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DE Nunzio C, Nacchia A, Grimaldi MC, Turchi B, Rovesti L, Franco A, Guarnotta G, Voglino O, Mancini E, Baldassarri V, Lombardo R, Cicione A, Tubaro A. Major adverse cardiovascular events related to phosphodiesterase 5 inhibitors: analysis of real-life data from Eudra-Vigilance database. Minerva Urol Nephrol 2024; 76:203-209. [PMID: 38498298 DOI: 10.23736/s2724-6051.23.05611-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND Phosphodiesterase 5 inhibitors (PDE5i) are the standard medical treatment for erectile dysfunction. Aim of our study was to evaluate the rate of major adverse cardiovascular events (MACE) reported during PDE5i treatment based on Eudra-Vigilance (EV) reports. METHODS EV database is the system for managing and analyzing data on suspected adverse reactions to medicines which have been authorized or being studied in clinical trials in the European Economic Area. MACE are defined as non-fatal stroke, non-fatal myocardial infarction, non-fatal congestive heart failure, revascularization after aorto-coronary graft bypass and cardiovascular death. We recorded the number of MACE for sildenafil, tadalafil, vardenafil, avanafil per category and severity until 1st July 2023. Pooled Relative Risk (PRR) was used to compare data between drugs. RESULTS Overall, 951 MACE events were reported. Most of them were observed in younger patients <65 years old (452/951 events, 48%). Overall, 377/8939 (4%) MACE events were observed for sildenafil, 221/5213 (4%) for tadalafil, 50/1029 (4%) for vardenafil and no events for avanafil. No significative differences were reported comparing sildenafil and tadalafil (PRR 0.71-0.99, IQR 0.61-1.35, P>0.05), neither sildenafil vs. vardenafil (PRR 0.68-0.79, IQR 0.43-1.55, P>0.05), neither tadalafil vs. vardenafil (PRR 0.77-0.95, IQR 0.64-1.30. P>0.05) even when compared for age. Comparison between different classes of age showed MACE were more frequent in patients younger than 65 years old taking sildenafil and tadalafil when compared to patients older than 85 years old (PRR 0.02-0.11. IQR 0.01-0.40. P<0.01) and when compared to patients in 65-85 class of age (PRR 0.02-0.12, IQR 0.01-0.95, P<0.01). CONCLUSIONS Real life data is consistent with MACE related to PDE5i. PDE5is are infrequently (<5%) associated with MACE. However, risk seems higher in younger patients, particularly for sildenafil (452/951 events, 48%). Clinicians should consider these data when prescribing PDE5i especially in young patients.
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Affiliation(s)
| | | | - Maria C Grimaldi
- Department of Cardiovascular and Pneumological Sciences, Sacred Heart Catholic University, Rome, Italy
- Department of Cardiovascular Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | | | | | | | | | | | - Elisa Mancini
- Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | | | | | | | - Andrea Tubaro
- Sant'Andrea Hospital, Sapienza University, Rome, Italy
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Brassetti A, Cacciatore L, Bove AM, Anceschi U, Proietti F, Misuraca L, Tuderti G, Flammia RS, Mastroianni R, Ferriero MC, Chiacchio G, D’Annunzio S, Pallares-Mendez R, Lombardo R, Leonardo C, De Nunzio C, Simone G. The Impact of Physical Activity on the Outcomes of Active Surveillance in Prostate Cancer Patients: A Scoping Review. Cancers (Basel) 2024; 16:630. [PMID: 38339381 PMCID: PMC10854832 DOI: 10.3390/cancers16030630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION Active surveillance has emerged as a valid therapeutic option in patients with low-risk prostate cancer, allowing for the deferral of definitive treatment until the time of possible disease progression. Although it is known that physical activity plays a protective role in the onset and progression of this tumor, its impact on patients with low-risk disease who are managed with active surveillance remains unclear. Our scoping review aims to summarize the existing evidence on this subject. EVIDENCE ACQUISITION On 9 April 2023, a systematic search was conducted using the PubMed and Scopus databases. The search employed the combination of the following terms: ("prostate cancer" OR "prostate tumor") AND ("active surveillance") AND ("physical activity" OR "physical exercise" OR "physical intensive activity" OR "intensive exercise") AND ("lifestyle"). Out of the 506 identified articles, 9 were used for the present scoping review, and their results were reported according to the PRISMA-ScR statement. EVIDENCE SYNTHESIS We discovered a lack of uniformity in the assessment of PA and its stratification by intensity. There was no consensus regarding what constitutes cancer progression in patients choosing expectant management. In terms of the impact of PA on AS outcomes, conflicting results were reported: some authors found no correlation, while others (six of total studies included) revealed that active men experience smaller increases in PSA levels compared to their sedentary counterparts. Additionally, higher levels of exercise were associated with a significantly reduced risk of PCa reclassification. CONCLUSION Due to the heterogeneity of the methodologies used in the available studies and the conflicting results reported, it is not possible to draw definitive conclusions concerning the role physical activity may play in the risk of prostate cancer progression in men managed with active surveillance.
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Affiliation(s)
- Aldo Brassetti
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi 53, 00144 Rome, Italy; (A.B.); (A.M.B.); (U.A.); (F.P.); (L.M.); (G.T.); (R.S.F.); (R.M.); (M.C.F.); (G.C.); (S.D.); (R.P.-M.); (C.L.); (G.S.)
| | - Loris Cacciatore
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi 53, 00144 Rome, Italy; (A.B.); (A.M.B.); (U.A.); (F.P.); (L.M.); (G.T.); (R.S.F.); (R.M.); (M.C.F.); (G.C.); (S.D.); (R.P.-M.); (C.L.); (G.S.)
| | - Alfredo Maria Bove
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi 53, 00144 Rome, Italy; (A.B.); (A.M.B.); (U.A.); (F.P.); (L.M.); (G.T.); (R.S.F.); (R.M.); (M.C.F.); (G.C.); (S.D.); (R.P.-M.); (C.L.); (G.S.)
| | - Umberto Anceschi
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi 53, 00144 Rome, Italy; (A.B.); (A.M.B.); (U.A.); (F.P.); (L.M.); (G.T.); (R.S.F.); (R.M.); (M.C.F.); (G.C.); (S.D.); (R.P.-M.); (C.L.); (G.S.)
| | - Flavia Proietti
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi 53, 00144 Rome, Italy; (A.B.); (A.M.B.); (U.A.); (F.P.); (L.M.); (G.T.); (R.S.F.); (R.M.); (M.C.F.); (G.C.); (S.D.); (R.P.-M.); (C.L.); (G.S.)
| | - Leonardo Misuraca
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi 53, 00144 Rome, Italy; (A.B.); (A.M.B.); (U.A.); (F.P.); (L.M.); (G.T.); (R.S.F.); (R.M.); (M.C.F.); (G.C.); (S.D.); (R.P.-M.); (C.L.); (G.S.)
| | - Gabriele Tuderti
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi 53, 00144 Rome, Italy; (A.B.); (A.M.B.); (U.A.); (F.P.); (L.M.); (G.T.); (R.S.F.); (R.M.); (M.C.F.); (G.C.); (S.D.); (R.P.-M.); (C.L.); (G.S.)
| | - Rocco Simone Flammia
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi 53, 00144 Rome, Italy; (A.B.); (A.M.B.); (U.A.); (F.P.); (L.M.); (G.T.); (R.S.F.); (R.M.); (M.C.F.); (G.C.); (S.D.); (R.P.-M.); (C.L.); (G.S.)
| | - Riccardo Mastroianni
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi 53, 00144 Rome, Italy; (A.B.); (A.M.B.); (U.A.); (F.P.); (L.M.); (G.T.); (R.S.F.); (R.M.); (M.C.F.); (G.C.); (S.D.); (R.P.-M.); (C.L.); (G.S.)
| | - Maria Consiglia Ferriero
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi 53, 00144 Rome, Italy; (A.B.); (A.M.B.); (U.A.); (F.P.); (L.M.); (G.T.); (R.S.F.); (R.M.); (M.C.F.); (G.C.); (S.D.); (R.P.-M.); (C.L.); (G.S.)
| | - Giuseppe Chiacchio
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi 53, 00144 Rome, Italy; (A.B.); (A.M.B.); (U.A.); (F.P.); (L.M.); (G.T.); (R.S.F.); (R.M.); (M.C.F.); (G.C.); (S.D.); (R.P.-M.); (C.L.); (G.S.)
| | - Simone D’Annunzio
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi 53, 00144 Rome, Italy; (A.B.); (A.M.B.); (U.A.); (F.P.); (L.M.); (G.T.); (R.S.F.); (R.M.); (M.C.F.); (G.C.); (S.D.); (R.P.-M.); (C.L.); (G.S.)
| | - Rigoberto Pallares-Mendez
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi 53, 00144 Rome, Italy; (A.B.); (A.M.B.); (U.A.); (F.P.); (L.M.); (G.T.); (R.S.F.); (R.M.); (M.C.F.); (G.C.); (S.D.); (R.P.-M.); (C.L.); (G.S.)
| | - Riccardo Lombardo
- “Sapienza” University of Rome, Department of Urology, Via di Grottarossa 1035, 00189 Rome, Italy; (R.L.); (C.D.N.)
| | - Costantino Leonardo
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi 53, 00144 Rome, Italy; (A.B.); (A.M.B.); (U.A.); (F.P.); (L.M.); (G.T.); (R.S.F.); (R.M.); (M.C.F.); (G.C.); (S.D.); (R.P.-M.); (C.L.); (G.S.)
| | - Cosimo De Nunzio
- “Sapienza” University of Rome, Department of Urology, Via di Grottarossa 1035, 00189 Rome, Italy; (R.L.); (C.D.N.)
| | - Giuseppe Simone
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi 53, 00144 Rome, Italy; (A.B.); (A.M.B.); (U.A.); (F.P.); (L.M.); (G.T.); (R.S.F.); (R.M.); (M.C.F.); (G.C.); (S.D.); (R.P.-M.); (C.L.); (G.S.)
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Wahlstedt E, Zhou C, Strup S, Kyung Kim J, Strup SE, Yenwong L, Allison DB, Hensley PJ. Locally advanced solitary fibrous tumour of the prostate. BMJ Case Rep 2023; 16:e257666. [PMID: 37848277 PMCID: PMC10583110 DOI: 10.1136/bcr-2023-257666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Abstract
Solitary fibrous tumours (SFTs) are rare mesenchymal neoplasms composed of spindle cells, most often occurring in the pleura. SFTs arising from the prostate are exceptionally rare, with only around 40 cases reported in literature to date. We report a man in his 60s who was referred to our clinic for elevated prostate-specific antigen and presented with mild obstructive lower urinary tract and defecatory symptoms. Prostate needle-core biopsy revealed neoplastic spindle cells that strongly expressed CD34. Cross-sectional imaging demonstrated a 12 cm locally advanced heterogeneous prostate mass with intravesical extension and mass effect on the anterior rectum. Radical cystoprostatectomy with orthotopic neobladder reconstruction was performed, and the diagnosis of primary prostatic SFT was made based on histological characteristics and immunophenotyping. We present diagnostic, clinical management and prognostic considerations in patients with primary prostatic SFT.
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Affiliation(s)
- Eric Wahlstedt
- Department of Urology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Christopher Zhou
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Sydney Strup
- Department of Urology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Joon Kyung Kim
- Department of Pathology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Stephen E Strup
- Department of Urology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Leonard Yenwong
- Department of Pathology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Derek B Allison
- Department of Urology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
- Department of Pathology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Patrick J Hensley
- Department of Urology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
- Department of Pathology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
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Jiang R, Wang X, Li Z, Cai H, Sun Z, Wu S, Chen S, Hu H. Association of metabolic syndrome and its components with the risk of urologic cancers: a prospective cohort study. BMC Urol 2023; 23:150. [PMID: 37736725 PMCID: PMC10514929 DOI: 10.1186/s12894-023-01324-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 09/15/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVE To investigate the association between metabolic syndrome (MetS) and its components and the risk of developing urologic cancers. METHODS This study included 101,510 observation subjects from May 2006 to December 2007. The subjects received questionnaires and were subjected to clinical and laboratory examinations to collect data on baseline population characteristics, waist circumference (WC), blood pressure (BP), blood glucose, blood lipids, lifestyle, and past disease history. Finally, follow-up was conducted from the date of recruitment to December 31, 2019. Cox proportional hazards modelling was applied to analyze the association between MetS and its components and the risk of developing urologic cancers. RESULTS A total of 97,975 observation subjects met the inclusion criteria. The cumulative follow-up period included 1,209,178.65 person-years, and the median follow-up time was 13.03 years. During the follow-up period, 485 cases of urologic cancers (165 cases of kidney cancer, 134 cases of prostate cancer, 158 cases of bladder cancer, and 28 cases of other urologic cancers) were diagnosed. The log-rank test results for the cumulative incidences of urologic cancer, kidney cancer, and prostate cancer indicated significant (P < 0.01) differences between the MetS and non-MetS groups (0.70% vs. 0.48%, 0.27% vs. 0.15%, and 0.22% vs. 0.13%, respectively). Compared to the non-MetS group, the risk of developing urologic [HR (95% CI) = 1.29 (1.08-1.55)], kidney [HR (95% CI) = 1.74 (1.28-2.37)], and prostate [HR (95% CI) = 1.47 (1.04-2.07)] cancers was significantly higher in the MetS group. In the MetS group, elevated BP increased the risk of developing of urologic cancer [HRs (95% CI) = 1.35 (1.10-1.66)] and kidney cancer [HR (95% CI) = 1.74 (1.21-2.51)], while central obesity increased the risk of developing prostate cancer [HR (95% CI) = 1.68 (1.18-2.40)]. CONCLUSIONS MetS increased the risk of developing urologic, kidney, and prostate cancers but had no association with the development of bladder cancer.
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Affiliation(s)
- Runxue Jiang
- Department of Oncology Surgery, Tangshan People's Hospital, No.65 Shengli Road, Tangshan, 063000, China
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, No.23 Pingjiang Road, Tianjin, 300211, China
| | - Xia Wang
- Department of Gynaecology, Tangshan Hongci Hospital, Tangshan, 063000, China
| | - Zhi Li
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, No.23 Pingjiang Road, Tianjin, 300211, China
| | - Haifeng Cai
- Department of Oncology Surgery, Tangshan People's Hospital, No.65 Shengli Road, Tangshan, 063000, China
| | - Zhiguo Sun
- Department of Oncology Surgery, Tangshan People's Hospital, No.65 Shengli Road, Tangshan, 063000, China
| | - Shouling Wu
- Health Department of Kailuan (Group), Tangshan, 063000, China
| | - Shuohua Chen
- Health Department of Kailuan (Group), Tangshan, 063000, China
| | - Hailong Hu
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, No.23 Pingjiang Road, Tianjin, 300211, China.
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Physical Inactivity, Metabolic Syndrome and Prostate Cancer Diagnosis: Development of a Predicting Nomogram. Metabolites 2023; 13:metabo13010111. [PMID: 36677036 PMCID: PMC9860889 DOI: 10.3390/metabo13010111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/26/2022] [Accepted: 01/02/2023] [Indexed: 01/10/2023] Open
Abstract
Insufficient physical activity (PA) may be a shared risk factor for the development of both metabolic syndrome (MetS) and prostate cancer (PCa). To investigate this correlation and to develop a nomogram able to predict tumor diagnosis. Between 2016 and 2018, a consecutive series of men who underwent prostate biopsy at three institutions were prospectively enrolled. PA was self-assessed by patients through the Physical Activity Scale for the Elderly (PASE) questionnaire; MetS was assessed according to Adult Treatment Panel III criteria. A logistic regression analyses was used to identify predictors of PCa diagnosis and high-grade disease (defined as International Society of Uro-Pathology grade >2 tumors). A nomogram was then computed to estimate the risk of tumor diagnosis. A total of 291 patients were enrolled; 17.5% of them (n = 51) presented with MetS. PCa was diagnosed in 110 (38%) patients overall while 51 presented high-grade disease. At multivariable analysis, age (OR 1.04; 95%CI: 1.00−1.08; p = 0.048), prostate volume (PV) (OR 0.98; 95%CI: 0.79−0.99; p = 0.004), suspicious digital rectal examination (OR 2.35; 95%CI: 1.11−4.98; p = 0.02), total PSA value (OR 1.12; 95%CI: 1.05−1.2; p < 0.001), and PASE score (OR 0.99; 95%CI: 0.98−0.99; p = 0.01) were independent predictors of tumor diagnosis. The latter two also predicted high-grade PCa. MetS was not associated with PCa diagnosis and aggressiveness. The novel nomogram displayed fair discrimination for PCa diagnosis (AUC = 0.76), adequate calibration (p > 0.05) and provided a net benefit in the range of probabilities between 20% and 90%. reduced PA was associated with an increased risk of PCa diagnosis and high-grade disease. Our nomogram could improve the selection of patients scheduled for prostate biopsy at increased risk of PCa.
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DE Nunzio C, Fiori C, Fusco F, Gregori A, Pagliarulo V, Alongi F. Androgen deprivation therapy and cardiovascular risk in prostate cancer. Minerva Urol Nephrol 2022; 74:508-517. [PMID: 35470648 DOI: 10.23736/s2724-6051.22.04847-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Androgen-deprivation therapy (ADT), with or without palliative local treatments, is the standard of care for many patients with locally-advanced and/or metastatic prostate cancer. However, the possible cardiovascular (CV) risks associated with gonadotropin-releasing hormone (GnRH) antagonists and agonists continue to be the subject of concern, especially in a patient population that may already be at increased CV risk. EVIDENCE ACQUISITION The present review provides a narrative summary of the evidence regarding the CV risks associated with GnRH antagonists and agonists from randomized clinical trials (RCTs), real-world evidence, and meta-analyses. EVIDENCE SYNTHESIS From RCTs, it appears clear that there is a direct class effect for CV risk in patients with prostate cancer being administered GnRH agonists and antagonists, with the latter being associated with reduced CV risk. Real-world data and the available meta-analyses largely indicate that CV risk is lower with GnRH antagonists than with GnRH agonists. CONCLUSIONS A review of the pathophysiological mechanisms of gives further support to the possibility that GnRH antagonists are associated with lower CV risk than agonists. It can be highlighted that when treating patients with advanced or metastatic prostate cancer it is important to screen for underlying comorbidities prior to choosing the most appropriate therapy; moreover, patients should be closely monitored for factors associated with CV risk in order to optimize outcomes. Further studies are needed to define the most appropriate treatment according to the individual patient characteristics.
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Affiliation(s)
| | - Cristian Fiori
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Ferdinando Fusco
- Urology Unit, Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy
| | | | | | - Filippo Alongi
- Advanced Radiation Oncology Department, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Verona, Italy.,University of Brescia, Brescia, Italy
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