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Wichtmann BD, Zöllner FG, Attenberger UI, Schönberg SO. Multiparametric MRI in the Diagnosis of Prostate Cancer: Physical Foundations, Limitations, and Prospective Advances of Diffusion-Weighted MRI. ROFO-FORTSCHR RONTG 2020; 193:399-409. [PMID: 33302312 DOI: 10.1055/a-1276-1773] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Diffusion-weighted imaging (DWI) is an essential component of the multiparametric MRI exam for the diagnosis and assessment of prostate cancer (PCa). Over the last two decades, various models have been developed to quantitatively correlate the DWI signal with microstructural characteristics of prostate tissue. The simplest approach (ADC: apparent diffusion coefficient) - currently established as the clinical standard - describes monoexponential decay of the DWI signal. While numerous studies have shown an inverse correlation of ADC values with the Gleason score, the ADC model lacks specificity and is based on water diffusion dynamics that are not true in human tissue. This article aims to explain the biophysical limitations of the standard DWI model and to discuss the potential of more complex, advanced DWI models. METHODS This article is a review based on a selective literature review. RESULTS Four phenomenological DWI models are introduced: diffusion tensor imaging, intravoxel incoherent motion, biexponential model, and diffusion kurtosis imaging. Their parameters may potentially improve PCa diagnostics but show varying degrees of statistical significance with respect to the detection and characterization of PCa in current studies. Phenomenological model parameters lack specificity, which has motivated the development of more descriptive tissue models that directly relate microstructural features to the DWI signal. Finally, we present two of such structural models, i. e. the VERDICT (Vascular, Extracellular, and Restricted Diffusion for Cytometry in Tumors) and RSI (Restriction Spectrum Imaging) model. Both have shown promising results in initial studies regarding the characterization and prognosis of PCa. CONCLUSION Recent developments in DWI techniques promise increasing accuracy and more specific statements about microstructural changes of PCa. However, further studies are necessary to establish a standardized DWI protocol for the diagnosis of PCa. KEY POINTS · DWI is paramount to the mpMRI exam for the diagnosis of PCa.. · Though of clinical value, the ADC model lacks specificity and oversimplifies tissue complexities.. · Advanced phenomenological and structural models have been developed to describe the DWI signal.. · Phenomenological models may improve diagnostics but show inconsistent results regarding PCa assessment.. · Structural models have demonstrated promising results in initial studies regarding PCa characterization.. CITATION FORMAT · Wichtmann BD, Zöllner FG, Attenberger UI et al. Multiparametric MRI in the Diagnosis of Prostate Cancer: Physical Foundations, Limitations, and Prospective Advances of Diffusion-Weighted MRI. Fortschr Röntgenstr 2021; 193: 399 - 409.
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Affiliation(s)
| | - Frank Gerrit Zöllner
- Computer Assisted Clinical Medicine, Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Stefan O Schönberg
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Germany
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Friedrich M, Wiedemann K, Reiche K, Puppel SH, Pfeifer G, Zipfel I, Binder S, Köhl U, Müller GA, Engeland K, Aigner A, Füssel S, Fröhner M, Peitzsch C, Dubrovska A, Rade M, Christ S, Schreiber S, Hackermüller J, Lehmann J, Toma MI, Muders MH, Sommer U, Baretton GB, Wirth M, Horn F. The Role of lncRNAs TAPIR-1 and -2 as Diagnostic Markers and Potential Therapeutic Targets in Prostate Cancer. Cancers (Basel) 2020; 12:E1122. [PMID: 32365858 PMCID: PMC7280983 DOI: 10.3390/cancers12051122] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 04/13/2020] [Accepted: 04/21/2020] [Indexed: 01/17/2023] Open
Abstract
In search of new biomarkers suitable for the diagnosis and treatment of prostate cancer, genome-wide transcriptome sequencing was carried out with tissue specimens from 40 prostate cancer (PCa) and 8 benign prostate hyperplasia patients. We identified two intergenic long non-coding transcripts, located in close genomic proximity, which are highly expressed in PCa. Microarray studies on a larger cohort comprising 155 patients showed a profound diagnostic potential of these transcripts (AUC~0.94), which we designated as tumor associated prostate cancer increased lncRNA (TAPIR-1 and -2). To test their therapeutic potential, knockdown experiments with siRNA were carried out. The knockdown caused an increase in the p53/TP53 tumor suppressor protein level followed by downregulation of a large number of cell cycle- and DNA-damage repair key regulators. Furthermore, in radiation therapy resistant tumor cells, the knockdown leads to a renewed sensitization of these cells to radiation treatment. Accordingly, in a preclinical PCa xenograft model in mice, the systemic application of nanoparticles loaded with siRNA targeting TAPIR-1 significantly reduced tumor growth. These findings point to a crucial role of TAPIR-1 and -2 in PCa.
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Affiliation(s)
- Maik Friedrich
- Institute of Clinical Immunology, Medical Faculty, University of Leipzig, Johannisallee 30, D-04103 Leipzig, Germany; (K.W.); (K.R.); (G.P.); (I.Z.); (S.B.); (U.K.); (F.H.)
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, RIBOLUTION Biomarker Center Perlickstr. 1, D-04103 Leipzig, Germany; (S.-H.P.); (M.R.); (S.C.)
| | - Karolin Wiedemann
- Institute of Clinical Immunology, Medical Faculty, University of Leipzig, Johannisallee 30, D-04103 Leipzig, Germany; (K.W.); (K.R.); (G.P.); (I.Z.); (S.B.); (U.K.); (F.H.)
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, RIBOLUTION Biomarker Center Perlickstr. 1, D-04103 Leipzig, Germany; (S.-H.P.); (M.R.); (S.C.)
| | - Kristin Reiche
- Institute of Clinical Immunology, Medical Faculty, University of Leipzig, Johannisallee 30, D-04103 Leipzig, Germany; (K.W.); (K.R.); (G.P.); (I.Z.); (S.B.); (U.K.); (F.H.)
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, RIBOLUTION Biomarker Center Perlickstr. 1, D-04103 Leipzig, Germany; (S.-H.P.); (M.R.); (S.C.)
| | - Sven-Holger Puppel
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, RIBOLUTION Biomarker Center Perlickstr. 1, D-04103 Leipzig, Germany; (S.-H.P.); (M.R.); (S.C.)
| | - Gabriele Pfeifer
- Institute of Clinical Immunology, Medical Faculty, University of Leipzig, Johannisallee 30, D-04103 Leipzig, Germany; (K.W.); (K.R.); (G.P.); (I.Z.); (S.B.); (U.K.); (F.H.)
| | - Ivonne Zipfel
- Institute of Clinical Immunology, Medical Faculty, University of Leipzig, Johannisallee 30, D-04103 Leipzig, Germany; (K.W.); (K.R.); (G.P.); (I.Z.); (S.B.); (U.K.); (F.H.)
| | - Stefanie Binder
- Institute of Clinical Immunology, Medical Faculty, University of Leipzig, Johannisallee 30, D-04103 Leipzig, Germany; (K.W.); (K.R.); (G.P.); (I.Z.); (S.B.); (U.K.); (F.H.)
| | - Ulrike Köhl
- Institute of Clinical Immunology, Medical Faculty, University of Leipzig, Johannisallee 30, D-04103 Leipzig, Germany; (K.W.); (K.R.); (G.P.); (I.Z.); (S.B.); (U.K.); (F.H.)
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, RIBOLUTION Biomarker Center Perlickstr. 1, D-04103 Leipzig, Germany; (S.-H.P.); (M.R.); (S.C.)
| | - Gerd A. Müller
- Molecular Oncology, Medical School University of Leipzig, Semmelweisstr. 14, D-04103 Leipzig, Germany; (G.A.M.); (K.E.)
- Department of Chemistry and Biochemistry, University of California at Santa Cruz, 1156 High Street, Santa Cruz, CA 95064, USA
| | - Kurt Engeland
- Molecular Oncology, Medical School University of Leipzig, Semmelweisstr. 14, D-04103 Leipzig, Germany; (G.A.M.); (K.E.)
| | - Achim Aigner
- Clinical Pharmacology, Rudolf-Boehm-Institute for Pharmacology and Toxicology, Faculty of Medicine, Leipzig University, Härtelstr. 16–18, D-04107 Leipzig, Germany;
| | - Susanne Füssel
- Department of Urology, University Hospital and Faculty of Medicine, Technische Universität Dresden, Fetscherstr. 74, D-01307 Dresden, Germany; (S.F.); (M.F.); (M.W.)
| | - Michael Fröhner
- Department of Urology, University Hospital and Faculty of Medicine, Technische Universität Dresden, Fetscherstr. 74, D-01307 Dresden, Germany; (S.F.); (M.F.); (M.W.)
- Zeisigwaldklinik BETHANIEN, Zeisigwaldstraße 101, D-09130 Chemnitz, Germany
| | - Claudia Peitzsch
- National Center for Tumor Diseases (NCT), Partner Site Dresden, German Cancer Research Center (DKFZ), D-69120 Heidelberg, Germany;
- OncoRay—National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden—Rossendorf, D-01307 Dresden, Germany;
- German Cancer Consortium (DKTK), Partner Site Dresden, German Cancer Research Center (DKFZ), D-69120 Heidelberg, Germany
| | - Anna Dubrovska
- OncoRay—National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden—Rossendorf, D-01307 Dresden, Germany;
- German Cancer Consortium (DKTK), Partner Site Dresden, German Cancer Research Center (DKFZ), D-69120 Heidelberg, Germany
- Helmholtz-Zentrum Dresden—Rossendorf, Institute of Radiooncology—OncoRay, D-01328 Dresden, Germany
| | - Michael Rade
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, RIBOLUTION Biomarker Center Perlickstr. 1, D-04103 Leipzig, Germany; (S.-H.P.); (M.R.); (S.C.)
| | - Sabina Christ
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, RIBOLUTION Biomarker Center Perlickstr. 1, D-04103 Leipzig, Germany; (S.-H.P.); (M.R.); (S.C.)
| | - Stephan Schreiber
- Helmholtz Centre for Environmental Research—UFZ, Young Investigators Group Bioinformatics & Transcriptomics, Permoserstr. 15, D-04318 Leipzig, Germany; (S.S.); (J.H.)
| | - Jörg Hackermüller
- Helmholtz Centre for Environmental Research—UFZ, Young Investigators Group Bioinformatics & Transcriptomics, Permoserstr. 15, D-04318 Leipzig, Germany; (S.S.); (J.H.)
| | - Jörg Lehmann
- Department of Therapy Validation, Fraunhofer Institute for Cell Therapy and Immunology, GLP Test Facility, Perlickstr. 1, D-04103 Leipzig, Germany;
| | - Marieta I. Toma
- Institute of Pathology, University Hospital and Faculty of Medicine, Technische Universität Dresden, Fetscherstraße 74, D-01307 Dresden, Germany; (M.I.T.); (M.H.M.); (U.S.); (G.B.B.)
- Institute of Pathology, Universitätsklinikum Bonn, Venusberg-Campus 1, D-53127 Bonn, Germany
| | - Michael H. Muders
- Institute of Pathology, University Hospital and Faculty of Medicine, Technische Universität Dresden, Fetscherstraße 74, D-01307 Dresden, Germany; (M.I.T.); (M.H.M.); (U.S.); (G.B.B.)
- Rudolf-Becker-Laboratory for Prostate Cancer Research, Institute of Pathology, Universitätsklinikum Bonn, Venusberg-Campus 1, D-53127 Bonn, Germany
| | - Ulrich Sommer
- Institute of Pathology, University Hospital and Faculty of Medicine, Technische Universität Dresden, Fetscherstraße 74, D-01307 Dresden, Germany; (M.I.T.); (M.H.M.); (U.S.); (G.B.B.)
| | - Gustavo B. Baretton
- Institute of Pathology, University Hospital and Faculty of Medicine, Technische Universität Dresden, Fetscherstraße 74, D-01307 Dresden, Germany; (M.I.T.); (M.H.M.); (U.S.); (G.B.B.)
| | - Manfred Wirth
- Department of Urology, University Hospital and Faculty of Medicine, Technische Universität Dresden, Fetscherstr. 74, D-01307 Dresden, Germany; (S.F.); (M.F.); (M.W.)
| | - Friedemann Horn
- Institute of Clinical Immunology, Medical Faculty, University of Leipzig, Johannisallee 30, D-04103 Leipzig, Germany; (K.W.); (K.R.); (G.P.); (I.Z.); (S.B.); (U.K.); (F.H.)
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, RIBOLUTION Biomarker Center Perlickstr. 1, D-04103 Leipzig, Germany; (S.-H.P.); (M.R.); (S.C.)
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Kowalewski KF, Tapking C, Hetjens S, Nickel F, Mandel P, Ritter M, Kriegmair MC. Interrupted versus continuous suturing for vesicourethral anastomosis during radical prostatectomy: protocol for a systematic review and meta-analysis. BMJ Open 2017; 7:e019823. [PMID: 29175892 PMCID: PMC5719287 DOI: 10.1136/bmjopen-2017-019823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Radical prostatectomy is the mainstay of treatment for prostate cancer. The vesicourethral anastomosis is a critical step, which most likely impacts urinary continence and urethral stenosis. To date, it still remains unclear whether interrupted and continuous suturing for the anastomosis have different outcomes. Therefore, the aim of this systematic review and meta-analysis is to compare different suture techniques for vesicourethral anastomosis in terms of surgical and functional parameters. METHODS AND ANALYSIS A comprehensive literature search will be conducted covering MEDLINE, Embase, Web of Science, the Cochrane Central Register of Controlled Trials and ClinicalTrials.gov. Studies comparing interrupted versus continuous suturing will be included in the analyses. No language restrictions will be applied. Screening, data extraction, statistical analysis and reporting will be done in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Quality assessment will be performed with the help of the Cochrane Collaboration's tool for assessing risk of bias and the Newcastle-Ottawa Scale for assessing quality of non-randomised studies. The quality of evidence will be evaluated with the Grading of Recommendations Assessment, Development and Evaluation. The primary outcome will be the time until removal of the urinary catheter. Secondary outcomes include rate of extravasation, length of hospital stay, time needed to perform the anastomosis, continence level at defined postoperative intervals and development of urethral strictures. Quantitative analysis will be calculated if meaningful. ETHICS AND DISSEMINATION In order to meet the highest ethical and methodological standards. we followed the PRISMA Protocol 2015 checklist. Each item was answered appropriately. For systematic reviews the ethical issues are strictly methodological as only data that were published earlier will be used. The full manuscript will be submitted to a peer-reviewed journal. Furthermore, the results will be presented on national and international congresses. TRIAL REGISTRATION NUMBER International prospective register of systematic reviews PROSPERO CRD42017076126.
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Affiliation(s)
- Karl Friedrich Kowalewski
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Christian Tapking
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Svetlana Hetjens
- Department Medical Faculty Mannheim and Department of Medical Statistics, University of Heidelberg, Mannheim, Germany
| | - Felix Nickel
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Philipp Mandel
- Department of Urology, University of Frankfurt, Frankfurt, Germany
| | - Manuel Ritter
- Department of Urology, University Medical Center Mannheim, Mannheim, Germany
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Auswirkungen geänderter Einschlusskriterien und negativer Berichterstattung zum PSA-Screening auf die Zahl potentiell für die PREFERE-Studie rekrutierbarer Patienten. Urologe A 2016; 55:1213-7. [DOI: 10.1007/s00120-016-0211-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ramsay CR, Adewuyi TE, Gray J, Hislop J, Shirley MDF, Jayakody S, MacLennan G, Fraser C, MacLennan S, Brazzelli M, N'Dow J, Pickard R, Robertson C, Rothnie K, Rushton SP, Vale L, Lam TB. Ablative therapy for people with localised prostate cancer: a systematic review and economic evaluation. Health Technol Assess 2016; 19:1-490. [PMID: 26140518 DOI: 10.3310/hta19490] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND For people with localised prostate cancer, active treatments are effective but have significant side effects. Minimally invasive treatments that destroy (or ablate) either the entire gland or the part of the prostate with cancer may be as effective and cause less side effects at an acceptable cost. Such therapies include cryotherapy, high-intensity focused ultrasound (HIFU) and brachytherapy, among others. OBJECTIVES This study aimed to determine the relative clinical effectiveness and cost-effectiveness of ablative therapies compared with radical prostatectomy (RP), external beam radiotherapy (EBRT) and active surveillance (AS) for primary treatment of localised prostate cancer, and compared with RP for salvage treatment of localised prostate cancer which has recurred after initial treatment with EBRT. DATA SOURCES MEDLINE (1946 to March week 3, 2013), MEDLINE In-Process & Other Non-Indexed Citations (29 March 2013), EMBASE (1974 to week 13, 2013), Bioscience Information Service (BIOSIS) (1956 to 1 April 2013), Science Citation Index (1970 to 1 April 2013), Cochrane Central Register of Controlled Trials (CENTRAL) (issue 3, 2013), Cochrane Database of Systematic Reviews (CDSR) (issue 3, 2013), Database of Abstracts of Reviews of Effects (DARE) (inception to March 2013) and Health Technology Assessment (HTA) (inception to March 2013) databases were searched. Costs were obtained from NHS sources. REVIEW METHODS Evidence was drawn from randomised controlled trials (RCTs) and non-RCTs, and from case series for the ablative procedures only, in people with localised prostate cancer. For primary therapy, the ablative therapies were cryotherapy, HIFU, brachytherapy and other ablative therapies. The comparators were AS, RP and EBRT. For salvage therapy, the ablative therapies were cryotherapy and HIFU. The comparator was RP. Outcomes were cancer related, adverse effects (functional and procedural) and quality of life. Two reviewers extracted data and carried out quality assessment. Meta-analysis used a Bayesian indirect mixed-treatment comparison. Data were incorporated into an individual simulation Markov model to estimate cost-effectiveness. RESULTS The searches identified 121 studies for inclusion in the review of patients undergoing primary treatment and nine studies for the review of salvage treatment. Cryotherapy [3995 patients; 14 case series, 1 RCT and 4 non-randomised comparative studies (NRCSs)], HIFU (4000 patients; 20 case series, 1 NRCS) and brachytherapy (26,129 patients; 2 RCTs, 38 NRCSs) studies provided limited data for meta-analyses. All studies were considered at high risk of bias. There was no robust evidence that mortality (4-year survival 93% for cryotherapy, 99% for HIFU, 91% for EBRT) or other cancer-specific outcomes differed between treatments. For functional and quality-of-life outcomes, the paucity of data prevented any definitive conclusions from being made, although data on incontinence rates and erectile dysfunction for all ablative procedures were generally numerically lower than for non-ablative procedures. The safety profiles were comparable with existing treatments. Studies reporting the use of focal cryotherapy suggested that incontinence rates may be better than for whole-gland treatment. Data on AS, salvage treatment and other ablative therapies were too limited. The cost-effectiveness analysis confirmed the uncertainty from the clinical review and that there is no technology which appears superior, on the basis of current evidence, in terms of average cost-effectiveness. The probabilistic sensitivity analyses suggest that a number of ablative techniques are worthy of further research. LIMITATIONS The main limitations were the quantity and quality of the data available on cancer-related outcomes and dysfunction. CONCLUSIONS The findings indicate that there is insufficient evidence to form any clear recommendations on the use of ablative therapies in order to influence current clinical practice. Research efforts in the use of ablative therapies in the management of prostate cancer should now be concentrated on the performance of RCTs and the generation of standardised outcomes. STUDY REGISTRATION This study is registered as PROSPERO CRD42012002461. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Craig R Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Joanne Gray
- Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Jenni Hislop
- Health Economics Group, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Mark D F Shirley
- School of Biology, Newcastle University, Newcastle upon Tyne, UK
| | | | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Cynthia Fraser
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Sara MacLennan
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - Miriam Brazzelli
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - James N'Dow
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - Robert Pickard
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Clare Robertson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Kieran Rothnie
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Luke Vale
- Health Economics Group, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Thomas B Lam
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
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Abstract
Prostate cancer represents the most common noncutaneous malignancy in men. With the widespread use of prostate-specific antigen screening, as many as one in six men in the USA will be diagnosed with prostate cancer. Significant healthcare resources are currently devoted to the treatment of this disease, specifically aimed at improving the side effects of successful treatment. Surgery or radiation therapy provides the best chance of cure from this disease. However, as many as 50% of patients treated with curative intent will develop a recurrence 10-15 years following treatment. Hormonal ablation via medical or surgical castration provides disease control, but is associated with significant hot flushes, loss of libido and impotence. Selective, apoptotic antineoplastic drugs, such as exisulind, may provide an alternative method to treating or preventing prostate cancer. This drug profile reviews the evidence for the use of exisulind in the treatment of prostate cancer.
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Affiliation(s)
- W Scott Webster
- Department of Urology, Mayo Clinic and Medical School, Rochester, MN 55905, USA
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Xu Y, Jiang Y, Wu B. New Agonist- and Antagonist-Based Treatment Approaches for Advanced Prostate Cancer. J Int Med Res 2012; 40:1217-26. [PMID: 22971474 DOI: 10.1177/147323001204000401] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Increased understanding of prostate cancer biology has led to new treatment strategies and promising new agents for treating prostate cancer, in particular peptide-based agonists and antagonists. In this review article, new therapy modalities and potential approaches for the treatment of advanced prostate cancer are discussed, including agonists and antagonists of luteinizing hormone-releasing hormone, antagonists of bombesin/gastrin-releasing peptide, and growth hormone-releasing hormone and somatostatin analogues. Though the prognosis of patients with prostate cancer is much improved by some of these treatment approaches, including combination treatment methods, extensive side-effects are still reported. These include sexual dysfunction, functional lesions of the liver and renal system, osteoporosis, anaemia and diarrhoea. Future studies should focus on new treatment agents and treatment approaches that can eliminate side-effects and improve quality of life in patients with prostate cancer on the basis of potent treatment efficacy.
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Affiliation(s)
- Y Xu
- Department of Urology, The Affiliated Jiangyin Hospital of Nantong University, Jiangyin, Jiangsu, China
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yf Jiang
- Department of Urology, The Affiliated Jiangyin Hospital of Nantong University, Jiangyin, Jiangsu, China
| | - B Wu
- Department of Urology, The Affiliated Jiangyin Hospital of Nantong University, Jiangyin, Jiangsu, China
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Kudahetti SC, Fisher G, Ambroisine L, Prowse D, Kattan MW, Foster CS, Møller H, Oliver T, Fletcher A, Cooper C, Reuter V, Scardino P, Cuzick J, Berney DM. Immunohistochemistry for p16, but not Rb or p21, is an independent predictor of prognosis in conservatively treated, clinically localised prostate cancer. Pathology 2010; 42:519-23. [DOI: 10.3109/00313025.2010.508788] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Weissbach L, Altwein J. Active surveillance or active treatment in localized prostate cancer? DEUTSCHES ARZTEBLATT INTERNATIONAL 2009; 106:371-6. [PMID: 19623304 DOI: 10.3238/arztebl.2009.0371] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Accepted: 01/22/2009] [Indexed: 11/27/2022]
Abstract
BACKGROUND At present, one in six men over age 50 carries the diagnosis of prostate cancer, but only one in 33 will die of the disease. In view of these facts, conservative strategies such as active surveillance (AS) are important in the management of prostate cancer. METHODS To obtain information on active surveillance, the Medline database was searched from January 2002 to April 2008 for the terms "prostate cancer" OR "prostatic neoplasms," AND "active surveillance" OR "expectant management". In addition a manual search was performed in the reference lists of relevant publications on the treatment of prostate cancer and on active surveillance. RESULTS 88 relevant publications about active surveillance were found. The studies varied in methodological quality but consistently showed low rates of tumor progression and high rates of tumor-specific survival with active surveillance (99% to 100%). All 7 guidelines on the treatment of prostate cancer that have been published since 2006 list active surveillance in their recommendations as a therapeutic option for prostate cancer if there is a low risk of progression. In fact, the National Institute of Clinical Excellence (U.K.) recommends the active surveillance exclusively as the treatment strategy for such cases. CONCLUSIONS The guideline recommendations reflect a changed attitude toward the treatment of prostate cancer in the light of the early detection of these tumors and the data now available regarding active surveillance. A corresponding change in actual medical practice would be desirable. The treatment of prostate cancer should always be adapted to the individual needs of the patient, and risky treatments should only be used when absolutely necessary.
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Affiliation(s)
- Lothar Weissbach
- Privatärztliche Urologische Gemeinschaftspraxis in der EuromedClinic Fürth, Fürth, Germany.
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10
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Rayford W. Managing the low-socioeconomic-status prostate cancer patient. J Natl Med Assoc 2006; 98:521-30. [PMID: 16623064 PMCID: PMC2569254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Management of patients with low socioeconomic status and/or low literacy who have prostate cancer presents a challenge to healthcare professionals. Improving treatment outcomes for these men requires specific educational programs to provide a better understanding of prostate cancer including careful posttreatment follow-up to ensure they have recovered well, that the cancer is not progressing and that complications are not proving troublesome. Practice nurses and health educators/navigators can play an important role in achieving these objectives. Education and knowledgeable advice can lead to earlier diagnosis of prostate cancer, improved patient participation in the treatment decision-making process and effective management of posttreatment complications.
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Affiliation(s)
- Walter Rayford
- Department of Urology, Louisiana State University Health Sciences Center, New Orleans 70112, USA.
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Bott SRJ, Birtle AJ, Taylor CJ, Kirby RS. Prostate cancer management: 2. An update on locally advanced and metastatic disease. Postgrad Med J 2004; 79:643-5. [PMID: 14654575 PMCID: PMC1742876 DOI: 10.1136/pmj.79.937.643] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Just under half of men with prostate cancer present with locally advanced or metastatic disease. A multidisciplinary approach is required to improve survival, minimise complications, and provide adequate palliation. Radiotherapy remains the mainstay of treatment for pelvic disease control and encouraging results have been reported with androgen ablation as adjuvant therapy. In metastatic disease androgen ablation is usually first line, although ultimately most tumours become hormone refractory, requiring second or third line treatments. Localised or systemic radiotherapy may be used for palliation in metastatic disease. With the advent of more potent bisphosphonates the common bony complications associated with metastases may be reduced. This, the second review of prostate cancer, explores the various treatments available to the multidisciplinary team.
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