrassolide (13-AC), holds greater potential for the development of anticancer drugs.

Estimating disparities of prostate cancer burden and its attributable risk factors for males across the BRICS-plus, 1990-2019: A comparable study of key nations with emerging economies

BACKGROUNDS

The study aimed to analyze epidemiology burden of male prostate cancer across the BRICS-plus, and identify potential risk factors by assessing the associations with age, period, birth cohorts and sociodemographic index (SDI).

METHODS

Data were extracted from the Global Burden of Disease Study 2019. The average annual percent change (AAPC) was calculated to assess long-term trends, and age-period-cohort analysis was used to analyze these three effects on prostate cancer burden. Quantile regression was used to investigate the association between SDI and health outcomes.

RESULTS

The higher incidence and mortality were observed in Mercosur and SACU regions, increasing trends were observed in prostate cancer incidence in almost all BRICS-plus countries (AAPC > 0), and EEU's grew by 24.31% (%AAPC range: -0.13-3.03). Mortality had increased in more than half of countries (AAPC > 0), and SACU grew by 1.82% (%AAPC range: 0.62-1.75). Incidence and mortality risk sharply increased with age across all BRICS-plus countries and globally, and the peak was reached in the age group 80-84 years. Rate ratio (RR) of incidence increased with birth cohorts in all BRICS-plus countries except for Kazakhstan where slightly decrease, while mortality RR decreased with birth cohort in most of BRICS-plus countries. SDI presented significantly positive associations with incidence in 50 percentiles. The deaths attributable to smoking declined in most of BRICS-plus nations, and many countries in China-ASEAN-FTA and EEU had higher values.

CONCLUSION

Prostate cancer posed a serious public health challenge with an increasing burden among most of BRICS-plus countries. Age had significant effects on prostate cancer burden, and recent birth cohorts suffered from higher incidence risk. SDI presented a positive relationship with incidence, and the smoking-attributable burden was tremendous in China-ASEAN-FTA and EEU region. Secondary prevention should be prioritized in BRICS-plus nations, and health policies targeting important populations should be strengthened based on their characteristics and adaptability.

Long noncoding RNA MEG3 regulates cell proliferation and apoptosis by disrupting microRNA-9-5p-mediated inhibition of NDRG1 in prostate cancer

BACKGROUND

Long noncoding RNA MEG3 has been described to be involved in the regulation of gene expression and cancer progression. However, the role of lncMEG3 in prostate cancer (PCa) remains largely uncharted.

METHODS

Differential expression of lncMEG3 was identified in PCa tissues using RNA-sequencing analysis. qRT-PCR was performed to examine the level of lncMEG3. Additionally, cellular fractionation and fluorescent in situ hybridization techniques were employed to determine the localization. Subsequently, functional assays were conducted to evaluate the impact of lncMEG3 and miR-9-5p on PCa proliferation and apoptosis in vitro and in vivo. The interaction between lncMEG3 and miR-9-5p was confirmed using RNA immunoprecipitation. Moreover, luciferase reporter assays were also utilized to investigate the relationship between miR-9-5p and NDRG1.

RESULTS

We observed downregulation of lncMEG3 in PCa cells and tissues. Patients with lower levels of lncMEG3 had a higher likelihood of experiencing biochemical recurrence. Overexpression of lncMEG3 resulted in the inhibition of PCa cell proliferation and the promotion of apoptosis. Moreover, lncMEG3 is competitively bound to miR-9-5p, preventing its inhibitory effect on the target gene NDRG1. This ultimately led to the inhibition of PCa cell proliferation and the promotion of apoptosis. Furthermore, increasing lncMEG3 levels also demonstrated inhibitory effects on PCa proliferation and promotion of apoptosis in vivo.

CONCLUSIONS

Our findings uncover a crucial role for lncMEG3 in inhibiting PCa proliferation and promoting apoptosis through disruption of miR-9-5p-mediated inhibition of NDRG1.

Computer-aided detection of prostate cancer in early stages using multi-parameter MRI: A promising approach for early diagnosis

BACKGROUND

Transrectal ultrasound-guided prostate biopsy is the gold standard diagnostic test for prostate cancer, but it is an invasive examination of non-targeted puncture and has a high false-negative rate.

OBJECTIVE

In this study, we aimed to develop a computer-assisted prostate cancer diagnosis method based on multiparametric MRI (mpMRI) images.

METHODS

We retrospectively collected 106 patients who underwent radical prostatectomy after diagnosis with prostate biopsy. mpMRI images, including T2 weighted imaging (T2WI), diffusion weighted imaging (DWI), and dynamic-contrast enhanced (DCE), and were accordingly analyzed. We extracted the region of interest (ROI) about the tumor and benign area on the three sequential MRI axial images at the same level. The ROI data of 433 mpMRI images were obtained, of which 202 were benign and 231 were malignant. Of those, 50 benign and 50 malignant images were used for training, and the 333 images were used for verification. Five main feature groups, including histogram, GLCM, GLGCM, wavelet-based multi-fractional Brownian motion features and Minkowski function features, were extracted from the mpMRI images. The selected characteristic parameters were analyzed by MATLAB software, and three analysis methods with higher accuracy were selected.

RESULTS

Through prostate cancer identification based on mpMRI images, we found that the system uses 58 texture features and 3 classification algorithms, including Support Vector Machine (SVM), K-nearest Neighbor (KNN), and Ensemble Learning (EL), performed well. In the T2WI-based classification results, the SVM achieved the optimal accuracy and AUC values of 64.3% and 0.67. In the DCE-based classification results, the SVM achieved the optimal accuracy and AUC values of 72.2% and 0.77. In the DWI-based classification results, the ensemble learning achieved optimal accuracy as well as AUC values of 75.1% and 0.82. In the classification results based on all data combinations, the SVM achieved the optimal accuracy and AUC values of 66.4% and 0.73.

CONCLUSION

The proposed computer-aided diagnosis system provides a good assessment of the diagnosis of the prostate cancer, which may reduce the burden of radiologists and improve the early diagnosis of prostate cancer.

Pistacia vera and its Combination with Cisplatin: A Potential Anticancer Candidate by Modulating Apoptotic Genes

INTRODUCTION

Many bioactive phytochemicals have essential significance for handling various diseases and developing new drugs. The aim was to investigate the anti-tumor activity and the underlying mechanisms of pistachio pericarp extract (PPE) and pistachio kernel extract (PKE) alone and combined with cisplatin (CP) in the treatment of prostate cancer.

METHODS

The effects of the PPE, PKE, and CP alone and PPE and PKE in combination with CP (PPE+CP and PKE+CP) on the proliferation of PC-3 cells were determined using the MTT assay. The fold changes of BAX, BCL-2, P53, KLK2, TNF, TGF, and NANOG expression against β-actin were determined by real-time technique. Data were analyzed by two-way ANOVA and repeated measure tests.

RESULTS

These research results indicated that a greater anti-proliferative effect of the PPE and PKE was shown in combination with CP compared with treatments using the PPE and PKE or CP alone. The extracts and Cisplatin in vitro had good synergistic effects on the inhibition of the proliferation of PC-3 cells. The IC50 values of PKE+CP were 4.141, 2.140, and 0.884 ug/mL, and PPE+CP were 2.754, 2.061, and 0.753 ug/mL after 24 h, 48 h, and 72 h treatment, respectively. Also, this result presented that the mRNA expression of BAX and P53 increased, and BCL-2, KLK2, TNF, TGF, and NANOG decreased in PC-3 cells.

CONCLUSIONS

The finding of this research showed for the first time the anti-carcinogenesis effects of separately and in the combination of PPE, PKE, and CP on the PC-3 prostate cancer cells via modulating some genes and that it may be nominated for the herbal anti-cancer medications.

Value of synthetic MRI quantitative parameters in preprocedural evaluation for TRUS/MRI fusion-guided biopsy of the prostate

BACKGROUND

Transrectal ultrasonography (TRUS)/magnetic resonance imaging (MRI) fusion-guided biopsy has a high clinical application value. However, this technique has some limitations, which limit its use in routine clinical practice. Therefore, the selection of suitable proatate lesions for this technique is worthy of our attention. Synthetic MRI (SyMRI) is capable of quantifying multiple relaxation parameters, which might have potential value in preprocedural evaluation for TRUS/MRI fusion-guided biopsy of the prostate. The aim of our study is to examine the value of SyMRI quantitative parameters in preprocedural evaluation for TRUS/MRI fusion-guided biopsy of the prostate.

METHODS

We prospectively selected 148 lesions in 137 patients who underwent prostate biopsy in our hospital. Next, 2-4 needles of TRUS/MRI fusion-guided biopsy combined with 10 needles of system biopsy (SB) were used as the protocol for prostate biopsy. Before biopsy, the MAGiC sequences of the MRI images of the enrolled patients underwent post-processing, and the longitudinal relaxation time (T1), transverse relaxation time (T2), and proton density (PD) were extracted. The biopsy pathology results were used as a gold standard to compare the differences in SyMRI quantitative parameters between benign and malignant prostate lesions in the peripheral and transitional zones. The receiver operating characteristic (ROC) curves were plotted to confirm the optimal SyMRI quantitative parameter for prostate lesion benignancy/malignancy performance, and the cutoff values of these parameters were used for grouping the lesions. The single-needle biopsy prostate cancer (PCa)-positivity rates (number of positive biopsy needles/total biopsy needles) and PCa overall detection rates by TRUS/MRI fusion-guided biopsy and SB were compared in different subgroups.

RESULTS

The T1 and T2 values can determine the benignancy/malignancy of prostate transition lesions(p < 0.01), and the T2 value has a greater diagnostic performance (p = 0.0376). The T2 value can determine the benignancy/malignancy of prostate peripheral lesions. The optimal diagnostic cutoff values for T2 were 77 and 81 ms, respectively. The single-needle PCa positivity rate of TRUS/MRI fusion-guided biopsy was higher than SB for any prostate lesions in different subgroups (p < 0.01). However, only in the subgroup of transition zone lesions with T2 ≤ 77 ms, the PCa overall detection rate of TRUS/MRI fusion-guided biopsy was significantly higher than that of SB (p = 0.031).

CONCLUSION

SyMRI-T2 value can provide a theoretical basis for the selection of suitable lesions for TRUS/MRI fusion-guided biopsy.

Evaluation of Usability and User Experience of Oncodoc 's M-Health Application for Early Detection of Cancer

OBJECTIVE

Cancer is a non-communicable disease that accounts for 71% of deaths globally. The prevalence of people living with cancer in Indonesia increased from 1.4/1000 population (2013) to 1.8/1,000 population (2018). This study aims to evaluate usability, user experience, and user feedback on the use of the Oncodoc m-health application.

METHODS

 The research method uses mixed methods with a cross-sectional approach and online survey sampling techniques (677 respondents), in December 2021-January 2022 in Indonesia. The instruments used are the System Usability Scale and User Experience Questionnaire. The variables measured include the characteristics of respondents, usability, user experience, and responses to using applications qualitatively. Quantitative data were analysed descriptively and the User Experience Questionnaire's analysis tool. Qualitative data were analysed thematically.

RESULTS

Evaluation of the usability of Oncodoc's m-health application is in the "acceptable" category (70.88), and the adjective rating is in the "Good" category. Evaluations of the relative quality of user experience are in the "good" and "very good" types. The average user experience scale is (mean; SD): attractiveness (1.80; 0.99), perspicuity (1.82; 1.05), efficiency (1.78; 1.09), dependability (1.56; 1.01), stimulation (1.81; 1.06), and novelty (1.32; 1.10). The findings of this study are 1) the ability to accommodate user needs, 2) usage barriers, and 3) user expectations for the Oncodoc application.

CONCLUSION

Overall, the Oncodoc m-health application is acceptable to users. We recommend developing a cancer early detection application with an approach that refers to user needs for further research.

Kinetic Analysis of Prostate-Specific Antigen Interaction with Monoclonal Antibodies for Development of a Magnetic Immunoassay Based on Nontransparent Fiber Structures

Prostate cancer is the second most common cancer diagnosed in men worldwide. Measuring the prostate-specific antigen (PSA) is regarded as essential during prostate cancer screening. Early diagnosis of this disease relapse after radical prostatectomy requires extremely sensitive methods. This research presents an approach to development of an ultrasensitive magnetic sandwich immunoassay, which demonstrates the limit of PSA detection in human serum of 19 pg/mL at a dynamic range exceeding 3.5 orders of concentration. Such attractive performance stems, inter alia, from the kinetic analysis of monoclonal antibodies (mAbs) against free PSA to select the mAbs exhibiting best kinetic characteristics and specificity. The analysis is carried out with a label-free multiplex spectral-correlation interferometry compatible with inexpensive single-use glass sensor chips. The high sensitivity of developed PSA immunoassay is due to electronic quantification of magnetic nanolabels functionalized by the selected mAbs and three-dimension porous filters used as an extended solid phase. The assay is promising for PSA monitoring after radical prostatectomy. The proposed versatile approach can be applied for the rational design of highly sensitive tests for detection of other analytes in many fields, including in vitro diagnostics, veterinary, food safety, etc.

Risk of prostate cancer in patients with inflammatory bowel disease: a nationwide cohort study in South Korea

Background

Several studies have suggested an association between inflammatory bowel disease (IBD) and the risk of prostate cancer development. However, these findings are inconsistent, and studies based on Asian populations are limited.

Objectives

We compared the risk of prostate cancer according to IBD status using the Korean National Health Insurance Service database.

Design

A population-based retrospective cohort of age-matched 59,044 non-IBD patients and 14,761 IBD patients between January 2009 and December 2011 was analyzed up to December 2017.

Methods

The risk of prostate cancer was compared between patients with IBD and controls using the Cox proportional hazards regression model and Kaplan-Meier survival analysis.

Results

During a median follow-up of 6 years, the incidence rate of prostate cancer was 264 per 100,000 person-years in non-IBD patients and 242 per 100,000 person-years in patients with IBD. IBD status was not associated with the risk of prostate cancer compared to non-IBD [adjusted hazard ratio (aHR) 0.93, 95% confidence interval (CI): 0.80-1.08, p = 0.32). The cumulative incidence of prostate cancer did not differ by IBD status (non-IBD patients versus IBD patients: log-rank p = 0.27; non-IBD patients versus ulcerative colitis versus Crohn's disease: log-rank p = 0.42). In multivariate analysis, age was an independent risk factor for the development of prostate cancer (HR 1.03, 95% CI: 1.02-1.03, p < 0.001).

Conclusion

In our population-based study, IBD status was not associated with the risk of prostate cancer.

MiR-96-5p induced NDRG1 deficiency promotes prostate cancer migration and invasion through regulating the NF-κB signaling pathway

OBJECTIVE: The N-myc downstream-regulated gene 1 (NDRG1) has been discovered as a significant gene in the progression of cancers. However, the regulatory mechanism of NDRG1 remained obscure in prostate cancer (PCa). METHODS: The miR-96-5p and NDRG1 expression levels were evaluated in PCa cell lines, prostate tissues, and validated public databases by real-time PCR, western blot analysis, and immunohistochemistry. The function of miR-96-5p and NDRG1 were investigated by wound healing and transwell assays in vitro, and mouse xenograft assay in vivo. The candidate pathway regulated by NDRG1 was conducted by the next-generation gene sequencing technique. Immunofluorescence and luciferase assay was used to detect the relation between miR-96-5p, NDRG1, and NF-kB pathway. RESULTS: Overexpressing NDRG1 suppresses the migration, invasion, and epithelial-mesenchymal transition (EMT) in vitro, and inhibits metastasis in vivo. Moreover, miR-96-5p contributes to NDRG1 deficiency and promotes PCa cell migration and invasion. Furthermore, NDRG1 loss activates the NF-KB pathway, which stimulates p65 and IKBa phosphorylation and induces EMT in PCa. CONCLUSIONS: MiR-96-5p promotes the migration and invasion of PCa by targeting NDRG1 and regulating the NF-κB pathway.

A new automated and putatively versatile synthesis of the PSMA-ligand derivative [18F]DCFPyL using the FASTlabTM synthesizer

Background

Noninvasive molecular imaging using peptides and biomolecules labelled with positron emitters has become important for detection of cancer and other diseases with PET (positron emission tomography). The positron emitting radionuclide fluorine-18 is widely available in high yield from cyclotrons and has favorable decay (t_1/2 109.7 min) and imaging properties. ¹⁸F-Labelling of biomolecules and peptides for use as radiotracers is customarily achieved in a two-step approach, which can be challenging to automate. 6-[¹⁸F]Fluoronicotinic acid 2,3,5,6-tetrafluorophenyl ester ([¹⁸F]F-Py-TFP) is a versatile ¹⁸F-prosthetic group for this purpose, which can be rapidly be produced in an one-step approach on solid support. This work details an automated procedure on the cassette-based GE FASTlab™ platform for the labeling of a peptidomimetic, exemplified by the case of using the Glu-CO-Lys motif to produce [¹⁸F]DCFPyL, a ligand targeting the prostate specific membrane antigen (PSMA).

Results

From fluorine-18 delivery a fully automated two-step radiosynthesis of [¹⁸F]DCFPyL was completed in 56 min with an overall end of synthesis yield as high as 37% using solid phase extraction (SPE) purification on the GE FASTlab™ platform.

Conclusions

Putatively, this radiolabeling methodology is inherently amenable to automation with a diverse set of synthesis modules, and it should generalize for production of a broad spectrum of biomolecule-based radiotracers for use in PET imaging.

Determination of Serum Prostate Specific Antigen Levels Amongst Apparently Healthy Nigerian Males in a University and University Hospital Community in the Federal Capital Territory

BACKGROUND

Prostate cancer is the commonest cancer among men worldwide and serum prostate specific antigen (PSA) has remained the most commonly applied screening test for the disease till date. Current PSA test results guidelines in our population are informed by reference intervals derived from studies from Caucasians and other racial groups. With scanty data on PSA reference values from our local population, this study evaluated the serum PSA levels of apparently healthy Nigerian male subjects in whom prostate cancer and urinary tract infection have been excluded.

METHOD

This study had participants aged 40 to 70 years, with no lower urinary tract symptoms or other symptoms suggestive of prostate disease recruited from the male staff population of the University of Abuja and University of Abuja Teaching Hospital and the adjoining local community. They were physically examined, had prostate ultrasonography, urine analysis, and blood sample collected for PSA testing. Data collected was analyzed using Statistical Package for Social Science (SPSS) version 24.

RESULT

Of a total of 210 men who participated in the study, 191 eventually met the inclusion criteria. The average age was 52.9 years, ninety seven percent of them had heard of prostate cancer before now. The mean total PSA was 1.46 ng/mL (SD +/-1.55), while the reference interval was .23-5.60 ng/mL. The average prostate size was 41.8 mL (SD+/-20.11), and there was a positive correlation between the PSA and the prostate size (.418) as well as the age of the subjects (.446). There was no significant difference in the mean PSA value for those with or without family history of prostate cancer (P=.979).

CONCLUSION

The reference range of PSA in Nigeria is higher than in other races, hence utilizing a local value in decision making would help to reduce unnecessary invasive procedures.

Prostate Cancer Incidence and Mortality: Global Status and Temporal Trends in 89 Countries From 2000 to 2019

Aims

To evaluate current status of prostate cancer incidence and mortality worldwide, and compare the global trends of incidence and mortality in the past two decades and in the most recent period.

Methods

Data on the incidence and mortality of prostate cancer for 174 countries in 2020 were obtained from the GLOBOCAN 2020 database, and associations with the human development index (HDI) were evaluated. Data for trend analyses in 89 countries from 2000 to 2019 were retrieved from the Global Burden of Disease 2019 platform. Age standardized incidence rate (ASIR) and mortality rate (ASMR) were calculated by using the Segi's population. The average annual percent changes (AAPC) of ASIRs and ASMRs were evaluated by joinpoint regression analysis.

Results

A total of 1 414 259 new cases of prostate cancer and 375 304 related deaths were reported in 2020 globally. HDI was positively correlated with ASIRs (P &lt; 0.001) and negatively correlated with ASMRs (P &lt; 0.001). In the past two decades, ASIRs have been increasing in 65 countries, stable in 15 countries and decreasing in 9 countries, and ASMRs have been increasing in 19 countries, stable in 25 countries and decreasing in 45 countries, respectively. In the most recent period, 44 countries have increasing ASIRs, and 32 countries have decreasing ASMRs, respectively. For instance, in the United States of America, the AAPC of ASIRs significantly decreased by 0.62% and ASMRs significantly decreased by 1.22% from 2000 to 2019, while the AAPC from 2015 to 2019 significantly increased by 0.49% for ASIRs and significantly increased by 0.48% for ASMRs.

Conclusion

The magnitude of increasing incidence and decreasing mortality of prostate cancer is attenuated in the recent period. Further study is needed to analyze the absolute effect of risk factors, PSA screening and treatment.

Spatial and temporal patterns of prostate cancer burden and their association with Socio-Demographic Index in Asia, 1990-2019

BACKGROUND

Prostate cancer is the second most frequently diagnosed cancer for males worldwide, but the spatial and temporal trends of prostate cancer burden remain unknown in Asia. This study aimed to investigate the changing spatial and temporal trends of incidence, prevalence, mortality, disability-adjusted life year (DALY), and mortality-to-incidence ratio (MIR) of prostate cancer, and their association with the Socio-Demographic Index (SDI) in 48 Asian countries from 1990 to 2019.

METHODS

Data were extracted from the Global Health Data Exchange query tool, covering 48 Asian countries from 1990 to 2019. The average annual percent change was calculated to evaluate temporal trends. Spatial autocorrelation analysis was used to obtain spatial patterns, and the association between SDI and prostate cancer burden was estimated using a spatial panel model.

RESULTS

In Asia, the age-standardized incidence and prevalence of prostate cancer increased in almost all countries, and its mortality and DALY also increased in over half of the countries. Significantly regional disparities were found in Asia, and the hot spots for incidence, prevalence, mortality, and DALY were all located in Western Asia, the hot spots of percent change also occurred in Western Asia for incidence and DALY. Furthermore, SDI had a positive association with mortality (coef = 2.51, 95% confidence interval [CI]: 2.13-2.90) and negative association with DALY (coef = -14.99, 95% CI: -20.37 to -9.60) and MIR (coef = -0.95, 95%CI: -0.99 to -0.92).

CONCLUSIONS

Prostate cancer burden increased rapidly throughout Asia and substantial disparities had persisted between countries. Geographically targeted interventions are needed to reduce the prostate cancer burden throughout Asia and in specific countries.

Prostate Cancer Disparities in Risk Group at Presentation and Access to Treatment for Asian Americans, Native Hawaiians, and Pacific Islanders: A Study With Disaggregated Ethnic Groups

PURPOSE

We identified (1) differences in localized prostate cancer (PCa) risk group at presentation and (2) disparities in access to initial treatment for Asian American, Native Hawaiian, and Pacific Islander (AANHPI) men with PCa after controlling for sociodemographic factors.

METHODS

We assessed all patients in the National Cancer Database with localized PCa with low-, intermediate-, and high-risk disease who identified as Thai, White, Asian Indian, Chinese, Vietnamese, Korean, Japanese, Filipino, Hawaiian, Pacific Islander, Laotian, Pakistani, Kampuchean, and Hmong. Multivariable logistic regression defined adjusted odds ratios (AORs) with 95% CI of (1) presenting at progressively higher risk group and (2) receiving treatment or active surveillance with intermediate- or high-risk disease, adjusting for sociodemographic and clinical factors.

RESULTS

Among 980,889 men (median age 66 years), all AANHPI subgroups with the exception of Thai (AOR = 0.84 [95% CI, 0.58 to 1.21], P > .05), Asian Indian (AOR = 1.12 [95% CI, 1.00 to 1.25], P > .05), and Pakistani (AOR = 1.34 [95% CI, 0.98 to 1.83], P > .05) men had greater odds of presenting at a progressively higher PCa risk group compared with White patients (Chinese AOR = 1.18 [95% CI, 1.11 to 1.25], P < .001; Japanese AOR = 1.36 [95% CI, 1.26 to 1.47], P < .001; Filipino AOR = 1.37 [95% CI, 1.29 to 1.46], P < .001; Korean AOR = 1.32 [95% CI, 1.18 to 1.48], P < .001; Vietnamese AOR = 1.20 [95% CI, 1.07 to 1.35], P = .002; Laotian AOR = 1.60 [95% CI, 1.08 to 2.36], P = .018; Hmong AOR = 4.07 [95% CI, 1.54 to 10.81], P = .005; Kampuchean AOR = 1.55 [95% CI, 1.03 to 2.34], P = .036; Asian Indian or Pakistani AOR = 1.15 [95% CI, 1.07 to 1.24], P < .001; Native Hawaiians AOR = 1.58 [95% CI, 1.38 to 1.80], P < .001; and Pacific Islanders AOR = 1.58 [95% CI, 1.37 to 1.82], P < .001). Additionally, Japanese Americans (AOR = 1.46 [95% CI, 1.09 to 1.97], P = .013) were more likely to receive treatment compared with White patients.

CONCLUSION

Our findings suggest that there are differences in PCa risk group at presentation by race or ethnicity among Asian American, Native Hawaiian, and Pacific Islander subgroups and that there exist disparities in treatment patterns. Although AANHPI are often studied as a homogenous group, heterogeneity upon subgroup disaggregation underscores the importance of further study to assess and address barriers to PCa care.

Blood and urine biomarkers in prostate cancer: Are we ready for reflex testing in men with an elevated prostate-specific antigen?

Objective

There is no consensus on the role of biomarkers in determining the utility of prostate biopsy in men with elevated prostate-specific antigen (PSA). There are numerous biomarkers such as prostate health index, 4Kscore, prostate cancer antigen 3, ExoDX, SelectMDx, and Mi-Prostate Score that may be useful in this decision-making process. However, it is unclear whether any of these tests are accurate and cost-effective enough to warrant being a widespread reflex test following an elevated PSA. Our goal was to report on the clinical utility of these blood and urine biomarkers in prostate cancer screening.

Methods

We performed a systematic review of studies published between January 2000 and October 2020 to report the available parameters and cost-effectiveness of the aforementioned diagnostic tests. We focus on the negative predictive value, the area under the curve, and the decision curve analysis in comparing reflexive tests due to their relevance in evaluating diagnostic screening tests.

Results

Overall, the biomarkers are roughly equivalent in predictive accuracy. Each test has additional clinical utility to the current diagnostic standard of care, but the added benefit is not substantial to justify using the test reflexively after an elevated PSA.

Conclusions

Our findings suggest these biomarkers should not be used in binary fashion and should be understood in the context of pre-existing risk predictors, patient's ethnicity, cost of the test, patient life-expectancy, and patient goals. There are more recent diagnostic tools such as multi-parametric magnetic resonance imaging, polygenic single-nucleotide panels, IsoPSA, and miR Sentinel tests that are promising in the realm of prostate cancer screening and need to be investigated further to be considered a consensus reflexive test in the setting of prostate cancer screening.

A multicenter retrospective study on evaluation of predicative factors for positive biopsy of prostate cancer in real-world setting

OBJECTIVE

This study aimed to evaluate the predictors for positive biopsy in prostate cancer (PCa) patients and develop a risk-stratification score model for positive biopsy rate in patients with prostate specific antigen (PSA) in the gray zone.

METHODS

In this retrospective, multicenter, real-world study, Chinese patients receiving prostate biopsy for the first time were included. The study evaluated the positive biopsy rate, predictors for positive biopsy and a risk prediction model for PSA 4-10 ng/mL PCa was developed. The univariate and multivariate logistic regression analyses were used to identify the risk factors.

RESULTS

A total of 2426 patients were included in the study. The biopsy positive rate was 47.57%, 25.77%, and 60.57% among overall patients, total PSA (t-PSA) 4-10 ng/mL patients, and PSA > 10 ng/mL patients respectively. Elderly age 60-74, ≥75, multi parametric magnetic resonance imaging (MP-MRI), pre-operative PSA > 10 and PSA density (PSAD) significantly increased the positive rate in overall population, and elderly age, MP-MRI, positive digital rectal examination and f-PSA were significant predictors for positive biopsy in PSA 4-10 ng/mL population. A risk prediction model for positive biopsy rate in patients with PSA in the gray zone was developed. Area under curve (AUC) was associated with low accuracy for all the variables used such as tPSA (0.53), PSAD (0.57), frequency of puncture (0.53) and MP-MRI (0.64) in prediction of biopsy positive rate.

CONCLUSION

Our study evaluated the significant predicative factors for positive biopsy and the PCa risk prediction model developed might help Clinicians to avoid unnecessary biopsy in patients with PSA in gray zone.

Single nucleotide polymorphisms (SNPs) in prostate cancer: its implications in diagnostics and therapeutics

Prostate cancer is one of the most frequently diagnosed malignancies in developed countries and approximately 248,530 new cases of prostate cancer are likely to be diagnosed in the United States in 2021. During the late 1990s and 2000s, the prostate cancer-related death rate has decreased by 4% per year on average because of advancements in prostate-specific antigen (PSA) testing. However, the non-specificity of PSA to distinguish between benign and malignant forms of cancer is a major concern in the management of prostate cancer. Despite other risk factors in the pathogenesis of prostate cancer, recent advancement in molecular genetics suggests that genetic heredity plays a crucial role in prostate carcinogenesis. Approximately, 60% of heritability and more than 100 well-recognized single-nucleotide-polymorphisms (SNPs) have been found to be associated with prostate cancer and constitute a major risk factor in the development of prostate cancer. Recent findings revealed that a low to moderate effect on the progression of prostate cancer of individual SNPs was observed compared to a strong progressive effect when SNPs were in combination. Here, in this review, we made an attempt to critically analyze the role of SNPs and associated genes in the development of prostate cancer and their implications in diagnostics and therapeutics. A better understanding of the role of SNPs in prostate cancer susceptibility may improve risk prediction, enhance fine-mapping, and furnish new insights into the underlying pathophysiology of prostate cancer.

Favorable intermediate risk prostate cancer with biopsy Gleason score of 6

BACKGROUND

To identify potential prognostic factors among patients with favorable intermediate risk prostate cancer with a biopsy Gleason score 6.

METHODS

From 2003 to 2019, favorable intermediate risk patients who underwent radical prostatectomy were included in this study. All patients were evaluated preoperatively with MRI. Using PI-RADS scores, patients were divided into two groups, and clinic-pathological outcomes were compared. The impact of preoperative factors on significant pathologic Gleason score upgrading (≥ 4 + 3) and biochemical recurrence were assessed via multivariate analysis. Subgroup analysis was performed in patients with PI-RADS ≤ 2.

RESULTS

Among the 239 patients, 116 (48.5%) were MRI-negative (PI-RADS ≤ 3) and 123 (51.5%) were MRI-positive (PI-RADS > 3). Six patients in the MRI-negative group (5.2%) were characterized as requiring significant pathologic Gleason score upgrading compared with 34 patients (27.6%) in the MRI-positive group (p < 0.001). PI-RADS score was shown to be a significant predictor of significant pathologic Gleason score upgrading (OR = 6.246, p < 0.001) and biochemical recurrence (HR = 2.595, p = 0.043). 10-years biochemical recurrence-free survival was estimated to be 84.4% and 72.6% in the MRI-negative and MRI-positive groups (p = 0.035). In the 79 patients with PI-RADS ≤ 2, tumor length in biopsy cores was identified as a significant predictor of pathologic Gleason score (OR = 11.336, p = 0.014).

CONCLUSIONS

Among the patients with favorable intermediate risk prostate cancer with a biopsy Gleason score 6, preoperative MRI was capable of predicting significant pathologic Gleason score upgrading and biochemical recurrence. Especially, the patients with PI-RADS ≤ 2 and low biopsy tumor length could be a potential candidate to active surveillance.

Multiparametric MRI in Active Surveillance of Prostate Cancer: An Overview and a Practical Approach

MRI has become important for the detection of prostate cancer. MRI-guided biopsy is superior to conventional systematic biopsy in patients suspected with prostate cancer. MRI is also increasingly used for monitoring patients with low-risk prostate cancer during active surveillance. It improves patient selection for active surveillance at diagnosis, although its role during follow-up is unclear. We aim to review existing evidence and propose a practical approach for incorporating MRI into active surveillance protocols.

Prostate cancer

Prostate cancer is a complex disease that affects millions of men globally, predominantly in high human development index regions. Patients with localized disease at a low to intermediate risk of recurrence generally have a favourable outcome of 99% overall survival for 10 years if the disease is detected and treated at an early stage. Key genetic alterations include fusions of TMPRSS2 with ETS family genes, amplification of the MYC oncogene, deletion and/or mutation of PTEN and TP53 and, in advanced disease, amplification and/or mutation of the androgen receptor (AR). Prostate cancer is usually diagnosed by prostate biopsy prompted by a blood test to measure prostate-specific antigen levels and/or digital rectal examination. Treatment for localized disease includes active surveillance, radical prostatectomy or ablative radiotherapy as curative approaches. Men whose disease relapses after prostatectomy are treated with salvage radiotherapy and/or androgen deprivation therapy (ADT) for local relapse, or with ADT combined with chemotherapy or novel androgen signalling-targeted agents for systemic relapse. Advanced prostate cancer often progresses despite androgen ablation and is then considered castration-resistant and incurable. Current treatment options include AR-targeted agents, chemotherapy, radionuclides and the poly(ADP-ribose) inhibitor olaparib. Current research aims to improve prostate cancer detection, management and outcomes, including understanding the fundamental biology at all stages of the disease.

Prostate cancer

Prostate cancer is a complex disease that affects millions of men globally, predominantly in high human development index regions. Patients with localized disease at a low to intermediate risk of recurrence generally have a favourable outcome of 99% overall survival for 10 years if the disease is detected and treated at an early stage. Key genetic alterations include fusions of TMPRSS2 with ETS family genes, amplification of the MYC oncogene, deletion and/or mutation of PTEN and TP53 and, in advanced disease, amplification and/or mutation of the androgen receptor (AR). Prostate cancer is usually diagnosed by prostate biopsy prompted by a blood test to measure prostate-specific antigen levels and/or digital rectal examination. Treatment for localized disease includes active surveillance, radical prostatectomy or ablative radiotherapy as curative approaches. Men whose disease relapses after prostatectomy are treated with salvage radiotherapy and/or androgen deprivation therapy (ADT) for local relapse, or with ADT combined with chemotherapy or novel androgen signalling-targeted agents for systemic relapse. Advanced prostate cancer often progresses despite androgen ablation and is then considered castration-resistant and incurable. Current treatment options include AR-targeted agents, chemotherapy, radionuclides and the poly(ADP-ribose) inhibitor olaparib. Current research aims to improve prostate cancer detection, management and outcomes, including understanding the fundamental biology at all stages of the disease.

Cost Analysis of Selected Radiotherapeutic Modalities for Prostate Cancer Treatment-Czech Republic Case Study for the Purposes of Hospital Based HTA

This study aims to calculate the costs of prostate cancer radiotherapy in a regional hospital Department of Radiation Oncology equipped with Three-Dimensional Conformal Radiation Therapy (3D-CRT) and Intensity Modulated Radiation Therapy (IMRT) Volumetric Arc Therapy (VMAT) radiation technology, using activity based costing (ABC), and to compare the costs of both methods at the level of component treatment process activities and with respect to insurance reimbursements. The costing was performed based on a sample of 273 IMRT VMAT patients and 312 3D-CRT patients in a regional hospital in the period from 2018 to 2019. The research has highlighted the necessity to place emphasis on factors that may skew the costing results. The resulting output has been supplemented by a sensitivity analysis, whereas the modeled parameter is represented by the time required for one patient fraction on a linear accelerator and the time the Radiology Assistant needs to prepare the complete radiation plan as part of radiotherapy planning. Moreover, the effects of the received grant, in the form of calculated write-offs, are also considered. The case study uses the example of radiotherapy to demonstrate the potential of ABC and suggests considering the application of this method as an effective management tool for cost and economic evaluation as part of comprehensive hospital assessment under the Hospital-Based Health Technology Assessment (HB-HTA) initiative.

Clinical utility of current biomarkers for prostate cancer detection

Although prostate-specific antigen (PSA) remains the most used test to detect prostate cancer (PCa), the limited specificity and an elevated rate of overdiagnosis are the main problems associated with PSA testing. Over the last three decades, a large body of evidence has indicated that PSA screening methods for PCa are problematic, although PSA screening significantly reduces PCa-specific mortality. A number of novel biomarkers have been introduced to overcome these limitations of PSA in the clinical setting. These biomarkers have demonstrated an increased ability to select patients for biopsy and identify men at risk for clinically significant PCa. Although a number of assays require further validation, initial data are promising. Forthcoming results will ultimately determine the clinical utility and commercial availability of these assays. Extensive efforts have recently been made to identify and commercialize novel PCa biomarkers for more effective detection of PCa, either alone or in combination with currently available clinical tools. This review highlights the role of existing and promising serum and urinary biomarkers for the detection and prognostication of PCa before prostate biopsy.

A scientometric study of the top 100 most-cited publications based on Web-of-Science regarding robotic versus laparoscopic surgery

Minimally invasive surgery includes traditional laparoscopic and robot-assisted surgery. Although many studies related to robotic surgery and laparoscopic surgery have been published, when doing our search, scientometric studies that focus on related robotic surgery versus laparoscopic surgery were limited. In this study, we aimed to analyze and review the research hots and research status of robotic surgery versus laparoscopic surgery. We searched publications that involved robotic surgery versus laparoscopic surgery in the Web of Science database from 1980 to May 23, 2020. The top 100 publications were published in 2012 with the number of 17 and citations ranged from 618 to 64. Published across 34 different journals, namely European urology (n = 17) and others, the greatest contribution among 36 institutes was made by the Cleveland Clinic (n = 11). Of the top 100 publications, a total of 429 unique words were identified and the most frequently occurring keyword was laparoscopy (n = 33). The co-occurrence of keywords in the top 100 publications indicated that the study of diseases mainly focused on prostatectomy, complications, prostate cancer, retropubic prostatectomy, nephron-sparing surgery, lymph-node dissection, total mesenteric excision, sexual function, rectal cancer, and assisted distal gastrectomy. In recent years, comparative research on robot and laparoscopic surgery has decreased and most studies focus on cancer.

The Impact of Mobile Health on Cancer Screening: A Systematic Review

Introduction:

Mobile health is an emerging technology around the world that can be effective in cancer screening. This study aimed to examine the effectiveness of mobile health applications on cancer screening.

Methods:

We conducted a systematic literature review of studies related to the use of mobile health applications in cancer screening. We also conducted a comprehensive search of articles on cancer screening related to the use of mobile health applications in journals published between January 1, 2008, and January 31, 2019, using 5 databases: IEEE, Scopus, Web of Science, Science Direct and PubMed.

Results:

A total of 23 articles met the inclusion criteria and were included in the present review. All studies have identified positive effects of applications on cancer screening and clinical health outcomes. Furthermore, more than half of mobile applications had multiple functions such as providing information, planning and education. Moreover, most of the studies, which examined the satisfaction of patients and quality improvement, showed healthcare application users have significantly higher satisfaction of living and it leads to improving quality.

Conclusion:

This study found that the use of mobile health applications has a positive impact on health-related behaviours and outcomes. Application users were more satisfied with applying mobile health applications to manage their health condition in comparison with users who received conventional care.

Development and validation of an explainable artificial intelligence-based decision-supporting tool for prostate biopsy

OBJECTIVES

To develop and validate a risk calculator for prostate cancer (PCa) and clinically significant PCa (csPCa) using explainable artificial intelligence (XAI).

PATIENTS AND METHODS

We used data of 3791 patients to develop and validate the risk calculator. We initially divided the data into development and validation sets. An extreme gradient-boosting algorithm was applied to the development calculator using five-fold cross-validation with hyperparameter tuning following feature selection in the development set. The model feature importance was determined based on the Shapley value. The area under the curve (AUC) of the receiver operating characteristic curve was analysed for each validation set of the calculator.

RESULTS

Approximately 1216 (32.7%) and 562 (14.8%) patients were diagnosed with PCa and csPCa. The data of 2843 patients were used for development, whereas the data of 948 patients were used as a test set. We selected the variables for each PCa and csPCa risk calculation according to the least absolute shrinkage and selection operator regression. The AUC of the final PCa model was 0.869 (95% confidence interval [CI] 0.844-0.893), whereas that of the csPCa model was 0.945 (95% CI 0.927-0.963). The prostate-specific antigen (PSA) level, free PSA level, age, prostate volume (both the transitional zone and total), hypoechoic lesions on ultrasonography, and testosterone level were found to be important parameters in the PCa model. The number of previous biopsies was not associated with the risk of csPCa, but was negatively associated with the risk of PCa.

CONCLUSION

We successfully developed and validated a decision-supporting tool using XAI for calculating the probability of PCa and csPCa prior to prostate biopsy.

Spatial Autocorrelation of Breast and Prostate Cancer in Slovakia

Cancer is one of the dominant causes of death in the Slovak population. Monitoring the course of the cancer death rate in Slovakia can be considered as a relevant subject for geographical research. Relatively little is known about the geographic distribution of breast and prostate cancer incidence in Slovakia. In the submitted paper, it is hypothesized that breast and prostate cancer in the examined territory are characterized by different intensities, incidences, and spatial differences. The spatial patterns of breast and prostate cancer in Slovakia were examined by means of spatial autocorrelation analyses with the Local Moran's I and Anselin Local Moran's statistics. Data on standardized death rates of breast and prostate cancer in Slovakia between 2001 and 2018 were used. Prostate cancer in men and breast cancer in women show a positive statistically significant Global Moran's I, whose values indicate a tendency to cluster. The Anselin Local Moran's I analysis indicates significant clusters of breast cancer in the western part of Slovakia, and prostate cancer clusters mostly in the central part of Slovakia. The findings we have obtained in this study may help us investigate further hypotheses regarding the causes and identification of spatial differences in breast and prostate cancer incidence. Our findings might stimulate further research into the possible causes which underlie the clusters.

Survival Rate of Prostate Cancer in Asian Countries: A Systematic Review and Meta-Analysis

Background:

Prostate cancer is one of the most common health issues among men, especially older men. In recent years, incidences of prostate cancer is increasing.

Objective:

The aim of this study was to provide a comprehensive estimate of the survival of prostate cancer in Asian countries.

Methods:

We searched five international databases including Medline/PubMed, Scopus, Embase, Web of Knowledge and ProQuest until June 1, 2018. The Newcastle-Ottawa Quality Assessment was used to evaluate the quality of selected papers. The review protocol was registered in PROSPERO (CRD42019117044).

Results:

A total of 714 titles were retrieved. Thirty-seven studies met the inclusion criteria. Based on the random-effect model one-year, five-year and ten-year survival rate of prostate cancer were 81% (95% CI 77.8–84.2), 61.9% (95% CI 59.5–64.3) and 36.2% (95% CI 9.2–63.2) respectively. Survival rates based on HDI level for five-year were 30.07, 43.43 and 70.84 percent for medium, high and very high levels, respectively.

Conclusion:

According to the results of our study, the prostate cancer survival rate in Asian countries is relatively lower than in Europe and North America.

Design of a New Peptide Substrate Probe of the Putative Biomarker Legumain with Potential Application in Prostate Cancer Diagnosis Ex Vivo

The lysosomal endoprotease legumain (asparaginyl endoprotease) has been proposed as a putative biomarker in prostate tumours, in which the enzyme is markedly overexpressed. Overexpression, coupled with highly selective specificity for cleavage of substrates at the C-terminus of asparagine (Asn) residues, make legumain an attractive biochemical target for potential diagnosis, prognosis and treatment. We report the design, synthesis, characterisation and preliminary evaluation of a new rhodamine-B (Rho-B)-labelled legumain peptide substrate probe5[Rho-Pro-Ala-Asn-PEG-AQ(4-OH)] and its selective targeting to lysosomes in PC3 prostate cancer cells. Probe5was efficiently activated by recombinant human legumain to afford the high quantum yield reporter fluorophore tripeptide4b(Rho-Pro-Ala-Asn-OH) with concomitant release of intense fluorescence. Furthermore, probe5was activated upon incubation with homogenates derived from fresh-frozen tissue material of prostatectomy specimens. Probe5represents a new viable biochemical tool for probing the activity of legumain with the potential to be used in ex vivo diagnostics in the cancer pathology laboratory.

Total saponins from Paris forrestii (Takht) H. Li. show the anticancer and RNA expression regulating effects on prostate cancer cells

Paris forrestii is a unique plant found in Tibet and Yunnan, China, and total saponins from Paris forrestii (PCT3) contain anticancer steroid glycosides. RNA expression plays an important role in various biological processes. However, the cytotoxicity effects and mechanisms of PCT3 in relation to prostate cancer (PCa) cells have not yet been reported. In the present study, the antitumor activity of PCT3 on PCa cells was evaluated. PCT3 displayed potent anticancer effects toward PCa cells that were similar to the effects of pure saponins from P. forrestii, but PCT3 had less activity in suppressing the prostate epithelial cell line RWPE. Furthermore, using CCK-8 assays, Edu incorporation, colony formation assays, Annexin V/PI assays and western blotting, we found that treatment with 4 μg/mL PCT3 significantly decreased proliferation and induced apoptosis in PCa cells. Using wound healing and transwell assays, we demonstrated that treatment with 2 μg/mL PCT3 significantly suppressed the migration and invasion of PCa cells. To explore the molecular mechanisms behind the anticancer effect of PCT3, PCT3 (5 μg/mL) treated and untreated PCa cells (LNCAP and PC3 cell lines) were analyzed using transcriptomics. Taking the commonly differentially expressed genes (log2FC > 0.585) in both cell lines, 41 mRNAs and 5 lncRNAs were eventually identified. Bioinformatics analysis (GO and KEGG analyses) revealed that some genes involved in classical cell proliferation and apoptosis pathways were aberrantly expressed after PCT3 treatment of PCa cells. By using q-PCR, the expression levels of NEAT1, MALAT1, TIPIN, LYAR, IQGAP3, GINS2, and ZGRF1 were validated as consistent with microarray data, suggesting that these genes might participate in the PCT3 anticancer effect. The present study suggests that PCT3 exhibits an anticancer effect on PCa and reveals some crucial lncRNAs and mRNAs that are involved in the anticancer mechanisms of PCT3 on Pca.

Is active surveillance an appropriate approach to manage prostate cancer patients with Gleason Score 3+3 who met the criteria for active surveillance?

OBJECTIVE

Prostate cancer is one of the common malignant tumors in men worldwide. Nowadays it seems that Gleason Score 3+3 may not need definite treatment and some of the experts even ignore it as a cancer but we should be aware that in some patients with Gleason Score 3+3 there is a higher risk for harboring higher-grade cancer. We had done this study to evaluate patients with prostate cancer with Gleason Score 3+3 to determine the value of tumor volume in these cases.

MATERIAL AND METHODS

From September 2010 to October 2017, radical prostatectomy was done for 123 sequential patients with localized prostate cancer in two referral centers of Shahid Beheshti Medical University, Tehran, Iran, and 42 cases with Gleason Scores 3+3 which who were candidates for active surveillance were included in the study.

RESULTS

Thirty of 42 (71.4%) patients had significant tumor volumes (≥0/5 cm3). When tumor volume was less than 0.5 cm3, none of the patients had extra prostatic tumor extension. In patients with tumor volume greater than 0.5 cm3, two cases (6.6%) had extra prostatic extension, 4 cases (13.3%) had positive margins, four cases (13.3%) reactive lymph nodes and 16 cases (53.3%) perineural invasion.

CONCLUSION

We suggest that some patients with Gleason Score 3+3 have tumor volume >0.5 cm3 who are considered having significant cancer pathology and active surveillance may not be appropriate approach to manage all cases with Gleason Score 3+3.

Improving the detection rate of prostate cancer in the gray zone of PI-RADS v2 and serum tPSA by using prostate-specific antigen-age volume

To improve the detection of prostate cancer (PCa) by combining the Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) and prostate-specific antigen-age volume (PSA-AV), especially among those in gray zone with PI-RADS v2 score 3 or serum total prostate-specific antigen (tPSA) 4 to 10 ng/mL.The 357 patients were enrolled in this study. The PI-RADS v2 scoring system was used to represent characteristics on multiparametric magnetic resonance imaging (mpMRI). PI-RADS v2 score 3 or tPSA 4 to 10 ng/mL were defined as the gray zone in detecting PCa. The formula equates to the patient age multiplied by the prostate volume, which is divided by the tPSA level. Univariate and multivariate analyses were done to ascertain significant predictors of prostate cancer.In all, 174 (48.7%) were benign prostatic hyperplasia, 183 (51.3%) had PCa. The results showed that PI-RADS v2, tPSA, and PSA-AV were significant independent predictors of prostate cancer. PI-RADS v2 score ≥4 could detect PCa with rate of 82.1%. Serum tPSA ≥10 ng/mL could detect PCa with rate of 66.2%, PSA density (PSAD) ≥0.15 ng/mL/cc with rate of 62.8%, and PSA-AV ≤250 with rate of 83.5%. Combining with PSA-AV ≤250, patients those with tPSA 4 to 10 ng/mL could improve the detection from 36.0% up to 81%, those with PI-RADS v2 score 3 from 28.6% up to 60.0%.PI-RADS v2 and PSA-AV are faithful variables for detecting PCa. And for patients, those in gray zones of PI-RADS v2 and tPSA, PSA-AV can improve detection rate of PCa.

Optimizing prostate cancer accumulating model: combined PI-RADS v2 with prostate specific antigen and its derivative data

BACKGROUND

To establish a new accumulating model to enhance the accuracy of prostate cancer (PCa) diagnosis by incorporating prostate-specific antigen (PSA) and its derivative data into the Prostate Imaging-Reporting and Data System version 2 (PI-RADS v2).

METHODS

A total of 357 patients who underwent prostate biopsy between January 2014 and December 2017 were included in this study. All patients had 3.0 T multiparametric magnetic resonance imaging (MRI) and complete laboratory examinations. PI-RADS v2 was used to assess the imaging. PSA, PSA density (PSAD), the free/total PSA ratio (f/t PSA) and the Gleason score (GS) were classified into four-tiered levels, and optimal weights were pursued on these managed levels to build a PCa accumulating model. A receiver operating characteristic curve was generated.

RESULTS

In all, 174 patients (48.7%) had benign prostatic hyperplasia, and 183 (51.3%) had PCa, among whom 149 (81.4%, 149/183) had clinically significant PCa. The established model 6 (PI-RADS v2 + level of PSAD + level of f/t PSA+ level of PSA) had a sensitivity and specificity of 81.4 and 84.5%, respectively, at the cut-off point of 11 in PCa diagnosis. Correspondingly, at the 12 cut-off point, the sensitivity and specificity were 87.7 and 83.0%, respectively, in diagnosing clinically significant PCa. The score of the new accumulating system was significantly different among the defined GS groups (p < 0.001). The mean values and 95% confidence intervals for GS 1-4 groups were 10.20 (9.63-10.40), 12.03 (11.19-12.87), 14.12 (13.60-14.64) and 15.44 (15.09-15.79).

CONCLUSIONS

A new PCa accumulating model may be useful in improving the accuracy of the primary diagnosis of PCa and helpful in the clinical decision to perform a biopsy when MRI results are negative.

Age-Specific Reference Ranges of Prostate-Specific Antigen among Saudi Men as a Representation of the Arab Population

OBJECTIVE

To describe the reference ranges of serum prostate-specific antigen (PSA) in Saudi men. Materials/Subjects and Methods: Saudi males, aged 30 and above, were invited to participate in the study. Blood samples were taken from each subject to determine serum levels of PSA. Blood sugar levels, lipid profile, and anthropometric measurements were also obtained.

RESULTS

Our cohort consisted of 7,814 men; their mean PSA level was 1.24 ng/mL. The majority (90.5%) had PSA values between 0 and 2.5 ng/mL. The median PSA and the 95th percentile increased steadily with age. There was a sharp increase in the 95th percentile, from 3.8 ng/mL in men between 60 and 70 years old to 6.9 ng/mL in men over 71 years old. The 95th percentiles of PSA serum levels were lower in Saudi men than in the general population.

CONCLUSIONS

PSA serum levels in Saudi men are lower than in other communities. Creating age-specific reference ranges could improve the sensitivity of the PSA tests by allowing the detection of treatable tumors in younger men if the threshold of 4.0 ng/mL is lowered. Furthermore, unnecessary biopsies among older men may be avoided if the threshold is increased.

Searching for the Novel Specific Predictors of Prostate Cancer in Urine: The Analysis of 84 miRNA Expression

The aim of this study was to investigate miRNA profiles of clarified urine supernatant and combined urine vesicle fractions of healthy donors and patients with benign prostatic hyperplasia and prostate cancer (PCa). The comparative analysis of miRNA expression was conducted with a custom miRCURY LNA miRNA qPCR panel. Significant combinations of miRNA pairs were selected by the RandomForest-based feature selection algorithm Boruta; the difference of the medians between the groups and a 95% confidence interval was built using the bootstrap approach. The Asymptotic Wilcoxon-Mann-Whitney Test was performed for miRNA combinations to compare different groups of donors. Benjamini-Hochberg correction was used to adjust the statistical significance for multiple comparisons. The most diagnostically significant miRNAs pairs were miR-107-miR-26b.5p and miR-375.3p-miR-26b.5p in the urine supernatant fraction that discriminated the group of healthy patients and PCa patients, as well as miR-31.5p-miR-16.5p, miR-31.5p-miR-200b, miR-31.5p-miR-30e.3p and miR-31.5p-miR-660.5p in the fraction extracellular vesicles that were different between healthy men and benign prostate hyperplasia patients. Such statistical criteria as the occurrence of individual significant miRNA pairs in the total number of comparisons, median ΔCt difference, and confidence interval can be useful tools for determining reliable markers of PCa.

Experimental Evidence of the Antitumor, Antimetastatic and Antiangiogenic Activity of Ellagic Acid

Ellagic acid (EA) is a naturally occurring polyphenolic compound endowed with strong antioxidant and anticancer properties that is present in high quantity in a variety of berries, pomegranates, and dried fruits. The antitumor activity of EA has been mostly attributed to direct antiproliferative and apoptotic effects. Moreover, EA can inhibit tumour cell migration, extra-cellular matrix invasion and angiogenesis, all processes that are crucial for tumour infiltrative behaviour and the metastatic process. In addition, EA may increase tumour sensitivity to chemotherapy and radiotherapy. The aim of this review is to summarize the in vitro and in vivo experimental evidence supporting the anticancer activity of pure EA, its metabolites, and EA-containing fruit juice or extracts in a variety of solid tumour models. The EA oral administration as supportive therapy to standard chemotherapy has been recently evaluated in small clinical studies with colorectal or prostate cancer patients. Novel formulations with improved solubility and bioavailability are expected to fully develop the therapeutic potential of EA derivatives in the near future.

Diagnostic performance of PCA3 and hK2 in combination with serum PSA for prostate cancer

OBJECTIVES

The prostate cancer gene 3 (PCA3), human kallikrein 2, and miRNA-141 are promising prostate cancer (Pca) specific biomarkers. Our aim was to evaluate the detection of PCA3, human glandular kallikrein 2 (hk2), and miRNA-141 mRNA in peripheral blood of patients received prostate biopsy. What's more, we want to detect the value of combination of PSA (prostate specific antigen) in the early diagnosis of PCa.

MATERIALS AND METHODS

Hundred patients were divided into 2 groups according to the results of pathologic diagnosis. Quantitative real-time PCR (qRT-PCR) was used to evaluate the mRNA of PCA3, hk2, and miRNA-141 in peripheral blood. At the same time, analyze those clinical outcomes used in the patients. We compared these different outcomes to evaluate the value of new molecular markers.

RESULTS

The level of mRNA of PCA3, hK2, and miR-141 in Pca group were significantly higher than that in BPH. PSA had the highest sensitivity in predicting Pca diagnosis (76.7%); PCA3 had the highest specificity (82.5%). And the combination of PCA3, PSA, and hK2 improved area under the curve (AUC)-receiver operating characteristic (ROC) curve largely, especially those with PSA 4-10ng/mL.

CONCLUSIONS

PCA3, hK2, and miRNA-141 were biomarkers of Pca with potential clinical application value, especially in patients with PSA gray area. Combining PCA3, PSA, and hK2 performed better than individual biomarkers alone in predicting Pca.

Prediction of unilateral prostate cancer by the combination of transrectal ultrasonography-guided prostate biopsy and multi-parametric magnetic resonance imaging: A real-life experience

Hemi-ablation of prostate cancer (PCa) requires an accurate prediction of laterality. Recently, multi-parametric magnetic resonance imaging (mpMRI) has recently been increasingly used to enhance clinical staging and characterization of tumor foci. Thus, we tried to investigate the real-life accuracy of combinatory approach of using both transrectal ultrasound (TRUS)-guided prostatic biopsy and mpMRI in predicting the laterality of PCa. We reviewed the records of 335 men who were suspected of having unilateral PCa on multi (≥ 12)-core TRUS-guided biopsy and preoperative mpMRI and subsequently had undergone radical prostatectomy (RP) at our institution. Based on the analysis of pathologic outcomes from RP, the performance of the combinatory approach in predicting the pathological laterality of PCa was evaluated. Pathology was classified to be unfavorable when showing a Gleason pattern of 4/5 or pT3/N1 features. Significant cancer was defined as non-organ-confined disease, having a Gleason pattern of 4/5, or showing a cancer volume of ≥ 0.5 mL. Among the 335 unilateral lobes not suspected to harbor tumor from either the TRUS biopsy or mpMRI, the actual absence rate of malignancy was only 13.7% from a pathologic analysis of RP specimens. Even among the 115 D'Amico low-risk group, the absence rate of malignancy was only 26.1% in unilateral lobes not suspected to harbor tumor. Among the 335 lobes, unfavorable pathology and significant cancer were not observed in 36.1% and 30.7%, respectively. The absence rates of unfavorable pathology and significant cancer among the D'Amico low risk group were 56.5% and 47.8%, respectively. Meanwhile, the absence rate of dominant Gleason pattern 4 or 5 was 74.9% among the 335 total subjects. Our real-life clinical experience showed that the combination of multi-core TRUS-guided biopsy and mpMRI did not provide reliable accuracy in the prediction of true unilaterality of PCa.

Colorimetric LAMP microfluidic chip for detecting three allergens: peanut, sesame and soybean

Food allergies can greatly harm people's health, and therefore detecting allergens in foods is extremely important. By integrating loop-mediated isothermal amplification (LAMP) with a microfluidic chip, we have developed a method for detecting the allergen genes of peanut (Arachis hypogaea), sesame (Sesamum indicum), and soybean (Glycine max) using a colorimetric method suitable for the naked eye, known as the colorimetric LAMP microfluidic chip. In the presence of peanut, sesame, or soybean in the samples, the corresponding reaction well of the microfluidic chip will appear pink, or otherwise remain light brown. This method of detection is specific and can easily distinguish these three allergens from others in foods. The detection limit for peanut, sesame and soybean allergens was 0.4 ng/μL using the LAMP-microfluidic chip. The accuracy of this novel and rapid method was validated using allergenic foods obtained commercially and was comparable with that of the typical TaqMan real-time PCR method.

Effects of microRNA‑210 on the diagnosis and treatment of prostate cancer

The present study aimed to investigate the effects of microRNA-210 (miR-210) in the diagnosis and treatment of prostate cancer. Venous blood was collected from 30 prostate cancer patients, that were treated in the Medical Group of Ping Mei Shenma General Hospital (Pingdingshan, China) from June 2013 to May 2015, and 20 healthy men. The miR‑210 expression levels in patients and healthy men was quantified. Primary prostate cancer cells were placed in three treatment groups: i) NC group, untreated; ii) BL group, empty vector; and iii) anti‑miR‑210 group, miR‑210 inhibitor‑transfected. Cell proliferation and apoptotic rate were detected by MTT and flow cytometry, respectively. The expression levels of miR‑210 and regulator of differentiation 1 (ROD1) were detected by reverse transcription‑quantitative polymerase chain reaction (RT‑qPCR) and the ROD1 protein expression in each group was detected by western blotting. Cell proliferation rate of the anti‑miR‑210 group was significantly reduced when compared with the NC and BL groups (P≤0.05); however, the apoptotic rate of the anti‑miR‑210 group was significantly increased compared with the NC and BL groups (P≤0.05). RT‑qPCR revealed that the expression level of miR‑210 and ROD1 in the anti‑miR‑210 group was significantly reduced when compared with the NC and BL groups (P<0.05). MiR‑210 was overexpressed in the serum of prostate cancer patients and transfection with an miR‑210 inhibitor was able to effectively inhibit the proliferation of prostate cancer cells and promote apoptosis.

p27-V109G Polymorphism Is Not Associated with the Risk of Prostate Cancer: A Case-Control Study of Han Chinese Men in Central China

Objective

We conducted an update meta-analysis aiming to verify the association between p27-V109G polymorphism and cancer risk, particular for prostate cancer (PCa). Then, we conducted a case-control study of Han Chinese in central China to verify the evidence-based results.

Methods

Relevant studies were collected from diverse databases up to March 2017. In addition, a hospital-based (H-B) case-control study enrolling 90 PCa patients and 140 healthy controls was included to verify these evidence-based findings. Genetic risk was calculated by odds ratio (OR) with its corresponding 95% confidence interval (CI). The p27-V109G polymorphism was determined by MassARRAY genotyping method.

Results

Finally, twenty-four published studies comprising 9627 cases and 12,102 controls were enrolled for the current meta-analysis. Overall analysis suggested that p27-V109G polymorphism decreased overall cancer risk in allelic contrast, heterozygote, and dominant models. When stratified analysis was conducted by ethnicity, data revealed that p27-V109G polymorphism was associated with a decreased cancer risk in Caucasians. Highlighted in the subgroup analysis by cancer type, we uncovered a significantly decreased risk of PCa in allelic contrast, dominant, homogeneous, and recessive models. However, in the validation case-control study, we failed to uncover a positive association between p27-V109G polymorphism and PCa risk. In addition, negative results were also identified when subgroup analyses were stratified by age, tumor grade, tumor stage, PSA levels, and other measurements.

Conclusion

Although evidence-based results suggest that p27-V109G polymorphism plays a protective role in overall cancer risk, particularly for PCa, our case-control study failed to validate any association between this particular polymorphism and PCa risk.

Attenuation of TGFBR2 expression and tumour progression in prostate cancer involve diverse hypoxia-regulated pathways

Background

Dysregulation of transforming growth factor β (TGF-β) signaling and hypoxic microenvironment have respectively been reported to be involved in disease progression in malignancies of prostate. Emerging evidence indicates that downregulation of TGFBR2, a pivotal regulator of TGF-β signaling, may contribute to carcinogenesis and progression of prostate cancer (PCa). However, the biological function and regulatory mechanism of TGFBR2 in PCa remain poorly understood. In this study, we propose to investigate the crosstalk of hypoxia and TGF-β signaling and provide insight into the molecular mechanism underlying the regulatory pathways in PCa.

Methods

Prostate cancer cell lines were cultured in hypoxia or normoxia to evaluate the effect of hypoxia on TGFBR2 expression. Methylation specific polymerase chain reaction (MSP) and demethylation agents was used to evaluate the methylation regulation of TGFBR2 promoter. Besides, silencing of EZH2 via specific siRNAs or chemical inhibitor was used to validate the regulatory effect of EZH2 on TGFBR2. Moreover, we conducted PCR, western blot, and luciferase assays which studied the relationship of miR-93 and TGFBR2 in PCa cell lines and specimens. We also detected the impacts of hypoxia on EZH2 and miR-93, and further examined the tumorigenic functions of miR-93 on proliferation and epithelial-mesenchymal transition via a series of experiments.

Results

TGFBR2 expression was attenuated under hypoxia. Hypoxia-induced EZH2 promoted H3K27me3 which caused TGFBR2 promoter hypermethylation and contributed to its epigenetic silencing in PCa. Besides, miR-93 was significantly upregulated in PCa tissues and cell lines, and negatively correlated with the expression of TGFBR2. Ectopic expression of miR-93 promoted cell proliferation, migration and invasion in PCa, and its expression could also be induced by hypoxia. In addition, TGFBR2 was identified as a bona fide target of miR-93.

Conclusions

Our findings elucidate diverse hypoxia-regulated pathways including EZH2-mediated hypermethylation and miR-93-induced silencing contribute to attenuation of TGFBR2 expression and promote cancer progression in prostate cancer.

Electronic supplementary material

The online version of this article (10.1186/s13046-018-0764-9) contains supplementary material, which is available to authorized users.