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Cussenot O, Fromont G, Cancel-Tassin G, Hamdy FC, Martin RM. Endemic statistical paradoxes in epidemiologic studies distort knowledge on prostate cancer: mitigation and caution of fallacies in prostate cancer causal epidemiological studies. Curr Opin Urol 2023; 33:421-427. [PMID: 37555785 DOI: 10.1097/mou.0000000000001119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
PURPOSE OF REVIEW Many studies on epidemiology of prostate cancer (PCa) are based on a diagnosis of PCa using PSA (prostate-specific antigen) level. However, biases can distort the interpretation of the results, which in turn limits policy and decision making on public health prevention strategies or clinical guidelines. The main confusion is to interpret the posterior probability of the outcome following the exposure as a change in the prevalence of the disease outcome, whereas this change reflects only the predictive values of the PSA test induced by the exposure of interest. RECENT FINDINGS Many studies report potential causal factors involved in PCa risk. However, the lack of integration of how physiological changes in PSA values are associated with the exposures being investigated, they explain in part contradictory and controversial results on PCa risk factors in the literature. SUMMARY A strategy to perform case--control studies based on PSA stratification is suggested to avoid misinterpretation related to PSA misclassification. Real data are analysed, and we show that we can exploit the mechanism of selection biases using different modalities of controls recruitment based on biomarker stratification to distinguish real from false causal factors.
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Affiliation(s)
- Olivier Cussenot
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- CeRePP, Paris, France
| | - Gaelle Fromont
- CeRePP, Paris, France
- Department of Pathology, CHRU Tours, Tours, France
| | | | - Freddie C Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Richard M Martin
- Population Health Sciences, Bristol Medical School, University of Bristol
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
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Yue L, Ge Y, Wang T, Ge M, Zhang C, Zhang W. The correlation between body mass index and prostatic-related parameters in men 40 years or older in Zhengzhou. Aging Male 2020; 23:483-488. [PMID: 30451056 DOI: 10.1080/13685538.2018.1530754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To understand the relationship between body mass index (BMI), age, prostate volume (PV), prostate-specific antigen (PSA), International Prostate Symptom Score (IPSS) and quality of life (QoL) in Zhengzhou. MATERIALS AND METHODS In the cross-sectional study, men living in Zhengzhou were invited to participate in this study. Men who were 40 years or older were subjected to the IPSS and related examination. A total of 1360 participants were included. Body mass index < 18.5 kg/m2 was determined as underweight, 18.5-24.99 kg/m2 normal, 25-29.99 kg/m2 overweight, and ≥30 kg/m2 obese. RESULTS The mean BMI was 24.92 ± 3.37 kg/m2. The mean PSA was 1.06 ± 0.85 ng/mL. The mean PV was 20.10 ± 9.96 mL. The mean age was 62.72 ± 11.03 years. The mean IPSS was 5.87 ± 3.48 scores. The mean QoL was 2.33 ± 1.28 scores. PSA showed a significant tendency to decrease with increasing BMI (r = -0.061, p = 0.018, ptrend = 0.037). The same with age (r = -0.109, p < .001; ptrend = .045). But the result suggested that both IPSS and QoL were positively correlated with BMI (r = 0.120, p < .001, ptrend < .001; r = 0.083, p = .001, ptrend = .021, respectively). PV increased with increasing BMI (r = 0.110, p < .001, ptrend = 0.045 ). CONCLUSIONS Age, PSA decreased with increasing BMI. But larger PV, IPSS, and QoL were associated with higher BMI.
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Affiliation(s)
- Limin Yue
- Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Yongchao Ge
- Department of Urology, Zhengzhou Third People's Hospital, Zhengzhou, Henan, China
| | - Tao Wang
- Department of General Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Mengying Ge
- Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Chengda Zhang
- Department of International Medicine, Beaumont Health System, Royal Oak, MI, USA
| | - Weidong Zhang
- Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, Henan, China
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Grammatikopoulou MG, Gkiouras K, Papageorgiou SΤ, Myrogiannis I, Mykoniatis I, Papamitsou T, Bogdanos DP, Goulis DG. Dietary Factors and Supplements Influencing Prostate Specific-Antigen (PSA) Concentrations in Men with Prostate Cancer and Increased Cancer Risk: An Evidence Analysis Review Based on Randomized Controlled Trials. Nutrients 2020; 12:nu12102985. [PMID: 33003518 PMCID: PMC7600271 DOI: 10.3390/nu12102985] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 09/19/2020] [Accepted: 09/24/2020] [Indexed: 12/15/2022] Open
Abstract
The quest for dietary patterns and supplements efficient in down-regulating prostate-specific antigen (PSA) concentrations among men with prostate cancer (PCa) or increased PCa risk has been long. Several antioxidants, including lycopene, selenium, curcumin, coenzyme Q10, phytoestrogens (including isoflavones and flavonoids), green tea catechins, cernitin, vitamins (C, E, D) and multivitamins, medicinal mushrooms (Ganoderma lucidum), fruit extracts (saw palmetto, cranberries, pomegranate), walnuts and fatty acids, as well as combined supplementations of all, have been examined in randomized controlled trials (RCTs) in humans, on the primary, secondary, and tertiary PCa prevention level. Despite the plethora of trials and the variety of examined interventions, the evidence supporting the efficacy of most dietary factors appears inadequate to recommend their use.
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Affiliation(s)
- Maria G. Grammatikopoulou
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41334 Larissa, Greece; (M.G.G.); (D.P.B.)
| | - Konstantinos Gkiouras
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41334 Larissa, Greece; (M.G.G.); (D.P.B.)
- Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, GR-54124 Thessaloniki, Greece; (S.Τ.P.); (I.M.)
- Correspondence: (K.G.); (D.G.G.)
| | - Stefanos Τ. Papageorgiou
- Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, GR-54124 Thessaloniki, Greece; (S.Τ.P.); (I.M.)
| | - Ioannis Myrogiannis
- Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, GR-54124 Thessaloniki, Greece; (S.Τ.P.); (I.M.)
| | - Ioannis Mykoniatis
- Institute for the Study of Urological Diseases (ISUD), 33 Nikis Avenue, GR-54622 Thessaloniki, Greece;
- 1st Department of Urology and Center for Sexual and Reproductive Health, G. Gennimatas—Aghios Demetrius General Hospital, 41 Ethnikis Amynis Street, Aristotle University of Thessaloniki, GR-54635 Thessaloniki, Greece
| | - Theodora Papamitsou
- Laboratory of Histology and Embryology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece;
| | - Dimitrios P. Bogdanos
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41334 Larissa, Greece; (M.G.G.); (D.P.B.)
- Division of Transplantation, Immunology and Mucosal Biology, MRC Centre for Transplantation, King’s College London Medical School, London SE5 9RS, UK
| | - Dimitrios G. Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, GR-56429 Thessaloniki, Greece
- Correspondence: (K.G.); (D.G.G.)
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Li BH, Deng T, Huang Q, Zi H, Weng H, Zeng XT. Body Mass Index and Risk of Prostate Volume, International Prostate Symptom Score, Maximum Urinary Flow Rate, and Post-Void Residual in Benign Prostatic Hyperplasia Patients. Am J Mens Health 2020; 13:1557988319870382. [PMID: 31426706 PMCID: PMC6702780 DOI: 10.1177/1557988319870382] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The objective of this study was to evaluate association between body mass index (BMI) and prostate volume (PV), international prostate symptom scores (IPSS), maximum urinary flow rate (Qmax), and post-void residual (PVR) of Chinese benign prostatic hyperplasia (BPH) patients. All newly diagnosed BPH patients between September 2016 and August 2018 were selected and 788 patients were included. According to BMI, the patients were categorized into four groups, while according to PV, IPSS, Qmax, and PVR, they were categorized into two groups based on clinical significant cutoffs. Univariable and multivariable logistic regressions and a restricted cubic spline (RCS) were applied to explore the relationship of BMI with categorical PV, IPSS, Qmax, and PVR. Compared with normal BMI, obesity presented significant association with increased risk of larger PV (>80 ml) in both unadjusted and adjusted models (unadjusted odds ratio [OR] = 1.772, 95% CI [1.201, 2.614], p = .004; adjusted OR = 1.912, 95% CI [1.212, 3.017], p = .005); however, underweight or overweight did not present a significant connection with such risk. No significant effect was identified for BMI on IPSS, Qmax, or PVR in either unadjusted or adjusted model. Nonlinear test including BMI using RCS and adjusting for confounders showed no significance (p > .05); however, a significant linear relationship was ascertained between BMI and the risk of larger PV (p < .001). In conclusion, there was a significant linear association between BMI and the risk of larger PV in BPH patients. Hence, this suggests urologists should consider both BMI and PV when providing surgical treatment for BPH patients.
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Affiliation(s)
- Bing-Hui Li
- 1 Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China.,2 Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.,3 Center for Evidence-Based Medicine, Institute of Evidence-Based Medicine and Knowledge Translation, Henan University, Kaifeng, China
| | - Tong Deng
- 2 Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.,3 Center for Evidence-Based Medicine, Institute of Evidence-Based Medicine and Knowledge Translation, Henan University, Kaifeng, China
| | - Qiao Huang
- 2 Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Hao Zi
- 1 Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China.,3 Center for Evidence-Based Medicine, Institute of Evidence-Based Medicine and Knowledge Translation, Henan University, Kaifeng, China
| | - Hong Weng
- 1 Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China.,2 Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xian-Tao Zeng
- 1 Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China.,2 Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.,3 Center for Evidence-Based Medicine, Institute of Evidence-Based Medicine and Knowledge Translation, Henan University, Kaifeng, China
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Nassir AM, Kamel HFM. Explication of the roles of prostate health index (PHI) and urokinase plasminogen activator (uPA) as diagnostic and predictor tools for prostate cancer in equivocal PSA range of 4-10 ng/mL. Saudi J Biol Sci 2020; 27:1975-1984. [PMID: 32714021 PMCID: PMC7376136 DOI: 10.1016/j.sjbs.2020.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/11/2020] [Accepted: 04/01/2020] [Indexed: 12/28/2022] Open
Abstract
Background Prostate cancer (PCa) is one of the most commonly encountered cancers and the leading cause of death worldwide. Currently used biomarkers accounts difficulties in discriminating benign from malignant cases or predicting outcome, so investigating new biomarkers performance is needed. Objectives Assessment of diagnostic and predictor roles of prostate health index (PHI) and urokinase plasminogen activator (uPA) in PCa. Methods 194 males with initial tPSA of 4-10 ng/mL were categorized into three groups: PCa, benign prostatic hyperplasia (BPH) and healthy control. Serum levels of tPSA, fPSA, p2PSA, and uPA were performed by ELISA with calculation of PHI as (p2PSA/fPSA) × √PSA. Results PHI and uPA were significantly higher in PCa patients relevant to BPH and healthy control (p ≤ 0.001). Both markers outperformed all assessed biomarkers and showed the highest area under the curve (AUC) in ROC curve analysis. Both were significantly higher in PCa patients with {Gleason score ≥ 7, late stages (cT2b,c; T3), LN extension and distant metastasis}relative to their counterparts. Additionally, PHI and uPA and were independent predictors of distant metastasis and Gleason score ≥ 7, while PHI was predictor of LN invasion (β = 0.25, p = 0.004). Conclusion PHI and uPA would be of potential value in discriminating between PCa, BPH and healthy men in addition, both are promising as independent predictors of adverse pathological features.
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Affiliation(s)
- Anmar M Nassir
- Surgery Department, Faculty of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia
| | - Hala F M Kamel
- Biochemistry Department, Faculty of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia.,Medical Biochemistry Department, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt
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Wu S, He H, Wang Y, Xu R, Zhu B, Zhao X. Association between benign prostate hyperplasia and metabolic syndrome in men under 60 years old: a meta-analysis. J Int Med Res 2019; 47:5389-5399. [PMID: 31612766 PMCID: PMC6862896 DOI: 10.1177/0300060519876823] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Shuiqing Wu
- Department of Urology, The Second Xiangya Hospital, Central South University, Hunan Province, People's Republic of China
| | - Haiqing He
- Department of Urology, The Second Xiangya Hospital, Central South University, Hunan Province, People's Republic of China
| | - Yinhuai Wang
- Department of Urology, The Second Xiangya Hospital, Central South University, Hunan Province, People's Republic of China
| | - Ran Xu
- Department of Urology, The Second Xiangya Hospital, Central South University, Hunan Province, People's Republic of China
| | - Bin Zhu
- Department of Urology, The Second Xiangya Hospital, Central South University, Hunan Province, People's Republic of China
| | - Xiaokun Zhao
- Department of Urology, The Second Xiangya Hospital, Central South University, Hunan Province, People's Republic of China
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Chen SSS, Cheng TC, Chiu LP, Tasi LY, Huang SS, Tsay SL. Predictors for lower urinary tract symptoms and the urinary specific quality of life in prostate cancer patients: One-year follow-up. J Chin Med Assoc 2019; 82:482-487. [PMID: 31180946 DOI: 10.1097/jcma.0000000000000110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Prostate cancer (PCa) is the most frequently diagnosed cancer and is becoming a growing concern in global epidemiology. Quality of life of patients has become a major outcome for cancer care but limited study investigated quality of life of PCa patients. Our study is to investigate predictors for treatment outcomes of lower urinary tract symptoms (LUTS), nocturia, and the urinary specific quality of life (uQoL) in PCa patients one year following treatment. METHODS A prospective study of 131 consecutive patients was conducted with outcome measurements before treatment, at 3 months, 6 months, and one year following therapy. We utilized the International Prostate Symptom Score questionnaire to collect data. Generalized estimating equations were performed to identify predictors for major outcomes of LUTS, nocturia, and uQoL. RESULTS LUTS increased slightly over time, but nocturia and uQoL were improved from baseline to 12 months. Results of the interaction analysis indicated that patients with TNM stage 3 compared with those with stage 2 had a reduction in LUTS from diagnosis to 6 months. Patients who received surgery or radiation compared to hormone therapy had worse nocturia from diagnosis to 6 months compared to those of patients who received hormone therapy. Higher body mass index (BMI) decreased the uQoL from diagnosis to 3 months, and higher prostate-specific antigen (PSA) level deteriorated the uQoL from diagnosis to 12 months. CONCLUSION TNM stage and BMI affected the LUTS. Patients undergone a prostatectomy or radiation therapy showed more frequency of nocturia, BMI and PSA were also risk factors for nocturia. Moreover, patients' age, BMI, and PSA affected uQoL. In such patients, we recommend close monitoring of patients' specific characteristics such as TNM stage, BMI, and PSA for a better quality of life.
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Affiliation(s)
- Saint Shiou-Sheng Chen
- Division of Urology, Taipei City Hospital, Taipei, Taiwan, ROC
- National Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC
| | - Tse-Chou Cheng
- Division of Urology, Chi-Mei Medical Center, Liouying, Taiwan, ROC
- College of Nursing & Health Sciences, Dayeh University, Changhua, Taiwan, ROC
| | - Li-Pin Chiu
- Division of General Surgery, Taipei City Hospital, Taipei, Taiwan, ROC
| | - Li-Yun Tasi
- College of Nursing & Health Sciences, Dayeh University, Changhua, Taiwan, ROC
| | - Sheng-Shiung Huang
- College of Nursing & Health Sciences, Dayeh University, Changhua, Taiwan, ROC
| | - Shiow-Luan Tsay
- College of Nursing & Health Sciences, Dayeh University, Changhua, Taiwan, ROC
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