Construction of lncRNA/Pseudogene-miRNA Network Based on In Silico Approaches for Glycolysis Pathway to Identify Prostate Adenocarcinoma-Related Potential Biomarkers

LncRNAs, pseudogenes, and miRNAs participate a fundamental function in tumorigenesis, metabolism, and invasion of cancer cells, although their regulation of tumor glycolysis in prostate adenocarcinoma (PRAD) is thoroughly not well studied. In this study, we applied transcriptomic, proteomic, and medical information to identify glycolysis-related key genes and modules associated with PRAD. Then, the glycolysis-related lncRNA/lncRNAs/pseudogenes-miRNA-mRNA network was constructed. Analysis of DNA methylation status and expression data determined a DNA methylation-dysregulated three-DE-mRNAs signature for predicting diagnosis, ANGPTL4, GNE, and HSPA in PRAD patients and healthy control. Several lncRNAs/pseudogenes, significantly correlated with the overall survival PVT1, CA5BP1, MIRLET7BHG, SNHG12, and ZNF37BP and disease-free survival status, MALAT1, GUSBP11, MIRLET7BHG, and SNHG1, of patients with PRAD were determined. The methylation profile of DE-lncRNA/pseudogenes was significantly proper for predicting PRAD prognostic model. The transcription level of 6 DE-mRNA ANGPTL4, QSOX1, BIK, CLDN3, DDIT4, and TFF3 was correlated with cancer-related fibroblast infiltration in PRAD. The mutated form of 7 mRNAs, COL5A1, IDH1, HK2, DDIT4, GNE, and QSOX1, was associated with PRAD. In addition to the glycolysis pathway, DE-RNAs play regulatory roles on several pathways, including DNA damage, RTK, cell cycle, RAS/MAPK, TSC/mTOR and PI3K/AKT, AR hormone, and EMT. Overall, our study improves our knowledge of the relation between lncRNAs/pseudogenes and miRNA related to glycolysis and PRAD pathogenesis.

Cost-effectiveness and budget impact analysis of enzalutamide in comparison to abiraterone in treatment of metastatic prostate cancer resistant to castration in Iran

INTRODUCTION

In recent years, enzalutamide and abiraterone have been widely used as treatments for metastatic castration-resistant prostate cancer (mCRPC). However, the cost-effectiveness of these drugs in Iran is unknown. This study evaluated the cost-effectiveness of enzalutamide for the treatment of metastatic prostate cancer resistant to castration in Iran.

METHODS

A 3-state Markov model was developed to evaluate the cost-effectiveness of enzalutamide and abiraterone from a social perspective over 10 years. The clinical inputs were obtained from the meta-analysis studies. The direct medical costs were obtained from the tariffs of the healthcare system, while the direct non-medical and indirect costs were collected from the patients. The data of utilities were derived from the literature. In addition, sensitivity analyses were conducted to assess the uncertainties.

RESULTS

Compared with Abiraterone, enzalutamide was associated with a high incremental cost-effectiveness ratio (ICER) of $6,260 per QALY gained. According to the one-way sensitivity analysis, ICER was most heavily influenced by the prices of enzalutamide and Abiraterone, non-medical costs, and indirect costs. Regardless of the variation, enzalutamide remained cost-effective. The budget impact analysis of enzalutamide in the health system during 5 years was estimated at $6,362,127.

CONCLUSIONS

At current prices, adding enzalutamide to pharmaceutical lists represents the cost-effective use of the healthcare resources in Iran for the treatment of metastatic castration-resistant prostate cancer.

Factor associated with willingness to pay for prevention of cancer: a study of prostate cancer screening

INTRODUCTION

This study investigates Iranian men's willingness to pay (WTP) for prostate cancer (PCa) screening and influencing factor, along with the impact of information.

METHOD

We assessed preferences for prostate cancer screening in 771 Iranian men aged 40 and above using an internet-based questionnaire survey. Participants received basic and complementary information, and their willingness to pay was determined through a payment card approach. A Wilcoxon test assessed the impact of information. We also analyzed prostate cancer screening demand and employed Heckman's two-step model to evaluate factors influencing the willingness to pay. Additionally, reasons for unwillingness to pay were explored.

RESULTS

Willingness to pay significantly decreased with complementary information relative to basic information (16.3$ vs 17.8$). Heckman model, using WTP based on basic information shows age, education, and monthly household expenditure positively influenced the decision to pay. In contrast, health status, expectations of remaining life and prostate problems history positively affect amount of WTP for PCa screening, and insurance coverage has a negative impact on it. Majority of respondents (91%) supported PCa screening, with 82% expressing a willingness to pay. Common reasons for not paying include seeing screening as a public good (43%), financial constraints (35%), and having insurance (20%). The screening demand is price-sensitive.

CONCLUSION

The basic mindset of Iranian men exaggerates the risk of prostate cancer. Reduced willingness to pay after receiving information reassures the reliability of their financial expectation. Taking into account the factors that influence PCa screening is essential for accurate planning and the successful implementation of this program.

Five Common Cancers in Iran in 2019: Secondary Analysis to Discovering Cluster of Cancers

INTRODUCTION

This study reports the prevalence of the 5 most common cancers and their geographical distribution based on the last update of cancer statistics in Iran (2019).

MATERIALS AND METHODS

The data used in this study were extracted from the Global Burden of Disease (GBD) studies. It was prepared regarding sex in different provinces. Moran's I test was used to check geographical correlation and identify hot spots and cold spots. A significance level of 5% was considered in all tests.

RESULTS

The most prevalent cancers among Iranian women reported Breast (312 per 100 000; 95% UI: 281-345), Thyroid (43 per 100 000; 95% UI: 26-51), Colon and Rectum (43 per 100 000; 95% UI: 39-47), Leukemia (33 per 100 000; 95% UI: 21 -41), and Uterine (29 per 100 000; 95% UI: 14-35) respectively; further, the most prevalent cancers among Iranian men reported Prostate (219 per 100 000; 95% UI: 158-258), Colon and Rectum (80; 72-88), Bladder (65 per 100 000; 95% UI: 58-71), Leukemia (40 per 100 000; 95% UI: 20-51), and Testicular (33 per 100 000; 95% UI: 20-48) respectively.

CONCLUSION

exclusive of any type of skin cancer, Breast, prostate, colon and rectum, bladder, thyroid, testicular, uterine, and leukemia are most prevalent cancers in Iranian population.

Targeting the MALAT1 gene with the CRISPR/Cas9 technique in prostate cancer

BACKGROUND

The MALAT1 lncRNA acts as an oncogene in Prostate cancer (PC); thus, it can be severe as a cancer biomarker.

METHODS

Using bioinformatics datasets including (HTSeq-Counts, GDC, and TCGA) 5501 gene expression profiling specimens were gathered. Then, expression profiles and sample survival of lncRNA were investigated using COX regression analyses, ROC curve analysis. The Database for Annotation, Visualization, and Integrated Discovery was used to conduct GO and KEGG studies on the lncRNA-related PCGs. After MALAT1 Knockout via CRISPR/Cas9 technique, the MALAT1 expression was assessed in DU-145 cells. The deletion of the target fragment was examined by polymerase chain reaction (PCR). Also, the expression of apoptosis genes was investigated by qRT-PCR. The viability and cell proliferation were measured using the MTT assay. Cell migration capability was determined using the cell scratch assay. The results of qRT-PCR were assessed by the ΔΔCt method, and finally, statistical analysis was performed in SPSS software.

RESULTS

A maximum of 451 lncRNAs were discovered to reflect different expressions between PC and non-carcinoma tissue samples, with 307 being upregulated and 144 being down-regulated. Thirty-six lncRNAs related to OS were carefully selected, which were then subjected to stepwise multivariate Cox regression analysis, with 2 lncRNAs (MALAT1, HOXB-AS3). MALAT1 is highly expressed in PC cells. MALAT1 Knockout in DU-145 cells increases apoptosis and prevents proliferation and migration, and DU-145 transfected cells were unable to migrate based on the scratch recovery test. Overall, data suggest that MALAT1 overexpression in PC helps metastasis and tumorigenesis. Also, MALAT1 knockout can be considered a therapeutic and diagnostic target in PC.

CONCLUSION

Targeting MALAT1 by CRISPR/Cas9 technique inhibit the cell proliferation and migration, and in addition induce apoptosis. Thus, MALAT1 can act as a tumor biomarker and therapeutic target.

Overall survival and prognostic factors prostate cancer in Kurdistan Province-Iran: a population-based study (2011-2018)

Background

The population-based survival rate is affected by the quality and effectiveness of health care systems. Overall, the survival of prostate cancer (PC) patients has improved over the past two decades worldwide. This study aimed to determine the overall survival rate and correlate it with the prognostic factors in patients with PC diagnosed in Kurdistan province.

Methods

In a retrospective cohort study, 410 PC patients registered in Kurdistan province population-based cancer registry from March 2011 to 2018 were recruited. Kaplan–Meier method and log-rank test were used to analyze the overall survival rates of PC patients. A Multivariate Cox regression model was used to determine adjusted hazard ratios for different variables.

Results

Of 410 patients with PC, 263 (64.1%) died within seven years due to the disease. The 1, 3, and 5 years survival rates were 93, 64.1, and 40.7%, respectively. According to the results of multiple Cox regression, the following factors were significantly related to PC survival: age at diagnosis (≥81-years old) (HR=2.23, 95% CI: 1.23-4.42) and 71-80 years old was (HR=1.26, 95% CI: 1.12-2.31), occupation (employee) (HR=0.42, 95% CI: 0.20–0.87), educational level: academic (HR=0.78, 95% CI: 0.64–0.91), AJCC stage of disease (HR=2.18, 95% CI: 1.9–3.68), Gleason score ≥ 9 (HR=7.12, 95% CI: 5.35–10.28), and Gleason score= 8 (HR=4.16, 95% CI: 2.50–6.93). There was less mortality rate among the patients who had received active care, radical prostatectomy, radiotherapy, combined treatment, and orchiectomy had a lower mortality rate than those who received no treatment (P<0.05).

Conclusions

This study demonstrated that factors such as age at diagnosis, level of education, occupation, AJCC stage of disease, Gleason score, and type of treatments were influential factors in the survival of PC patients in Kurdistan province and needed more attention.

Prevalence of Human Polyomavirus BK Virus in Prostate Cancer Patients and Benign Prostatic Hyperplasia: A Cross-sectional Study on Prostate Patients Referred to Imam Khomeini Hospital in Ahvaz Between 2015 and 2017

Background: Human polyomavirus BK virus (BKV) belongs to the Polyomaviridae family and seems to be a drastic virus in prostate cancer (PCa) etiology. BK virus induces oncogenesis via the expression of large tumor antigen (LTAg) and small tumor antigen (stAg). Also, BKV infection seems to play an essential role in prostate cancer development. Objectives: In this study was aimed to study the prevalence of BKV in benign and cancerous prostate tissues. Methods: In this study, 100 formalin-fixed paraffin-embedded tissues of PCa specimens and benign prostatic hyperplasia (BPH) were collected. The DNA was extracted from tissue samples, and the BKV DNA was investigated using a semi-nested polymerase chain reaction (PCR). The MEGA 6.0 software was used for phylogenetic analysis to assemble the viral genome. A phylogenetic tree was constructed by neighbor-joining analysis with 1,000 replicates of the bootstrap resampling test. Results: The BKV DNA was found in 66% (33/50) of patients with PCa and 36% (18/50) of patients with benign prostatic hyperplasia (BPH) (P = 0.003). The frequency of BKV DNA in different classes of Gleason score (5 - 10) was not significant (0.094). The distribution of BKV DNA among different age groups was not significant (P = 0.086). Conclusions: High frequency of BKV infection was detected in patients with PCa compared to patients with BPH (P = 0.003), and the coexistence of BKV DNA was confirmed in 51% (51/100) of tissue samples, which were confirmed to be subtype 1 of BKV infection.

Dietary energy density and risk of prostate cancer: (A case-control study)

OBJECTIVE

Some observational studies investigated the association between dietary energy density (DED) and risk of cancers with inconstant results. In addition, there is no study on such association among patients with prostate cancer (PC). The present study was performed to evaluate the association between dietary energy density (DED) and PC risk.

METHODS

In this case-control study, one hundred and twenty-five participants were enrolled (62 cases and 63 controls). Dietary intakes were assessed using 160-item semi-quantitative food frequency questionnaire. In addition, demographic characteristics were collected using a general questionnaire and anthropometric indices were measured based on the available guidelines. The association between DED and PC risk was evaluated using multivariable logistic regression.

RESULTS

The results showed that higher DED score was associated with increased risk of PC (OR = 2.59; 95% CI= (1.24-5.40)). Interestingly, after adjusting for potential confounders ((smoking, physical activity, energy intake, education, ethnicity, job, anti-hyperlipidemic drugs, antihypertensive drugs, and aspirin) the results remained significant (OR = 2.87; 95% CI= (1.17-7.05)).

CONCLUSION

Our findings suggest that DED may increase the risk of PC. However, more prospective studies are warranted to confirm these results.

Cancer Trends in Iraq 2000-2016

OBJECTIVES

Precise and quantitative assessment of the trend of cancer burden enables policymakers and health managers to prioritize diseases and allocate resources better. This infers what caused a decrease or increase in the rate of cancer occurrence, and if it denotes timing of implementation of a control measure, it presents the impact on the disease rate. This study's objective was to evaluate trends in child and adult cancer in Iraq from 2000 onwards.

METHODS

We used the registries of the Iraqi Ministry of Health that were gathered from all governorates from 2000-2016. Data were presented as incidence rates to depict the trends of different types of cancers distributed by age, gender, and governorates.

RESULTS

Breast cancer witnessed a significant increase with predominance in females. Lung cancer rate increased significantly from 4.08 to 5.60/100 000 (p = 0.038), affecting males more than females. The brain cancer trend showed a bimodal pattern (two peaks in 2004 and 2011) with no significant trend change (p = 0.788). Both genders were similarly affected. The trend of stomach and colorectal cancer showed an accelerated increase after 2007.

CONCLUSIONS

Almost all cancers (particularly lung and gastrointestinal) showed constantly raising trends, especially after 2007. Only cervical and laryngeal cancer had a decreasing trend. Most cancers were predominant in males.

Descriptive Epidemiology of Brain and Central Nervous System Tumours: Results from Iran National Cancer Registry, 2010-2014

Background

Central nervous system (CNS) tumours account for only 1-2% of cancer incidence but are a major reason for mortality and morbidity due to malignancies. Recent studies show an increase in the rate of CNS tumours worldwide, especially in developing countries. Moreover, there is significant heterogeneity in epidemiological patterns worldwide. This study is aimed at representing nationwide epidemiology of CNS tumours in Iran.

Methods

Iran National Cancer Registry 2010-2014 data were reviewed for CNS tumours. The epidemiological rates were calculated for both genders and all age groups using the 2011 census information.

Results

Out of 17345 cases, 58.5% were men and 41.5% were women. The mean age was 45.55 years ranging from less than 1 month to 100 years old. Average total age-standardized incidence rate (ASR) was 5.19 for primary tumours. The annual percent change (APC) was 14.23% during the study period. The most frequent site and histology recorded were brain, NOS and diffuse astrocytic, respectively. Geographical distribution showed about five-fold difference in ASRs between different provinces.

Conclusion

The overall ASR calculated was higher than the global rate in 2012 but lower than that of most developed countries, showing an increasing trend which may be due to either advances in diagnosing or risk factor augmentation. The mean age and incident rates were higher than those of previous reports in Iran.

Association study between common variations in some candidate genes and prostate adenocarcinoma predisposition through multi-stage approach in Iranian population

BACKGROUND

Prostate cancer is one of the five common cancers and has the second incidence rate and the third mortality rate in Iranian population. The purpose of this study was to evaluate the association of rs16901979, rs4242382 and rs1447295 on 8q24 locus, rs2735839 (KLK3 gene) and rs721048 (EHBP1 gene) with prostate adenocarcinoma through multi-stage approach to identify the polymorphisms associated with prostate cancer and use them as screening factors. Screening tests can identify people who may have a chance of developing the disease before detection and any symptoms.

METHODS

The case-control study included 103 cases (prostate adenocarcinoma) and 100 controls (benign prostatic hyperplasia). Tetra-primer ARMS-PCR was used to genotyping of each participant. A Multi-stage approach was used for efficient genomic study. In this method, a smaller number of people can be used. Chi-squared, Fisher's exact test and logistic regression were used to investigate the SNPs associated with prostate cancer and Gleason score.

RESULTS

In the first stage (59 men), the frequency of polymorphisms rs16901979, rs4242382, rs1447295, rs2735839 and rs721048 in the prostate adenocarcinoma group was evaluated compared to the control group (P-value < 0.3) in order to select meaningful polymorphisms. There was not any significant difference between genotype frequency rs16901979 (P = 0.671) and rs721048 (P = 0.474) in the case group compared to BPH. Therefore, these polymorphisms were eliminated, and in the second step (144 men), rs4242382, rs2735839 and rs1447295 were evaluated (P-value < 0.05). According to the total population (203 men), there was significant difference between genotype frequency rs4242382 (P = 0.001), rs2735839 (P = 0.000) and rs1447295 (P = 0.005) even after using Bonferroni correction (p = 0.016). The effect of these three polymorphisms on prostate cancer was not modified by age and PSA. There was a significant difference between the allelic frequency of A vs G (rs4242382, rs2735839) at all classes of Gleason score and A vs C (rs1447295) at Gleason score ≥ 8.

CONCLUSIONS

The results of this study for rs2735839, rs4242382 and rs1447295 indicate the association of these polymorphisms with prostate adenocarcinoma predisposition in Iranian population. Exposure effect is homogeneous between different ages and PSA level categories. These three polymorphisms should be studied in a larger population to confirm these results.

Investigation of GSTP1 and epigenetic regulators expression pattern in a population of Iranian patients with prostate cancer

BACKGROUND AND AIM

Prostate cancer is the leading cause of death in many countries. It is important to diagnose the disease in the early stages. Current methods detect the disease with low specificity. Examining the expression of genes responsible for disease and their epigenetic regulators are good tools in this regard.

MATERIAL AND METHODS

In this prospective case-control study, 40 Iranian patients with cancer, 40 Iranian patients with prostate hyperplasia, and 40 control samples were examined. After blood sampling from each individual, RNA extraction and cDNA synthesis, GSTP1, HDAC, DNMT3A, and DNMT3B expressions were measured in three understudy groups using specific primers and Real-Time PCR method.

RESULTS

A reverse correlation was identified between loss of GSTP1 expression and overexpression of HDAC, DNMT3A, and DNMT3B (P value < 0.0001) with a beneficial pattern of cancer development with high efficiency. The significant decrease of GSTP1 expression in patients in comparison to the healthy controls and the elevated expression levels of the studied epigenetic regulators in PCA and BPH samples indicate the impact of the regulators on GSTP1 expression activity.

CONCLUSION

This study showed that the measurement of combined GSTP1 and its epigenetic regulators' expression could be used as suitable genetic markers for the detection and separation of healthy individuals from prostatic patient groups in the Iranian population. However, a similar study in a larger population of case and control could help us to distinguish between normal, benign, and malignant conditions.

Epstein-Barr and BK virus in cancerous and noncancerous prostate tissue

Aim: We conducted a case–control study to examine the presence of BK virus (BKV) and Epstein barr virus (EBV) genome in prostate specimens of benign prostatic hyperplasia (BPH) and prostate cancer (PCa) in Iran. Materials & methods: 64 paraffin-embedded PCa specimens were included as case subjects and 57 paraffin-embedded BPH specimens as control. DNA extraction was carried out by phenol–chloroform technique and PCR for detection of BKV and EBV. Results: 90 (73%) out of 121 specimens were collected by prostatectomy and 31 (27%) by transurethral resection of the prostate. BKV was not detected in any of the samples and one positive EBV was reported. Conclusion: These findings provide further evidence against a causative role of BKV and EBV in the development of PCa.

Current trend of worsening prognosis of prostate small cell carcinoma: A population-based study

OBJECTIVE

To determine the accurate age-adjusted incidence of prostate small cell carcinoma (SCC), update the clinical and pathological characteristics, as well as survival data of prostate SCC from Surveillance, Epidemiology, and End Results (SEER) datasets.

METHODS

A total of 260 patients with prostate SCC were selected from the SEER database of the National Cancer Institute between 2004 and 2015. Age-adjusted incidence (AAI) rates, the observed and relative survival rates were evaluated over time by the SEER*Stat Software version 8.3.5. Overall survival (OS) rates that stratified by summary stage and treatment effects were evaluated by Kaplan-Meier method. The significant differences were assessed in a log-rank test. Univariate and multivariate cox hazard regression analysis were performed to determine independent predictors of OS.

RESULTS

The incidence of prostate SCC has increased over time. The average age of prostate SCC patients was 70.25 years. More than 90% of tumors were poorly differentiated or undifferentiated. The majority of prostate SCC (77.7%) was at stage IV. 49% of patients had lymph node metastases and 68% of patients presented distant metastases (Compared with 60.5% of patients with distant metastases between 1973-2003). Interestingly only 23.5% patients had high level PSA (>10 ng/mL). 58.8% of patients underwent chemotherapy, 25.4% of patients were treated by surgery, and 31.9% of patients were treated by radiotherapy. The observed survival rates of 1-year, 2-year, and 5-year were 42.1%, 22.1%, and 12.5%, respectively (Compared with 47.9%, 27.5%, and 14.3%, respectively, between 1973 and 2003). Chemotherapy prolonged the OS of patients with regional (distant) metastases from 3 months (2 months) to 12 months (9 months). Multivariate cox regression analysis showed age, race, and stage were independent prognostic factors for prostate SCC patients.

CONCLUSION

Prostate SCC is a highly malignant cancer and our analysis of recent data has shown its incidence is increasing. Incidence rate of metastatic prostate SCC has increased and the survival rates have worsened in recent years. However, chemotherapy shows some survival benefit for prostate SCC patients with regional and distant metastasis over other treatment methods. Further work is needed to understand the reason prognosis of this type prostate cancer is worsening.

Novel Insight into Differential Gene Expression and Clinical Significance of Dopamine Receptors, COMT, and IL6 in BPH and Prostate Cancer

BACKGROUND

Benign prostatic hyperplasia (BPH) and prostate cancer (PCa) are the most prevalent diseases in male population, implicated with fundamental differences between benign and malignant growth of prostate cells. An imbalance through a network of nervous, endocrine, and immune systems initiate a signal of altered growth from the brain to the prostate gland, leading to adverse effects such as inflammation.

OBJECTIVE

The aim of this study was to evaluate the gene expression of dopamine receptor family, COMT, and IL6 to identify novel correlations in BPH and PCa in both blood and tumor of the patients.

METHODS

Peripheral blood mononuclear cells from BPH (n= 30) and PCa (n= 30) patients, and prostate tumor tissues (n= 14) along with pathologically normal adjacent tissues (n= 14) were isolated, mRNA was extracted, and cDNA was synthesized, respectively. Quantitative real- time PCR was applied for DRD1- DRD5, COMT, and IL6 genes in all samples.

RESULTS

We found, for the first time, that the expression of COMT and IL6 genes were inversely correlated with the expression of DRD1 and DRD2 genes through the extent of differentiation of PCa from BPH condition. In addition, the PSA levels were correlated with the expression of DRD1 in BPH cases and DRD1, DRD4, DRD5, and IL6 in PCa cases.

CONCLUSION

Results implicate a potential cross- talk between the signaling pathways derived by IL6 cytokine and dopamine receptors in PCa. Thus, it seems promising to reassemble the consequent signaling pathways by adequate agonists and antagonists to help increase therapeutic efficacy.

Is active surveillance an appropriate approach to manage prostate cancer patients with Gleason Score 3+3 who met the criteria for active surveillance?

OBJECTIVE

Prostate cancer is one of the common malignant tumors in men worldwide. Nowadays it seems that Gleason Score 3+3 may not need definite treatment and some of the experts even ignore it as a cancer but we should be aware that in some patients with Gleason Score 3+3 there is a higher risk for harboring higher-grade cancer. We had done this study to evaluate patients with prostate cancer with Gleason Score 3+3 to determine the value of tumor volume in these cases.

MATERIAL AND METHODS

From September 2010 to October 2017, radical prostatectomy was done for 123 sequential patients with localized prostate cancer in two referral centers of Shahid Beheshti Medical University, Tehran, Iran, and 42 cases with Gleason Scores 3+3 which who were candidates for active surveillance were included in the study.

RESULTS

Thirty of 42 (71.4%) patients had significant tumor volumes (≥0/5 cm3). When tumor volume was less than 0.5 cm3, none of the patients had extra prostatic tumor extension. In patients with tumor volume greater than 0.5 cm3, two cases (6.6%) had extra prostatic extension, 4 cases (13.3%) had positive margins, four cases (13.3%) reactive lymph nodes and 16 cases (53.3%) perineural invasion.

CONCLUSION

We suggest that some patients with Gleason Score 3+3 have tumor volume >0.5 cm3 who are considered having significant cancer pathology and active surveillance may not be appropriate approach to manage all cases with Gleason Score 3+3.

A systematic review and meta-analysis on incidence of prostate cancer in Iran

Background: Prostate cancer is a global health concern. In Iran, its epidemiology is not precisely recognized. We aimed to evaluate incidence of prostate cancer among Iranian populations.

Methods: In this systematic review, we searched the databases PubMed, Web of Sciences, Scopus and Google Scholar for English studies and the databases Magiran, Scientific information Database, IranMedex and IranDoc for Persian studies, using related keywords. The cross sectional articles published from inception to 31 December 2018 were included. Meta-analysis was conducted on the collected data with STATA software using random effects model.

Results: Out of 763 articles initially obtained, 9 articles were finally included after applying the predefined exclusion criteria. Analysis of 9 studies on the incidence of prostate cancer showed a crude rate of 7.1 per 100000 population (95% confidence interval [CI]: 5.6-8.6). Also, the pooled age-standardized incidence rate was 8.7 per 100000 (95% CI: 6.7-10.4). Studies performed in the period 2004-2012 had significantly a higher pooled estimate of the crude incidence rate (9.2 per 100000 [95% CI: 7.9-10.4]) compared with those conducted in the period 1996-2003 (4.5 per 100000 [95% CI: 2.8-6.2]). This trend was also observed based on the age-standardized incidence rate (11 per 100000 [95% CI: 9.4-12.5] versus 6.3 per 100000[95% CI: 4-8.5]).

Conclusion: Despite low rate of prostate cancer occurrence in Iran, it is recommended that preventive measures be taken against this disease by health policymakers. Also, more epidemiological studies are needed to better find out the pattern of prostate cancer among Iranian populations.

Dietary Nutrient Patterns and Prostate Cancer Risk: A Case-Control Study from Iran

Background:

Prostate cancer is the second common cancer in the world. Although some associations between dietary intakes and prostate cancer have been found, the effects of dietary nutrients interactions have not yet evaluated. The aim of this study is to assess the association between nutrient patterns and risk of prostate cancer.

Methods and Materials:

Ninety-seven patients with prostate cancer and 205 controls were asked about their demographic and dietary intakes using validated questionnaires. To extract nutrient patterns, Principal Component Analysis (PCA) based on the 35 nutrient items were applied. Varimax rotation was used for improving interpretation and minimizing correlation between the factors. Logistic regression was used to determine the odds ratio (OR) with 95% confidence interval (CI) of prostate cancer by higher scores on the nutrient patterns.

Results:

High adherence to the “plant source” pattern was negatively associated with prostate cancer risk (OR 0.29 for the highest vs. the lowest score tertile; 95% CI= 0.13 – 0.65; P value for trend: <0.003). Similarly, the “antioxidant and fiber” pattern was associated with decreasing risk of prostate cancer (OR 0.06 for the highest vs. the lowest score tertile;95% CI=0.02 – 0.19; P value for trend: <0.001). There was no significant association for the “mixed” and “vitamin and minerals” pattern with risk of prostate cancer.

Conclusion:

This study confirms the potential and important role of nutrients on prostate cancer risk. Our finding revealed that “antioxidant and fiber” and “plant source” pattern is inversely associated with prostate cancer risk; however, further longitudinal and trial studies are needed to make a firm conclusion.

Efficacy and safety of 177Lutetium-prostate-specific membrane antigen therapy in metastatic castration-resistant prostate cancer patients: First experience in West Asia - A prospective study

Prostate-specific membrane antigen (PSMA) is a transmembrane protein that is highly expressed on the surface of prostate cancer (PC) cells, making it an excellent radiotracer for both therapeutic and diagnostic purposes. In this prospective study, we investigated the efficacy and toxicity of ¹⁷⁷Lutetium (Lu)-PSMA in metastatic castration-resistant PC (mCRPC) patients for the establishment and approval of this therapy in Iran. Fourteen mCRPC patients (mean age 70.57 ± 7.3 years) were treated with a single dose of ¹⁷⁷Lu-PSMA. Complete blood count, liver function tests (aspartate aminotransferase and alanine aminotransferase), alkaline phosphatase levels, renal function tests (urea and creatinine), and prostate-specific antigen (PSA) levels were obtained for the patients at baseline and every 2 weeks. A majority of the patients (11 patients, 64.2%) experienced a decline in their PSA levels; in 5 (45.4%) of these patients, the PSA levels declined > 50%.The severity of pain decreased in 8 (57.1%) patients, and performance status was improved in 5 (45.4%) patients. The treatment was well tolerated, and no severe hematological or nonhematological side effects were observed. Our findings show that ¹⁷⁷Lu-PSMA had a high efficacy and a low toxicity in an Iranian population and is a promising treatment option for PC patients.

Estimating the Cost of Illness of Prostate Cancer in Iran

PURPOSE

Prostate cancer is the second most common cancer among men worldwide. In the past 10 years in Iran, prostate cancer has increased and become more common among hormone-related cancers. As the percentage of seniors in the population increases, the economic burden of this cancer will likely increase significantly. This study aims to estimate direct and indirect costs of treatment at different stages of prostate cancer in Iran.

METHODS

This cross-sectional study was conducted on 263 patients diagnosed with prostate cancer who were referred to prostate treatment centers in 2016. Data on direct medical costs were collected by face-to-face interviews with patients and from health care files and medical and financial documents available in the educational or referral centers. Direct nonmedical costs and indirect costs were based on self-reports by patients through face-to-face interview.

FINDINGS

The results indicate that mean (SD) direct medical costs for low-risk metastatic prostate cancer, local nonmetastatic prostate cancer, local regionalized nonmetastatic prostate cancer nonresistant metastatic prostate cancer, and resistant metastatic prostate cancer were $102.79 ($33.03), US$2673.43 ($87.42), $2210.51 ($306.92), $4133.15 ($650.87), and $7747.89 ($455.80), respectively. The results indicate that mean (SD) direct nonmedical costs for low-risk, local, local regionalized, nonresistant, and resistant cancers were $97.06 ($45.00), $339.71 ($58.02), $485.29 ($36.77), $776.47 ($99.25), and $1067.65 ($600.92), respectively, and mean (SD) indirect costs for these categories were $23.85 ($20.44), $83.49 ($65.06), $119.27 ($32.59), $238.54 ($87.35), and $357.81 ($73.00), respectively.

IMPLICATIONS

The findings of this research indicate that patients diagnosed with prostate cancer must bear high costs at advanced stages of the disease, whereas in the early stages of the disease, the medical costs are relatively low. The health system of Iran should work to prevent patients from reaching the metastatic stages of the disease by implementing a suitable screening system for timely diagnosis of the disease and its effective treatment.

Association of homeobox B13 (HOXB13) gene variants with prostate cancer risk in an Iranian population

Background: Prostate cancer is a complex condition in which both genetic and environmental factors concomitantly contribute to the tumor initiation and progression. Recently, HOXB13 has been proposed as a susceptibility gene for prostate cancer.

Objective: The present study was conducted to determine the existence of potential variations in HOXB13 gene in Iranian men with prostate cancer (PCa) compared to benign prostatic hyperplasia (BPH) cases.

Methods: HOXB13 genetic status was screened in 51 samples, including 21 blood and tissue of PCa cases, and compared to 30 cases affected by BPH using PCR/sequencing. Then, the existence of potential association was investigated between genomic DNA alterations in blood and tissue PCa specimens.

Results: Analysis of BPH tissues showed single nucleotide variations c.366C > T (rs) or c.513T > C (rs9900627) in exon 1, but not in exon 2. Evaluation of PCa tissues revealed 2 cases with both synonymous c.366C > T and c.513T > C variants and 2 cases with the synonymous c.366C > T variant in exon 1. The variants c.366C > T and c.513T > C, simultaneously or separately, were found in blood samples of PCa patients. The novel variant c.127A > G in exon 2 was detected in 1 PCa blood sample. Our analysis indicated a significant reciprocal correlation between HOXB13 mutation in the tissue and blood samples of PCa cases (p= 0.02).

Conclusion: The variants in exon 2 of HOXB13 may influence the risk of prostate cancer. Also, evaluation of HOXB13 mutation may be considered as a novel marker for screening PCa. Further investigations are warranted to evaluate the clinical significance of HOXB13 in Iranian population.

Prevalence, Cognitive and Socio-Demographic Determinants of Prostate Cancer Screening

Screening may be effective for reducing deaths due to prostate cancer. The aim of this study was determine the prevalence and determinants influencing prostate cancer early detection behaviors based on the theory planned behavior (TPB). In this cross-sectional study, conducted in the west of Iran, a total of 250 men aged 50 to 70 years old were randomly selected to participate. Of these, 200 (80%) signed the consent form and voluntarily agreed to take part. A structured questionnaire based on TPB constructs was applied for collecting data by interview. Analyses were conducted with SPSS version 16 using bivariate correlations, and logistic and linear regression. Some 26.5% of the participants demonstrated prostate cancer early detection behavior. Age higher than 60 (OR: 5.969), academic education (OR: 2.904), number of family members more than four (OR: 3.144), and knowledge about prostate cancer (OR: 3.693) were the most influential predictive factors for early detection behavior. Furthermore, among the TPB constructs, attitude (OR=1.090) and subjective norms (OR=1.280) were the most influential predictors. Attitude, subjective norms, and perceived behavioral control accounted for 43% of the variation in the outcome measure of the intention to screen for prostate cancer (adjusted R squared= 0.43, F= 49.270 and P < 0.001). Designing and implementation programs to increase positive attitudes and encourage subjective norms towards prostate cancer screening behavior may be useful for promotion of early detection.

Dietary patterns and risk of prostate cancer: a factor analysis study in a sample of Iranian men

Background: Prostate cancer is one of the most common types of cancer with a high mortality rate. The current study was conducted to investigate the relationship between dietary patterns and prostate cancer risk among Iranian men.

Methods: This case-control study was conducted in Kermanshah province in western Iran in November 2016. Fifty patients with prostate cancer were selected as cases and 150 healthy men matched for age and body mass index (BMI) were selected as controls. Dietary intake data were collected by a semi-quantitative food frequency questionnaire (FFQ). Food items were grouped according to the similarity of nutrient profiles. The main dietary patterns were identified by factor analysis.

Results: After adjustment for potential confounders, a healthy dietary pattern was associated with decreased risk of prostate cancer (highest versus lowest tertile OR:0.24; 95% CI: 0.07-0.81;trend p: 0.025). An unhealthy dietary pattern was related to increased risk of prostate cancer(highest versus lowest tertile OR:3.4; 95% CI: 1.09-10.32; trend p: 0.037).

Conclusion: This study shows that an unhealthy dietary pattern was associated with increased risk of prostate cancer. However, a healthy dietary pattern was associated with decreased risk of prostate cancer.

The role of blood neutrophil count and the neutrophil-to-lymphocyte ratio as a predictive factor for prostate biopsy results

BACKGROUND:

It is apparent that prostate cancer has harmful effects on the erythrocytes, leucocytes, and platelets. In addition, it has been suggested that the toxic granules in neutrophils lead to inflammation in the cancerous tissues besides the activation of monocytes, so in this study we aimed to evaluate the blood neutrophil count besides the neutrophil-to-lymphocyte ratio as a predictive factor for prostate biopsy results and their relationship with prostate cancer grade in patients undergoing biopsy of the prostate.

METHODS:

For all men with irritative lower urinary tract symptoms visiting Hasheminezhad Hospital from January to July 2015, in case of having a suspicious digital rectal examination or aged above 40 years, prostate-specific antigen was requested and in case of abnormal results, they underwent prostate biopsy. In order to examine the study hypothesis, the blood neutrophil count and the neutrophil-to-lymphocyte ratio were measured and compared with the abnormal prostate-specific antigen results and suspicious digital rectal examination.

RESULTS:

Among the 500 referred samples for biopsy, 352 (70.4%) had a negative biopsy result, while it was positive in the other 148 (29.6). The mean neutrophil count showed no statistical difference regarding the biopsy results (p = 0.381). When measuring the neutrophil-to-lymphocyte ratio again with biopsy results, no statistically significant difference was obtained based on the biopsy results (p = 0.112).

CONCLUSION:

Neutrophil count and neutrophil-to-lymphocyte ratio cannot be predictive factors for positive prostate cancer biopsy.

The Clinical Efficacy of Prostate Cancer Screening in Worldwide and Iran: Narrative Review

Prostate cancer (CaP) imposes a great health burden on men, while its incidence has significantly increased in recent years. The screening program for CaP is still controversial and recent large trials have failed to present a significant reduction in prostate-specific mortality and all-cause mortality. An entire body of data obtained from worldwide studies conducted on CaP screening is required to better evaluate health policy decisions and patient decision-making. In current review, the clinical efficacy of screening programs on CaP was discussed in numerous parts of the world, such as in the US, Europe, and Asia, to provide an updated screening recommendation. Finally, we discuss about CaP screening status in Iran and update the screening recommendation in Iran.

Association between Dietary Inflammatory Index and Prostate Cancer in Shiraz Province of Iran

Background: Dietary components like food items and nutrients have been implicated to play a role in modulating inflammation and the development of prostate cancer. Studies examining this association have not been extensively explored in Middle Eastern Countries. Material and Methods: We examined the association between the dietary inflammatory index (DIITM) and prostate cancer in the Shiraz province of Iran. A total of 60 incident cases and 60 controls attending the same hospital as the cases were recruited. The energy adjusted DII (E-DIITM) was computed based on dietary intake assessed using a validated food frequency questionnaire (FFQ). Logistic regression was used to estimate odds ratios. Results: Men with higher E-DII (>0.96) were at higher risk of prostate cancer (OR = 2.55; 95% CI =1.04–6.23) compared to men with E-DII ≤0.96. Conclusion: These data suggest a pro-inflammatory diet, as indicated by increasing DII score, may be a risk factor for prostate cancer in Iranian men.

Mortality Rate and Years of Life Lost Due to Prostate Cancer in Yazd Province, Iran: A 10-year study

Objectives

Prostate cancer is a leading cause of cancer-related deaths. The number of deaths and years of life lost (YLL) due to a disease can be used to monitor health status, assess healthcare needs and determine the prioritisation and allocation of health resources within a population; in addition, the latter calculation can serve as a baseline indicator of premature mortality. This study aimed to measure prostate cancer-related mortality and YLL in Yazd Province, Iran.

Methods

This study included all prostate cancer-related deaths in Yazd Province reported between March 2001 and March 2010. Mortality data were obtained from a provincial death registration system which integrates data from different sources. YLL was calculated based on an individual's age at death and their life expectancy according to age group.

Results

During the study period, prostate cancer was the fourth most common fatal cancer among men, resulting in 324 deaths or 10.0% of all cancer-related deaths. The crude mortality rate per 100,000 individuals increased from 4.7 in 2001 to 8.8 in 2010. Premature deaths caused 1,358.7 YLL and the YLL caused by prostate cancer deaths more than doubled from 94.7 in 2001 to 196.5 in 2010.

Conclusion

Due to changes in population structure, it is likely that the burden of prostate cancer will continue to increase in Yazd Province. As such, it is necessary that the national health system implements screening programmes and improves public awareness of prostate cancer-associated risk factors.

The incidence of prostate cancer in Iran: a systematic review and meta-analysis

Background

Prostate cancer is one of the most common cancers among men. There are various estimates of prostate cancer incidence from different geographical areas in Iran. In addition, no systematic reviews are available regarding the incidence rate of prostate cancer in Iran. Therefore, the present systematic review aimed to address this epidemiological gap.

Method

This systematic review was performed based on the preferred reporting items for systematic reviews and meta-analyses in July 2017. In doing so, the researchers searched Medline/PubMed, Scopus, Embase, ScienceDirect, and Google Scholar for international articles and four Iranian databases (Scientific Information Database, MagIran, IranMedex, and IranDoc) for Persian articles.

Result

A total of 274 titles were retrieved in the initial search of the databases. Further refinement and screening of the retrieved studies produced a total of 21 studies. Based on the random-effect model, the age-standardized rate of prostate cancer was 9.11 and 95% confidence interval was 8.19–10.04. Besides, the results of Cochran's test indicated the heterogeneity of the studies (Q = 1457.8, df = 46.0, I² = 96.8%, P < 0.001).

Conclusion

The incidence of prostate cancer was lower in Iran than in the other parts of the world. Yet, establishing cancer registries covering a broader perspective of the population and conducting further studies are required to map out the exact incidence rate and trend of prostate cancer in Iran.

Genetic variations in UGT2B28, UGT2B17, UGT2B15 genes and the risk of prostate cancer: A case-control study

Glucuronidation is a major pathway for elimination of exogenous and endogenous compounds such as environmental carcinogens and androgens from the body. This biochemical pathway is mediated by enzymes called uridine diphosphoglucuronosyltransferases (UGTs). Null (del/del) genes polymorphisms in UGT2B17, and UGT2B28 and D85Y single-nucleotide polymorphism (SNP) of UGT2B15 have been reported to increase the risk of prostate cancer. The goal of this study was to determine the association of mentioned genetic variants with the risk of prostate cancer. We investigated the copy number variations (CNVs) of UGT2B17 and UGT2B28 loci and the association between rs1902023 polymorphism of UGT2B15 gene in 360 subjects consisted of 120 healthy controls, 120 prostate cancer (PC) patients and 120 benign prostatic hyperplasia (BPH) patients. No association was detected for the mentioned polymorphisms and the risk of PC. However, a significant association was detected between UGT2B17 copy number variation and BPH risk (OR=2.189; 95% CI, 1.303-3.675; p=0.003). Furthermore, we observed that the D85Y polymorphism increases the risk of BPH when analyzed in combination with the copy number variation of UGT2B17 gene (OR=0.135; 95% CI, 0.036-0.512; p=0.003). Our findings suggest that the D85Y polymorphism of UGT2B15 and CNVs in UGT2B28 and UGT2B17 genes is not associated with prostate cancer risk in Iranian patients. To our knowledge, this is the first report that implicates the role of CNV of UGT2B17 gene in BPH.

Healthy Plant Foods Intake Could Protect Against Prostate Cancer Risk: A Case-Control Study

Background:

Several studies have investigated the association between healthy plant foods intake and prostate cancer risk with inconsistent results. So this study was conducted to examine the existence of any possible association between healthy plant foods and prostate cancer risk.

Materials and Methods:

Sixty newly diagnosed prostate cancer cases and 60 controls engaged in a hospital-based case-control study. A validated 16o-items semi-quantitative FFQ was used to assess usual dietary intakes. Energy-adjusted amounts of healthy plant foods intake were calculated using the residual method. Logistic regression model was also used to derive beta estimates and odds ratios.

Results:

Cases were older and more likely to be inactive. In crude model, individuals in the highest tertile vs lowest tertile of total healthy plant foods (OR= 0.12; 95 % CI 0.04, 0.34), total fruits (OR= 0.11; 95 % CI 0.04, 0.30), total vegetables (OR= 0.08; 95 % CI 0.03, 0.24), fresh fruits (OR= 0.11; 95 % CI 0.04, 0.30), and raw vegetables (OR= 0.06; 95 % CI 0.02, 0.18) had significantly lower risk of prostate cancer. After controlling for potential confounders (age, BMI, total energy intake, job, education, smoking, physical activity, some drug usage, and also dietary intakes), just total healthy plant foods (OR= 0.12; 95 % CI 0.02, 0.55), total vegetables (OR=0.03; 95 % CI 0.00, 0.25), and raw vegetables (OR= 0.01; 95 % CI 0.00, 0.12) were associated with lower prostate cancer risk.

Conclusions:

The results of this study suggest that a diet rich in healthy plant foods and especially total or raw vegetable may protect against prostate cancer.

Detection of HPV genotypes and their association with p53 codon 72 polymorphism in prostate cancer

Aim: In this study, we focused on the p53 codon 72 polymorphism and HPV infections as a possible contributing factor in susceptibility to prostate cancer (PCa). Methods: Eighty histopathologically confirmed prostate biopsies comprising of 40 cancer cases and 40 benign prostate hyperplasia cases were used. Results: A significant difference was not observed between HPV presence and PCa progression. Our results showed that the p53 protein with Arg (p53-Arg72) variant contributes to the development of PCa. Conclusion: There is a near-significant association between Arg/Arg polymorphism and PCa.

Clinical significance of endothelial cell marker CD34 and mast cell marker CD117 in prostate adenocarcinoma

Prostate cancer is the second cause of cancer-related deaths in men and this is attributed to its aggressiveness and metastatic identity. Our objective was to evaluate the expression patterns of endothelial cell marker CD34 and mast cell marker CD117 in prostate adenocarcinoma (PCa) compared to benign prostate tissue and their relation to the clinicopathological features. A total of 90 prostate samples, including 45 PCa and 45 benign prostate tissues were immunohistochemically examined for the detection of CD34 and CD117 markers. The expression of these markers was also correlated with clinicopathological parameters. Significant overexpression of CD34 was found in PCa group compared to benign prostate tissues (P≤0.001). The expression of CD34 and CD117 in PCa with advanced Gleason score was more than PCa with early Gleason score (P=0.02 and P=0.005, respectively). A significant positive correlation was observed between CD34 expression and the level of total serum prostate specific antigen (sPSA) (P=0.006). In addition, CD34High/CD117High phenotype was frequently observed in PCa cases compared to benign prostate tissues (P≤0.001). There was a positive significant association between CD34High/CD117High phenotype with advanced Gleason score (P≤0.001) and total sPSA level (P=0.02). Our findings showed that increased expression of CD34 and CD117 markers confer tumor progression and aggressiveness on PCa. These molecules may be good candidates for targeted therapy of PCa patients.

Colorectal cancer in Iran: Epidemiology and morphology trends

Colorectal cancer is one of the most prevalent cancers in different countries, including Iran. No comprehensive study has been done in the country for colorectal cancer, but information on the incidence and trends is essential to planning. This study aimed to evaluate the occurrence and morphology of colorectal cancer and its trend in Iran. This study was conducted using data from the national cancer registry system in Iran from 2003-2008. We used joinpoint regression analysis for assessing incidence time trends and morphology change percentage. Of all cases of colorectal cancer, 61.83 % were colon cancer, 27.54 % rectal cancer, 7.46 % rectosigmoid cancer, and 3.10 anal cancer. The most common histological types with the frequencies of 80.85 % was related to adenocarcinoma, NOS. The Annual percentage changes (APC) in ASIR for colorectal cancer significantly increased in both men and women. APC in ASIR was 13.7 (CI: 10.5-17.1) in women and 16.4 (CI: 12.4-20.5) in men. APC of adenocarcinoma in villous adenoma showed significant declining trend (p<0.05), while APC of adenocarcinoma, NOS had a constant trend. The incidence of the cancer in recent years has increased in Iran because of changes in lifestyle and diet. Therefore, further studies are necessary to detect the cause of this cancer and perform preventive measures.

Incidence and mortality of prostate cancer and their relationship with the Human Development Index worldwide

Background

The aim of this study was to evaluate the incidence and mortality of prostate cancer and their relationship with the Human Development Index (HDI) and its components in Asia in 2012.

Methods

This study was an ecological study conducted based on the GLOBOCAN project of the World Health Organization. The correlation between standardized incidence rate (SIR) and standardized mortality rate (SMR) of prostate cancer with HDI and its components was assessed using SPSS Inc Version 18.0 (Chicago).

Results

There were 1,094,916 incident cases of prostate cancer and 307,481 deaths recorded in 2012 worldwide. SIR and SMR due to HDI were 72 and 9.7 in very high human development regions, 37.5 and 12.9 in high human development regions, 7 and 3.7 in medium human development regions, and 14.9 and 12.1 in low human development regions per 100,000 people, respectively. A positive correlation of 0.475 was seen between SIR of prostate cancer and HDI (P ≤ 0.001). Also, a negative correlation of 0.160 was seen between SMR of prostate cancer and HDI (P = 0.032).

Conclusion

The incidence of prostate cancer is high in countries with higher development. A positive correlation was observed between the SIR of prostate cancer and the HDI and its components, such as life expectancy at birth, mean years of schooling, and the gross national income per capita. In addition, there was a negative correlation between SMR and HDI.