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Zhu J, Zhang J, Hu P, Fan M, Song D, Yin H, Yan P, Xian S, Li Z, Guo J, Long C, Xu R, Huang R, Meng T, Zhang J, Huang Z. Identification of Bone Metastatic and Prognostic Alternative Splicing Signatures in Prostate Adenocarcinoma. Biochem Genet 2023; 61:2242-2259. [PMID: 37010714 PMCID: PMC10665256 DOI: 10.1007/s10528-023-10367-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 08/07/2022] [Indexed: 04/04/2023]
Abstract
As the most common nonepithelial malignancy, prostate adenocarcinoma (PRAD) is the fifth chief cause of cancer mortality in men. Distant metastasis often occurs in advanced PRAD and most patients are dying from it. However, the mechanism of PRAD progression and metastasis is still unclear. It's widely reported that more than 94% of genes are selectively splicing in humans and many isoforms are particularly related with cancer progression and metastasis. Spliceosome mutations occur in a mutually exclusive manner in breast cancer, and different components of spliceosomes are targets of somatic mutations in different types of breast cancer. Existing evidence strongly supports the key role of alternative splicing in breast cancer biology, and innovative tools are being developed to use splicing events for diagnostic and therapeutic purposes. In order to identify if the PRAD metastasis is associated with alternative splicing events (ASEs), the RNA sequencing data and ASEs data of 500 PRAD patients were retrieved from The Cancer Genome Atlas (TCGA) and TCGASpliceSeq databases. By Lasso regression, five genes were screened to construct the prediction model, with a good reliability by ROC curve. Additionally, results in both univariate and multivariate Cox regression analysis confirmed the well prognosis efficacy of the prediction model (both P < 0.001). Moreover, a potential splicing regulatory network was established and after multiple-database validation, we supposed that the signaling axis of HSPB1 up-regulating the PIP5K1C - 46,721 - AT (P < 0.001) might mediate the tumorigenesis, progression and metastasis of PRAD via the key members of Alzheimer's disease pathway (SRC, EGFR, MAPT, APP and PRKCA) (P < 0.001).
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Affiliation(s)
- Jiwen Zhu
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, 1 East Jianshe Road, Zhengzhou, 450052, China
- Division of Spine, Department of Orthopedics, Tongji Hospital affiliated to Tongji University School of Medicine, Shanghai, 200065, China
- Tongji University School of Medicine, Shanghai, 200092, China
| | - Jiayao Zhang
- School of Mathematical Sciences of Tongji University, Shanghai, 200092, China
| | - Peng Hu
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, 1 East Jianshe Road, Zhengzhou, 450052, China
| | - Mingxiang Fan
- Tongji University School of Medicine, Shanghai, 200092, China
| | - Dianwen Song
- Department of Orthopedics, School of Medicine, Shanghai General Hospital, Shanghai Jiaotong University, 100 Haining Road, Shanghai, 200065, China
| | - Huabin Yin
- Department of Orthopedics, School of Medicine, Shanghai General Hospital, Shanghai Jiaotong University, 100 Haining Road, Shanghai, 200065, China
| | - Penghui Yan
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, 1 East Jianshe Road, Zhengzhou, 450052, China
| | - Shuyuan Xian
- Tongji University School of Medicine, Shanghai, 200092, China
| | - Zhenyu Li
- Tongji University School of Medicine, Shanghai, 200092, China
| | - Juanru Guo
- School of Mathematical Sciences of Tongji University, Shanghai, 200092, China
| | - Chunling Long
- Tongji University School of Medicine, Shanghai, 200092, China
| | - Runping Xu
- Tongji University School of Medicine, Shanghai, 200092, China
| | - Runzhi Huang
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, 1 East Jianshe Road, Zhengzhou, 450052, China.
- Division of Spine, Department of Orthopedics, Tongji Hospital affiliated to Tongji University School of Medicine, Shanghai, 200065, China.
- Tongji University School of Medicine, Shanghai, 200092, China.
| | - Tong Meng
- Division of Spine, Department of Orthopedics, Tongji Hospital affiliated to Tongji University School of Medicine, Shanghai, 200065, China.
- Department of Orthopedics, School of Medicine, Shanghai General Hospital, Shanghai Jiaotong University, 100 Haining Road, Shanghai, 200065, China.
| | - Jie Zhang
- Tongji University School of Medicine, Shanghai, 200092, China.
- Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, 201204, China.
| | - Zongqiang Huang
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, 1 East Jianshe Road, Zhengzhou, 450052, China.
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Yu EM, Hwang MW, Aragon-Ching JB. Mechanistic Insights on Localized to Metastatic Prostate Cancer Transition and Therapeutic Opportunities. Res Rep Urol 2023; 15:519-529. [PMID: 38050587 PMCID: PMC10693764 DOI: 10.2147/rru.s386517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/15/2023] [Indexed: 12/06/2023] Open
Abstract
Prostate cancer is the most common non-cutaneous cancer among American men. Multiple mechanisms are involved in tumorigenesis and progression to metastases. While androgen deprivation therapy remains the cornerstone of treatment, progression to castration-resistant disease becomes inevitable. Aberrant pathway activations of PI3K/AKT due to PTEN loss, epithelial-mesenchymal transition pathways, homologous recombination repair, and DNA repair pathway mechanisms of resistance and cross-talk lead to opportunities for therapeutic targeting in metastatic castration-resistant prostate cancer. This review focuses on mechanisms of progression and key trials that evaluate the drugs and combinations that exploit these pathways.
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Affiliation(s)
- Eun-mi Yu
- GU Medical Oncology, Inova Schar Cancer Institute, Fairfax, VA, USA
| | - Min Woo Hwang
- Department of Internal Medicine, Inova Fairfax Hospital, Fairfax, VA, USA
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Kim MJ, Ku JM, Hong SH, Kim HI, Kwon YY, Park JS, Jung DH, Shin YC, Ko SG. In vitro Anticancer Effects of JI017 on Two Prostate Cancer Cell Lines Involve Endoplasmic Reticulum Stress Mediated by Elevated Levels of Reactive Oxygen Species. Front Pharmacol 2021; 12:683575. [PMID: 34054558 PMCID: PMC8155384 DOI: 10.3389/fphar.2021.683575] [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: 03/21/2021] [Accepted: 04/30/2021] [Indexed: 02/05/2023] Open
Abstract
Prostate cancer is the second most commonly diagnosed cancer, and prostate cancer is the second most common cause of cancer death in United States men after lung cancer. Many therapies are used to treat prostate cancer, and chemotherapy is one of the most relevant treatments. However, chemotherapy has many side effects, and repeated administration of chemotherapeutic agents leads to acquired resistance. Thus, new drugs with few side effects are needed. We investigated the molecular mechanism of action of JI017 in human prostate cancer cells. We identified an endoplasmic reticulum (ER) stress pathway that depended on the reactive oxygen species (ROS) pathway and played a crucial role in JI017-induced apoptosis. We measured cell viability by the MTS assay to determine the effect of JI017. Analysis of apoptosis, mitochondrial dysfunction, and cell cycle features was performed by flow cytometry. We used western blot and RT-PCR to measure the levels of the proteins of the unfolded protein response (UPR) pathway and apoptosis markers. Immunoprecipitation assay and transfection were used to determine the expression levels of proteins interacting with the pathways influenced by JI017 in prostate cancer cells. The anticancer effects induced by JI017 were evaluated. JI017 induced cell death that regulated apoptotic molecules and caused cell cycle arrest that inhibited the proliferation of cancer cells. Moreover, JI017 generated ROS. Accumulation of ROS caused ER stress through the PERK-eIF2α-CHOP and IRE1α-CHOP pathways. Furthermore, persistent activation of the UPR pathway induced by JI017 treatment triggered mitochondrial dysfunction, including dissipation of mitochondrial membrane potential, which activated intrinsic apoptotic pathway in human prostate cancer cells. The data indicated that N-acetyl-L-cysteine diminished apoptosis. We demonstrated that JI017 induced ER stress and cell death. Anticancer properties of JI017 in prostate cancer cells and in a human prostate cancer model involved ROS-mediated ER stress. Thus, JI017 treatment provides a new strategy for chemotherapy of prostate cancer.
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Affiliation(s)
- Min Jeong Kim
- Department of Science in Korean Medicine, Graduate School, Kyung Hee University, Seoul, South Korea
| | - Jin Mo Ku
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul, South Korea.,Pharmacological Toxicology Laboratory, Jeil Pharmaceutical, Yongin-si, South Korea
| | - Se Hyang Hong
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul, South Korea.,Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Hyo In Kim
- Department of Science in Korean Medicine, Graduate School, Kyung Hee University, Seoul, South Korea.,Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School Boston, Boston, MA, United States
| | - Yun Young Kwon
- Department of Korean Medicine, College of Korean Medicine, Graduate School, Kyung Hee University, Seoul, South Korea
| | - Joon-Sang Park
- Department of Korean Medicine, College of Korean Medicine, Graduate School, Kyung Hee University, Seoul, South Korea
| | - Deok Hyun Jung
- Department of Korean Medicine, College of Korean Medicine, Graduate School, Kyung Hee University, Seoul, South Korea
| | - Yong Cheol Shin
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
| | - Seong-Gyu Ko
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
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Shou J, Zhang Q, Wang S, Zhang D. The prognosis of different distant metastases pattern in prostate cancer: A population based retrospective study. Prostate 2018; 78:491-497. [PMID: 29436722 DOI: 10.1002/pros.23492] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 01/22/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND The present of metastases is a poor prognostic factor in prostate cancer, but the prognostic impact of different distant metastases pattern is unclear. The aim of this study is to investigate the impact of different distant metastases pattern on the survival of patients with stage IV prostate cancer. METHODS Data queried for this study include prostate cancer (2010-2014) from the Surveillance, Epidemiology, and End Results (SEER) program. Metastatic distribution information was provided for bone, brain, liver and lung. The overall survival was calculated by the Kaplan-Meier method. Multivariable Cox regression models were used to analyze survival outcome and risk factors. RESULTS A total of 265 900 eligible patients were identified from SEER database. Among these patients, stage of IV prostate cancer accounted for 7.53% (20 034/265 900) at diagnosis. Patients who suffered metastasis to either one of the four organs occupied 61.24% (12 268/20 034) in stage of IV patients. Comparing with other three single metastases, the patients with liver metastasis exhibited worst OS whose mean survival was 17.529 months (P < 0.001). The mean survival of metastases with bong and lung was 25.238 months, which was the best survival of the six forms with two metastatic sites (P < 0.001). The results of univariate survival analysis showed that metastatic forms, race, N-classification and differentiated grade did not have impact on the overall survival of patients with three metastatic sites (all, P > 0.05). CONCLUSIONS In analysis of both one and two metastatic sites, patients with liver metastasis seemed to have worse survival outcome. On the other hand, bone metastasis had better outcome than other three visceral metastases. Knowledge of these differences in metastatic patterns may help to better guide pre-treatment evaluation of prostate cancer and make determination regarding curative-intent interventions.
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Affiliation(s)
- Jiafeng Shou
- Department of Urology, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang Province, People's Republic of China
| | - Qi Zhang
- Department of Urology, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang Province, People's Republic of China
| | - Shuai Wang
- Department of Urology, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang Province, People's Republic of China
| | - Dahong Zhang
- Department of Urology, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang Province, People's Republic of China
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Sanda MG, Cadeddu JA, Kirkby E, Chen RC, Crispino T, Fontanarosa J, Freedland SJ, Greene K, Klotz LH, Makarov DV, Nelson JB, Rodrigues G, Sandler HM, Taplin ME, Treadwell JR. Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline. Part II: Recommended Approaches and Details of Specific Care Options. J Urol 2018; 199:990-997. [PMID: 29331546 DOI: 10.1016/j.juro.2018.01.002] [Citation(s) in RCA: 226] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2017] [Indexed: 01/14/2023]
Abstract
PURPOSE This guideline is structured to provide a clinical framework stratified by cancer severity to facilitate care decisions and guide the specifics of implementing the selected management options. The summary presented herein represents Part II of the two-part series dedicated to Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline discussing risk stratification and care options by cancer severity. Please refer to Part I for discussion of specific care options and outcome expectations and management. MATERIALS AND METHODS The systematic review utilized in the creation of this guideline was completed by the Agency for Healthcare Research and Quality and through additional supplementation by ECRI Institute. This review included articles published between January 2007 and March 2014 with an update search conducted through August 2016. When sufficient evidence existed, the body of evidence for a particular treatment was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. Additional information is provided as Clinical Principles and Expert Opinions (table 2 in supplementary unabridged guideline, http://jurology.com/). RESULTS The AUA (American Urological Association), ASTRO, and SUO (Society of Urologic Oncology) formulated an evidence-based guideline based on a risk stratified clinical framework for the management of localized prostate cancer. CONCLUSIONS This guideline attempts to improve a clinician's ability to treat patients diagnosed with localized prostate cancer, but higher quality evidence in future trials will be essential to improve the level of care for these patients. In all cases, patient preferences should be considered when choosing a management strategy.
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Affiliation(s)
- Martin G Sanda
- American Urological Association Education and Research, Inc., Linthicum, Maryland; ASTRO, Arlington, Virginia; Society of Urologic Oncology, Schamburg, Illinois
| | - Jeffrey A Cadeddu
- American Urological Association Education and Research, Inc., Linthicum, Maryland; ASTRO, Arlington, Virginia; Society of Urologic Oncology, Schamburg, Illinois
| | - Erin Kirkby
- American Urological Association Education and Research, Inc., Linthicum, Maryland; ASTRO, Arlington, Virginia; Society of Urologic Oncology, Schamburg, Illinois
| | - Ronald C Chen
- American Urological Association Education and Research, Inc., Linthicum, Maryland; ASTRO, Arlington, Virginia; Society of Urologic Oncology, Schamburg, Illinois
| | - Tony Crispino
- American Urological Association Education and Research, Inc., Linthicum, Maryland; ASTRO, Arlington, Virginia; Society of Urologic Oncology, Schamburg, Illinois
| | - Joann Fontanarosa
- American Urological Association Education and Research, Inc., Linthicum, Maryland; ASTRO, Arlington, Virginia; Society of Urologic Oncology, Schamburg, Illinois
| | - Stephen J Freedland
- American Urological Association Education and Research, Inc., Linthicum, Maryland; ASTRO, Arlington, Virginia; Society of Urologic Oncology, Schamburg, Illinois
| | - Kirsten Greene
- American Urological Association Education and Research, Inc., Linthicum, Maryland; ASTRO, Arlington, Virginia; Society of Urologic Oncology, Schamburg, Illinois
| | - Laurence H Klotz
- American Urological Association Education and Research, Inc., Linthicum, Maryland; ASTRO, Arlington, Virginia; Society of Urologic Oncology, Schamburg, Illinois
| | - Danil V Makarov
- American Urological Association Education and Research, Inc., Linthicum, Maryland; ASTRO, Arlington, Virginia; Society of Urologic Oncology, Schamburg, Illinois
| | - Joel B Nelson
- American Urological Association Education and Research, Inc., Linthicum, Maryland; ASTRO, Arlington, Virginia; Society of Urologic Oncology, Schamburg, Illinois
| | - George Rodrigues
- American Urological Association Education and Research, Inc., Linthicum, Maryland; ASTRO, Arlington, Virginia; Society of Urologic Oncology, Schamburg, Illinois
| | - Howard M Sandler
- American Urological Association Education and Research, Inc., Linthicum, Maryland; ASTRO, Arlington, Virginia; Society of Urologic Oncology, Schamburg, Illinois
| | - Mary Ellen Taplin
- American Urological Association Education and Research, Inc., Linthicum, Maryland; ASTRO, Arlington, Virginia; Society of Urologic Oncology, Schamburg, Illinois
| | - Jonathan R Treadwell
- American Urological Association Education and Research, Inc., Linthicum, Maryland; ASTRO, Arlington, Virginia; Society of Urologic Oncology, Schamburg, Illinois
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Hammes J, Täger P, Drzezga A. EBONI: A Tool for Automated Quantification of Bone Metastasis Load in PSMA PET/CT. J Nucl Med 2017; 59:1070-1075. [PMID: 29242401 DOI: 10.2967/jnumed.117.203265] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 11/23/2017] [Indexed: 12/18/2022] Open
Abstract
Prostate-specific membrane antigen (PSMA) PET/CT has a high diagnostic accuracy for lesion detection in metastatic prostate cancer, including bone metastases. Novel therapeutic approaches require valid biomarkers for standardized disease staging and for evaluation of progression and therapy response. Here, we introduce EBONI (Evaluation of Bone Involvement), a software tool to automatically quantify the bone metastasis load in PSMA PET/CT. Lesion quantity, mean and maximum lesional SUV, z score, and percentage of affected bone volume are determined. EBONI is open source and freely available. Methods: To validate EBONI, the results of automated quantification of 38 PSMA PET/CT scans with different levels of bone involvement were compared with visual expert reading. The influence of SUV threshold and Hounsfield unit thresholds was analyzed. Results: A high correlation between bone lesion quantity as determined visually and automatically was found (SUVmax, r2 = 0.97; SUVmean, r2 = 0.88; lesion count, r2 = 0.97). The Hounsfield unit threshold had no significant influence, whereas an SUV threshold of 2.5 proved optimal for automated lesion quantification. The systematic error of false-positive tissue misclassification was low, occurred mainly around the salivary and lacrimal glands, and could easily be corrected. There were no false-negative ratings. Conclusion: EBONI analysis is robust, quick (<3 min per scan), and 100% reproducible. It allows rater-independent quantification of bone metastasis in metastatic prostate cancer. It provides lesion quantification equivalent to that of visual assessment, as well as providing complementary information. It can be easily implemented as an add-on to visual analysis of PSMA PET/CT scans and has the potential to reduce turnaround time.
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Affiliation(s)
- Jochen Hammes
- Department of Nuclear Medicine, University Hospital Cologne, Cologne, Germany
| | - Philipp Täger
- Department of Nuclear Medicine, University Hospital Cologne, Cologne, Germany
| | - Alexander Drzezga
- Department of Nuclear Medicine, University Hospital Cologne, Cologne, Germany
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Expert System for Bone Scan Interpretation Improves Progression Assessment in Bone Metastatic Prostate Cancer. Adv Ther 2017; 34:986-994. [PMID: 28265811 DOI: 10.1007/s12325-017-0505-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The bone scan index (BSI) was introduced as a quantitative tool for tumor involvement in bone of patients with metastatic prostate cancer (mPCa). The computer-aided diagnosis device for BSI analysis EXINIboneBSI seems to represent technical progress for the quantitative assessment of bone involvement. But it is not yet clear if the automated BSI (aBSI) could contribute to improved evaluation of progression in patients under antiandrogens or chemotherapy in contrast to the visual interpretation and/or conventional biomarkers such as the prostate-specific antigen (PSA). METHODS In 49 mPCa patients, bone scans were performed initially and during different therapy courses. Scans were evaluated visually and by the artificial-neural-network-based expert system EXINIboneBSI. Progression of metastatic bone involvement was defined according to the Prostate Cancer Clinical Trials Working Group 2 (PCWG2) criteria in the visual interpretation. The computer-assisted interpretation was based on different cutoff values in relative changes of the aBSI. Additionally, assessments according to bone scanning were compared to changes in the PSA value as a potential surrogate for treatment response. RESULTS Using a sensitive cutoff value (5% or 10%) for the relative aBSI increase led to significantly increased progression determination compared to the visual interpretation of bone scans (49% and 43% vs. 27%, p < 0.001). In 63% of the cases PSA and BSI changes matched, whereas in 18% progression was only indicated by the aBSI. A relative cutoff of 5% for the aBSI decrease could reclassify 47 serial scan pairs which were visually interpreted as stable into 22 progressive and 25 remissive scans. CONCLUSION Distinct thresholds of the relative aBSI could help to better assess disease progression in mPCa patients. Manual corrections of the BSI values are not required in most cases. The aBSI could serve as a useful additional parameter for therapy monitoring in mPCa patients in the future.
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Abstract
Worldwide, prostate cancer is considered the second most common cancer in men. Most common sites for metastatic disease are lymph nodes and bones. However, isolated liver metastasis from prostate cancer is rare. We present a 75 year-old male with prostate adenocarcinoma diagnosed 7 years ago. With rising PSA, he underwent imaging and found to have isolated hepatic metastasis. After left hepatic lobectomy, his PSA dramatically decreased to < 0.01. Physicians should be aware of isolated hepatic metastasis in patients with prostate cancer. Metastasectomy should be considered in such case, and combined medical and surgical approach may prolong the overall survival.
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Poulsen MH, Rasmussen J, Edenbrandt L, Høilund-Carlsen PF, Gerke O, Johansen A, Lund L. Bone Scan Index predicts outcome in patients with metastatic hormone-sensitive prostate cancer. BJU Int 2015; 117:748-53. [DOI: 10.1111/bju.13160] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Mads H. Poulsen
- Department of Urology,; Odense University Hospital; Odense Denmark
| | - Janne Rasmussen
- Department of Nuclear Medicine; Odense University Hospital; Odense Denmark
| | - Lars Edenbrandt
- Department of Clinical Sciences; Skåne University Hospital; Malmø Sweden
| | - Poul F. Høilund-Carlsen
- Department of Nuclear Medicine; Odense University Hospital; Odense Denmark
- Clinical Institute,; University of Southern Denmark; Odense Denmark
| | - Oke Gerke
- Department of Nuclear Medicine; Odense University Hospital; Odense Denmark
- Centre of Health Economics Research; University of Southern Denmark; Odense Denmark
| | - Allan Johansen
- Department of Nuclear Medicine; Odense University Hospital; Odense Denmark
| | - Lars Lund
- Clinical Institute,; University of Southern Denmark; Odense Denmark
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Diagnostic performance of bone scintigraphy and 11C-choline PET/CT in the detection of bone metastases in patients with biochemical recurrence of prostate cancer. Rev Esp Med Nucl Imagen Mol 2015. [DOI: 10.1016/j.remnie.2015.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Garcia JR, Moreno C, Valls E, Cozar P, Bassa P, Soler M, Alvarez-Moro FJ, Moragas M, Riera E. [Diagnostic performance of bone scintigraphy and (11)C-Choline PET/CT in the detection of bone metastases in patients with biochemical recurrence of prostate cancer]. Rev Esp Med Nucl Imagen Mol 2014; 34:155-61. [PMID: 25443648 DOI: 10.1016/j.remn.2014.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 08/11/2014] [Accepted: 08/16/2014] [Indexed: 10/24/2022]
Abstract
AIM To compare bone scan (BS) with (11)C-Choline PET/CT for the detection of bone metastases in patients with biochemical recurrence of prostate cancer (PC). MATERIAL AND METHODS A total of 169 patients with biochemical recurrence of PC(PSA:2.4-58 ng/ml) who were referred for both exams (0-15 days-in-between) were included. Lesion-detection-rate per patients and lesions were analyzed for both BS and (11)C-Choline PET/CT. Metastasis diagnosis was reached by: biopsy, CT/(18)F-Fluoride PET/MRI confirmation, or evidence of progression in subsequent imaging procedures. RESULTS A total of 91 lesions were found to be active in BS and/or (11)C-choline PET/CT (40 patients), with 78 of which were metastatic. BS detected 38 blastic, 2 lytic and 10 non-CT-evident lesions. (11)C-Choline PET/CT detected 41 blastic, 4 lytic and 29 non-CT-evident lesions. BS and (11)C-Choline PET/CT sensitivities were 65.4% and 96.1%; specificities ere 38.5 and 92.3% (χ(2) 8.27, p<0.04). Both imaging techniques were negative in 118 patients. Tracer avid lesions were found in 51 patients: with 30/51 being BS and (11)C-Choline PET/CT concordant; in 21/51 patients had discordant lesions (kappa 0.712, p=0.00). Lesions were absolutely discordant in 10/19 patients,: 5 FN BS, 2 FP BS (degenerative changes; dysplasia), 1 FN (11)C-Choline PET/CT (blastic), 1 FP (11)C-Choline PET/CT (degenerative), 1 out of field-of-view lesion with (11)C-Choline PET/CT (tibia alone). (11)C-Choline PET/CT showed extraosseous involvement in 26/51 patients with bone metastases: 9 local recurrences, 5 infra-diaphragmatic-lymph-nodes, 2 supra-diaphragmatic, 5 local and infra-diaphragmatic, 4 infra- and supra-diaphragmatic, 1 supra-diaphragmatic and lung metastases. CONCLUSION (11)C-Choline PET/CT yielded better sensitivity and specificity than BS for the detection of bone involvement in patients with biochemical recurrence of PC and allowed extraosseous restaging, with an impact in the clinical management of these patients.
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Affiliation(s)
- J R Garcia
- Unidad PET CETIR-ERESA, Esplugues, Barcelona, España.
| | - C Moreno
- Unidad PET CETIR-ERESA, Esplugues, Barcelona, España
| | - E Valls
- Unidad PET CETIR-ERESA, Esplugues, Barcelona, España
| | - P Cozar
- Unidad PET CETIR-ERESA, Esplugues, Barcelona, España
| | - P Bassa
- Unidad PET CETIR-ERESA, Esplugues, Barcelona, España
| | - M Soler
- Unidad PET CETIR-ERESA, Esplugues, Barcelona, España
| | | | - M Moragas
- Unidad PET CETIR-ERESA, Esplugues, Barcelona, España
| | - E Riera
- Unidad PET CETIR-ERESA, Esplugues, Barcelona, España
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A literature review of 18F-fluoride PET/CT and 18F-choline or 11C-choline PET/CT for detection of bone metastases in patients with prostate cancer. Nucl Med Commun 2014; 34:935-45. [PMID: 23903557 DOI: 10.1097/mnm.0b013e328364918a] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although the detection of early bone metastases in men with prostate cancer remains a challenge in today's medicine, current guidelines state that bone scintigraphy with Tc-phosphonates (Tc-BS) is the most sensitive method for assessing bone metastases in these patients. In general, it is stated that bone scintigraphy has reasonable sensitivity and low specificity. The aim of this study was to present a review of the contemporary literature on the performance of F-fluoride and C-choline or F-choline and to reconsider the arguments based on which the present European and US guidelines are founded. A literature search was conducted using the Medline database. Data were taken from eligible studies and the level of evidence was scored. Data were pooled to calculate the weighted sensitivity and specificity. Thirteen studies were eligible for inclusion in this review. On a lesion basis, we found a sensitivity and specificity of 84.0 and 97.7% for C-choline and F-choline and 88.6 and 90.7% for F-fluoride, respectively. On a patient basis, the sensitivity and specificity were 85.2 and 96.5% for C-choline and F-choline and 86.9 and 79.9% for F-fluoride, respectively. No significant differences were found between the sensitivity and specificity of C-choline or F-choline and F-fluoride. There was large inconsistency in the reported sensitivity (range 39-100%) and specificity (range 57-80%) for Tc-BS. The literature provides evidence for superior detection of bone metastases by both F-fluoride PET and F-choline or C-choline PET with or without computed tomography (CT) compared with conventional Tc-BS. Guidelines should include F-fluoride PET/CT and C-choline or F-choline PET/CT as alternatives for Tc-BS for the detection of bone metastases in patients with prostate cancer.
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Marcus A, Eshhar Z. Allogeneic chimeric antigen receptor-modified cells for adoptive cell therapy of cancer. Expert Opin Biol Ther 2014; 14:947-54. [PMID: 24661086 DOI: 10.1517/14712598.2014.900540] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Chimeric antigen (or antibody) receptors (CAR) are fusion proteins typically combining an antibody-derived targeting fragment with signaling domains capable of activating immune cells. Recent clinical trials have shown the tremendous potential of adoptive cell transfer (ACT) of autologous T cells engineered to express a CD19-specific CAR targeting B-cell malignancies. Building on this approach, ACT therapies employing allogeneic CAR-expressing cytotoxic cells are now being explored. AREAS COVERED The basic principles of CAR-ACT are introduced. The potential benefits as well as problems of using allogeneic CAR-modified cells against tumor antigens are discussed. Various approaches to allogeneic CAR therapy are presented, including donor leukocyte infusion, CAR-redirected γδ T cells and natural killer cells, strategies to avoid graft-versus-host disease, modulation of lymphocyte migration, and exploitation of graft-versus-host reactivity. EXPERT OPINION CAR-modified allogeneic cells have the potential to act as universal effector cells, which can be administered to any patient regardless of MHC type. Such universal effector cells could be used as an 'off-the-shelf' cell-mediated treatment for cancer.
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Affiliation(s)
- Assaf Marcus
- University of California, Department of Molecular and Cell Biology, Cancer Research Laboratory Berkeley , Berkeley, CA 94720-3200 , USA
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Wang H, Yao Y, Li B. Factors associated with the survival of prostate cancer patients with rectal involvement. Diagn Pathol 2014; 9:35. [PMID: 24555830 PMCID: PMC3938032 DOI: 10.1186/1746-1596-9-35] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 12/27/2013] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Prostate cancer patients with rectal involvement are rare, and the factors associated with the survival of these patients are yet to be elucidated. PATIENTS AND METHODS We collected data on patients who were admitted to our hospital for prostate cancer in the last thirteen years and of those in studies in the literature. The associations of clinical characteristics with survival were evaluated using Cox regression models. RESULTS This study included 94 patients (5 admitted to our hospital and 89 from studies in the literature) of prostate cancer with rectal involvement. 11 patients in the group of synchronous rectal involvement at first cancer diagnosis (n = 58) and 23 patients in the group of metachronous diagnosis of rectal involvement (n = 29) died at the latest follow up. The estimated overall survival rate (% ± SE) at 1, 3, and 5 years were 68.3 ± 5.3%, 54.4 ± 7.2%, and 38.1 ± 11.1%, respectively. In the Cox univariate analysis, Asian prostate cancer (p = 0.001) was associated with better survival, while rectal bleeding (p = 0.043), metachronous presentation of development of rectal involvement (p = 0.000), prior hormonal therapy (p = 0.000) and extrarectal metastases (p = 0.054) were associated with poor survival. In multivariate analysis, prior hormone therapy (HR = 14.540, p = 0.000) and rectal bleeding (HR = 2.195, p = 0.041) retained independent poor prognostic values. There were 13 patients survived for more than 3 years, the longest survival time was 96 months. Total pelvic extenteration (TPE) combined with hormonal therapy in 12 hormone-untreated prostate cancer give us six of thirteen long-term survivors for more than 3 years in this series. CONCLUSIONS Our findings suggest that rectal involvement does not necessarily predict a worse outcome when presenting as a previously hormone-untreated disease and that the prognosis was worse when presenting as a hormone relapsed disease. Prior hormone therapy and rectal bleeding were associated independently with a significantly poor overall survival in prostate cancer patients with rectal involvement. TPE combined with hormonal therapy appears to confer better overall survival in hormonally untreated patients. VIRTUAL SLIDES The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1604504118106105.
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Affiliation(s)
- HaiTao Wang
- Department of Interventional Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
- Research Group of Evidence-based Clinical Oncology, Tianjin, China
- Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - YanHong Yao
- Department of Interventional Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
| | - BaoGuo Li
- Department of Interventional Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
- Research Group of Evidence-based Clinical Oncology, Tianjin, China
- Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
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Gandaglia G, Abdollah F, Schiffmann J, Trudeau V, Shariat SF, Kim SP, Perrotte P, Montorsi F, Briganti A, Trinh QD, Karakiewicz PI, Sun M. Distribution of metastatic sites in patients with prostate cancer: A population-based analysis. Prostate 2014; 74:210-6. [PMID: 24132735 DOI: 10.1002/pros.22742] [Citation(s) in RCA: 311] [Impact Index Per Article: 31.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 09/18/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND There is few data on what constitutes the distribution of metastatic sites in prostate cancer (PCa). The aim of our study was to systematically describe the most common sites of metastases in a contemporary cohort of PCa patients. METHODS Patients with metastatic PCa were abstracted from the Nationwide Inpatient Sample (1998-2010). Most common metastatic sites within the entire population were described. Stratification was performed according to the presence of single or multiple (≥ 2 sites) metastases. Additionally, we evaluated the distribution of metastatic sites amongst patients with and without bone metastases. RESULTS Overall, 74,826 patients with metastatic PCa were identified. The most common metastatic sites were bone (84%), distant lymph nodes (10.6%), liver (10.2%), and thorax (9.1%). Overall, 18.4% of patients had multiple metastatic sites involved. When stratifying patients according to the site of metastases, only 19.4% of men with bone metastases had multiple sites involved. Conversely, among patients with lymph nodes, liver, thorax, brain, digestive system, retroperitoneum, and kidney and adrenal gland metastases the proportion of men with multiple sites involved was 43.4%, 76.0%, 76.7%, 73.0%, 52.2%, 60.9%, and 76.4%, respectively. When focusing exclusively on patients with bone metastases, the most common sites of secondary metastases were liver (39.1%), thorax (35.2%), distant lymph nodes (24.6%), and brain (12.4%). CONCLUSIONS Although the majority of patients with metastatic PCa experience bone location, the proportion of patients with atypical metastases is not negligible. These findings might be helpful when planning diagnostic imaging procedures in patients with advanced PCa.
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Affiliation(s)
- Giorgio Gandaglia
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Department of Urology, Urological Research Institute, Vita Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy
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Clinical characteristics and prognostic factors of prostate cancer with liver metastases. Tumour Biol 2013; 35:595-601. [DOI: 10.1007/s13277-013-1083-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 08/05/2013] [Indexed: 10/26/2022] Open
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Reis ST, Timoszczuk LS, Pontes-Junior J, Viana N, Silva IA, Dip N, Srougi M, Leite KRM. The role of micro RNAs let7c, 100 and 218 expression and their target RAS, C-MYC, BUB1, RB, SMARCA5, LAMB3 and Ki-67 in prostate cancer. Clinics (Sao Paulo) 2013; 68:652-7. [PMID: 23778407 PMCID: PMC3654318 DOI: 10.6061/clinics/2013(05)12] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 11/22/2012] [Accepted: 01/16/2013] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE The aim of this study is to verify the expression of proteins that are controlled by miR-let7c, 100 and 218 using immunohistochemistry in tissue microarray representative of localized and metastasized the lymph nodes and bone prostate cancer. METHODS To verify the expression of proteins that are controlled by miR-let7c (C-MYC, BUB1, RAS) 100 (SMARCA5, RB) and 218 (LAMB3) and cell proliferation (Ki-67) we used immunohistochemistry and computerized image system ImageJ MacBiophotonics in three tissue microarrays representative of localized prostate cancer and lymph node and bone metastases. miRNA expression was evaluated by qRT-PCR using 60 paraffin blocks to construct the tissue microarray representative of localized disease. RESULTS RAS expression was increased in localized prostate cancer and bone metastases compared to the lymph nodes (p=0.017). RB showed an increase in expression from localized prostate cancer to lymph node and bone metastasis (p=0.036). LAMB3 was highly expressed in localized and lymph node metastases (p<0.001). Cell proliferation evaluated by Ki-67 showed an increase from localized prostate cancer to metastases (p<0.001). We did not found any relationship between C-MYC (p=0.253), BUB1 (p=0.649) and SMARCA5 (p=0.315) protein expression with prognosis or tumor behavior. CONCLUSION We found that the expression of RAS, RB, LAMB3 and Ki-67 changed in the different stages of prostate cancer. Furthermore, we confirmed the overexpression of the miRNAs let7c, 100 and 218 in localized prostate cancer but failed to show the control of protein expression by the putative controller miRNAs using immunohistochemistry.
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Affiliation(s)
- Sabrina T Reis
- Faculdade de Medicina da Universidade de São Paulo, Urology Department, Laboratory of Medical Research, LIM55, São Paulo/SP, Brazil
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Hatzoglou V, Patel GV, Morris MJ, Curtis K, Zhang Z, Shi W, Huse J, Rosenblum M, Holodny AI, Young RJ. Brain metastases from prostate cancer: an 11-year analysis in the MRI era with emphasis on imaging characteristics, incidence, and prognosis. J Neuroimaging 2012; 24:161-6. [PMID: 23279641 DOI: 10.1111/j.1552-6569.2012.00767.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 06/13/2012] [Accepted: 07/23/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE Brain metastases from prostate cancer are uncommon and their imaging appearance has not been well defined. The main objectives of this study were to evaluate the incidence, MRI characteristics, and prognosis of parenchymal brain metastases originating in prostate cancer. METHODS We retrospectively identified 21 patients with prostate cancer and evidence of brain metastases from 2000 to 2010. We reviewed the initial brain MRI scans and characterized the lesions according to location and appearance on MRI, while also determining patient demography, staging, and survival. RESULTS The incidence of brain metastasis from prostate cancer was .16%. At the time of brain metastasis detection, 95% of the patients had concurrent osseous metastases, 86% lymph node metastases, and 76% liver and/or lung metastases. Brain metastases were multifocal in 71% of patients, hemorrhagic in 33%, diffusion restricted in 19%, and partially cystic/necrotic in 19%. The median overall survival after brain metastasis detection was 2.8 months. CONCLUSIONS Brain metastasis from prostate cancer remains a rare phenomenon that most frequently occurs in the setting of widely disseminated bone and soft tissue disease. Patients with nonadenocarcinoma pathology are more likely to develop brain metastases. The MRI appearance is highly variable and prognosis is poor.
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Affiliation(s)
- Vaios Hatzoglou
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY; Brain Tumor Center, Memorial Sloan-Kettering Cancer Center, New York, NY
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Differential expression of matrix metalloproteinase-2 expression in disseminated tumor cells and micrometastasis in bone marrow of patients with nonmetastatic and metastatic prostate cancer: theoretical considerations and clinical implications-an immunocytochemical study. BONE MARROW RESEARCH 2012; 2012:259351. [PMID: 23227342 PMCID: PMC3513718 DOI: 10.1155/2012/259351] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 10/18/2012] [Indexed: 01/06/2023]
Abstract
Matrix metalloproteinase-2 (MMP-2) is important in the dissemination and invasion of tumor cells and activates angiogenesis. We present an immunocytochemical study of MMP-2 expression in circulating prostate cells (CPCs), disseminated tumor cells (DTCs), and micrometastasis (mM) in bone marrow of men with prostate cancer. Methods and Patients. Tumor cells were identified with anti-PSA immunocytochemistry. Positive samples underwent processing with anti-MMP-2, its expression was compared with Gleason score, concordance of expression, and metastatic and nonmetastatic disease. Results. 215 men participated, CPCs were detected in 62.7%, DTCs in 62.2%, and mM in 71.4% in nonmetastatic cancer; in metastatic cancer all had CPCs, DTCs, and mM detected. All CPCs and DTCs expressed MMP-2; in mM MMP-2 expression was positively associated with increasing Gleason score. MMP-2 expression in CPCs and DTCs showed concordance. In low grade tumors, mM and surrounding stromal cells were MMP-2 negative, with variable expression in high grade tumors; in metastatic disease, both mM and stromal cells were MMP-2 positive. Conclusions. CPCs and DTCs are different from mM, with inhibition of MMP-2 expression in mM of low grade tumors. With disease progression, MMP-2 expression increases in both mM and surrounding stromal cells, with implications for the use of bisphosphonates or MMP-2 inhibitors.
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Johansen TEB, Botto H, Cek M, Grabe M, Tenke P, Wagenlehner FME, Naber KG. Critical review of current definitions of urinary tract infections and proposal of an EAU/ESIU classification system. Int J Antimicrob Agents 2011; 38 Suppl:64-70. [PMID: 22018988 DOI: 10.1016/j.ijantimicag.2011.09.009] [Citation(s) in RCA: 121] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Classification of urinary tract infections (UTI) is important for clinical decisions, research, quality measurement and teaching. Current definitions of UTI are above all based on the concept of the two main categories, complicated and uncomplicated UTI. The category "complicated UTI" especially is very heterogeneous and not always clear. We propose the EAU/ESIU classification system ORENUC based on the clinical presentation of the UTI, categorisation of risk factors and availability of appropriate antimicrobial therapy, which finally may result in the definition of UTI severity groups.
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Affiliation(s)
- Truls E Bjerklund Johansen
- Department of Urology, Århus University Hospital, Skejby, Århus University, Brendstrupgårdvej 100, DK-8200 Århus, Denmark.
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Trerè D, Zilbering A, Dittus D, Kim P, Ginsberg PC, Daskal I. AgNOR quantity in needle biopsy specimens of prostatic adenocarcinomas: correlation with proliferation state, Gleason score, clinical stage, and DNA content. Mol Pathol 2010; 49:M209-13. [PMID: 16696076 PMCID: PMC408060 DOI: 10.1136/mp.49.4.m209] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Aims-To define the relation between the quantity of silver stained nucleolar organiser regions (AgNORs) and histological grade, clinical stage, DNA content, and MIB-1 immunostaining in needle biopsy specimens of prostatic adenocarcinomas.Methods-Histological grade was determined according to the Gleason system. AgNOR quantity, DNA content and MIB-1 immunostaining were evaluated by image cytometry on routine histological sections stained with silver, Feulgen reaction and MIB-1 antibody, respectively.Results-The mean AgNOR area increased with increasing Gleason score. A significant difference was found in the AgNOR values between low, intermediate and high grade tumours. Patients with clinically localised tumour (stages A and B) had lower AgNOR values than patients with advanced disease (stages C and D), but the difference in the mean AgNOR values between the two groups was not statistically significant. Non-diploid tumours had a significantly higher mean (SD) AgNOR area than diploid tumours (3.68 (1.04) mum(2)v 2.73 (0.60) mum(2), respectively), while no significant difference was observed in the mean AgNOR values between aneuploid and tetraploid tumours (3.68 (1.04) mum(2)v 3.70 (1.05) mum(2)). When AgNOR and MIB-1-PI values were compared using linear regression analysis, a highly significant correlation was found.Conclusions-These data demonstrate that AgNOR quantity reflects the proliferative potential of prostatic adenocarcinomas, and is significantly related to histological grade and DNA content. The ease of application on routine sections, maintaining the morphological integrity of the tissue, the ability to evaluate selected histological areas of limited size and objective quantification by image cytometry make the AgNOR method particularly suitable for cell kinetic analysis in prostatic needle biopsy specimens.
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Affiliation(s)
- D Trerè
- Albert Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141-3098, USA
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E-cadherin and beta-catenin loss of expression related to bone metastasis in prostate cancer. Appl Immunohistochem Mol Morphol 2010; 18:179-84. [PMID: 18685493 DOI: 10.1097/pai.0b013e3181640bca] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES E-cadherin and beta-catenin are adhesion molecules responsible for the maintenance of normal epithelial cell phenotype. A disturbance in epithelial cell adhesion, which leads to a more invasive and metastatic phenotype, is a hallmark of tumor progression. Several immunohistochemical studies have reported a strong correlation between loss of their expression to higher stage and grade in prostate carcinoma, but their influence in metastatic process is not yet known. The aim of this study is to verify the role of adhesion molecules in the progression of prostate cancer (PC), assessing the expression of E-cadherin and beta-catenin in bone metastasis. MATERIALS AND METHODS Twenty-eight bone metastases of prostate carcinoma were submitted to immunohistochemistry analysis for E-cadherin and beta-catenin expression. In 6 patients, we were able to assess the expression of the adhesion molecules in the primary tumors and their respective metastases. The definition of normal expression for both antibodies was strong and diffuse expression in more than 70% of tumor cells. RESULTS In bone metastases, there was loss of expression of E-cadherin and beta-catenin in 86% and 82%, respectively. Among the primary tumors, E-cadherin and beta-catenin expression was normal in 83% and 50% cases, respectively. Considering the 6 patients with paired primary and bone metastasis, we found loss of expression for both E-cadherin and beta-catenin in most of the cases. CONCLUSIONS Comparing primary PC and its metastasis, we showed persistent loss of E-cadherin and beta-catenin expression. This phenomenon may be related to metastatic potential in PC, because we have shown underexpression for E-cadherin and beta-catenin in 86% and 82% of bone metastases.
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Hirano D, Minei S, Sugimoto S, Yamaguchi K, Yoshikawa T, Hachiya T, Kawata N, Yoshida T, Takahashi S. Implications of circulating chromogranin A in prostate cancer. ACTA ACUST UNITED AC 2009; 41:297-301. [PMID: 17763220 DOI: 10.1080/00365590701303934] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate whether measurement of circulating chromogranin A (CgA) levels provides clinicopathological and prognostic information in prostate cancer. MATERIAL AND METHODS Plasma CgA levels were measured in 57 patients with histologically confirmed prostate cancer (stage B or less, n=22; stage C, n=10; stage D1, n=2; hormone-naive D2, n=12; hormone-refractory D2, n=11) and in 22 with undetected prostate cancer using an enzyme-linked immunoabsorbent assay. RESULTS Median plasma CgA levels were significantly higher in patients with prostate cancer than in those with undetected cancer (p=0.0271). Higher stage (p<0.0001) and higher grade (p=0.0412) tumours were also significantly associated with higher plasma CgA levels. Above-normal CgA levels were also detected in 4/27 patients (15%) who underwent radical prostatectomy. Postoperative clinical failure was not reported in the prostatectomy patients; however, prostate-specific antigen (PSA) failure was reported in 44% of patients after a median follow-up period of 20.3 months. Multivariate analysis revealed that the pathological stage of the tumour was the only independent predictive variable for postoperative PSA failure (p=0.0494). Preoperative plasma CgA levels had no impact on postoperative PSA failure in the subgroup (prostatectomy patients). Elevated plasma CgA levels were associated with a poor survival prognosis in patients with stage D2 prostate cancer after a median follow-up period of 22.5 months (p=0.0416). CONCLUSIONS It was demonstrated in this study that plasma CgA levels in prostate cancer increase with the severity of the disease, especially for progressive hormone-refractory prostate cancer (HRPC), after hormone therapy. Although this cross-sectional study involved only a small number of patients, we believe that plasma CgA levels may effectively predict HRPC status and prognosis in metastatic cases.
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Affiliation(s)
- Daisaku Hirano
- Department of Urology, Nihon University School of Medicine, 30-1 Ooyaguchi Kamimachi, Itabashi-ku, Tokyo, Japan.
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Abstract
PURPOSE OF REVIEW Bone is the most common site of metastasis in prostate cancer. The burden of disease from bone metastasis has repercussions in terms of cost to society, decreased quality of life, and decreased survival. Given the magnitude of bone-related morbidity in advanced prostate cancer, physicians need to be aware of preventive and therapeutic measures, and to be proactive in implementing them. RECENT FINDINGS Patients with prostate cancer are often osteopenic at baseline. Implementing androgen-deprivation therapy further increases bone mineral density loss. Lifestyle changes, vitamin D and calcium supplementation may slow the rate of bone mineral density loss. Bisphosphonates reduce androgen-deprivation therapy-related bone loss in prostate cancer patients. Zoledronic acid is the only bisphosphonate proven to decrease skeletal-related events in a randomized controlled trial in patients with metastatic prostate cancer. Newer agents such as selective oestrogen receptor modifiers and antibodies targeting receptor activator of nuclear factor-kappaB ligand are under investigation. SUMMARY Bone mineral density loss and skeletal complications are directly related to androgen-deprivation therapy and metastases in prostate cancer patients. Preventive and therapeutic modalities are available to physicians, who should be proactive in implementing them. Novel agents are under investigation and data pertaining to their efficacy should become available in the near future.
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Kamidono S, Ohshima S, Hirao Y, Suzuki K, Arai Y, Fujimoto H, Egawa S, Akaza H, Hara I, Hinotsu S, Kakehi Y, Hasegawa T. Evidence-based clinical practice Guidelines for Prostate Cancer (Summary - JUA 2006 Edition). Int J Urol 2008; 15:1-18. [PMID: 18184166 DOI: 10.1111/j.1442-2042.2007.01959.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Martínez del Valle Torres MD, Gutiérrez Cardo AL, Ortega Lozano SJ, Jiménez-Hoyuela García JM. Técnicas de imagen en el diagnóstico de metástasis óseas. ACTA ACUST UNITED AC 2007; 26:237-58. [PMID: 17662193 DOI: 10.1157/13107978] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Mason MD, Sydes MR, Glaholm J, Langley RE, Huddart RA, Sokal M, Stott M, Robinson AC, James ND, Parmar MKB, Dearnaley DP. Oral sodium clodronate for nonmetastatic prostate cancer--results of a randomized double-blind placebo-controlled trial: Medical Research Council PR04 (ISRCTN61384873). J Natl Cancer Inst 2007; 99:765-76. [PMID: 17505072 DOI: 10.1093/jnci/djk178] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The most frequent site of metastases from prostate cancer is bone. Adjuvant bisphosphonate treatment improves outcomes of patients with bone metastasis-negative breast cancer, but the effects of bisphosphonates on bone metastases in prostate cancer are not known. METHODS We performed a randomized double-blind placebo-controlled trial to determine whether a first-generation bisphosphonate could improve symptomatic bone metastasis-free survival (time to symptomatic bone metastases or death from prostate cancer) in men with nonmetastatic prostate cancer who were at high risk of developing bone metastases. Between June 1, 1994, and December 31, 1997, 508 men from 26 UK sites and one New Zealand site who were within 3 years of initial prostate cancer diagnosis with no evidence of metastases from current bone scanning were randomly assigned to daily oral sodium clodronate (2080 mg/day, n = 254) or placebo (n = 254) for a maximum of 5 years. Estimates of outcome risks were compared using Kaplan-Meier analyses. RESULTS The groups allocated to each treatment were well balanced. After a median follow-up of nearly 10 years, no evidence of benefit to the clodronate group was observed in terms of bone metastases-free survival (clodronate versus placebo, 80 events versus 68 events; hazard ratio [HR] = 1.22; 95% confidence interval [CI] = 0.88 to 1.68) or overall survival (clodronate versus placebo, 130 deaths versus 127 deaths; HR = 1.02; 95% CI = 0.80 to 1.30). Adverse events, notably gastrointestinal problems and increased lactate dehydrogenase levels, were more frequent in the clodronate group than in the placebo group; otherwise, clodronate was well tolerated. Modification of trial drug dose was more frequent in the clodronate group than the placebo group (HR = 1.63, 95% CI = 1.21 to 2.19). CONCLUSION Adjuvant sodium clodronate does not modify the natural history of nonmetastatic prostate cancer.
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Affiliation(s)
- Malcolm D Mason
- Velindre Hospital, Department of Oncology & Palliative Medicine, School of Medicine, Cardiff University, Cardiff, UK
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Ramankulov A, Lein M, Kristiansen G, Loening SA, Jung K. Plasma osteopontin in comparison with bone markers as indicator of bone metastasis and survival outcome in patients with prostate cancer. Prostate 2007; 67:330-40. [PMID: 17192877 DOI: 10.1002/pros.20540] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The study was undertaken to evaluate the diagnostic and prognostic value of plasma osteopontin (OPN) in comparison to bone markers as well as the relationships between the markers and clinico-pathological factors in prostate cancer (PCa) patients. METHODS OPN and the bone markers carboxyterminal-telopeptide of type I collagen, bone-specific alkaline phosphatase (bALP), and aminoterminal-propeptide of type I procollagen (PINP) were measured in 90 PCa patients with and without bone metastases, 35 patients with benign prostatic hyperplasia, and 29 healthy men. RESULTS OPN and bone markers were significantly elevated in patients with bone metastases compared to the other groups. Significant correlations were found between all four-bone markers (r(s) = 0.43-0.79, all P < 0.01). OPN correlated with tumor grade (r(s) = 0.23, P < 0.05). In receiver-operating characteristics (ROC) analyses, OPN and bone markers were effective in distinguishing PCa patients with and without bone metastases showing areas under the curve (AUC) between 0.80 and 0.88 (all P < 0.001). OPN had an AUC of 0.85 that increased in combination with bALP up to 0.93 providing at the point with the highest diagnostic accuracy both a sensitivity and specificity of about 90%. Kaplan-Meier analyses and Cox proportional hazards regression models showed decreased survival of patients with high OPN and bone marker levels, while only high OPN and PINP were independent negative prognostic factors for PCa-related death. CONCLUSIONS OPN alone or in combination with bone markers is useful as diagnostic marker in the detection of bone metastases and as prognosticator in the survival prediction in PCa patients.
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Affiliation(s)
- Azizbek Ramankulov
- Department of Urology, Charité--University Medicine Berlin, Campus Charité Mitte, Berlin, Germany
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Pinthus JH, Waks T, Malina V, Kaufman-Francis K, Harmelin A, Aizenberg I, Kanety H, Ramon J, Eshhar Z. Adoptive immunotherapy of prostate cancer bone lesions using redirected effector lymphocytes. J Clin Invest 2004. [DOI: 10.1172/jci200422284] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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Abstract
This article discusses general principles of medical management of bone metastases, including diagnosis and follow-up; management of specific symptoms; options for systemic treatment, including bisphosphonates; specific details about each cancer type; and future directions in therapy.
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Affiliation(s)
- Margaret K Yu
- Division of Medical Oncology, Department of Internal Medicine, University of Utah School of Medicine, 2000 Circle of Hope, Room 3344, Salt Lake City, UT 84112, USA.
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Schröder FH, Kurth KH, Fosså SD, Hoekstra W, Karthaus PPM, Debois M, Collette L. EARLY VERSUS DELAYED ENDOCRINE TREATMENT OF pN1-3 M0 PROSTATE CANCER WITHOUT LOCAL TREATMENT OF THE PRIMARY TUMOR: RESULTS OF EUROPEAN ORGANISATION FOR THE RESEARCH AND TREATMENT OF CANCER 30846—A PHASE III STUDY. J Urol 2004; 172:923-7. [PMID: 15310999 DOI: 10.1097/01.ju.0000135742.13171.d2] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The timing of endocrine treatment for prostate cancer remains controversial. The issue is addressed in protocol 30846 of the European Organisation for Research and Treatment of Cancer for patients with lymph node positive cancer without local treatment of the primary tumor. MATERIALS AND METHODS A total of 302 patients with metastatic regional lymph nodes who had not received local treatment for the primary tumor were included in the trial, of whom 234 were randomized to immediate vs delayed endocrine treatment. Endocrine treatment consisted of an luteinizing hormone-releasing hormone agonist and 1 month of antiandrogen treatment or surgical castration. The main end point of the trial was overall survival. Analysis followed the intent to treat principle. RESULTS At a median followup of 9.6 years (8.7 in the randomized sample) 190 patients (62.9%) had died, including 76% of prostate cancer. In the randomized sample the HR for survival on delayed vs immediate treatment was 1.23 (95% CI 0.88 to 1.71), indicating a 23% nonsignificant trend in favor of early treatment. However, the wide CI showed that results remained compatible with true effects, ranging from a 12% benefit in favor of delayed treatment to a 71% detriment for the same treatment approach. CONCLUSIONS While this study suggests an advantage for early treatment, it is under powered to show equivalence or superiority for the early or delayed approach. When dealing with individual patients, the potential survival advantage on early treatment must be balanced against potential advantages in quality of life on delayed treatment.
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Affiliation(s)
- Fritz H Schröder
- Department of Urology, Erasmus Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
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Roudier MP, True LD, Higano CS, Vesselle H, Ellis W, Lange P, Vessella RL. Phenotypic heterogeneity of end-stage prostate carcinoma metastatic to bone. Hum Pathol 2003; 34:646-53. [PMID: 12874759 DOI: 10.1016/s0046-8177(03)00190-4] [Citation(s) in RCA: 227] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
To better understand the clinical and pathologic features of end-stage, androgen-independent carcinoma of the prostate (CaP), we performed rapid autopsies on 14 men who died of progressive CaP and recorded relevant clinical data. The timing of tumor progression varied widely. The median time to androgen independence was 2 years (range, 4 months to 13.6 years). The median survival after androgen independence was 1 year (range, 1 month to 3.6 years). Because osseous metastases are prevalent in progressive CaP, up to 20 bone sites were systematically sampled in each patient. Bone metastases were widespread; tumor filled the marrow in an average of 14 bone sites. Tumor histology and expression of prostate-specific antigen (PSA) and chromogranin A (CGA) were examined in all metastases and were compared with the primary tumor. Five histological patterns of metastatic tumor were observed: solid (10 patients), macroacinar (1 patient), microacinar (1 patient), clear cell (1 patient), and comedocarcinoma (1 patient). Gleason grade of the primary tumor did not predict the histological pattern of the metastases. Although >70% of tumor cells expressed PSA, the fraction of PSA-positive cells varied widely in separate metastases in some patients (standard deviation >25). Likewise, the fraction of neuroendocrine (NE) (CGA-positive) tumor cells in different metastases varied widely. For example, between 0 and 95% of tumor cells in different metastases in 1 patient had a NE phenotype. The present study highlights the heterogeneity--histologically and immunophenotypically--of metastatic CaP. Consequently, therapy directed to the phenotype of 1 metastasis may have no effect on other metastases in the same patient because of phenotypic heterogeneity.
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Affiliation(s)
- Martine P Roudier
- Department of Urology, University of Washington, and Puget Sound VA Medical Center, Seattle, 98195, USA
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Berruti A, Tucci M, Terrone C, Gorzegno G, Scarpa RM, Angeli A, Dogliotti L. Background to and management of treatment-related bone loss in prostate cancer. Drugs Aging 2003; 19:899-910. [PMID: 12495366 DOI: 10.2165/00002512-200219120-00002] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Prostate cancer is a common disease among older men. Androgen suppression by either orchiectomy or administration of luteinising hormone-releasing hormone (LHRH) analogues is the mainstay of treatment. Since the use of prostate-specific antigen (PSA) serum testing has become widespread, however, the timing of endocrine therapy has expanded considerably to include patients with limited involvement of extraprostatic sites and patients presenting an isolated elevation of PSA after radical treatments. These patients are expected to be treated for a long time, since they have a rather low risk of disease progression and there is no recommended time limit for LHRH analogue therapy. The long-term adverse effects of androgen deprivation therapy, therefore, deserve more attention than they have received in the past. Osteoporosis represents a special concern for men with prostate cancer receiving androgen deprivation therapy. The rate of bone loss in these men seems to markedly exceed that associated with menopause in women, and fractures occur more frequently than in the healthy elderly male population. Serial bone mineral density (BMD) evaluation could allow the detection of patients with prostate cancer who are at greater risk of osteoporosis and adverse skeletal events after androgen deprivation therapy, such as patients already osteopenic or osteoporotic at baseline and men with rapid bone loss during treatment. BMD evaluated during treatment could also be a potential surrogate parameter of antiosteoporotic therapeutic efficacy. Treatment of bone loss induced by androgen deprivation comprises general prevention measures, antiosteoporotic drugs and the use of alternative endocrine therapies. Optimising lifestyle and diet is important, although it cannot completely prevent bone loss. Patients with nonsevere bone disease may benefit from calcium and vitamin D supplements. Men who are osteoporotic before androgen deprivation or men becoming osteoporotic during treatment and/or experiencing adverse skeletal events may also require bisphosphonates. The effectiveness of these drugs in preventing fractures has been shown in a single randomised study involving patients with osteoporosis, but it has not yet been established in a prostatic cancer population without bone metastases given androgen deprivation therapy. Different forms of endocrine therapy such as low-dose estrogens, antiandrogens and intermittent androgen ablation are under investigation. They could offer the advantage of avoiding (or limiting) treatment-related bone loss. In our opinion, however, the data available so far are not robust enough to recommend these alternative endocrine therapies instead of standard androgen deprivation in routine clinical practice.
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Affiliation(s)
- Alfredo Berruti
- Oncologia Medica, Azienda Ospedaliera San Luigi, Orbassano, Italy
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36
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Prognostic Value of Bone Scan in Patients With Metastatic Prostate Cancer Treated Initially With Androgen Deprivation Therapy. J Urol 2002. [DOI: 10.1097/00005392-200210010-00029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rigaud J, Tiguert R, Le Normand L, Karam G, Glemain P, Buzelin JM, Bouchot O. Prognostic value of bone scan in patients with metastatic prostate cancer treated initially with androgen deprivation therapy. J Urol 2002; 168:1423-6. [PMID: 12352409 DOI: 10.1016/s0022-5347(05)64465-5] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE We analyzed whether classifying bone prostate cancer metastases correlates with survival in patients treated primarily with androgen deprivation. MATERIALS AND METHODS We identified 86 patients with bone metastases who were followed between September 1988 and September 1999. Only those treated initially with androgen deprivation as monotherapy were included in this study. Clinical, pathological and radiological information were obtained by patient chart review. The 86 patients were divided into 2 groups according to metastasis grade on bone scan at diagnosis. Group 1 included patients with metastases on the axial skeleton and group 2 included those with bone metastases on the appendicular skeleton. In addition to our classification, we stratified patients according to the Soloway and Crawford et al classifications, and analyzed survival. RESULTS There were no statistical differences in the groups with axial versus appendicular metastases in terms of patient age, biopsy Gleason score, serum prostate specific antigen or clinical stage. Median survival was 53 and 29 months in patients with axial and appendicular bone metastases, respectively. Those with axial disease had better survival than those with appendicular bone metastases (p = 0.048). No statistical difference was observed when grading bone scan according to the Soloway and Crawford et al classifications. CONCLUSIONS Classifying bone scans according to the site of metastases (axial versus appendicular) had many advantages. It is easy to understand and helps urologist better predict the patient prognosis. Axial metastases carries a better prognosis than appendicular metastasis.
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Bollito E, Berruti A, Bellina M, Mosca A, Leonardo E, Tarabuzzi R, Cappia S, Ari MM, Tampellini M, Fontana D, Gubetta L, Angeli A, Dogliotti L. Relationship between neuroendocrine features and prognostic parameters in human prostate adenocarcinoma. Ann Oncol 2002; 12 Suppl 2:S159-64. [PMID: 11762345 DOI: 10.1093/annonc/12.suppl_2.s159] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE The biological behaviour of prostate cancer is highly variable and prediction by the commonly employed prognostic parameters is not sufficient. The concept of neuroendocrine (NE) differentiation in prostate adenocarcinoma has recently received increasing attention due to possible implications for prognosis and therapy. MATERIALS AND METHODS Core needle biopsies from 142 newly diagnosed patients were immunohistochemically examined for the coexistence of NE differentiation using an antibody against chromogranin A (CgA). Circulating CgA was available in 106 of these patients. RESULTS NE differentiation was found in 64 (45.1%) tumors. Among them 29 (20.4%) had CgA positive cells scattered or focally distributed in less than 5% per mm3 of tumor tissues, 26 (18.3%) between 5% and 10% and 9 (6.4%) more than 10%, respectively. There was a significant correlation between the extent of NE features and either Gleason score (P < 0.01) or stage of disease. Circulating CgA but not PSA correlated with immunohistochemical CgA (P < 0.03) particularly in metastatic cases. CONCLUSIONS These data support the concept that NE differentiation in human prostate cancer has a negative prognostic significance. Circulating CgA levels reflect immunohistochemical findings.
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Affiliation(s)
- E Bollito
- Dipartimento di Anatomia Patologica, Università di Torino, Orbassano, Italy
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Elliott TE, Elliott BA, Regal RR, Renier CM, Haller IV, Crouse BJ, Witrak MT, Jensen PB. Lake Superior Rural Cancer Care Project, Part III: provider practice. CANCER PRACTICE 2002; 10:75-84. [PMID: 11903272 DOI: 10.1046/j.1523-5394.2002.102005.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE Effective methods that encourage rural primary-care physicians to adopt state-of-the-art cancer-management practices are needed. The purpose of this study was to evaluate educational and systems strategies to improve rural primary-care physicians' cancer practice behaviors. DESCRIPTION OF STUDY The Lake Superior Rural Cancer Care Project was a group-randomized, controlled trial conducted with 18 rural communities in the North Central United States over 4 years. Although the unit of analysis was the community, the subjects were 104 primary-care physicians and 2089 rural patients with cancer. The intervention was educational and comprised systems strategies that targeted rural primary-care physicians and their healthcare delivery systems. The outcome measures reported here were physician practice behaviors regarding cancer diagnosis, staging, treatment, clinical trial participation, and post-treatment surveillance. RESULTS The intervention significantly improved 5 of the 37 cancer practice end points. The overall result of the study did not support the majority of the study hypotheses. Because 16 practice end points were found to be at acceptable performance levels, the possibility of a measurable intervention effect was limited. CLINICAL IMPLICATIONS Earlier, the authors reported the results of the intervention on providers' cancer management knowledge, which showed significant improvement. The present study findings demonstrated that improving provider knowledge does not necessarily improve practice performance. Changing practice behaviors requires much more effort. Furthermore, interventions found to be effective in other diseases, types of providers, or settings may not work on rural providers for cancer management.
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Affiliation(s)
- Thomas E Elliott
- Division of Education and Research, St. Mary's/Duluth Clinic Health System, and Clinical Professor, University of Minnesota Duluth, School of Medicine, Duluth, MN 55805, USA
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Do LV, Do TM, Smith R, Parker RG. Postoperative radiotherapy for carcinoma of the prostate: impact on both local control and distant disease-free survival. Am J Clin Oncol 2002; 25:1-8. [PMID: 11823687 DOI: 10.1097/00000421-200202000-00001] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The role of postoperative irradiation in patients with clinically localized prostate cancer, either as an adjuvant or salvage radiotherapy, remains controversial. In this study, we evaluate the impact of postoperative radiotherapy on patients diagnosed with prostate cancer with respect to biochemical and clinical disease free survival. Between 1987 and 1996, 179 patients with clinically localized prostate cancer were found to have adverse histopathologic findings on radical prostatectomy specimens (positive surgical margins, extracapsular extension, and seminal vesicle invasion). Of these patients, 42 were referred for postoperative adjuvant radiotherapy, whereas 73 were referred for salvage irradiation because of rising serum prostate-specific antigen (PSA) levels postoperatively. The remaining 64 patients underwent prostatectomy only. The 10-year biochemical relapse-free survival (RFS) from date of surgery were 88%, 45%, and 25% for patients treated with postoperative adjuvant radiotherapy, salvage irradiation, and with surgery alone, respectively (p = 0.046). Ten-year distant RFS from date of surgery were 82%, 74%, and 44% for adjuvantly treated patients, those with salvage radiotherapy, and those with surgery alone, respectively (p = 0.0180). Ten-year overall disease RFS from date of surgery was 89%, 76%, and 30% for adjuvantly treated patients, those with salvage radiotherapy, and those with surgery alone, respectively (p = 0.0237). Multivariate analyses revealed that a preoperative PSA greater than 20 ng/ml and pathologic Gleason Score of 8 to 10 were adverse predictors for biochemical relapse, whereas pathologic Gleason Score of 8 to 10, seminal vesicle invasion, and extracapsular extension were adverse predictors of distant metastases. Postoperative radiotherapy, either delivered as adjuvant treatment for adverse histopathologic findings or as salvage therapy for local relapses, appear to confer superior local, distant disease RFS, and overall disease RFS than surgery alone.
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Affiliation(s)
- Ly V Do
- University of California Irvine, College of Medicine, UCI Medical Center, Irvine, California, U.S.A
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41
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Cooner WH, Mosley BR, Rutherford CL, Beard JH, Pond HS, Terry WJ, Igel TC, Kidd DD. Prostate cancer detection in a clinical urological practice by ultrasonography, digital rectal examination and prostate specific antigen. 1990. J Urol 2002; 167:966-73; discussion 973-5. [PMID: 11905926 DOI: 10.1016/s0022-5347(02)80313-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Berruti A, Dogliotti L, Mosca A, Bellina M, Mari M, Torta M, Tarabuzzi R, Bollito E, Fontana D, Angeli A. Circulating neuroendocrine markers in patients with prostate carcinoma. Cancer 2000; 88:2590-7. [PMID: 10861438 DOI: 10.1002/1097-0142(20000601)88:11<2590::aid-cncr23>3.0.co;2-d] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Circulating neuroendocrine markers were measured in patients with prostate carcinoma (PC), prostatic intraepithelial neoplasia (PIN), and benign prostatic hypertrophy (BPH) with the goal to: 1) evaluate the differences in the expression of these markers in patients with benign, premalignant, and primary or metastatic PC; 2) evaluate their prognostic significance; 3) compare values in patients with hormone-naive and hormone-refractory disease; and 4) assess changes after androgen deprivation or chemotherapy. METHODS Serum neuron specific enolase (NSE) (immunoradiometric assay) and plasma chromogranin A (CgA) (enzyme-linked immunoadsorbent assay) were evaluated in 141 patients with BPH, 54 patients with PIN, and 159 patients with PC; 119 patients were bearing hormone-naive disease and 40 were bearing hormone-refractory disease. CgA was monitored in 31 patients submitted to androgen deprivation and in 24 patients receiving chemotherapy. RESULTS Supranormal CgA was observed more frequently in patients with American Urologic Association (AUA) Stage D2 disease (45.5%) compared with those with Stage D1 disease (33.3%), Stage C disease (16.7%), Stage A/B disease (18.8%), PIN (25.9%), and BPH (17.0%) (P < 0.02). Supranormal NSE did not change in any of the patient subgroups. Elevated CgA was observed in 36.0% of patients with metastases who had hormone-naive disease and in 45.0% of patients with hormone-refractory disease (P value not significant). Supranormal NSE and CgA values were predictors for poor prognosis in patients with hormone-refractory disease. Elevated baseline CgA values decreased > 50% in 1 of 12 patients who received luteinizing hormone-releasing hormone analogs and in 2 of 12 patients who underwent chemotherapy. CONCLUSIONS CgA appears to reflect the neuroendocrine activity of PC better than NSE. Elevated CgA values correlate with poor prognosis and are scarcely influenced by either endocrine therapy or chemotherapy.
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Affiliation(s)
- A Berruti
- Dipartimento di Scienze Cliniche e Biologiche Università di Torino, Oncologia Medica, Medicina Interna, Azienda Ospedaliera San Luigi, Orbassano, Italy
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Abstract
In the detection of prostate cancer, the most important role of imaging is ultrasound-guided prostatic biopsy. In the staging evaluation of prostate cancer, each presently used modality--transrectal US (TRUS), MR imaging, CT, nuclear medicine, and positron emission tomography--has advantages and disadvantages. Evidence-based guidelines on the use of CT and nuclear medicine bone scan, in assessing the risk of distant spread of prostate cancer, are available. There is no consensus and there are no guidelines, however, for the use of imaging in the evaluation of prostate cancer local tumor extent. Results on the value of TRUS vary widely, and prospective multicenter studies suggest that TRUS is no better than digital rectal examination in predicting extracapsular extension. MR imaging offers the most promise for local staging of prostate cancer, but it must resolve problems of reproducible image quality and interobserver variability, and it should prove its efficacy in multicenter trials before it can be recommended for general clinical use. The introduction of MR spectroscopic imaging further expands the value of MR imaging, offering anatomic and metabolic evaluation of prostate cancer.
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Affiliation(s)
- K K Yu
- Department of Radiology, University of California San Francisco, USA
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Silcocks P, Needham P, Hemsley F. Audit of prostate cancer: lessons learnt for current clinical practice, surrogates for quality of care and standardisation and quality assurance. Public Health 1999; 113:161-4. [PMID: 10483076 DOI: 10.1038/sj.ph.1900567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Two-hundred and fifty-one prostate cancer patients first registered during 1994 were sampled from a Regional Cancer Registry. In the six months after diagnosis, 39% received drug treatment alone, while 37% had no active treatment. Eighty-one percent of cases were histologically proven. Seventy-six percent had a prostate specific antigen (PSA) test and in 3% the PSA test was the basis for diagnosis. Of histologically proven cases 29% had a Gleason grade. None were staged by clinicians. Key lessons were: The result was a snapshot of current clinical practice which suggested other possible surrogates for quality of care, such as basis of stage and timing of investigations; There is a need for standardisation and quality assurance of the content of pathology reports; Standard treatment protocols would aid recording and comparison of treatments.
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Affiliation(s)
- P Silcocks
- Trent Institute for Health Services Research, University of Nottingham, Queen's Medical Centre, Nottingham, UK
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46
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Silcocks P, Needham P, Hemsley F. Audit of prostate cancer: validity and feasibility of registry-based staging. Public Health 1999; 113:157-60. [PMID: 10483075 DOI: 10.1038/sj.ph.1900566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The sample consisted of 251 prostate cancer patients who were newly registered during 1994 from a Regional Cancer Registry. It was possible for 96% of cases to be staged by Registry clerical staff, but none had been formally staged by clinicians. In 45% of cases tumour extent was based only on Digital Rectal Examination (DRE), and on 32% there was no assessment found. 81% had no investigation of nodal status and 16% of cases had echography other than trans-rectal ultrasound. To find metastases 18% had scintigraphy and 13% had a plain chest X Ray while 61% had no investigation. Cox regression gave age-adjusted hazard ratios relative to stage A (95% CI) of 2.94 (1.59 to 5.44) for Stage B, 6.43 (3.37 to 12.24) for Stage C, and 9.03 (5.12 to 15.95) for stage D. Key lessons were: Registry clerical staff can abstract stage-related information from a high proportion of case-notes even if stage is not explicitly recorded by clinicians; The validity of registry based staging information is supported by survival analysis; This activity has resource implications and would be more appropriately performed by a member of the clinical team.
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Affiliation(s)
- P Silcocks
- Trent Institute for Health Services Research, University of Nottingham, Queen's Medical Centre, Nottingham, UK
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Ruijter E, van de Kaa C, Miller G, Ruiter D, Debruyne F, Schalken J. Molecular genetics and epidemiology of prostate carcinoma. Endocr Rev 1999; 20:22-45. [PMID: 10047972 DOI: 10.1210/edrv.20.1.0356] [Citation(s) in RCA: 97] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- E Ruijter
- Department of Urology, University Hospital Nijmegen, The Netherlands
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Zhang PJ, Driscoll DL, Lee HK, Nolan C, Velagapudi SR. Decreased immunoexpression of prostate inhibin peptide in prostatic carcinoma: a study with monoclonal antibody. Hum Pathol 1999; 30:168-72. [PMID: 10029444 DOI: 10.1016/s0046-8177(99)90271-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Prostate inhibin peptide (PIP) is a follicle-stimulating hormone (FSH) regulating peptide produced by the prostate. The mechanism of its endocrine role in regulating prostate growth is believed to be androgen-independent but FSH-dependent. Previous studies using polyclonal antibody proposed PIP as a prostatic-specific marker in cancer diagnosis. However, the recently available monoclonal antibody has not yet been evaluated. Paraffin sections of 72 prostatectomy specimens for prostate cancer with or without hormonal blockage therapy and 10 nonneoplastic prostate tissues from autopsy were stained by using PIP monoclonal antibody (clone: 4A6A6) with the avidin-biotin complex method. PIP reactivity was semiquantitatively estimated in prostatic carcinoma (PCA), prostatic intraepithelial neoplasia (PIN), benign prostatic hyperplasia (BPH) and normal tissue in each case when ever present. Statistical analyses were performed accordingly. PIP expression is predominantly cytoplasmic. Urothelium, seminal vesicles, inflamed prostatic glands, basal cells, and squamous metaplasia were negative for PIP. Average percentage of cells expressing PIP was significantly decreased in PIN (40%) and PCA (14%) when compared with BPH (81%) and normal tissue (68%). There was no correlation of tumor PIP level with patient's age, tumor size, Gleason score, tumor stage, or the usage of preoperative hormonal blockage therapy. PIP monoclonal antibody should be used with caution as a prostate-specific marker in surgical pathology. The mechanism for this alteration and the effect of PIP on prostatic tumor growth, particularly in patients under a variety of hormonal therapies, needs further study.
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Affiliation(s)
- P J Zhang
- Department of Pathology, Roswell Park Cancer Institute, Buffalo, NY, USA
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Affiliation(s)
- CG Berman
- Radiology Service, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida 33612, USA
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50
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Mazeron JJ, Bolla M. [Localized prostatic adenocarcinoma: role of pelvic radiotherapy following radical prostatectomy]. Cancer Radiother 1998; 1:423-30. [PMID: 9587372 DOI: 10.1016/s1278-3218(97)89563-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Radical prostatectomy after pelvic lymphadenectomy is an effective treatment for patients with T1-2 pN0 adenocarcinoma of the prostate. However, pathologic analysis of resected tissue reveals that in 20 to 40% of clinical stage B lesions, the tumour has extended locally beyond the prostate. This infra-clinical disease may be the origin of local relapse. Radiation oncologists are often asked to deliver post-operative irradiation. There is sufficient evidence in the literature that postoperative radiation therapy can improve local control rate for patients with pT3 pN0 adenocarcinoma of the prostate; however, the effect of this radiotherapy on survival in this category of patients remains unclear. It is the reason why randomised clinical trials have been implemented for investigating the role of pelvic external irradiation with respect to the effects on local control, acute and late morbidity, overall survival and cancer-related survival, and for better defining the selective indications of radiotherapy, regarding pathological data.
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Affiliation(s)
- J J Mazeron
- Centre des tumeurs, groupe hospitalier Pitié-Salpêtrière, Paris, France
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