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Jeong JH, Zhong S, Li F, Huang C, Chen X, Liu Q, Peng S, Park H, Lee YM, Dhillon J, Luo JL. Tumor-derived OBP2A promotes prostate cancer castration resistance. J Exp Med 2022; 220:213776. [PMID: 36547668 PMCID: PMC9789742 DOI: 10.1084/jem.20211546] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 06/22/2022] [Accepted: 11/17/2022] [Indexed: 12/24/2022] Open
Abstract
Androgen deprivation therapy (ADT) is a systemic therapy for advanced prostate cancer (PCa); although most patients initially respond to ADT, almost all cancers eventually develop castration-resistant PCa (CRPC). Currently, most research focuses on castration-resistant tumors, and the role of tumors in remission is almost completely ignored. Here, we report that odorant-binding protein (OBP2A) released from tumors in remission during ADT catches survival factors, such as CXCL15/IL8, to promote PCa cell androgen-independent growth and enhance the infiltration of myeloid-derived suppressor cells (MDSCs) into tumor microenvironment, leading to the emergence of castration resistance. OBP2A knockdown significantly inhibits CRPC and metastatic CRPC development and improves therapeutic efficacy of CTLA-4/PD-1 antibodies. Treatment with OBP2A-binding ligand α-pinene interrupts the function of OBP2A and suppresses CRPC development. Furthermore, α-pinene-conjugated doxorubicin/docetaxel can be specifically delivered to tumors, resulting in improved anticancer efficacy. Thus, our studies establish a novel concept for the emergence of PCa castration resistance and provide new therapeutic strategies for advanced PCa.
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Affiliation(s)
- Ji-Hak Jeong
- Department of Molecular Medicine, The Scripps Research Institute, Jupiter, FL, USA,Vessel-Organ Interaction Research Center (VOICE, MRC), College of Pharmacy, Kyungpook National University, Daegu, South Korea
| | - Shangwei Zhong
- Department of Molecular Medicine, The Scripps Research Institute, Jupiter, FL, USA,The Cancer Research Institute, Hengyang Medical School, University of South China, Hengyang, China
| | - Fuzhuo Li
- Department of Chemistry, The Scripps Research Institute, Jupiter, FL, USA
| | - Changhao Huang
- Department of Molecular Medicine, The Scripps Research Institute, Jupiter, FL, USA
| | - Xueyan Chen
- Department of Molecular Medicine, The Scripps Research Institute, Jupiter, FL, USA
| | - Qingqing Liu
- The Cancer Research Institute, Hengyang Medical School, University of South China, Hengyang, China
| | - Shoujiao Peng
- Department of Molecular Medicine, The Scripps Research Institute, Jupiter, FL, USA
| | - HaJeung Park
- X-ray Core Facility, The Scripps Research Institute, Jupiter, FL, USA
| | - You Mie Lee
- Vessel-Organ Interaction Research Center (VOICE, MRC), College of Pharmacy, Kyungpook National University, Daegu, South Korea
| | | | - Jun-Li Luo
- Department of Molecular Medicine, The Scripps Research Institute, Jupiter, FL, USA,The Cancer Research Institute, Hengyang Medical School, University of South China, Hengyang, China,Correspondence to Jun-Li Luo:
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2
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Essential of Immediate Exercises on Cancer-Related Fatigue in Patients with Prostate Cancer Receiving Androgen Deprivation Therapy: A Meta-Analysis of Randomized Controlled Trials. Semin Oncol Nurs 2022:151368. [DOI: 10.1016/j.soncn.2022.151368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 12/12/2022]
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3
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Papadopoulos E, Leach HJ, Tomlinson G, Durbano S, Danyluk JM, Sabiston CM, Mina DS, Alibhai SMH, Culos-Reed SN. Factors predicting gains in moderate-to-vigorous physical activity in prostate cancer survivors on androgen deprivation therapy. Support Care Cancer 2022; 30:9011-9018. [PMID: 35948848 DOI: 10.1007/s00520-022-07300-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/24/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Whether individual, environmental, and psychosocial factors predict changes in moderate-to-vigorous physical activity (MVPA) is poorly addressed in prostate cancer (PC) survivors undergoing androgen deprivation therapy (ADT). PURPOSE This secondary analysis of a randomized controlled trial examined changes in MVPA following a supervised personal training (PT), supervised group-based (GROUP) program, or a home-based, smartphone-assisted exercise (HOME) intervention in PC survivors on ADT and explored individual, environmental, and psychosocial predictors of MVPA. METHODS PC survivors on ADT underwent aerobic and resistance training for 6 months via PT, GROUP, or HOME. MVPA was captured via accelerometers and the Godin Leisure-Time Exercise Questionnaire. Changes in MVPA between groups were assessed using linear regression. The following predictors of MVPA were examined using Spearman correlations: the Neighborhood Environment Walkability Scale (NEWS); the Planning, Attitudes, and Behaviours (PAB) scale; the Relatedness to Others in Physical Activity Scale (ROPAS); and individual factors at baseline. RESULTS Participants (n = 37) were 69.4 ± 6.5 years old and 78.4% were on ADT for ≥ 3 months. Changes in accelerometry-based bouts and MVPA as well as self-reported MVPA did not differ between groups at 6 months. The Aesthetics domain of the NEWS questionnaire at baseline was the strongest predictor of positive MVPA changes (r = .66). Attitude (r = .64), planning (r = .57), and motivation (r = .50) at baseline were also predictive of engaging in higher MVPA throughout the intervention. CONCLUSION Changes in objective MVPA were modest. Additional emphasis on specific psychosocial and individual factors is important to inform theory-based interventions that can foster PA behavior change in PC survivors on ADT. Registration # NCT02046837.
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Affiliation(s)
| | - Heather J Leach
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA.,Department of Community and Behavioral Health, Colorado School of Public Health, Fort Collins, CO, USA
| | - George Tomlinson
- Department of Medicine, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Sara Durbano
- Department of Medicine, University Health Network, Toronto, ON, Canada
| | | | - Catherine M Sabiston
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Shabbir M H Alibhai
- Department of Medicine, University Health Network, Toronto, ON, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
| | - S Nicole Culos-Reed
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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4
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Hawthorne B, Lund K, Freggiaro S, Kaga R, Meng J. The mechanism of the cytotoxic effect of Panax notoginseng extracts on prostate cancer cells. Biomed Pharmacother 2022; 149:112887. [PMID: 35367754 DOI: 10.1016/j.biopha.2022.112887] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION Panax notoginseng (Burkill) F.H. commonly referred to as Sanqi, is a Chinese herb that has long been used to treat various conditions including blood disorders and cardiovascular diseases. While Panax notoginseng has been used as an anti-cancer medicinal herb in recent years, how it achieves this therapeutic effect has not been thoroughly elucidated. The purpose of this study was to reveal more about the mechanism of the cytotoxic effect of Panax notoginseng on prostate cancer (PCa) cells. METHODS Ethanol extract of Panax notoginseng root was authenticated using high-performance liquid chromatography (HPLC). The cytotoxic activity of this herb against PCa cells was determined using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) method, flow cytometry, and enzyme-linked immunosorbent assay (ELISA). RESULTS The assessment of cellular metabolic activity demonstrated that Panax notoginseng reduces the viability of LNCaP and 22Rv1 cells in a dose-dependent manner. Annexin-V binding flow cytometry assay showed that Panax notoginseng induces apoptosis in PCa cells. Cell cycle analysis by quantification of DNA content using flow cytometry showed that Panax notoginseng arrests the cell cycle at the G2/M phase in both LNCaP and 22Rv1 cells. Moreover, ELISA demonstrated that Panax notoginseng-treated PCa cells secrete significantly less tumor-promoting cytokine interleukin-4 (IL-4) to the supernatant compared with controls. CONCLUSIONS These results provide evidence for the cytotoxic effects of Panax notoginseng on PCa cell lines. This botanical is a promising candidate for the complementary and integrative medicine treatment of PCa and further studies are indicated to determine the anti-cancer mechanism of Panax notoginseng.
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Affiliation(s)
- Benjamin Hawthorne
- School of Naturopathic Medicine, Bastyr University, 14500 Juanita Drive NE, Kenmore, WA 98028, USA
| | - Kaleb Lund
- School of Naturopathic Medicine, Bastyr University, 14500 Juanita Drive NE, Kenmore, WA 98028, USA
| | - Sydney Freggiaro
- School of Naturopathic Medicine, Bastyr University, 14500 Juanita Drive NE, Kenmore, WA 98028, USA
| | - Risa Kaga
- School of Natural Health Arts & Sciences, Bastyr University, 14500 Juanita Drive NE, Kenmore, WA 98028, USA
| | - Jing Meng
- School of Natural Health Arts & Sciences, Bastyr University, 14500 Juanita Drive NE, Kenmore, WA 98028, USA.
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5
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Aydh A, Motlagh RS, Alshyarba M, Mori K, Katayama S, Grossmann N, Rajwa P, Mostafai H, Laukhtina E, Pradere B, Quhal F, König F, Nyirady P, Karakiewicz PI, Haydter M, Shariat SF. Association of statins use and mortality outcomes in prostate cancer patients who received androgen deprivation therapy: a systematic review and meta-analysis. Cent European J Urol 2022; 74:484-490. [PMID: 35083066 PMCID: PMC8771132 DOI: 10.5173/ceju.2021.0260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/01/2021] [Accepted: 11/29/2021] [Indexed: 01/10/2023] Open
Abstract
Introduction While several recent studies investigated the influence of statins on survival outcomes in prostate cancer (PCa) patients on androgen deprivation therapy (ADT), definitive conclusions are still missing. The present systematic review and meta-analysis aimed to develop an overarching framework for the association of statins use and survival outcomes in PCa patients who receive ADT. Material and methods We conducted a systematic review and meta-analysis of the literature assessing the survival outcomes for statin compared to non-statin users in PCa patients who received ADT. We searched PubMed and Web of Science for studies published before March 1, 2021. We used the random effect model in the presence of heterogeneity and the fixed-effects model in the absence of heterogeneity per the I2 statistic. We did two meta-analyses; the primary meta-analysis was accomplished for articles reporting cancer-specific survival (CSS) as an outcome. A secondary meta-analysis was completed for articles reporting overall survival (OS) as an outcome. Results Ten studies were eligible for inclusion. Nine studies included in the first meta-analysis comprising 136,285 patients showed no statistically significant difference in CSS (HR 0.77; 95% CI 0.49–1.21) between statin users and non-users in PCa patients who received ADT. In four studies included in the second meta-analysis comprising 95,032 patients, statin users had a significantly better OS compared to non-users (HR 0.67; 95% CI 0.62–0.73). Conclusions Although the combination of statins and ADT in PCa patients significantly improves OS, it seems not to be through an effect on cancer-specific factors.
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Affiliation(s)
- Abdulmajeed Aydh
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Department of Urology, King Faisal Medical City, Abha, Saudi Arabia
| | - Reza Sari Motlagh
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Keiichiro Mori
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Satoshi Katayama
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Nico Grossmann
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Pawel Rajwa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Hadi Mostafai
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Fahad Quhal
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Frederik König
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Nyirady
- Department of Urology, Semmelweis University, Budapest, Hungary
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health outcomes Unit, University of Montreal Health Center, Montreal, Canada
| | - Martin Haydter
- Department of Urology, Landesklinikum Wiener Neustadt, Vienna, Austria
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.,Department of Urology, Weill Cornell Medical College, New York, USA.,European Association of Urology Research Foundation, Arnhem, Netherlands
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6
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Zhong S, Jeong JH, Huang C, Chen X, Dickinson SI, Dhillon J, Yang L, Luo JL. Targeting INMT and interrupting its methylation pathway for the treatment of castration resistant prostate cancer. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2021; 40:307. [PMID: 34587977 PMCID: PMC8482636 DOI: 10.1186/s13046-021-02109-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/19/2021] [Indexed: 02/07/2023]
Abstract
Background Castration-resistant prostate cancer (CRPC) is associated with a very poor prognosis, and the treatment of which remains a serious clinical challenge. Methods RNA-seq, qPCR, western blot and immunohistochemistry were employed to identify and confirm the high expression of indolethylamine N-methyltransferase (INMT) in CRPC and the clinical relevance. Chip assay was used to identify Histone-Lysine N-Methyltransferase (SMYD3) as a major epigenetic regulator of INMT. LC-MS/MS were used to identify new substrates of INMT methylation in CRPC tissues. Gene knockdown/overexpression, MTT and mouse cancer models were used to examine the role of INMT as well as the anticancer efficacy of INMT inhibitor N,N-dimethyltryptamine (DMT), the SMYD3 inhibitor BCl-12, the selenium compounds methaneseleninic acid (MSA) and Se-(Methyl)selenocysteine hydrochloride (MSC), and the newly identified endogenous INMT substrate Bis(7)-tacrine. Results We found that the expression of INMT was highly increased in CRPC and was correlated with poor prognosis of clinical prostate cancer (PCa). INMT promoted PCa castration resistance via detoxification of anticancer metabolites. Knockdown of INMT or treatment with INMT inhibitor N,N-dimethyltryptamine (DMT) significantly suppressed CRPC development. Histone-Lysine N-Methyltransferase SMYD3 was a major epigenetic regulator of INMT expression, treatment with SMYD3 inhibitor BCl-121 suppressed INMT expression and inhibits CRPC development. Importantly, INMT knockdown significantly increased the anticancer effect of the exogenous selenium compounds methaneseleninic acid (MSA) and Se-(Methyl)selenocysteine hydrochloride (MSC) as well as the endogenous metabolite Bis(7)-tacrine. Conclusions Our study suggests that INMT drives PCa castration resistance through detoxification of anticancer metabolites, targeting INMT or its regulator SMYD3 or/and its methylation metabolites represents an effective therapeutic avenue for CRPC treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s13046-021-02109-z.
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Affiliation(s)
- Shangwei Zhong
- Department of Molecular Medicine, The Scripps Research Institute, Jupiter, FL, 33458, USA
| | - Ji-Hak Jeong
- Department of Molecular Medicine, The Scripps Research Institute, Jupiter, FL, 33458, USA.,College of Pharmacy, Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, 41566, Republic of Korea
| | - Changhao Huang
- Department of Molecular Medicine, The Scripps Research Institute, Jupiter, FL, 33458, USA
| | - Xueyan Chen
- Department of Molecular Medicine, The Scripps Research Institute, Jupiter, FL, 33458, USA
| | | | - Jasreman Dhillon
- Department of Pathology, Moffitt Cancer Center, 2902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Li Yang
- Department of Molecular Medicine, The Scripps Research Institute, Jupiter, FL, 33458, USA. .,Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, People's Republic of China.
| | - Jun-Li Luo
- Department of Molecular Medicine, The Scripps Research Institute, Jupiter, FL, 33458, USA.
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7
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Salvage Radical Prostatectomy for Radio-Recurrent Prostate Cancer: An Updated Systematic Review of Oncologic, Histopathologic and Functional Outcomes and Predictors of Good Response. ACTA ACUST UNITED AC 2021; 28:2881-2892. [PMID: 34436018 PMCID: PMC8395524 DOI: 10.3390/curroncol28040252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 07/26/2021] [Indexed: 11/23/2022]
Abstract
A valid treatment option for recurrence after definite radiotherapy (RT) for localized prostate cancer (PC) is salvage radical prostatectomy (SRP). However, data on SRP are scarce, possibly resulting in an underutilization. A systematic review was performed using MEDLINE (Pubmed), Embase, and Web of Science databases including studies published between January 1980 and April 2020. Overall, 23 English language articles including a total number of 2323 patients were selected according to PRISMA criteria. The overall median follow-up was 37.5 months (IQR 35.5–52.5). Biochemical-recurrence (BCR)-free probability ranged from 34% to 83% at five years, respectively, and from 31% to 37% at 10 years. Cancer specific survival (CSS) and overall survival (OS) ranged from 88.7% to 98% and 64% to 95% at five years and from 72% to 83% and 65% to 72% at 10 years, respectively. Positive surgical margins ranged from 14% to 45.8% and pathologic organ-confined disease was reported from 20% to 57%. The rate of pathologic > T2-disease ranged from 37% to 80% and pN1 disease differed between 0% to 78.4%. Pre-SRP PSA, pre-SRP Gleason Score (GS), pathologic stage after SRP, and pathologic lymph node involvement seemed to be the strongest prognostic factors for good outcomes. SRP provides accurate histopathological and functional outcomes, as well as durable cancer control. Careful patient counseling in a shared decision-making process is recommended.
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8
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Sattar S, Haase KR, Bradley C, Papadopoulos E, Kuster S, Santa Mina D, Tippe M, Kaur A, Campbell D, Joshua AM, Rediger C, Souied O, Alibhai S. Barriers and facilitators related to undertaking physical activities among men with prostate cancer: a scoping review. Prostate Cancer Prostatic Dis 2021; 24:1007-1027. [PMID: 34108646 DOI: 10.1038/s41391-021-00399-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/30/2021] [Accepted: 05/19/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Prostate cancer (PC) and its treatments lead to significant acute, chronic, or latent adverse effects that result in declines in patients' physical functions, quality of life and reduced sense of masculinities. Robust evidence shows that physical activity (PA) can improve many health outcomes in men with PC; however, less is known about the facilitators, preferences, and barriers to PA engagement in this population. The purpose of this scoping review is to document the nature and extent of literature related to these aspects of PA participation among men with PC. METHODS We conducted a scoping review of PA among men with PC. Databases searched included Medline, CINAHL, Embase, Rehabilitation & Sports Medicine Source, and SportDiscus from inception to June 30, 2020. Multiple reviewers were used in all screening and data abstractions. RESULTS The search yielded 2788 individual citations after duplicates were removed. Following title and abstract screening, 129 underwent full-text review, and 46 articles were included. Quantitative data related to our research question showed that structured group exercise was the most commonly reported facilitator/preference among men with PC, whereas treatment-related effects and lack of time are the most common barriers. In terms of qualitative data, the most prominent theme noted related to masculinities and gender-specific needs within the context of having PC. CONCLUSION Men with PC have unique facilitators and barriers concerning PA. More work is needed from the research and clinical practice perspectives to enable this population to engage and remain in regular PA.
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Affiliation(s)
- S Sattar
- College of Nursing, University of Saskatchewan, Regina, SK, Canada.
| | - K R Haase
- Faculty of Applied Science, School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - C Bradley
- Library, University of Regina, Regina, SK, Canada
| | - E Papadopoulos
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - S Kuster
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, SK, Canada
| | - D Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada
| | - M Tippe
- Patient consultant, Toronto, ON, Canada
| | - A Kaur
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada
| | - D Campbell
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada
| | - A M Joshua
- Department of Medical Oncology, Kinghorn Cancer Centre; Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - C Rediger
- Saskatchewan Health Authority, Regina, SK, Canada
| | - O Souied
- Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - S Alibhai
- University Health Network, Toronto, ON, Canada.,Department of Medicine, Institute of Health Policy, Management, and Evaluation, Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
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9
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Bressi B, Cagliari M, Contesini M, Mazzini E, Bergamaschi FAM, Moscato A, Bassi MC, Costi S. Physical exercise for bone health in men with prostate cancer receiving androgen deprivation therapy: a systematic review. Support Care Cancer 2021; 29:1811-1824. [PMID: 33119791 PMCID: PMC7892525 DOI: 10.1007/s00520-020-05830-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/13/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE Androgen deprivation therapy (ADT) is a treatment used in men with prostate cancer (PCa); however it is responsible for many adverse effects, with negative impact on quality of life. ADT causes loss of bone mineral density (BMD) and skeletal muscle mass, alteration of body composition, and cognitive function, which altogether lead to increased risk of accidental falls and fractures. This systematic review analyses the effectiveness of physical exercise (PE) in preventing accidental falls and fractures and reducing the loss of BMD in men with PCa receiving ADT. METHODS We searched MEDLINE, EMBASE, CINAHL, and the Cochrane Library for articles between database inception and September 2, 2020. Eligible studies included randomized controlled trials (RCTs) investigating the effects of exercise on bone health in men with PCa receiving ADT. RESULTS Nine RCTs were included. Experimental PE consisted in multicomponent programmes that involved aerobic, resistance, impact-loading exercise, and football training. None of the RCTs investigated the risk of accidental falls and fractures, while two trials reported beneficial effects of PE on lumbar spine, hip, and femoral shaft BMD. No further significant difference was detected in the outcomes investigated. CONCLUSION Evidence of the effectiveness of PE to prevent the risk of accidental falls and fractures and BMD loss is lacking. Nevertheless, clinical guidelines recommend PE as a part of the clinical management of men with PCa receiving ADT due to its known numerous health benefits. Research should focus on PE strategies to prevent accidental falls, a clinically relevant outcome in this vulnerable population. TRIAL REGISTRATION The study protocol was registered with International Prospective Register of Systematic Reviews (PROSPERO, number CRD 42020158444 ) on 04/28/2020.
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Affiliation(s)
- Barbara Bressi
- PhD Program in Clinical and Experimental Medicine, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Reggio Emilia, Italy.
- Physical Medicine and Rehabilitation Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | - Maribel Cagliari
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Massimiliano Contesini
- Human Resource Development - Training Radiographers and Radiations Terapist, Azienda USL-IRCCS di Reggio Emilia , Reggio Emilia, Italy
| | - Elisa Mazzini
- Medical Directorate Hospital Network, Azienda USL-IRCCS di Reggio Emilia , Reggio Emilia, Italy
| | - Franco Antonio Mario Bergamaschi
- Urology and Mininvasive Surgery, Department of General and Specialist Surgeries, Azienda USL-IRCCS di Reggio Emilia , Reggio Emilia, Italy
| | - Alfredo Moscato
- Urology and Mininvasive Surgery, Department of General and Specialist Surgeries, Azienda USL-IRCCS di Reggio Emilia , Reggio Emilia, Italy
| | - Maria Chiara Bassi
- Medical Library, Azienda USL-IRCCS di Reggio Emilia , Reggio Emilia, Italy
| | - Stefania Costi
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Scientific Directorate , Azienda USL-IRCCS di Reggio Emilia , Reggio Emilia, Italy
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10
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Ribeiro AM, Nammur LG, Mateus-Vasconcelos ECL, Ferreira CHJ, Muglia VF, de Oliveira HF. Pelvic floor muscles after prostate radiation therapy: morpho-functional assessment by magnetic resonance imaging, surface electromyography and digital anal palpation. Int Braz J Urol 2020; 47:120-130. [PMID: 33047917 PMCID: PMC7712707 DOI: 10.1590/s1677-5538.ibju.2019.0765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/12/2020] [Indexed: 11/21/2022] Open
Abstract
Aim: To evaluate the radiotherapy (RT) effect in the pelvic floor muscles (PFM) function in men with prostate cancer (PC). Materials and Methods: A cross-sectional study included three groups of patients with PC and RT indication: 1) Pre-RT group: evaluated before the beginning of RT; 2) Acute group: evaluated between six months and one year after RT; 3) Late Group: evaluated between two and a half years and four years post-RT. PFM assessment was divided into: a) functional assessment through the digital anal palpation (Modified Oxford Scale) and surface electromyography (sEMG) with anal probe; b) anatomical assessment by pelvic magnetic resonance imaging (MRI) with thickness measurements of levator ani muscle and pelvic specific parameters at rest and under Valsalva maneuver. We used Student t test, considering as significant p <0.05. Results: Thirty-three men were assessed: Pre-RT (n=12); Acute (n=10) and Late (n=11) groups. PFM functional assessment showed Late group with lower electromyographic activity, especially in the sustained contractions when compared to the Pre-RT (p=0.003) and Acute groups (p=0.006). There was no significant difference between groups in MRI. Conclusion: PFM functional assessment showed a decrease in sEMG activity in the Late group post-RT. Most of the sample (72.7%) did not know how to actively contract the PFM or had a weak voluntary contraction when assessed by digital anal palpation. Also, these patients presented higher prevalence of pelvic complaints. No changes were observed in the morpho-functional parameters evaluated by MRI, except the measurement of the membranous urethra length when comparing Pre-RT Group and Acute and Late Groups.
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Affiliation(s)
- Aline Moreira Ribeiro
- Departamento de Ciências da Saúde, Curso de Educação Física, Centro Mineiro do Ensino Superior, Campo Belo, MG, Brasil
| | - Larissa Guerra Nammur
- Faculdade de Fisioterapia e Educação Física, Universidade Federal de Uberlândia, Uberlândia, MG, Brasil
| | | | - Cristine Homsi Jorge Ferreira
- Departamento de Biomecânica, Medicina e Reabilitação do Sistema Locomotor, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Valdair Francisco Muglia
- Departamento de Clínica Médica, Divisão de Radiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Harley Francisco de Oliveira
- Departamento de Clínica Médica, Divisão de Radioterapia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Yan M, Moideen N, Bratti VF, Moraes FYD. Stereotactic body radiotherapy (SBRT) in metachronous oligometastatic prostate cancer: a systematic review and meta-analysis on the current prospective evidence. Br J Radiol 2020; 93:20200496. [PMID: 32822547 DOI: 10.1259/bjr.20200496] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE In contrast to traditional views of incurability, patients with oligometastatic disease present with an opportunity for disease eradication with aggressive treatment. There is mounting evidence in support of the role of stereotactic body radiotherapy (SBRT) in oligometastatic prostate cancer (OMPC). METHODS MEDLINE and EMBASE were queried for prospective cohort studies reporting the outcomes of metachronous OMPC treated with SBRT. The primary outcome was overall local control. Secondary outcomes included androgen deprivation therapy-free survival (ADTFS), biochemical recurrence free survival (BCFS), and progression-free survival (PFS). When appropriate, these endpoints were combined in a meta-analysis. RESULTS We screened 356 abstracts and identified 10 studies to include in our analysis, with a total of 653 patients and 1,111 lesions. The maximum number of lesions included in any single study ranged from 3 to 5. PET-CT staging occurred in 92.4% of all patients. SBRT dose varied, with BED1.5 ranging from 152 to 408. Only one Grade 3 bone toxicity was observed. Meta-analysis reported an overall local control rate of 97% (95% CI, 94-100). Median ADTFS was 24.7 months (95% CI, 20.1-29.2 months). Two-year BCFS, PFS, and ADTFS were 33% (95% CI, 11-55), 39% (95% CI, 24-54), and 52% (95%CI, 41-62), respectively. Patients treated with SBRT were half as likely to experience PSA progression than those on observation when looking at randomized control trial data alone. CONCLUSION SBRT appears to be effective in controlling overall disease burden in metachronous OMPC patients and is associated with minimal significant toxicity. The current prospective literature is scarce, and further prospective data are needed to guide treatment recommendations. ADVANCES IN KNOWLEDGE This study provides a comprehensive summary of the prospective evidence reporting the outcomes of SBRT in the management of OMPC patients. We quantify the rates of local control, biochemical-free recurrence, progression-free survival, and ADT-free survival through meta-analysis.
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Affiliation(s)
- Michael Yan
- Department of Oncology, Cancer Centre of Southeastern Ontario, Queen's University, Kingston, Canada
| | - Nikitha Moideen
- Department of Oncology, Cancer Centre of Southeastern Ontario, Queen's University, Kingston, Canada
| | | | - Fabio Ynoe de Moraes
- Department of Oncology, Cancer Centre of Southeastern Ontario, Queen's University, Kingston, Canada
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13
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Hong JH, Huang CY, Chang CH, Muo CH, Jaw FS, Lu YC, Chung CJ. Different androgen deprivation therapies might have a differential impact on cognition - An analysis from a population-based study using time-dependent exposure model. Cancer Epidemiol 2020; 64:101657. [PMID: 31918180 DOI: 10.1016/j.canep.2019.101657] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 12/03/2019] [Accepted: 12/06/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Androgen deprivation therapy (ADT) remains the mainstay treatment for locally advanced or metastatic prostate cancer (PC). However, potential effects of ADT treatment on neurocognitive dysfunction remain unclear. The present study was conducted to assess the relation between ADT treatment and risk of cognitive decline in Asian men with PC. METHODS A population-based cohort of 24,464 men with PC, each newly diagnosed between 2000 and 2008, was selected from the Taiwan National Health Insurance Database. Subjects were further grouped by treatment as non-ADT (n = 4685) or ADT (n = 12,740), members of the latter subjected to bilateral orchiectomy or medical treatment (ie, luteinizing hormone-releasing hormone agonists, antiandrogens, or combination therapy). A multivariable Cox proportional hazard model with ADT as time-dependent covariate was used to generate adjusted hazard ratios (HRs) of subsequent cognitive decline, including dementia, Alzheimer's disease (AD), and Parkinson's disease (PD). RESULTS ADT showed a significant association with overall risk of cognitive decline (HR = 1.51, 95 % CI: 1.31-1.74), especially for PD, dementia, and non-Alzheimer dementia (non-AZD). When stratified by various ADT regimens, antiandrogen-only recipients displayed significantly heightened risks of subsequent AD, non-AZD, and PD. However, combined androgen blockade also imposed an increased risk of PD. There was no apparent correlation between duration of ADT exposure and cognitive dysfunction. CONCLUSIONS Various ADT therapies may have disparate impacts on cognitive function. Prospective studies exploring pertinent clinical characteristics more fully are needed to confirm these findings.
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Affiliation(s)
- Jian-Hua Hong
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan; Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Chao-Yuan Huang
- Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Chao-Hsiang Chang
- Department of Urology, China Medical University and Hospital, Taichung, Taiwan; Department of Medicine, College of Medicine, China Medical University and Hospital, Taichung, Taiwan.
| | - Chih-Hsin Muo
- Management Office for Health Data, China Medical University and Hospital, Taichung, Taiwan.
| | - Fu-Shan Jaw
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.
| | - Yu-Chuan Lu
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan; Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Chi-Jung Chung
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
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Inoue S, Hayashi T, Teishima J, Matsubara A. Prevalence of hand joint symptoms in androgen deprivation therapy among japanese patients with prostate cancer. UROLOGICAL SCIENCE 2020. [DOI: 10.4103/uros.uros_41_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Avenell A, Stewart F, Grey A, Gamble G, Bolland M. An investigation into the impact and implications of published papers from retracted research: systematic search of affected literature. BMJ Open 2019; 9:e031909. [PMID: 31666272 PMCID: PMC6830710 DOI: 10.1136/bmjopen-2019-031909] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 09/03/2019] [Accepted: 09/10/2019] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Analyses of the impact of a body of clinical trial reports subject to research misconduct have been few. Our objective was to examine the impact on clinically relevant research of a group of researchers' trial reports ('affected trial reports') affected by research misconduct, and whether identification of misconduct invoked a reappraisal. DESIGN In 2016, we used five databases and search engines to identify 'citing publications', that is, guidelines, systematic and other reviews, and clinical trials citing any of 12 affected trial reports, published 1998-2011, eventually retracted for research misconduct. The affected trial reports were assessed more likely to have had impact because they had hip fracture outcomes and were in journals with impact factor >4. Two authors assessed whether findings of the citing publications would change if the affected trial reports were removed. In 2018, we searched for evidence that the citing publications had undertaken a reassessment as a result of the potential influence of the affected trial reports. RESULTS By 2016 the affected trial reports were cited in 1158 publications, including 68 systematic reviews, meta-analyses, narrative reviews, guidelines and clinical trials. We judged that 13 guidelines, systematic or other reviews would likely change their findings if the affected trial reports were removed, and in another eight it was unclear if findings would change. By 2018, only one of the 68 citing publications, a systematic review, appeared to have undertaken a reassessment, which led to a correction. CONCLUSIONS We found evidence that this group of affected trial reports distorted the evidence base. Correction of these distortions is slow, uncoordinated and inconsistent. Unless there is a rapid, systematic, coordinated approach by bibliographic databases, authors, journals and publishers to mitigate the impact of known cases of research misconduct, patients, other researchers and their funders may continue to be adversely affected.
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Affiliation(s)
- Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Fiona Stewart
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Andrew Grey
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Greg Gamble
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Mark Bolland
- Department of Medicine, University of Auckland, Auckland, New Zealand
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Wolny-Rokicka E, Tukiendorf A, Wydmański J, Ostrowska M, Zembroń-Łacny A. Lipid Status During Combined Treatment in Prostate Cancer Patients. Am J Mens Health 2019; 13:1557988319876488. [PMID: 31559896 PMCID: PMC6767737 DOI: 10.1177/1557988319876488] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The aim of this study was to provide a specific review of current medical literature regarding the lipid profile during prostate carcinoma (PCa) treatment. The main aim was to analyze the results presented by different authors and to find a commonality in the changes occurring during the treatment-hormonotherapy. The levels of total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL) cholesterol, and low-density lipoprotein (LDL) cholesterol were measured before and after the follow-up treatment. The manuscripts reviewed came from the period between 2008 and 2016. The size of the studies ranged from 16 participants to 310. The mean age was from 65 to 74 years in all studies. The Q test was used to attain all lipid parameters and to specify heterogeneity (p < .0001). After 12 months of androgen deprivation therapy (ADT), the patients had a significantly higher level serum TC and TG.
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Affiliation(s)
- Edyta Wolny-Rokicka
- Department of Radiotherapy, Multidisciplinary Hospital, Gorzow Wielkopolski, Poland.,Faculty of Medicine and Health Sciences, University of Zielona Góra, Zielona Góra, Poland
| | | | - Jerzy Wydmański
- Department of Radiotherapy, Centre of Oncology, Maria Skłodowska-Curie Memorial Institute, Branch in Gliwice, Poland
| | - Małgorzata Ostrowska
- Department of Nephrology, Medical University Hospital of Karol Marcinkowski, Zielona Góra, Poland
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Poirier D, Roy J, Maltais R, Ayan D. Antisulfatase, Osteogenic, and Anticancer Activities of Steroid Sulfatase Inhibitor EO-33 in Mice. J Med Chem 2019; 62:5512-5521. [DOI: 10.1021/acs.jmedchem.9b00382] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Donald Poirier
- Laboratory of Medicinal Chemistry, Endocrinology and Nephrology Unit, CHU de Québec—Research Center, Québec, Québec G1V 4G2, Canada
- Department of Molecular Medicine, Faculty of Medicine, Université Laval, Québec, Québec G1V 0A6, Canada
| | - Jenny Roy
- Laboratory of Medicinal Chemistry, Endocrinology and Nephrology Unit, CHU de Québec—Research Center, Québec, Québec G1V 4G2, Canada
| | - René Maltais
- Laboratory of Medicinal Chemistry, Endocrinology and Nephrology Unit, CHU de Québec—Research Center, Québec, Québec G1V 4G2, Canada
| | - Diana Ayan
- Laboratory of Medicinal Chemistry, Endocrinology and Nephrology Unit, CHU de Québec—Research Center, Québec, Québec G1V 4G2, Canada
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Singh P, Agrawal T, Yadav S, Nayak B, Seth A, Dogra PN. A comparative study of the effects of medical versus surgical androgen deprivation therapy on health-related quality of life in patients with metastatic carcinoma prostate. Indian J Cancer 2019; 55:148-153. [PMID: 30604726 DOI: 10.4103/ijc.ijc_531_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Androgen deprivation therapy (ADT) is known to adversely affect the quality of life (QoL). One may choose between surgical and medical forms depending on his economic status, education status, and taboos. The aim of this study was to assess the impact of medical versus surgical ADT on health-related quality of life (HRQoL) in patients with metastatic cancer prostate in Indian population. MATERIALS AND METHODS From July 2012 to December 2014, 50 patients (10 medical castration and 40 surgical castration) of hormone-naïve metastatic prostate cancer who were started on combined ADT were included in this study. Before starting therapy, baseline data and QoL score (short form [SF-36] scale) were noted and all patients were followed up at 3 months, 6 months, and 1 year. Baseline data and HRQoL at all time intervals between surgical and medical castration groups were compared. RESULTS All patients, except two, completed the 1-year follow-up period. Patients who opted for medical castration were more educated and belonged to higher socioeconomic status. For all the domains of SF-36 QoL questionnaire, a similar improvement in the score was noted at first 3-month follow-up which deteriorated in the next follow-up at 6 months and then further at 1 year. There was no difference in HRQoL after medical or surgical castration. CONCLUSIONS In patients with metastatic cancer, prostate initiation of ADT, irrespective of method, causes an initial improvement in HRQoL followed later by a more gradual decline below the baseline.
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Affiliation(s)
- Prabhjot Singh
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Tapan Agrawal
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Siddharth Yadav
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Brusabhanu Nayak
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Amlesh Seth
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Prem Nath Dogra
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
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Alibhai SMH, Santa Mina D, Ritvo P, Tomlinson G, Sabiston C, Krahn M, Durbano S, Matthew A, Warde P, O’Neill M, Timilshina N, Segal R, Culos-Reed N. A phase II randomized controlled trial of three exercise delivery methods in men with prostate cancer on androgen deprivation therapy. BMC Cancer 2019; 19:2. [PMID: 30606137 PMCID: PMC6318980 DOI: 10.1186/s12885-018-5189-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 12/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Existing evidence demonstrates that 1:1 personal training (PT) improves many adverse effects of androgen deprivation therapy (ADT). Whether less resource-intensive exercise delivery models are as effective remains to be established. We determined the feasibility of conducting a multi-center non-inferiority randomized controlled trial comparing PT with supervised group (GROUP) and home-based (HOME) exercise programs, and obtained preliminary efficacy estimates for GROUP and HOME compared to PT on quality of life (QOL) and physical fitness. METHODS Men with prostate cancer on ADT were recruited from one of two experienced Canadian centres and randomized 1:1:1 to PT, GROUP, or HOME. Randomization was stratified by length of ADT use and site. Participants completed moderate intensity aerobic and resistance exercises 4-5 days per week for 6 months with a target 150 min per week of exercise. Exercise prescriptions were individualized and progressed throughout the trial. Feasibility endpoints included recruitment, retention, adherence, and participant satisfaction. The efficacy endpoints QOL, fatigue, and fitness (VO2 peak, grip strength, and timed chair stands) in GROUP and HOME were compared for non-inferiority to PT. Descriptive analyses were used for feasibility endpoints. Between-group differences for efficacy endpoints were examined using Bayesian linear mixed effects models. RESULTS Fifty-nine participants (mean age 69.9 years) were enrolled. The recruitment rate was 25.4% and recruitment was slower than projected. Retention was 71.2%. Exercise adherence as measured through attendance was high for supervised sessions but under 50% by self-report and accelerometry. Satisfaction was high and there was no difference in this measure between all three groups. Between-group differences (comparing both GROUP and HOME to PT) were smaller than the minimum clinically important difference on most measures of QOL, fatigue, and fitness. However, two of six outcomes for GROUP and four of six outcomes for HOME had a > 20% probability of being inferior for GROUP. CONCLUSIONS Feasibility endpoints were generally met. Both GROUP and HOME interventions in men with PC on ADT appeared to be similar to PT for multiple efficacy outcomes, although conclusions are limited by a small sample size and cost considerations have not been incorporated. Efforts need to be targeted to improving recruitment and adherence. A larger trial is warranted. TRIAL REGISTRATION ClinicalTrials.gov: NCT02046837 . Date of registration: January 20, 2014.
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Affiliation(s)
- Shabbir M. H. Alibhai
- University Health Network, University of Toronto, Toronto, ON M5G 2C4 Canada
- Toronto General Hospital, 200 Elizabeth St Room EN14-214, Toronto, Ontario M5G 2C4 Canada
| | - Daniel Santa Mina
- University Health Network, University of Toronto, Toronto, ON M5G 2C4 Canada
- Cancer Care Ontario, York University, Toronto, ON M3J 1P3 Canada
| | - Paul Ritvo
- Cancer Care Ontario, York University, Toronto, ON M3J 1P3 Canada
| | - George Tomlinson
- University Health Network, University of Toronto, Toronto, ON M5G 2C4 Canada
- Cancer Care Ontario, York University, Toronto, ON M3J 1P3 Canada
| | | | - Murray Krahn
- University Health Network, University of Toronto, Toronto, ON M5G 2C4 Canada
- Cancer Care Ontario, York University, Toronto, ON M3J 1P3 Canada
| | - Sara Durbano
- University Health Network, University of Toronto, Toronto, ON M5G 2C4 Canada
| | - Andrew Matthew
- University Health Network, University of Toronto, Toronto, ON M5G 2C4 Canada
| | - Padraig Warde
- University Health Network, University of Toronto, Toronto, ON M5G 2C4 Canada
- Cancer Care Ontario, York University, Toronto, ON M3J 1P3 Canada
- University of Toronto, Toronto, ON M5S 2J7 Canada
| | - Meagan O’Neill
- University Health Network, University of Toronto, Toronto, ON M5G 2C4 Canada
| | - Narhari Timilshina
- University Health Network, University of Toronto, Toronto, ON M5G 2C4 Canada
| | - Roanne Segal
- The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON K1N 6N5 Canada
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Gender-independent efficacy of mesenchymal stem cell therapy in sex hormone-deficient bone loss via immunosuppression and resident stem cell recovery. Exp Mol Med 2018; 50:1-14. [PMID: 30559383 PMCID: PMC6297134 DOI: 10.1038/s12276-018-0192-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 09/10/2018] [Accepted: 10/01/2018] [Indexed: 12/13/2022] Open
Abstract
Osteoporosis develops with high prevalence in both postmenopausal women and hypogonadal men. Osteoporosis results in significant morbidity, but no cure has been established. Mesenchymal stem cells (MSCs) critically contribute to bone homeostasis and possess potent immunomodulatory/anti-inflammatory capability. Here, we investigated the therapeutic efficacy of using an infusion of MSCs to treat sex hormone-deficient bone loss and its underlying mechanisms. In particular, we compared the impacts of MSC cytotherapy in the two genders with the aim of examining potential gender differences. Using the gonadectomy (GNX) model, we confirmed that the osteoporotic phenotypes were substantially consistent between female and male mice. Importantly, systemic MSC transplantation (MSCT) not only rescued trabecular bone loss in GNX mice but also restored cortical bone mass and bone quality. Unexpectedly, no differences were detected between the genders. Furthermore, MSCT demonstrated an equal efficiency in rectifying the bone remodeling balance in both genders of GNX animals, as proven by the comparable recovery of bone formation and parallel normalization of bone resorption. Mechanistically, using green fluorescent protein (GFP)-based cell-tracing, we demonstrated rapid engraftment but poor inhabitation of donor MSCs in the GNX recipient bone marrow of each gender. Alternatively, MSCT uniformly reduced the CD3+T-cell population and suppressed the serum levels of inflammatory cytokines in reversing female and male GNX osteoporosis, which was attributed to the ability of the MSC to induce T-cell apoptosis. Immunosuppression in the microenvironment eventually led to functional recovery of endogenous MSCs, which resulted in restored osteogenesis and normalized behavior to modulate osteoclastogenesis. Collectively, these data revealed recipient sexually monomorphic responses to MSC therapy in gonadal steroid deficiency-induced osteoporosis via immunosuppression/anti-inflammation and resident stem cell recovery.
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21
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Alibhai SMH, Ritvo P, Santa Mina D, Sabiston C, Krahn M, Tomlinson G, Matthew A, Lukka H, Warde P, Durbano S, O’Neill M, Culos-Reed SN. Protocol for a phase III RCT and economic analysis of two exercise delivery methods in men with PC on ADT. BMC Cancer 2018; 18:1031. [PMID: 30352568 PMCID: PMC6199786 DOI: 10.1186/s12885-018-4937-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 10/10/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Androgen deprivation therapy (ADT) is commonly used to treat prostate cancer. However, side effects of ADT often lead to reduced quality of life and physical function. Existing evidence demonstrates that exercise can ameliorate multiple treatment-related side effects for men on ADT, yet adherence rates are often low. The method of exercise delivery (e.g., supervised group in-centre vs. individual home-based) may be important from clinical and economic perspectives; however, few studies have compared different delivery models. Additionally, long-term exercise adherence and an understanding of predictors of adherence are critical to achieving sustained benefits, but such data are lacking. The primary aim of this multi-centre phase III non-inferiority randomized controlled trial is to determine whether a home-based delivery model is non-inferior to a group-based delivery model in terms of benefits in fatigue and fitness in this population. Two other key aims include examining cost-effectiveness and long-term adherence. METHODS Men diagnosed with prostate cancer of any stage, starting or continuing on ADT for at least 6 months, fluent in English, and living close to a study centre are eligible. Participants complete five assessments over 12 months (baseline and every 3 months during the 6-month intervention and 6-month follow-up phases), including a fitness assessment and self-report questionnaires. Biological outcomes are collected at baseline, 6, and 12 months. A total of 200 participants will be randomized in a 1:1 fashion to supervised group training or home-based training supported by smartphones, health coaches, and Fitbit technology. Participants are asked to complete 4 to 5 exercise sessions per week, incorporating aerobic, resistance and flexibility training. Outcomes include fatigue, quality of life, fitness measures, body composition, biological outcomes, and program adherence. Cost information will be obtained using patient diary-based self-report and utilities via the EQ-5D. DISCUSSION To disseminate publicly funded exercise programs widely, clinical efficacy and cost-effectiveness have to be demonstrated. The goals of this trial are to provide these data along with an increased understanding of adherence to exercise among men with prostate cancer receiving ADT. TRIAL REGISTRATION The trial has been registered at clinicaltrials.gov (Registration # NCT02834416 ). Registration date was June 2, 2016.
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Affiliation(s)
- Shabbir M. H. Alibhai
- University Health Network, Toronto, ON M5G 2C4 Canada
- University of Toronto, Toronto, ON M5S 2J7 Canada
- Toronto General Hospital, 200 Elizabeth St Room EN14-214, Toronto, ON M5G 2C4 Canada
| | - Paul Ritvo
- Cancer Care Ontario, Toronto, ON M5G 2L3 Canada
| | - Daniel Santa Mina
- University Health Network, Toronto, ON M5G 2C4 Canada
- University of Toronto, Toronto, ON M5S 2J7 Canada
| | | | - Murray Krahn
- University Health Network, Toronto, ON M5G 2C4 Canada
- University of Toronto, Toronto, ON M5S 2J7 Canada
| | - George Tomlinson
- University Health Network, Toronto, ON M5G 2C4 Canada
- University of Toronto, Toronto, ON M5S 2J7 Canada
| | | | - Himu Lukka
- The Juravinski Cancer Centre, Hamilton, ON L8V 5C2 Canada
| | - Padraig Warde
- University Health Network, Toronto, ON M5G 2C4 Canada
- University of Toronto, Toronto, ON M5S 2J7 Canada
- Cancer Care Ontario, Toronto, ON M5G 2L3 Canada
| | - Sara Durbano
- University Health Network, Toronto, ON M5G 2C4 Canada
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Hussain SS, Huang SB, Bedolla RG, Rivas P, Basler JW, Swanson GP, Hui-Ming Huang T, Narayanasamy G, Papanikolaou N, Miyamoto H, Yeh IT, Reddick RL, Pollock BH, Ghosh R, Kumar AP. Suppression of ribosomal protein RPS6KB1 by Nexrutine increases sensitivity of prostate tumors to radiation. Cancer Lett 2018; 433:232-241. [PMID: 30003927 DOI: 10.1016/j.canlet.2018.07.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 07/03/2018] [Accepted: 07/04/2018] [Indexed: 10/28/2022]
Abstract
Radiation therapy (XRT) is a standard treatment for prostate cancer (PCa). Although dose escalation increases local control, toxicity hampers further escalation. Broader improvement will be possible by the addition of adjuvant therapies, which can synergize with radiation and thus improve efficacy. We have identified a natural compound (Nexrutine, Nx) that inhibits the survival and growth of PCa cells in combination with radiation. Combination studies demonstrated strong interaction between Nx and radiation both in vitro in multiple PCa cell lines and in the Transgenic adenocarcinoma of mouse prostate (TRAMP) model. Nx potentiated growth inhibitory effects of IR by down regulating ribosomal protein S6K (RPS6KB1), CyclinD1, Chk1 and HIF-1 α and prolonging G2/M checkpoint block. RPS6KB1 is upregulated in prostate cancers and its expression is correlated with tumor grade. Knockdown of RPS6KB1 in PCa cells increased their sensitivity toward radiation-induced survival inhibition. Overall, we provide scientific evidence (i) in support of Nx as an adjuvant in PCa patients receiving XRT (ii) suggesting that RPS6KB1 is an important player in Nx-mediated combinatorial benefits and emphasizes that RPS6KB1 is a novel target for PCa treatment. These data underscore the need to test the agent in additional preclinical models to validate these observations.
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Affiliation(s)
- Suleman S Hussain
- Department of Urology, University of Texas Health, San Antonio, TX, USA; Department of Pharmacology, University of Texas Health, San Antonio, TX, USA; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, USA
| | - Shih-Bo Huang
- Department of Urology, University of Texas Health, San Antonio, TX, USA
| | - Roble G Bedolla
- Department of Urology, University of Texas Health, San Antonio, TX, USA
| | - Paul Rivas
- Department of Urology, University of Texas Health, San Antonio, TX, USA
| | - Joseph W Basler
- Department of Urology, University of Texas Health, San Antonio, TX, USA
| | - Gregory P Swanson
- Department of Radiation Oncology, University of Texas Health, San Antonio, TX, USA
| | - Tim Hui-Ming Huang
- Department of Molecular Medicine, University of Texas Health, San Antonio, TX, USA
| | - Ganesh Narayanasamy
- Department of Radiation Oncology, University of Texas Health, San Antonio, TX, USA; Department of Radiation Oncology, University of Arkansas for Medical Sciences, USA
| | - Nikos Papanikolaou
- Department of Radiation Oncology, University of Texas Health, San Antonio, TX, USA
| | - Hiroshi Miyamoto
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - I-Tien Yeh
- Department of Pathology, Virginia Hospital Center, Arlington, VA, USA
| | - Robert L Reddick
- Department of Pathology, University of Texas Health, San Antonio, TX, USA
| | - Brad H Pollock
- Department of Public Health Sciences, University of California, Davis, USA
| | - Rita Ghosh
- Department of Urology, University of Texas Health, San Antonio, TX, USA; Department of Pharmacology, University of Texas Health, San Antonio, TX, USA; Department of Molecular Medicine, University of Texas Health, San Antonio, TX, USA; Mays Cancer Center, University of Texas Health, San Antonio, TX, USA
| | - Addanki P Kumar
- Department of Urology, University of Texas Health, San Antonio, TX, USA; Department of Pharmacology, University of Texas Health, San Antonio, TX, USA; Department of Molecular Medicine, University of Texas Health, San Antonio, TX, USA; Mays Cancer Center, University of Texas Health, San Antonio, TX, USA; South Texas Veterans Health Care System, San Antonio, TX, USA.
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23
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Zabegalina NS, Henderickx MMEL, Lamotte V, Segers B, Stassijns G, De Wachter S, Hoekx L. Effects of a six-month supervised physical exercise program on physical and cardio-metabolic profile and quality of life in patients with prostate cancer on androgen deprivation therapy: a pilot and feasibility study. Cent European J Urol 2018; 71:234-241. [PMID: 30038816 PMCID: PMC6051362 DOI: 10.5173/ceju.2018.1652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 04/15/2018] [Accepted: 05/04/2018] [Indexed: 11/22/2022] Open
Abstract
Introduction To evaluate the effect of a six-month supervised physical exercise program on the physical and cardio-metabolic profile and quality of life in patients with prostate cancer on androgen deprivation therapy. Material and methods Twenty-seven patients with prostate cancer on androgen deprivation therapy were included in a physical exercise program. The program consisted of supervised physical exercises during a six-month period (two hours, twice a week). The exercise program contained moderate to high intensity aerobic and resistance exercises: cycling, walking or jogging for 45 minutes at an intensity of ±80% of the individual maximum heart rate, followed by resistance exercises targeting the major lower and upper body muscles. All patients were assessed prior to the exercise program, including anthropometrical parameters, blood analysis, quality of life and physical fitness. Blood analysis was repeated at a three-month follow-up. Anthropometrical parameters, physical fitness and quality of life were recorded at a three-, six- and nine-month follow-up. Results A positive effect on physical performance, muscular strength and quality of life was seen. The applied physical exercise program was well tolerated and characterized by a high satisfaction rate. An alarming issue of remarkably unfavorable baseline cardio-metabolic profile was revealed within our study population. Conclusions Our data indicates that a six-month supervised physical exercise program can be beneficial in preventing androgen deprivation therapy-related side effects in patients with prostate cancer. We emphasize the importance of screening for cardio-metabolic risk factors in patients who are treated with androgen deprivation therapy.
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Affiliation(s)
| | - Michaël M E L Henderickx
- Department of Urology, Antwerp University Hospital, Edegem, Belgium.,Department of Urology, Academic Medical Center, Amsterdam, The Netherlands
| | - Veerle Lamotte
- Department of Urology, Antwerp University Hospital, Edegem, Belgium.,Multidisciplinary Oncological Center of Antwerp (MOCA), Antwerp, Belgium
| | - Bart Segers
- Department of Physical Medicine and Rehabilitation, Antwerp University Hospital, Edegem, Belgium
| | - Gaetane Stassijns
- Department of Physical Medicine and Rehabilitation, Antwerp University Hospital, Edegem, Belgium
| | | | - Lucien Hoekx
- Department of Urology, Antwerp University Hospital, Edegem, Belgium.,Multidisciplinary Oncological Center of Antwerp (MOCA), Antwerp, Belgium
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24
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Wong JS, Gravel J. Do Sex Offenders Have Higher Levels of Testosterone? Results From a Meta-Analysis. SEXUAL ABUSE : A JOURNAL OF RESEARCH AND TREATMENT 2018; 30:147-168. [PMID: 27000267 DOI: 10.1177/1079063216637857] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The purpose of the current study is to review the available scientific evidence on the relationship between testosterone and sexual aggression. A systematic search for all primary studies comparing basal testosterone levels in sex offenders and non-sex offenders was undertaken across 20 electronic databases using an explicit search strategy and inclusion/exclusion criteria. A total of seven studies were identified and 11 effect sizes were computed; effects were pooled using both fixed and random effects meta-analysis models. Although individual study findings present a mix of results wherein sex offenders have higher or lower baseline levels of testosterone than non-sex offenders, pooled results indicate no overall difference between groups. Moderators of the analyses suggest possibly lower rates of testosterone in child molesters than controls; however, results are dependent on study weighting. Limitations, policy implications with respect to chemical castration laws, and future directions for research are discussed.
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25
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Lamboley CR, Xu H, Dutka TL, Hanson ED, Hayes A, Violet JA, Murphy RM, Lamb GD. Effect of androgen deprivation therapy on the contractile properties of type I and type II skeletal muscle fibres in men with non-metastatic prostate cancer. Clin Exp Pharmacol Physiol 2017; 45:146-154. [DOI: 10.1111/1440-1681.12873] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 08/30/2017] [Accepted: 09/28/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Cedric R Lamboley
- Institute of Sport, Exercise and Active Living (ISEAL); College of Sport and Exercise Science; Victoria University; Melbourne Vic. Australia
- School of Life Sciences; La Trobe University; Melbourne Vic. Australia
| | - Hongyang Xu
- Department of Biochemistry and Genetics; La Trobe Institute for Molecular Science; La Trobe University; Melbourne Vic. Australia
| | - Travis L Dutka
- School of Life Sciences; La Trobe University; Melbourne Vic. Australia
| | - Erik D Hanson
- Institute of Sport, Exercise and Active Living (ISEAL); College of Sport and Exercise Science; Victoria University; Melbourne Vic. Australia
- Australian Institute for Musculoskeletal Science (AIMSS); Sunshine Hospital; Western Health; Melbourne Vic. Australia
- College of Health and Biomedicine; Victoria University; Melbourne Vic. Australia
| | - Alan Hayes
- Institute of Sport, Exercise and Active Living (ISEAL); College of Sport and Exercise Science; Victoria University; Melbourne Vic. Australia
- Australian Institute for Musculoskeletal Science (AIMSS); Sunshine Hospital; Western Health; Melbourne Vic. Australia
- College of Health and Biomedicine; Victoria University; Melbourne Vic. Australia
| | - John A Violet
- Division of Radiation Oncology and Cancer Imaging; Peter MacCallum Cancer Centre; East Melbourne Vic. Australia
| | - Robyn M Murphy
- Department of Biochemistry and Genetics; La Trobe Institute for Molecular Science; La Trobe University; Melbourne Vic. Australia
| | - Graham D Lamb
- School of Life Sciences; La Trobe University; Melbourne Vic. Australia
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26
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Kim HJ, Koo HS, Kim YS, Kim MJ, Kim KM, Joo NS, Haam JH. The association of testosterone, sex hormone-binding globulin, and insulin-like growth factor-1 with bone parameters in Korean men aged 50 years or older. J Bone Miner Metab 2017; 35:659-665. [PMID: 27873076 DOI: 10.1007/s00774-016-0803-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/31/2016] [Indexed: 11/24/2022]
Abstract
Testosterone and insulin-like growth factor-1 (IGF-1) are essential factors for the maintenance of bone health in men. However, the results for the association of testosterone and IGF-1 with bone parameters were not consistent in prior studies. We evaluated the relationship of testosterone, sex hormone-binding globulin (SHBG), and IGF-1 with bone mineral density (BMD) and bone turnover markers (BTMs) in Korean men. We enrolled 1227 men aged ≥50 years in this cross-sectional study. Serum levels of total testosterone (TT), SHBG, IGF-1, osteocalcin, and C-terminal cross-linking telopeptide of type I collagen (CTX) were measured. Free testosterone (FT) was calculated using Vermeulen's method. BMD was measured by dual-energy X-ray absorptiometry. TT level was not related to BMD or BTMs in the unadjusted model; however, after adjusting for SHBG and IGF-1, the association between TT and BTMs was significant (β = -0.139 for osteocalcin and β = -0.204 for CTX). SHBG levels were negatively associated with lumbar BMD, and positively associated with BTMs in all models. As SHBG level increased, the prevalence of osteopenia or osteoporosis defined by BMD significantly increased (OR of 1SD change, 1.24). IGF-1 levels were significantly related with BMD, but not with BTMs. Meanwhile, FT levels were positively associated with BMD and negatively associated with BTMs. In conclusion, SHBG levels were independently related with bone parameters and osteopenia in men aged ≥50 years. IGF-1 levels were positively associated with BMD, but not with BTMs. SHBG may play a role in regulating age-related bone loss in men after middle-age.
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Affiliation(s)
- Hye-Jung Kim
- Department of Family Medicine, Green-cross I-MED, 06647, Seoul, South Korea
| | - Hyung Suk Koo
- Department of Family Medicine, Dongguk University Bundang Oriental Hospital, 13601, Seongnam, South Korea
| | - Young-Sang Kim
- Department of Family Medicine, CHA Bundang Medical Centre, CHA University, 59 Yatap-ro, Bundang-gu, 13496, Seongnam-Si, Gyeonggi-do, South Korea.
| | - Moon Jong Kim
- Department of Family Medicine, CHA Bundang Medical Centre, CHA University, 59 Yatap-ro, Bundang-gu, 13496, Seongnam-Si, Gyeonggi-do, South Korea
| | - Kwang-Min Kim
- Department of Family Practice and Community Health, School of Medicine, Ajou University, 16499, Suwon, South Korea
| | - Nam-Seok Joo
- Department of Family Practice and Community Health, School of Medicine, Ajou University, 16499, Suwon, South Korea
| | - Ji-Hee Haam
- Department of Family Medicine, CHA Bundang Medical Centre, CHA University, 59 Yatap-ro, Bundang-gu, 13496, Seongnam-Si, Gyeonggi-do, South Korea
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27
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Abstract
Sexual dysfunction is a common concern for many patients with cancer after treatment. Hormonal changes as a result of cancer-directed therapy can affect both male and female sexual health. This has the potential to significantly impact patients' quality of life, but is underreported and undertreated in the oncology setting. This review discusses commonly reported sexual issues and the role that hormonal changes play in this dysfunction. Although medical and psychosocial intervention strategies exist, there is a clear need for further research to formally develop programming that can assist people whose sexual health has been impacted by cancer treatment.
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Affiliation(s)
- Eric S Zhou
- Pediatric Oncology, Perini Family Survivors' Center, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA; Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Natasha N Frederick
- Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Pediatric Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Sharon L Bober
- Pediatric Oncology, Perini Family Survivors' Center, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA; Sexual Health Program, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA; Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
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28
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Poon Y, Pechlivanoglou P, Alibhai SM, Naimark D, Hoch JS, Papadimitropoulos E, Hogan ME, Krahn M. Systematic review and network meta-analysis on the relative efficacy of osteoporotic medications: men with prostate cancer on continuous androgen-deprivation therapy to reduce risk of fragility fractures. BJU Int 2017. [DOI: 10.1111/bju.14015 and (select 5863 from (select(sleep(5)))nccq)-- llmm] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Yeesha Poon
- The University of Toronto; Toronto ON Canada
| | - Petros Pechlivanoglou
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- The Hospital for Sick Children; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
| | - Shabbir M.H. Alibhai
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
| | - David Naimark
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Sunnybrook Health Sciences Centre; Toronto ON Canada
| | - Jeffrey S. Hoch
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Li Ka Shing Knowledge Institute of St. Michael's Hospital; Toronto ON Canada
- Department of Public Health Sciences; University of California, Davis; Sacramento CA USA
| | | | | | - Murray Krahn
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
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29
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Poon Y, Pechlivanoglou P, Alibhai SMH, Naimark D, Hoch JS, Papadimitropoulos E, Hogan ME, Krahn M. Systematic review and network meta-analysis on the relative efficacy of osteoporotic medications: men with prostate cancer on continuous androgen-deprivation therapy to reduce risk of fragility fractures. BJU Int 2017; 121:17-28. [PMID: 28921820 DOI: 10.1111/bju.14015] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Androgen-deprivation therapy (ADT) is an effective treatment for men with advanced prostate cancer, but loss of bone mineral density (BMD) is a major risk factor for fractures. This review compared the efficacy of available treatments to provide prescribing guidance to healthcare professionals. This is the first review to compare the effectiveness of different osteoporotic treatments (bisphosphonates, denosumab, toremifene, and raloxifene) on BMD in patients with non-metastatic prostate cancer on ADT using network meta-analysis. Results suggest that all evaluated treatments are effective in improving BMD compared to placebo. Zoledronic acid (ZA) was found to have a greater improvement in BMD compared to other active treatments at all three studied sites, except for risedronate, which had better BMD improvement compared to ZA at the femoral neck site in one small study. Our study did not identify evidence that one drug is unequivocally more effective than another. All drugs appeared to be effective in reducing the rate of bone loss. Healthcare professionals should also consider patient preference, costs, and local availability as part of the decision process.
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Affiliation(s)
- Yeesha Poon
- The University of Toronto, Toronto, ON, Canada
| | - Petros Pechlivanoglou
- The University of Toronto, Toronto, ON, Canada.,Toronto Health Economic and Technology Assessment Collaborative, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada.,Institute of Health Policy Management and Evaluation, Toronto, ON, Canada
| | - Shabbir M H Alibhai
- The University of Toronto, Toronto, ON, Canada.,Toronto Health Economic and Technology Assessment Collaborative, Toronto, ON, Canada.,Institute of Health Policy Management and Evaluation, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada
| | - David Naimark
- The University of Toronto, Toronto, ON, Canada.,Institute of Health Policy Management and Evaluation, Toronto, ON, Canada.,Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Jeffrey S Hoch
- The University of Toronto, Toronto, ON, Canada.,Institute of Health Policy Management and Evaluation, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada.,Department of Public Health Sciences, University of California, Davis, Sacramento, CA, USA
| | | | | | - Murray Krahn
- The University of Toronto, Toronto, ON, Canada.,Toronto Health Economic and Technology Assessment Collaborative, Toronto, ON, Canada.,Institute of Health Policy Management and Evaluation, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada
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30
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Poon Y, Pechlivanoglou P, Alibhai SM, Naimark D, Hoch JS, Papadimitropoulos E, Hogan ME, Krahn M. Systematic review and network meta-analysis on the relative efficacy of osteoporotic medications: men with prostate cancer on continuous androgen-deprivation therapy to reduce risk of fragility fractures. BJU Int 2017. [DOI: 10.1111/bju.14015 union all select null,null,null,null-- muqg] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Yeesha Poon
- The University of Toronto; Toronto ON Canada
| | - Petros Pechlivanoglou
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- The Hospital for Sick Children; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
| | - Shabbir M.H. Alibhai
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
| | - David Naimark
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Sunnybrook Health Sciences Centre; Toronto ON Canada
| | - Jeffrey S. Hoch
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Li Ka Shing Knowledge Institute of St. Michael's Hospital; Toronto ON Canada
- Department of Public Health Sciences; University of California, Davis; Sacramento CA USA
| | | | | | - Murray Krahn
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
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31
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Poon Y, Pechlivanoglou P, Alibhai SM, Naimark D, Hoch JS, Papadimitropoulos E, Hogan ME, Krahn M. Systematic review and network meta-analysis on the relative efficacy of osteoporotic medications: men with prostate cancer on continuous androgen-deprivation therapy to reduce risk of fragility fractures. BJU Int 2017. [DOI: 10.1111/bju.14015 union all select null,null-- hets] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Yeesha Poon
- The University of Toronto; Toronto ON Canada
| | - Petros Pechlivanoglou
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- The Hospital for Sick Children; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
| | - Shabbir M.H. Alibhai
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
| | - David Naimark
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Sunnybrook Health Sciences Centre; Toronto ON Canada
| | - Jeffrey S. Hoch
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Li Ka Shing Knowledge Institute of St. Michael's Hospital; Toronto ON Canada
- Department of Public Health Sciences; University of California, Davis; Sacramento CA USA
| | | | | | - Murray Krahn
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
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32
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Poon Y, Pechlivanoglou P, Alibhai SM, Naimark D, Hoch JS, Papadimitropoulos E, Hogan ME, Krahn M. Systematic review and network meta-analysis on the relative efficacy of osteoporotic medications: men with prostate cancer on continuous androgen-deprivation therapy to reduce risk of fragility fractures. BJU Int 2017. [DOI: 10.1111/bju.14015 order by 2320-- qdof] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Yeesha Poon
- The University of Toronto; Toronto ON Canada
| | - Petros Pechlivanoglou
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- The Hospital for Sick Children; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
| | - Shabbir M.H. Alibhai
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
| | - David Naimark
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Sunnybrook Health Sciences Centre; Toronto ON Canada
| | - Jeffrey S. Hoch
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Li Ka Shing Knowledge Institute of St. Michael's Hospital; Toronto ON Canada
- Department of Public Health Sciences; University of California, Davis; Sacramento CA USA
| | | | | | - Murray Krahn
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
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33
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Poon Y, Pechlivanoglou P, Alibhai SM, Naimark D, Hoch JS, Papadimitropoulos E, Hogan ME, Krahn M. Systematic review and network meta-analysis on the relative efficacy of osteoporotic medications: men with prostate cancer on continuous androgen-deprivation therapy to reduce risk of fragility fractures. BJU Int 2017. [DOI: 10.1111/bju.14015 and 7021=dbms_pipe.receive_message(chr(105)||chr(104)||chr(107)||chr(119),5)-- tlyd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Yeesha Poon
- The University of Toronto; Toronto ON Canada
| | - Petros Pechlivanoglou
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- The Hospital for Sick Children; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
| | - Shabbir M.H. Alibhai
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
| | - David Naimark
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Sunnybrook Health Sciences Centre; Toronto ON Canada
| | - Jeffrey S. Hoch
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Li Ka Shing Knowledge Institute of St. Michael's Hospital; Toronto ON Canada
- Department of Public Health Sciences; University of California, Davis; Sacramento CA USA
| | | | | | - Murray Krahn
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
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34
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Poon Y, Pechlivanoglou P, Alibhai SM, Naimark D, Hoch JS, Papadimitropoulos E, Hogan ME, Krahn M. Systematic review and network meta-analysis on the relative efficacy of osteoporotic medications: men with prostate cancer on continuous androgen-deprivation therapy to reduce risk of fragility fractures. BJU Int 2017. [DOI: 10.1111/bju.14015 union all select null,null,null,null,null,null,null,null,null,null-- fzos] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Yeesha Poon
- The University of Toronto; Toronto ON Canada
| | - Petros Pechlivanoglou
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- The Hospital for Sick Children; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
| | - Shabbir M.H. Alibhai
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
| | - David Naimark
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Sunnybrook Health Sciences Centre; Toronto ON Canada
| | - Jeffrey S. Hoch
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Li Ka Shing Knowledge Institute of St. Michael's Hospital; Toronto ON Canada
- Department of Public Health Sciences; University of California, Davis; Sacramento CA USA
| | | | | | - Murray Krahn
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
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35
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Poon Y, Pechlivanoglou P, Alibhai SM, Naimark D, Hoch JS, Papadimitropoulos E, Hogan ME, Krahn M. Systematic review and network meta-analysis on the relative efficacy of osteoporotic medications: men with prostate cancer on continuous androgen-deprivation therapy to reduce risk of fragility fractures. BJU Int 2017. [DOI: 10.1111/bju.14015 union all select null,null,null,null,null,null-- qhvx] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Yeesha Poon
- The University of Toronto; Toronto ON Canada
| | - Petros Pechlivanoglou
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- The Hospital for Sick Children; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
| | - Shabbir M.H. Alibhai
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
| | - David Naimark
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Sunnybrook Health Sciences Centre; Toronto ON Canada
| | - Jeffrey S. Hoch
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Li Ka Shing Knowledge Institute of St. Michael's Hospital; Toronto ON Canada
- Department of Public Health Sciences; University of California, Davis; Sacramento CA USA
| | | | | | - Murray Krahn
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
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36
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Poon Y, Pechlivanoglou P, Alibhai SM, Naimark D, Hoch JS, Papadimitropoulos E, Hogan ME, Krahn M. Systematic review and network meta-analysis on the relative efficacy of osteoporotic medications: men with prostate cancer on continuous androgen-deprivation therapy to reduce risk of fragility fractures. BJU Int 2017. [DOI: 10.1111/bju.14015 and 7021=dbms_pipe.receive_message(chr(105)||chr(104)||chr(107)||chr(119),5)] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Yeesha Poon
- The University of Toronto; Toronto ON Canada
| | - Petros Pechlivanoglou
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- The Hospital for Sick Children; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
| | - Shabbir M.H. Alibhai
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
| | - David Naimark
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Sunnybrook Health Sciences Centre; Toronto ON Canada
| | - Jeffrey S. Hoch
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Li Ka Shing Knowledge Institute of St. Michael's Hospital; Toronto ON Canada
- Department of Public Health Sciences; University of California, Davis; Sacramento CA USA
| | | | | | - Murray Krahn
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
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Poon Y, Pechlivanoglou P, Alibhai SM, Naimark D, Hoch JS, Papadimitropoulos E, Hogan ME, Krahn M. Systematic review and network meta-analysis on the relative efficacy of osteoporotic medications: men with prostate cancer on continuous androgen-deprivation therapy to reduce risk of fragility fractures. BJU Int 2017. [DOI: 10.1111/bju.14015 union all select null,null,null,null,null,null,null-- qixb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Yeesha Poon
- The University of Toronto; Toronto ON Canada
| | - Petros Pechlivanoglou
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- The Hospital for Sick Children; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
| | - Shabbir M.H. Alibhai
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
| | - David Naimark
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Sunnybrook Health Sciences Centre; Toronto ON Canada
| | - Jeffrey S. Hoch
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Li Ka Shing Knowledge Institute of St. Michael's Hospital; Toronto ON Canada
- Department of Public Health Sciences; University of California, Davis; Sacramento CA USA
| | | | | | - Murray Krahn
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
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Poon Y, Pechlivanoglou P, Alibhai SM, Naimark D, Hoch JS, Papadimitropoulos E, Hogan ME, Krahn M. Systematic review and network meta-analysis on the relative efficacy of osteoporotic medications: men with prostate cancer on continuous androgen-deprivation therapy to reduce risk of fragility fractures. BJU Int 2017. [DOI: 10.1111/bju.14015 union all select null,null,null,null,null,null,null,null-- oqme] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Yeesha Poon
- The University of Toronto; Toronto ON Canada
| | - Petros Pechlivanoglou
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- The Hospital for Sick Children; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
| | - Shabbir M.H. Alibhai
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
| | - David Naimark
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Sunnybrook Health Sciences Centre; Toronto ON Canada
| | - Jeffrey S. Hoch
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Li Ka Shing Knowledge Institute of St. Michael's Hospital; Toronto ON Canada
- Department of Public Health Sciences; University of California, Davis; Sacramento CA USA
| | | | | | - Murray Krahn
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
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Poon Y, Pechlivanoglou P, Alibhai SM, Naimark D, Hoch JS, Papadimitropoulos E, Hogan ME, Krahn M. Systematic review and network meta-analysis on the relative efficacy of osteoporotic medications: men with prostate cancer on continuous androgen-deprivation therapy to reduce risk of fragility fractures. BJU Int 2017. [DOI: 10.1111/bju.14015 and (select 5863 from (select(sleep(5)))nccq)] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Yeesha Poon
- The University of Toronto; Toronto ON Canada
| | - Petros Pechlivanoglou
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- The Hospital for Sick Children; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
| | - Shabbir M.H. Alibhai
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
| | - David Naimark
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Sunnybrook Health Sciences Centre; Toronto ON Canada
| | - Jeffrey S. Hoch
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Li Ka Shing Knowledge Institute of St. Michael's Hospital; Toronto ON Canada
- Department of Public Health Sciences; University of California, Davis; Sacramento CA USA
| | | | | | - Murray Krahn
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
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Poon Y, Pechlivanoglou P, Alibhai SM, Naimark D, Hoch JS, Papadimitropoulos E, Hogan ME, Krahn M. Systematic review and network meta-analysis on the relative efficacy of osteoporotic medications: men with prostate cancer on continuous androgen-deprivation therapy to reduce risk of fragility fractures. BJU Int 2017. [DOI: 10.1111/bju.14015 union all select null-- myvn] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Yeesha Poon
- The University of Toronto; Toronto ON Canada
| | - Petros Pechlivanoglou
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- The Hospital for Sick Children; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
| | - Shabbir M.H. Alibhai
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
| | - David Naimark
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Sunnybrook Health Sciences Centre; Toronto ON Canada
| | - Jeffrey S. Hoch
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Li Ka Shing Knowledge Institute of St. Michael's Hospital; Toronto ON Canada
- Department of Public Health Sciences; University of California, Davis; Sacramento CA USA
| | | | | | - Murray Krahn
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
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Poon Y, Pechlivanoglou P, Alibhai SM, Naimark D, Hoch JS, Papadimitropoulos E, Hogan ME, Krahn M. Systematic review and network meta-analysis on the relative efficacy of osteoporotic medications: men with prostate cancer on continuous androgen-deprivation therapy to reduce risk of fragility fractures. BJU Int 2017. [DOI: 10.1111/bju.14015 and 2121=6958-- ytdc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Yeesha Poon
- The University of Toronto; Toronto ON Canada
| | - Petros Pechlivanoglou
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- The Hospital for Sick Children; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
| | - Shabbir M.H. Alibhai
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
| | - David Naimark
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Sunnybrook Health Sciences Centre; Toronto ON Canada
| | - Jeffrey S. Hoch
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Li Ka Shing Knowledge Institute of St. Michael's Hospital; Toronto ON Canada
- Department of Public Health Sciences; University of California, Davis; Sacramento CA USA
| | | | | | - Murray Krahn
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
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Poon Y, Pechlivanoglou P, Alibhai SM, Naimark D, Hoch JS, Papadimitropoulos E, Hogan ME, Krahn M. Systematic review and network meta-analysis on the relative efficacy of osteoporotic medications: men with prostate cancer on continuous androgen-deprivation therapy to reduce risk of fragility fractures. BJU Int 2017. [DOI: 10.1111/bju.14015 and 7386=(select 7386 from pg_sleep(5))] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Yeesha Poon
- The University of Toronto; Toronto ON Canada
| | - Petros Pechlivanoglou
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- The Hospital for Sick Children; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
| | - Shabbir M.H. Alibhai
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
| | - David Naimark
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Sunnybrook Health Sciences Centre; Toronto ON Canada
| | - Jeffrey S. Hoch
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Li Ka Shing Knowledge Institute of St. Michael's Hospital; Toronto ON Canada
- Department of Public Health Sciences; University of California, Davis; Sacramento CA USA
| | | | | | - Murray Krahn
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
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Poon Y, Pechlivanoglou P, Alibhai SM, Naimark D, Hoch JS, Papadimitropoulos E, Hogan ME, Krahn M. Systematic review and network meta-analysis on the relative efficacy of osteoporotic medications: men with prostate cancer on continuous androgen-deprivation therapy to reduce risk of fragility fractures. BJU Int 2017. [DOI: 10.1111/bju.14015 and 9855=cast((chr(113)||chr(98)||chr(112)||chr(118)||chr(113))||(select (case when (9855=9855) then 1 else 0 end))::text||(chr(113)||chr(122)||chr(98)||chr(98)||chr(113)) as numeric)-- zmhj] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Yeesha Poon
- The University of Toronto; Toronto ON Canada
| | - Petros Pechlivanoglou
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- The Hospital for Sick Children; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
| | - Shabbir M.H. Alibhai
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
| | - David Naimark
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Sunnybrook Health Sciences Centre; Toronto ON Canada
| | - Jeffrey S. Hoch
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Li Ka Shing Knowledge Institute of St. Michael's Hospital; Toronto ON Canada
- Department of Public Health Sciences; University of California, Davis; Sacramento CA USA
| | | | | | - Murray Krahn
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
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Poon Y, Pechlivanoglou P, Alibhai SM, Naimark D, Hoch JS, Papadimitropoulos E, Hogan ME, Krahn M. Systematic review and network meta-analysis on the relative efficacy of osteoporotic medications: men with prostate cancer on continuous androgen-deprivation therapy to reduce risk of fragility fractures. BJU Int 2017. [DOI: 10.1111/bju.14015 union all select null,null,null,null,null,null,null,null,null-- kkui] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Yeesha Poon
- The University of Toronto; Toronto ON Canada
| | - Petros Pechlivanoglou
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- The Hospital for Sick Children; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
| | - Shabbir M.H. Alibhai
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
| | - David Naimark
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Sunnybrook Health Sciences Centre; Toronto ON Canada
| | - Jeffrey S. Hoch
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Li Ka Shing Knowledge Institute of St. Michael's Hospital; Toronto ON Canada
- Department of Public Health Sciences; University of California, Davis; Sacramento CA USA
| | | | | | - Murray Krahn
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
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Poon Y, Pechlivanoglou P, Alibhai SM, Naimark D, Hoch JS, Papadimitropoulos E, Hogan ME, Krahn M. Systematic review and network meta-analysis on the relative efficacy of osteoporotic medications: men with prostate cancer on continuous androgen-deprivation therapy to reduce risk of fragility fractures. BJU Int 2017. [DOI: 10.1111/bju.14015 waitfor delay '0:0:5'-- mani] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Yeesha Poon
- The University of Toronto; Toronto ON Canada
| | - Petros Pechlivanoglou
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- The Hospital for Sick Children; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
| | - Shabbir M.H. Alibhai
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
| | - David Naimark
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Sunnybrook Health Sciences Centre; Toronto ON Canada
| | - Jeffrey S. Hoch
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Li Ka Shing Knowledge Institute of St. Michael's Hospital; Toronto ON Canada
- Department of Public Health Sciences; University of California, Davis; Sacramento CA USA
| | | | | | - Murray Krahn
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
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Poon Y, Pechlivanoglou P, Alibhai SM, Naimark D, Hoch JS, Papadimitropoulos E, Hogan ME, Krahn M. Systematic review and network meta-analysis on the relative efficacy of osteoporotic medications: men with prostate cancer on continuous androgen-deprivation therapy to reduce risk of fragility fractures. BJU Int 2017. [DOI: 10.1111/bju.14015 waitfor delay '0:0:5'] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Yeesha Poon
- The University of Toronto; Toronto ON Canada
| | - Petros Pechlivanoglou
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- The Hospital for Sick Children; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
| | - Shabbir M.H. Alibhai
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
| | - David Naimark
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Sunnybrook Health Sciences Centre; Toronto ON Canada
| | - Jeffrey S. Hoch
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Li Ka Shing Knowledge Institute of St. Michael's Hospital; Toronto ON Canada
- Department of Public Health Sciences; University of California, Davis; Sacramento CA USA
| | | | | | - Murray Krahn
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
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Poon Y, Pechlivanoglou P, Alibhai SM, Naimark D, Hoch JS, Papadimitropoulos E, Hogan ME, Krahn M. Systematic review and network meta-analysis on the relative efficacy of osteoporotic medications: men with prostate cancer on continuous androgen-deprivation therapy to reduce risk of fragility fractures. BJU Int 2017. [DOI: 10.1111/bju.14015 and 7386=(select 7386 from pg_sleep(5))-- jpln] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Yeesha Poon
- The University of Toronto; Toronto ON Canada
| | - Petros Pechlivanoglou
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- The Hospital for Sick Children; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
| | - Shabbir M.H. Alibhai
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
| | - David Naimark
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Sunnybrook Health Sciences Centre; Toronto ON Canada
| | - Jeffrey S. Hoch
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Li Ka Shing Knowledge Institute of St. Michael's Hospital; Toronto ON Canada
- Department of Public Health Sciences; University of California, Davis; Sacramento CA USA
| | | | | | - Murray Krahn
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
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Poon Y, Pechlivanoglou P, Alibhai SM, Naimark D, Hoch JS, Papadimitropoulos E, Hogan ME, Krahn M. Systematic review and network meta-analysis on the relative efficacy of osteoporotic medications: men with prostate cancer on continuous androgen-deprivation therapy to reduce risk of fragility fractures. BJU Int 2017. [DOI: 10.1111/bju.14015 and 6632 in (select (char(113)+char(98)+char(112)+char(118)+char(113)+(select (case when (6632=6632) then char(49) else char(48) end))+char(113)+char(122)+char(98)+char(98)+char(113)))] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Yeesha Poon
- The University of Toronto; Toronto ON Canada
| | - Petros Pechlivanoglou
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- The Hospital for Sick Children; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
| | - Shabbir M.H. Alibhai
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
| | - David Naimark
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Sunnybrook Health Sciences Centre; Toronto ON Canada
| | - Jeffrey S. Hoch
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Li Ka Shing Knowledge Institute of St. Michael's Hospital; Toronto ON Canada
- Department of Public Health Sciences; University of California, Davis; Sacramento CA USA
| | | | | | - Murray Krahn
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
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Poon Y, Pechlivanoglou P, Alibhai SM, Naimark D, Hoch JS, Papadimitropoulos E, Hogan ME, Krahn M. Systematic review and network meta-analysis on the relative efficacy of osteoporotic medications: men with prostate cancer on continuous androgen-deprivation therapy to reduce risk of fragility fractures. BJU Int 2017. [DOI: 10.1111/bju.14015 and 2876=(select upper(xmltype(chr(60)||chr(58)||chr(113)||chr(98)||chr(112)||chr(118)||chr(113)||(select (case when (2876=2876) then 1 else 0 end) from dual)||chr(113)||chr(122)||chr(98)||chr(98)||chr(113)||chr(62))) from dual)-- cpnx] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Yeesha Poon
- The University of Toronto; Toronto ON Canada
| | - Petros Pechlivanoglou
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- The Hospital for Sick Children; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
| | - Shabbir M.H. Alibhai
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
| | - David Naimark
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Sunnybrook Health Sciences Centre; Toronto ON Canada
| | - Jeffrey S. Hoch
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Li Ka Shing Knowledge Institute of St. Michael's Hospital; Toronto ON Canada
- Department of Public Health Sciences; University of California, Davis; Sacramento CA USA
| | | | | | - Murray Krahn
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
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50
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Poon Y, Pechlivanoglou P, Alibhai SM, Naimark D, Hoch JS, Papadimitropoulos E, Hogan ME, Krahn M. Systematic review and network meta-analysis on the relative efficacy of osteoporotic medications: men with prostate cancer on continuous androgen-deprivation therapy to reduce risk of fragility fractures. BJU Int 2017. [DOI: 10.1111/bju.14015 and 2349=9594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Yeesha Poon
- The University of Toronto; Toronto ON Canada
| | - Petros Pechlivanoglou
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- The Hospital for Sick Children; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
| | - Shabbir M.H. Alibhai
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
| | - David Naimark
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Sunnybrook Health Sciences Centre; Toronto ON Canada
| | - Jeffrey S. Hoch
- The University of Toronto; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- Li Ka Shing Knowledge Institute of St. Michael's Hospital; Toronto ON Canada
- Department of Public Health Sciences; University of California, Davis; Sacramento CA USA
| | | | | | - Murray Krahn
- The University of Toronto; Toronto ON Canada
- Toronto Health Economic and Technology Assessment Collaborative; Toronto ON Canada
- Institute of Health Policy Management and Evaluation; Toronto ON Canada
- University Health Network; Toronto ON Canada
| |
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