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Liu W, Wang J, Wang M, Ding X, Wang M, Liu M. Association between immune-inflammatory indexes and lower urinary tract symptoms: an analysis of cross-sectional data from the US National Health and Nutrition Examination Survey (2005-2008). BMJ Open 2024; 14:e080826. [PMID: 38521530 PMCID: PMC10961552 DOI: 10.1136/bmjopen-2023-080826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 03/08/2024] [Indexed: 03/25/2024] Open
Abstract
OBJECTIVE This study aimed to systematically investigate the relationship between immune-inflammatory indexes with lower urinary tract symptoms (LUTSs). DESIGN Cross-sectional study. SETTING National Health and Nutrition Examination Survey (NHANES) (2005-2008). PARTICIPANTS A total of 2709 men with complete information for immune-inflammatory indexes and LUTSs were included from NHANES 2005-2008. OUTCOMES AND ANALYSES Automated haematology analysing devices are used to measure blood cell counts, and LUTSs were presented by standard questionnaires. Non-linear and logistic regression analyses were used to estimate their association after adjustment for confounders. RESULTS Multivariate logistic regression showed that pan-immune-inflammation value (OR (95% CI)=1.60 (1.14 to 2.23)), systemic inflammation response index (SIRI) (OR (95% CI)=1.82 (1.21 to 2.73)), neutrophil/lymphocyte ratio (NLR) (OR (95% CI)=1.81 (1.31 to 2.49)), derived NLR (dNLR) (OR (95% CI)=1.91 (1.35 to 2.70)) and C reactive protein (CRP) (OR (95% CI)=1.71 (1.05 to 2.79)) was positively associated with LUTS. Additionally, composite immune-inflammation markers exhibited a stronger association with LUTS than any single index, with the ORs for high SIRI+high CRP, high NLR+high CRP and high dNLR+high CRP being 2.26, 2.44 and 2.16, respectively (all p<0.05). Furthermore, subgroup analyses revealed that age, smoking status and hypertension have different effects on the relationship between immune-inflammatory markers and LUTS. CONCLUSIONS This study indicated that high levels of immune-inflammatory markers were associated with an increased risk of clinical LUTS. The combination of CRP with SIRI, NLR and dNLR, respectively, showed a stronger positive correlation with clinical LUTS compared with any single index.
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Affiliation(s)
- Wen Liu
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jia Wang
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Miaomiao Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xin Ding
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Miao Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Ming Liu
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Handelsman DJ, Grossmann M, Yeap BB, Stuckey BGA, Shankara-Narayana N, Conway AJ, Inder WJ, McLachlan RI, Allan C, Jenkins AJ, Jesudason D, Bracken K, Wittert GA. Long-term Outcomes of Testosterone Treatment in Men: A T4DM Postrandomization Observational Follow-up Study. J Clin Endocrinol Metab 2023; 109:e25-e31. [PMID: 37623257 DOI: 10.1210/clinem/dgad485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/07/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023]
Abstract
CONTEXT The T4DM study randomized 1007 men with impaired glucose tolerance or newly diagnosed diabetes to testosterone undecanoate (TU, 1000 mg) or matching placebo (P) injections every 12 weeks for 24 months with a lifestyle program with testosterone (T) treatment reducing diabetes diagnosis by 40%. BACKGROUND The long-term effects on new diagnosis of diabetes, cardiovascular and prostate disease, sleep apnea, weight maintenance trajectory and androgen dependence were not yet described. METHODS A follow-up email survey after a median of 5.1 years since last injection obtained 599 (59%) completed surveys (316 T, 283 P), with participants in the follow-up survey compared with nonparticipants in 23 anthropometric and demographic variables. RESULTS Randomization to was TU associated with stronger belief in study benefits during (64% vs 49%, P < .001) but not after the study (44% vs 40%, P = .07); there is high interest in future studies. At T4DM entry, 25% had sleep apnea with a new diagnosis more frequent on TU (3.0% vs 0.4%, P = .03) during, but not after, the study. Poststudy, resuming prescribed T treatment was more frequent among TU-treated men (6% vs 2.8%, P = .03). Five years after cessation of TU treatment there was no difference in self-reported rates of new diagnosis of diabetes, and prostate or cardiovascular disease, nor change in weight maintenance or weight loss behaviors. CONCLUSION We conclude that randomized T treatment for 24 months in men with impaired glucose tolerance or new diabetes but without pathological hypogonadism was associated with higher levels of self-reported benefits and diagnosis of sleep apnea during, but not after, the study as well as more frequent prescribed poststudy T treatment consistent with androgen dependence in some men receiving prolonged injectable TU.
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Affiliation(s)
- David J Handelsman
- ANZAC Research Institute, University of Sydney and Department of Andrology, Concord Hospital, Sydney, NSW 2139, Australia
| | - Mathis Grossmann
- Department of Medicine Austin Health, The University of Melbourne and Department of Endocrinology, Austin Health, Heidelberg, VIC 3084, Australia
| | - Bu B Yeap
- Medical School, University of Western Australia, Perth, WA 6009, Australia
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, WA 6150, Australia
| | - Bronwyn G A Stuckey
- Keogh Institute for Medical Research, and Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Medical School, University of Western Australia, Nedlands, WA 6009, Australia
| | - Nandini Shankara-Narayana
- ANZAC Research Institute, University of Sydney and Department of Andrology, Concord Hospital, Sydney, NSW 2139, Australia
| | - Ann J Conway
- ANZAC Research Institute, University of Sydney and Department of Andrology, Concord Hospital, Sydney, NSW 2139, Australia
| | - Warrick J Inder
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, and PA-Southside Clinical Unit, Medical School, the University of Queensland, Woolloongabba, QLD 4102, Australia
| | - Robert I McLachlan
- Hudson Institute of Medical Research, Monash University, Clayton, VIC 3168, Australia
| | - Carolyn Allan
- Hudson Institute of Medical Research, Monash University, Clayton, VIC 3168, Australia
| | - Alicia J Jenkins
- Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
| | - David Jesudason
- Department of Endocrinology, The Queen Elizabeth Hospital, Adelaide, SA 5011, Australia
| | - Karen Bracken
- Kolling Institute, University of Sydney, Sydney, NSW 2064, Australia
| | - Gary A Wittert
- Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA 506, Australia
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Kaneta K, Tanaka A, Nakai M, Sumita Y, Kaneko H, Noguchi M, Node K. Prevalence and temporal trends of prostate diseases among inpatients with cardiovascular disease: a nationwide real-world database survey in Japan. Front Cardiovasc Med 2023; 10:1236144. [PMID: 37928758 PMCID: PMC10620699 DOI: 10.3389/fcvm.2023.1236144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/09/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Benign prostate hyperplasia (BPH) and prostate cancer (PCa) are major prostate diseases that potentially share cardiometabolic risk factors and an elevated risk for cardiovascular disease (CVD). However, the prevalence of prostate diseases among patients with established CVD remains unclear. Materials and methods This nationwide retrospective study assessed the prevalence and temporal trend of prostate diseases (i.e., BPH or PCa) among patients hospitalized for CVDs in Japan. We used a claims database (the Japanese Registry of All Cardiac and Vascular Diseases-Diagnosis Procedure Combination), which included data on 6,078,487 male patients recorded from 1,058 hospitals between April 2012 and March 2020. We conducted the Cochran-Armitage trend test and calculated the adjusted odds ratio (aOR) with 95% confidence intervals (CIs). Results The prevalence of prostate diseases over the entire study period was 5.7% (BPH, 4.4%; PCa, 1.6%). When dividing the overall cohort into age categories (<65, 65-74, and ≥75 years old), the prevalence was 1.1%, 4.7%, and 9.9%, respectively (P for trend <0.05). In addition, the annual prevalence showed a modest increasing trend over time. Patients admitted for heart failure (HF) were significantly associated with a higher incidence of coexisting prostate diseases than those admitted for non-HF causes [aOR 1.02 (95% CI, 1.01-1.03)] or acute coronary syndrome [aOR 1.19 (95% CI, 1.17-1.22)]. Conclusions The nationwide real-world database revealed that the prevalence of prostate diseases is increasing among patients hospitalized for CVD, particularly HF. Attention to detailed causality and continued surveillance are needed to further clarify the clinical characteristics of prostate diseases among patients with CVD.
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Affiliation(s)
- Kohei Kaneta
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Michikazu Nakai
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoko Sumita
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hidehiro Kaneko
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
| | | | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
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Driedger SM, Kirby S, Maier R, Süss R, Thorlacius L, Saranchuk JW, Bohm E, Singer A. Strategies used in managing conversations about prostate-specific antigen (PSA) testing among family physicians (FPs): a qualitative study. BMJ Open 2023; 13:e073415. [PMID: 37117002 PMCID: PMC10151868 DOI: 10.1136/bmjopen-2023-073415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
OBJECTIVES Screening for prostate cancer in healthy asymptomatic men using the prostate-specific antigen (PSA) test is controversial due to conflicting recommendations from and a lack of strong evidence regarding the benefit of population-based screening. In Canada and internationally, there is variability in how family physicians (FPs) approach PSA testing in asymptomatic men. The purpose of our study was to explore how family FPs approach discussions with their male patients around PSA testing in Manitoba, Canada. DESIGN Qualitative descriptive study. SETTING AND PARTICIPANTS High-ordering and median-ordering FPs were invited to participate in an interview. In addition to exploring practice behaviours around PSA testing, participants were asked to elaborate on their typical discussion with asymptomatic men who request a PSA test or other tests and procedures that they do not feel are clinically warranted. Data were analysed inductively using a constant-comparison approach. RESULTS There were important variations between high-ordering and median-ordering FP's approaches to discussing PSA testing. Strategies to facilitate conversations were more frequently identified by median-ordering physicians and often included methods to facilitate assessing their patient's understanding and values. In addition to decision aids, median-ordering FPs used motivational interviewing to tailor a discussion, organised their practice structure and workflow habits in a way that enhanced patient-provider discussions and leveraged 'new' evidence and other aids to guide conversations with men. CONCLUSION We found that high-ordering FPs tended to use the PSA test for screening asymptomatic men with limited shared decision-making. Median-ordering FPs used conversational strategies that emphasised uncertainty of benefit and potential risk and did not present the test as a recommendation.
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Affiliation(s)
- S Michelle Driedger
- Department of Community Health Sciences, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sarah Kirby
- George & Fay Yee Centre for Healthcare Innovation, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ryan Maier
- Department of Community Health Sciences, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Roger Süss
- Department of Family Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Laurel Thorlacius
- Department of Pathology, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Biochemistry and Medical Genetics, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jeffery W Saranchuk
- Department of Surgery, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- CancerCare Manitoba Research Institute, Winnipeg, Manitoba, Canada
| | - Eric Bohm
- Department of Community Health Sciences, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Surgery, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alexander Singer
- Department of Family Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Lehto US, Aromaa A, Tammela T. Psychological recovery and well-being of spouses of patients with prostate cancer 5 years after primary treatment in Finland: a follow-up survey. BMJ Open 2023; 13:e063435. [PMID: 37105703 PMCID: PMC10151865 DOI: 10.1136/bmjopen-2022-063435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVE AND SETTING To study longitudinally cancer-related experiences of spouses of patients with prostate cancer and the predictors of their psychological recovery and quality of life (QOL) by following the participants of our previous survey at primary cancer treatment in a university hospital. DESIGN A 5-year longitudinal cohort design. PARTICIPANTS AND PROCEDURE A follow-up questionnaire was mailed to the female spouses/partners who participated in our previous survey (n=104). We quantitatively explored the spouses' prostate cancer-related experiences since the previous survey and measured their current psychological symptom distress and well-being/QOL. Seventy-seven (74%) of the initial participants responded. OUTCOMES The main outcome measures were the spouses' psychological recovery (psychological symptoms at the initial survey vs currently) and well-being/QOL (depressive symptoms, domains of QOL) at 5 years. We analysed their predictors with regression analyses. RESULTS The treatment had been prostatectomy in 70% of the patients. Psychological distress had alleviated in 76% of spouses (p<0.001) and emotional changes decreased (p=0.02), but a deteriorating impact on the partnership (from 4% to 16%) and on sex life ('strong impact' from 23% to 37%) had increased. The outcomes were inversely associated with negative depression-related psychological symptoms and emotional changes either initially or at follow-up. However, some early experiences also predicted the outcomes when other factors were controlled for. Prostate cancer-related information received by the spouses from several sources (leaflets/handouts, TV/radio, internet) predicted better recovery and well-being/QOL, whereas the patients' prostate cancer and treatment-related symptoms (pain, irritability/anger, bowel dysfunction) predicted poorer recovery and well-being/QOL in spouses. CONCLUSIONS A major negative impact of prostate cancer was experienced by the spouses still 5 years after primary treatment. Early prostate cancer-related experiences predicted long-term psychological recovery and QOL. Responding to the early information needs of spouses and effective symptom management for the patients are likely to enhance the spouses' long-term recovery and well-being.
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Affiliation(s)
- Ulla-Sisko Lehto
- Population Health/ Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Arpo Aromaa
- Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Teuvo Tammela
- Department of Surgery, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Medical Technology, University of Tampere, Tampere, Finland
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Spindler NJ, Persson GF, Theile S, Nielsen DL, Høgdall EV, Al-Farra G, Hendel HW, Lorentzen T, Svane IM, Lindberg H, Eefsen RL. Randomised phase II trial of stereotactic body radiotherapy in combination with checkpoint inhibitors in metastatic castration-resistant prostate cancer (CheckPRO): a study protocol. BMJ Open 2023; 13:e063500. [PMID: 36717150 PMCID: PMC9887717 DOI: 10.1136/bmjopen-2022-063500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Immunotherapy with checkpoint inhibitors (CPIs) has revolutionised cancer treatment but has no convincing effect in metastatic castration-resistant prostate cancer (mCRPC). It has been suggested that a combination of CPI and hypofractionated stereotactic body radiotherapy (SBRT) may work synergistically, and recent trials have supported this. We hypothesise that adding SBRT to CPI treatment can improve response rates in patients with mCRPC. METHODS AND ANALYSIS The CheckPRO trial is an open-label, randomised, two-stage, phase II trial. We aim to enrol and randomise 80 evaluable patients with mCRPC who progressed following ≥2 lines of treatment. Enrolment started in November 2019 with 38 months expected enrolment period. The participants receive treatment for 52 weeks including four cycles of ipilimumab and nivolumab with or without concomitant SBRT (24 Gray in three fractions) to a single soft tissue or bone metastasis, followed by 10 cycles of nivolumab. Participants are followed until progression, death, or for 12 months after the end of treatment.Co-primary endpoints are the objective response rate and prostate-specific antigen (PSA) response rate. Secondary endpoints include safety, radiographic progression-free survival, clinical benefit rate, duration of response, PSA-progression-free survival beyond 12 weeks, quality of life and overall survival. Exploratory endpoints include translational analyses of tumour biopsies and consecutive blood samples. Biopsies from metastatic sites are collected at baseline, before the third treatment and at the end of treatment. Blood sampling for immune monitoring and circulating tumour DNA is performed consecutively at baseline and every radiographic assessment. ETHICS AND DISSEMINATION This study follows the Helsinki Declaration and is approved by the Danish Ethics Committee System (journal no. H-19016100). All participants must receive written and oral information and provide a signed informed consent document prior to inclusion. The study results will be published in an international peer-review journal. TRIAL REGISTRATION NUMBER EudraCT number: 2018-003461-34. CLINICALTRIALS gov ID NCT05655715.
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Affiliation(s)
- Nicklas Juel Spindler
- Department of Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Gitte Fredberg Persson
- Department of Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Susann Theile
- Department of Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Dorte Lisbeth Nielsen
- Department of Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Estrid V Høgdall
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Pathology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Gina Al-Farra
- Department of Radiology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Helle Westergren Hendel
- Department of Clinical Physiology and Nuclear Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Torben Lorentzen
- Department of Surgery, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Inge Marie Svane
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Oncology, Herlev and Gentofte Hospital, National Center for Cancer Immune Therapy, Copenhagen University Hospital, Herlev, Denmark
| | - Henriette Lindberg
- Department of Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Rikke Løvendahl Eefsen
- Department of Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
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Zhao M, Guo J, Gao QH, Wang H, Wang F, Wang ZR, Liu SJ, Deng YJ, Zhao ZW, Zhang YY, Yu WX. Relationship between pyroptosis-mediated inflammation and the pathogenesis of prostate disease. Front Med (Lausanne) 2023; 10:1084129. [PMID: 36744134 PMCID: PMC9892550 DOI: 10.3389/fmed.2023.1084129] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/03/2023] [Indexed: 01/20/2023] Open
Abstract
The largest solid organ of the male genitalia, the prostate gland, is comprised of a variety of cells such as prostate epithelial cells, smooth muscle cells, fibroblasts, and endothelial cells. Prostate diseases, especially prostate cancer and prostatitis, are often accompanied by acute/chronic inflammatory responses or even cell death. Pyroptosis, a cell death distinct from necrosis and apoptosis, which mediate inflammation may be closely associated with the development of prostate disease. Pyroptosis is characterized by inflammasome activation via pattern recognition receptors (PRR) upon recognition of external stimuli, which is manifested downstream by translocation of gasdermin (GSDM) protein to the membrane to form pores and release of inflammatory factors interleukin (IL)-1β and IL-18, a process that is Caspase-dependent. Over the past number of years, many studies have investigated the role of inflammation in prostate disease and have suggested that pyroptosis may be an important driver. Understanding the precise mechanism is of major consequence for the development of targeted therapeutic strategies. This review summarizes the molecular mechanisms, regulation, and cellular effects of pyroptosis briefly and then discuss the current pyroptosis studies in prostate disease research and the inspiration for us.
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Affiliation(s)
- Ming Zhao
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Jun Guo
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Qing-He Gao
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Hao Wang
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Fu Wang
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Zi-Rui Wang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Sheng-Jing Liu
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Ying-Jun Deng
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Zi-Wei Zhao
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Yue-Yang Zhang
- Department of Andrology, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Wen-Xiao Yu
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China,*Correspondence: Wen-Xiao Yu,
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Chen S, Wang S, Liu S, Wang S, Xuan L, Gao Y. Efficacy of electrical pudendal nerve stimulation versus pelvic floor muscle training in treating postradical prostatectomy urinary incontinence: study protocol for a randomised controlled trial. BMJ Open 2023; 13:e062323. [PMID: 36604129 PMCID: PMC9827247 DOI: 10.1136/bmjopen-2022-062323] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Urinary incontinence (UI) is one of the main complications of radical prostatectomy. Electrical pudendal nerve stimulation (EPNS) has been used to treat stress UI based on its mechanism of passive pelvic floor muscle contraction reported in the previous research. However, there are no studies comparing the effects of EPNS and active pelvic floor muscle training (PFMT) in the treatment of postradical prostatectomy UI (PPUI). Here, we describe the protocol for a randomised controlled trial to evaluate the efficacy of EPNS in treating PPUI compared with PFMT. METHODS AND ANALYSIS This study is designed as an open-label randomised controlled trial with blinded assessment and analysis. A total of 90 eligible men will be randomly allocated to two groups. The treatment group (n=45) will receive EPNS while the control group will perform PFMT by doing the Kegel exercise. Forty EPNS treatment sessions will occur over a period of 8 weeks. The primary outcome measure will be improvement rate, and the secondary outcome measures, the number of pads used, 24-hour pad test, and International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form will be compared between baseline and the study endpoint. The International Consultation on Incontinence Questionnaire-Lower Urinary Tract Symptoms Quality of Life and care compared as the quality of life and satisfaction outcomes between groups. ETHICS AND DISSEMINATION This protocol has been approved by the Ethics Committee of the First Affiliated Hospital of Zhejiang Chinese Medical University (approval no. 2021 KL-040-02). Written informed consent will be obtained from each participant. The results of the study will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ChiCTR2200055461.
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Affiliation(s)
- Shan Chen
- Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Siyou Wang
- Clinical Research Section, Shanghai Research Institute of Acupuncture and Meridian, Shanghai Yueyang Hospital, Shanghai, China
| | - Shan Liu
- Clinical Evaluation and Analysis Center, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Shenhong Wang
- Department of Urology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Lihua Xuan
- Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Yunqiu Gao
- Department of Urology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
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Abstract
Frequently, periodontal health and it's associated oral biofilm has not been addressed in those patients who have systemic health issues, especially those who are not responding to medical treatment via their physician. Oral biofilm may be present in the periodontal sulcus in the absence of clinical disease of periodontal disease (bleeding on probing, gingival inflammation) and periodontal reaction is dependent on the patient's immune response to the associated bacterial and their byproducts. Increasing evidence has been emerging the past decade connecting oral biofilm with systemic conditions, either initiating them or complicating those medical conditions. The patient's health needs to be thought of as a whole-body system with connections that may originate in the oral cavity and have distant affects throughout the body. To maximize total health, a coordination in healthcare needs to be a symbiosis between the physician and dentist to eliminate the oral biofilm and aid in prevention of systemic disease or minimize those effects to improve the patient's overall health and quality of life. Various areas of systemic health have been associated with the bacteria and their byproducts in the oral biofilm. Those include cardiovascular disease, chronic kidney disease, diabetes, pulmonary disease, prostate cancer, colon cancer, pancreatic cancer, pre-term pregnancy, erectile dysfunction Alzheimer's disease and Rheumatoid arthritis. This article will discuss oral biofilm, its affects systemically and review the medical conditions associated with the oral systemic connection with an extensive review of the literature.
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Affiliation(s)
| | - Robert A. Horowitz
- Private periodontal practice Scarsdale, New York, USA
- Adjunct Clinical Assistant Professor, Department of Periodontology and Implant Dentistry, New York University College of Dentistry
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Nam R, Patel C, Milot L, Hird A, Wallis C, Macinnis P, Singh M, Emmenegger U, Sherman C, Haider MA. Prostate MRI versus PSA screening for prostate cancer detection (the MVP Study): a randomised clinical trial. BMJ Open 2022; 12:e059482. [PMID: 36351725 PMCID: PMC9644313 DOI: 10.1136/bmjopen-2021-059482] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Our objective was to compare prostate cancer detection rates between patients undergoing serum prostate-specific antigen (PSA) vs magnetic resonance imaging (MRI) for prostate cancer screening. DESIGN Phase III open-label randomised controlled trial. SETTING Single tertiary cancer centre in Toronto, Canada. PARTICIPANTS Men 50 years of age and older with no history of PSA screening for ≥3 years, a negative digital rectal exam and no prior prostate biopsy. INTERVENTIONS Patients were recommended to undergo a prostate biopsy if their PSA was ≥2.6 ng/mL (PSA arm) or if they had a PIRADS score of 4 or 5 (MRI arm). Patients underwent an end-of-study PSA in the MRI arm. PRIMARY AND SECONDARY OUTCOME MEASURES Adenocarcinoma on prostate biopsy. Prostate biopsy rates and the presence of clinically significant prostate cancer were also compared. RESULTS A total of 525 patients were randomised, with 266 in the PSA arm and 248 in the MRI arm. Due to challenges with accrual and study execution during the COVID-19 pandemic, the study was terminated early. In the PSA arm, 48 patients had an abnormal PSA and 28 (58%) agreed to undergo a prostate biopsy. In the MRI arm, 25 patients had a PIRADS score of 4 or 5 and 24 (96%) agreed to undergo a biopsy. The relative risk for MRI to recommend a prostate biopsy was 0.52 (95% CI 0.33 to 0.82, p=0.005), compared with PSA. The cancer detection rate for patients in the PSA arm was 29% (8 of 28) vs 63% (15 of 24, p=0.019) in the MRI arm, with a higher proportion of clinically significant cancer detected in the MRI arm (73% vs 50%). The relative risk for detecting cancer and clinically significant with MRI compared with PSA was 1.89 (95% CI 0.82 to 4.38, p=0.14) and 2.77 (95% CI 0.89 to 8.59, p=0.07), respectively. CONCLUSIONS Prostate MRI as a stand-alone screening test reduced the rate of prostate biopsy. The number of clinically significant cancers detected was higher in the MRI arm, but this did not reach statistical significance. Due to early termination, the study was underpowered. More patients were willing to follow recommendations for prostate biopsy based on MRI results. TRIAL REGISTRATION NUMBER NCT02799303.
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Affiliation(s)
- Robert Nam
- Division of Urology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Chirag Patel
- Division of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Laurent Milot
- Division of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Amanda Hird
- Division of Urology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Patrick Macinnis
- Division of Urology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Mala Singh
- Division of Urology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Urban Emmenegger
- Division of Medical Oncology and Hematology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Christopher Sherman
- Division of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Masoom A Haider
- Division of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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11
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Tran V, Hong A, Sutherland T, Taubman K, Lee SF, Lenaghan D, Sethi K, Corcoran NM, Lawrentschuk N, Woo H, Tarlinton L, Bolton D, Spelman T, Thomas L, Booth R, Hegarty J, Perry E, Wong LM. PEDAL protocol: a prospective single-arm paired comparison of multiparametric MRI and 18F-DCPFyl PSMA PET/CT to diagnose prostate cancer. BMJ Open 2022; 12:e061815. [PMID: 36123093 PMCID: PMC9486365 DOI: 10.1136/bmjopen-2022-061815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Prostate-specific membrane antigen positron emission tomography (PSMA-PET) has emerged as valuable imaging to assessing metastatic disease in prostate malignancy. However, there has been limited studies exploring the utility PSMA-PET as primary imaging assessing for index lesions prior to biopsy. The primary objective of this study is to compare the diagnostic accuracy of 18-fluorine PSMA (18F DCFPyL PSMA) PET scans to multiparametric MRI (mpMRI) to detect primary prostate cancer at prostate biopsy. METHODS AND ANALYSIS The PEDAL trial is a multicentre, prospective, single-arm, paired comparison, non-randomised phase III trial in subjects considered for diagnostic prostate biopsy. Subjects who are eligible for a diagnostic mpMRI prostate will undergo additional same-day 18 F DCFPyl PSMA PET/CT of the chest, abdomen and pelvis. Software coregistration of the mpMRI and PSMA-PET/CT images will be performed. The reporting of the mpMRI prostate, PSMA-PET/CT and PSMA PET/MRI coregistration will be performed blinded. The diagnostic accuracy of PSMA PET/CT alone, and in combination with mpMRI, to detect prostate cancer will be assessed. Histopathology at prostate biopsy will be used as the reference standard. Sample size calculations estimate that 240 subjects will need to be recruited to demonstrate 20% superiority of PSMA-PET/CT. The sensitivity, specificity, positive predictive value and negative predictive value of the combination of mpMRI prostate and PSMA PET/CT compared with targeted and systematic prostate biopsy will be evaluated. It is hypothesised that PSMA PET/CT combined with mpMRI prostate will have improved diagnostic accuracy compared with mpMRI prostate alone for detection of prostate cancer in biopsy-naïve men, resulting in a significant impact on patient management. ETHICS AND DISSEMINATION This study was approved by the independent Human Research Ethics Committee. Results will be published in peer-reviewed medical journals with eligible investigators will significantly contribute. TRIAL REGISTRATION NUMBER ACTRN12620000261910.
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Affiliation(s)
- Vy Tran
- Department of Urology, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anne Hong
- Department of Urology, Austin Health, Heidelberg, Victoria, Australia
| | - Tom Sutherland
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Medical Imaging, St Vincent's Hospital Melbourne Pty Ltd, Melbourne, Victoria, Australia
| | - Kim Taubman
- Department of Nuclear Medicine, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia
| | - Su-Faye Lee
- Department of Nuclear Medicine, St Vincent's Hospital Melbourne Pty Ltd, Melbourne, Victoria, Australia
| | - Daniel Lenaghan
- Department of Urology, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia
| | - Kapil Sethi
- Department of Urology, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Niall M Corcoran
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Urology, The Royal Melbourne Hospital City Campus, Parkville, Victoria, Australia
| | - Nathan Lawrentschuk
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Urology, The Royal Melbourne Hospital City Campus, Parkville, Victoria, Australia
| | - H Woo
- Department of Urology, Sydney Adventist Hospital, Wahroonga, New South Wales, Australia
- Department of Surgery, The University of Sydney, Sydney, New South Wales, Australia
| | - Lisa Tarlinton
- San Radiology and Nuclear Medicine, Sydney Adventist Hospital, Wahroonga, New South Wales, Australia
| | - Damien Bolton
- Department of Urology, Austin Health, Heidelberg, Victoria, Australia
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Tim Spelman
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lauren Thomas
- Department of Nuclear Medicine, St Vincent's Hospital Melbourne Pty Ltd, Melbourne, Victoria, Australia
| | - Russell Booth
- Department of Nuclear Medicine, St Vincent's Hospital Melbourne Pty Ltd, Melbourne, Victoria, Australia
| | - Justin Hegarty
- Pacific Radiology Christchurch, Christchurch, Canterbury, New Zealand
| | - Elisa Perry
- Pacific Radiology Christchurch, Christchurch, Canterbury, New Zealand
| | - Lih-Ming Wong
- Department of Urology, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia
- Department of Urology, Austin Health, Heidelberg, Victoria, Australia
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
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12
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Merriel SWD, Archer S, Forster AS, Eldred-Evans D, McGrath J, Ahmed HU, Hamilton W, Walter FM. Experiences of 'traditional' and 'one-stop' MRI-based prostate cancer diagnostic pathways in England: a qualitative study with patients and GPs. BMJ Open 2022; 12:e054045. [PMID: 35882453 PMCID: PMC9330318 DOI: 10.1136/bmjopen-2021-054045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES This study aimed to understand and explore patient and general practitioner (GP) experiences of 'traditional' and 'one-stop' prostate cancer diagnostic pathways in England. DESIGN Qualitative study using semi-structured interviews, analysed using inductive thematic analysis SETTING: Patients were recruited from National Health Service (NHS) Trusts in London and in Devon; GPs were recruited via National Institute for Health Research (NIHR) Clinical Research Networks. Interviews were conducted in person or via telephone. PARTICIPANTS Patients who had undergone a MRI scan of the prostate as part of their diagnostic work-up for possible prostate cancer, and GPs who had referred at least one patient for possible prostate cancer in the preceding 12 months. RESULTS 22 patients (aged 47-80 years) and 10 GPs (6 female, aged 38-58 years) were interviewed. Patients described three key themes: cancer beliefs in relation to patient's attitudes towards prostate cancer;communication with their GP and specialist having a significant impact on experience of the pathway and pathway experience being influenced by appointment and test burden. GP interview themes included: the challenges of dealing with imperfect information in the current pathway; managing uncertainty in identifying patients with possible prostate cancer and sharing this uncertainty with them, and other social, cultural and personal contextual influences. CONCLUSIONS Patients and GPs reported a range of experiences and views of the current prostate cancer diagnostic pathways in England. Patients valued 'one-stop' pathways integrating prostate MRI and diagnostic consultations with specialists over the more traditional approach of several hospital appointments. GPs remain uncertain how best to identify patients needing referral for urgent prostate cancer testing due to the lack of accurate triage and risk assessment strategies.
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Affiliation(s)
| | - Stephanie Archer
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Alice S Forster
- Department of Behavioural Science and Health, University College London, London, UK
| | | | - John McGrath
- Department of Urology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | - Willie Hamilton
- Institute of Health Research, University of Exeter, Exeter, UK
| | - Fiona M Walter
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Wolfson Institute of Public Health, Queen Mary University of London, London, UK
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13
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Payne HA, Jain S, Peedell C, Edwards A, Thomas JA, Das P, Hansson Hedblom A, Woodward E, Saunders R, Bahl A. Delphi study to identify consensus on patient selection for hydrogel rectal spacer use during radiation therapy for prostate cancer in the UK. BMJ Open 2022; 12:e060506. [PMID: 35858729 PMCID: PMC9305805 DOI: 10.1136/bmjopen-2021-060506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To identify consensus on patient prioritisation for rectal hydrogel spacer use during radiation therapy for the treatment of prostate cancer in the UK. DESIGN Delphi study consisting of two rounds of online questionnaires, two virtual advisory board meetings and a final online questionnaire. SETTING Radical radiation therapy for localised and locally advanced prostate cancer in the UK. PARTICIPANTS Six leading clinical oncologists and one urologist from across the UK. INTERVENTIONS Rectal hydrogel spacer. PRIMARY AND SECONDARY OUTCOME MEASURES None reported. RESULTS The panel reached consensus on the importance of minimising toxicity for treatments with curative intent and that even low-grade toxicity-related adverse events can significantly impact quality of life. There was agreement that despite meeting rectal dose constraints, too many patients experience rectal toxicity and that rectal hydrogel spacers in eligible patients significantly reduces toxicity-related adverse events. However, as a consequence of funding limitations, patients need to be prioritised for spacer use. A higher benefit of spacers can be expected in patients on anticoagulation and in patients with diabetes or inflammatory bowel disease, but consensus could not be reached regarding patient groups expected to benefit less. While radiation therapy regimen is not a main factor determining prioritisation, higher benefit is expected in ultrahypofractionated regimens. CONCLUSION There is a strong and general agreement that all patients with prostate cancer undergoing radical radiation therapy have the potential to benefit from hydrogel spacers. Currently, not all patients who could potentially benefit can access hydrogel spacers, and access is unequal. Implementation of the consensus recommendations would likely help prioritise and equalise access to rectal spacers for patients in the UK.
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Affiliation(s)
- Heather Ann Payne
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Suneil Jain
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Clive Peedell
- Department of Radiotherapy and Oncology, James Cook University Hospital, Middlesbrough, UK
| | | | | | - Prantik Das
- Department of Oncology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | | | - Emily Woodward
- Health Economics, Boston Scientific AG, Solothurn, Switzerland
| | | | - Amit Bahl
- Bristol Haematology and Oncology Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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14
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Robles LA, Shingler E, McGeagh L, Rowe E, Koupparis A, Bahl A, Shiridzinomwa C, Persad R, Martin RM, Lane JA. Attitudes and adherence to changes in nutrition and physical activity following surgery for prostate cancer: a qualitative study. BMJ Open 2022; 12:e055566. [PMID: 35768108 PMCID: PMC9244678 DOI: 10.1136/bmjopen-2021-055566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Interventions designed to improve men's diet and physical activity (PA) have been recommended as methods of cancer prevention. However, little is known about specific factors that support men's adherence to these health behaviour changes, which could inform theory-led diet and PA interventions. We aimed to explore these factors in men following prostatectomy for prostate cancer (PCa). DESIGN, SETTING AND PARTICIPANTS A qualitative study using semistructured interviews with men, who made changes to their diet and/or PA as part of a factorial randomised controlled trial conducted at a single hospital in South West England. Participants were 17 men aged 66 years, diagnosed with localised PCa and underwent prostatectomy. Interview transcripts underwent thematic analysis. RESULTS Men were ambivalent about the relationship of nutrition and PA with PCa risk. They believed their diet and level of PA were reasonable before being randomised to their interventions. Men identified several barriers and facilitators to performing these new behaviours. Barriers included tolerance to dietary changes, PA limitations and external obstacles. Facilitators included partner involvement in diet, habit formation and brisk walking as an individual activity. Men discussed positive effects associated with brisk walking, such as feeling healthier, but not with nutrition interventions. CONCLUSIONS The facilitators to behaviour change suggest that adherence to trial interventions can be supported using well-established behaviour change models. Future studies may benefit from theory-based interventions to support adherence to diet and PA behaviour changes in men diagnosed with PCa.
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Affiliation(s)
- Luke A Robles
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Ellie Shingler
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Lucy McGeagh
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
- Supportive Cancer Care Research Group, Faculty of Health and Life Sciences, Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University, Oxford, UK
| | - Edward Rowe
- Bristol Urology Institute, Department of Urology, North Bristol NHS Trust, Bristol, UK
| | - Anthony Koupparis
- Bristol Urology Institute, Department of Urology, North Bristol NHS Trust, Bristol, UK
| | - Amit Bahl
- Bristol Haematology and Oncology Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Raj Persad
- Bristol Urology Institute, Department of Urology, North Bristol NHS Trust, Bristol, UK
| | - Richard M Martin
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - J Athene Lane
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
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15
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Siltari A, Riikonen J, Koskimäki J, Pakarainen T, Ettala O, Boström P, Seikkula H, Kotsar A, Tammela T, Helminen M, Raittinen PV, Lehtimäki T, Fode M, Østergren P, Borre M, Rannikko A, Marttila T, Salonen A, Ronkainen H, Löffeler S, Murtola TJ. Randomised double-blind phase 3 clinical study testing impact of atorvastatin on prostate cancer progression after initiation of androgen deprivation therapy: study protocol. BMJ Open 2022; 12:e050264. [PMID: 35487730 PMCID: PMC9058683 DOI: 10.1136/bmjopen-2021-050264] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Blood cholesterol is likely a risk factor for prostate cancer prognosis and use of statins is associated with lowered risk of prostate cancer recurrence and progression. Furthermore, use of statins has been associated with prolonged time before development of castration resistance (CR) during androgen deprivation therapy (ADT) for prostate cancer. However, the efficacy of statins on delaying castration-resistance has not been tested in a randomised placebo-controlled setting.This study aims to test statins' efficacy compared to placebo in delaying development of CR during ADT treatment for primary metastatic or recurrent prostate cancer. Secondary aim is to explore effect of statin intervention on prostate cancer mortality and lipid metabolism during ADT. METHODS AND ANALYSIS In this randomised placebo-controlled trial, a total of 400 men with de novo metastatic prostate cancer or recurrent disease after primary treatment and starting ADT will be recruited and randomised 1:1 to use daily 80 mg of atorvastatin or placebo. All researchers, study nurses and patients will be blinded throughout the trial. Patients are followed until disease recurrence or death. Primary outcome is time to formation of CR after initiation of ADT. Serum lipid levels (total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL) and trigyserides) are analysed to test whether changes in serum cholesterol parameters during ADT predict length of treatment response. Furthermore, the trial will compare quality of life, cardiovascular morbidity, changes in blood glucose and circulating cell-free DNA, and urine lipidome during trial. ETHICS AND DISSEMINATION This study is approved by the Regional ethics committees of the Pirkanmaa Hospital District, Science centre, Tampere, Finland (R18065M) and Tarto University Hospital, Tarto, Estonia (319/T-6). All participants read and sign informed consent form before study entry. After publication of results for the primary endpoints, anonymised summary metadata and statistical code will be made openly available. The data will not include any information that could make it possible to identify a given participant. TRIAL REGISTRATION NUMBER Clinicaltrial.gov: NCT04026230, Eudra-CT: 2016-004774-17, protocol code: ESTO2, protocol date 10 September 2020 and version 6.
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Affiliation(s)
- Aino Siltari
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Faculty of Medicine, Pharmacology, University of Helsinki, Helsinki, Finland
| | - Jarno Riikonen
- Department of Urology, TAYS Cancer Center, Tampere, Finland
| | - Juha Koskimäki
- Department of Urology, TAYS Cancer Center, Tampere, Finland
| | | | - Otto Ettala
- Department of Urology, University of Turku, Turku, Finland
| | - Peter Boström
- Department of Urology, University of Turku, Turku, Finland
| | - Heikki Seikkula
- Department of Surgery, Central Finland Central Hospital, Jyvaskyla, Finland
| | - Andres Kotsar
- Department of Urology, Tartu University Hospital, Tartu, Tartumaa, Estonia
| | - Teuvo Tammela
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Mika Helminen
- Health Sciences, Tampere University, Tampere, Finland
| | - Paavo V Raittinen
- Department of Mathematics and Systems Analysis, Aalto University School of Science and Technology, Espoo, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Tampere University, Tampere, Finland
| | - Mikkel Fode
- Department of Urology, Herlev and Gentofte University Hospital, Herlev, Denmark
| | - Peter Østergren
- Department of Urology, Herlev and Gentofte University Hospital, Herlev, Denmark
| | - Michael Borre
- Department of Urology, Aarhus Universitetshospital, Aarhus, Denmark
| | - Antti Rannikko
- Department of Urology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Timo Marttila
- Department of Urology, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Arto Salonen
- Department of Urology, Kuopio University Hospital, Kuopio, Finland
| | - Hanna Ronkainen
- Department of Urology, Oulu University Hospital, Oulu, Finland
| | - Sven Löffeler
- Section of Urology, Vestfold Hospital Trust, Tonsberg, Norway
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16
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Vredeveld T, van Benten E, Beekmans REPM, Koops MP, Ket JCF, Mollema J, Ramaekers SPJ, Pool JJM, Coppieters MW, Pool-Goudzwaard AL. Reliability and validity of assessment methods available in primary care for bladder outlet obstruction and benign prostatic obstruction in men with lower urinary tract symptoms: a systematic review. BMJ Open 2022; 12:e056234. [PMID: 35487713 PMCID: PMC9058800 DOI: 10.1136/bmjopen-2021-056234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To systematically review the literature regarding the reliability and validity of assessment methods available in primary care for bladder outlet obstruction or benign prostatic obstruction in men with lower urinary tract symptoms (LUTS). DESIGN Systematic review with best evidence synthesis. SETTING Primary care. PARTICIPANTS Men with LUTS due to bladder outlet obstruction or benign prostatic obstruction. REVIEW METHODS PubMed, Ebsco/CINAHL and Embase databases were searched for studies on the validity and reliability of assessment methods for bladder outlet obstruction and benign prostatic obstruction in primary care. Methodological quality was assessed with the COSMIN checklist. Studies with poor methodology were excluded from the best evidence synthesis. RESULTS Of the 5644 studies identified, 61 were scored with the COSMIN checklist, 37 studies were included in the best evidence synthesis, 18 evaluated bladder outlet obstruction and 17 benign prostatic obstruction, 2 evaluated both. Overall, reliability was poorly evaluated. Transrectal and transabdominal ultrasound showed moderate to good validity to evaluate bladder outlet obstruction. Measured prostate volume with these ultrasound methods, to identify benign prostatic obstruction, showed moderate to good accuracy, supported by a moderate to high level of evidence. Uroflowmetry for bladder outlet obstruction showed poor to moderate diagnostic accuracy, depending on used cut-off values. Questionnaires were supported by high-quality evidence, although correlations and diagnostic accuracy were poor to moderate compared with criterion tests. Other methods were supported by low level evidence. CONCLUSION Clinicians in primary care can incorporate transabdominal and transrectal ultrasound or uroflowmetry in the evaluation of men with LUTS but should not solely rely on these methods as the diagnostic accuracy is insufficient and reliability remains insufficiently researched. Low-to-moderate levels of evidence for most assessment methods were due to methodological shortcomings and inconsistency in the studies. This highlights the need for better study designs in this domain.
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Affiliation(s)
- Tom Vredeveld
- Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Esther van Benten
- Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- HU University of Applied Sciences Utrecht, Institute of Movement Sciences, Utrecht, The Netherlands
| | | | - M Patrick Koops
- Physiotherapy Practice De Werfheegde, Haaksbergen, The Netherlands
| | - Johannes C F Ket
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jurgen Mollema
- Medical Library, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Stephan P J Ramaekers
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Jan J M Pool
- HU University of Applied Sciences Utrecht, Institute of Movement Sciences, Utrecht, The Netherlands
| | - Michel W Coppieters
- Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Queensland, Australia
| | - Annelies L Pool-Goudzwaard
- Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- SOMT University of Physiotherapy, Amersfoort, The Netherlands
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17
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Ettala O, Jambor I, Montoya Perez I, Seppänen M, Kaipia A, Seikkula H, Syvänen KT, Taimen P, Verho J, Steiner A, Saunavaara J, Saukko E, Löyttyniemi E, Sjoberg DD, Vickers A, Aronen H, Boström P. Individualised non-contrast MRI-based risk estimation and shared decision-making in men with a suspicion of prostate cancer: protocol for multicentre randomised controlled trial (multi-IMPROD V.2.0). BMJ Open 2022; 12:e053118. [PMID: 35428621 PMCID: PMC9014036 DOI: 10.1136/bmjopen-2021-053118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION European Association of Urology and UK National Institute for Health and Care Excellence guidelines recommend that all men with suspicions of prostate cancer should undergo prebiopsy contrast enhanced, that is, multiparametric prostate MRI. Subsequent prostate biopsies should also be performed if MRI is positive, that is, Prostate Imaging-Reporting and Data System (PI-RADS) scores 3-5. However, several retrospective post hoc analyses have shown that this approach still leads to many unnecessary biopsy procedures. For example, 88%-96% of men with PI-RADS, three findings are still diagnosed with clinically non-significant prostate cancer or no cancer at all. METHODS AND ANALYSIS This is a prospective, randomised, controlled, multicentre trial, being conducted in Finland, to demonstrate non-inferiority in clinically significant cancer detection rates among men undergoing prostate biopsies post-MRI and men undergoing prostate biopsies post-MRI only after a shared decision based on individualised risk estimation. Men without previous diagnosis of prostate cancer and with abnormal digital rectal examination findings and/or prostate-specific antigen between 2.5 ug/L and 20.0 ug/L are included. We aim to recruit 830 men who are randomised at a 1:1 ratio into control (all undergo biopsies after MRI) and intervention arms (the decision to perform biopsies is based on risk estimation and shared decision-making). The primary outcome of the study is the proportion of men with clinically significant prostate cancer (Gleason 4+3 prostate cancer or higher). We will also compare the overall biopsy rate, benign biopsy rate and the detection of non-significant prostate cancer between the two study groups. ETHICS AND DISSEMINATION The study (protocol V.2.0, 4 January 2021) was approved by the Ethics Committee of the Hospital District of Southwest Finland (IORG number: 0001744, IBR number: 00002216; trial number: 99/1801/2019). Participants are required to provide written informed consent. Full reports of this study will be submitted to peer-reviewed journals, mainly urology and radiology. TRIAL REGISTRATION NUMBER NCT04287088; the study is registered at ClinicalTrials.gov.
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Affiliation(s)
- Otto Ettala
- Department of Urology, TYKS Turku University Hospital and University of Turku, Turku, Varsinais-Suomi, Finland
| | - Ivan Jambor
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Medical Imaging Centre of Southwest Finland, TYKS Turku University Hospital, Turku, Varsinais-Suomi, Finland
| | - Ileana Montoya Perez
- Medical Imaging Centre of Southwest Finland, TYKS Turku University Hospital, Turku, Varsinais-Suomi, Finland
- Department of Computing, University of Turku, Turku, Varsinais-Suomi, Finland
| | - Marjo Seppänen
- Department of Urology, Satakunta Hospital District, Pori, Satakunta, Finland
| | - Antti Kaipia
- Department of Urology, Tampere University, Tampere, Pirkanmaa, Finland
- Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Heikki Seikkula
- Department of Urology, Central Finland Central Hospital, Jyvaskyla, Finland
| | - Kari T Syvänen
- Department of Urology, TYKS Turku University Hospital and University of Turku, Turku, Varsinais-Suomi, Finland
| | - Pekka Taimen
- Department of Pathology, TYKS Turku University Hospital, Turku, Varsinais-Suomi, Finland
- Institute of Biomedicine, University of Turku, Turku, Varsinais-Suomi, Finland
| | - Janne Verho
- Medical Imaging Centre of Southwest Finland, TYKS Turku University Hospital, Turku, Varsinais-Suomi, Finland
| | - Aida Steiner
- Medical Imaging Centre of Southwest Finland, TYKS Turku University Hospital, Turku, Varsinais-Suomi, Finland
| | - Jani Saunavaara
- Department of Medical Physics, TYKS Turku University Hospital, Turku, Varsinais-Suomi, Finland
| | - Ekaterina Saukko
- Medical Imaging Centre of Southwest Finland, TYKS Turku University Hospital, Turku, Varsinais-Suomi, Finland
| | - Eliisa Löyttyniemi
- Department of Biostatistics, University of Turku, Turku, Varsinais-Suomi, Finland
| | - Daniel D Sjoberg
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Andrew Vickers
- Integrative Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Hannu Aronen
- Medical Imaging Centre of Southwest Finland, TYKS Turku University Hospital, Turku, Varsinais-Suomi, Finland
| | - Peter Boström
- Department of Urology, TYKS Turku University Hospital and University of Turku, Turku, Varsinais-Suomi, Finland
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18
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Beyer K, Moris L, Lardas M, Haire A, Barletta F, Scuderi S, Molnar M, Herrera R, Rauf A, Campi R, Greco I, Shiranov K, Dabestani S, van den Broeck T, Arun S, Gacci M, Gandaglia G, Omar MI, MacLennan S, Roobol MJ, Farahmand B, Vradi E, Devecseri Z, Asiimwe A, Zong J, Maclennan SJ, Collette L, NDow J, Briganti A, Bjartell A, Van Hemelrijck M. Diagnostic and prognostic factors in patients with prostate cancer: a systematic review. BMJ Open 2022; 12:e058267. [PMID: 35379637 PMCID: PMC8981333 DOI: 10.1136/bmjopen-2021-058267] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES As part of the PIONEER Consortium objectives, we have explored which diagnostic and prognostic factors (DPFs) are available in relation to our previously defined clinician and patient-reported outcomes for prostate cancer (PCa). DESIGN We performed a systematic review to identify validated and non-validated studies. DATA SOURCES MEDLINE, Embase and the Cochrane Library were searched on 21 January 2020. ELIGIBILITY CRITERIA Only quantitative studies were included. Single studies with fewer than 50 participants, published before 2014 and looking at outcomes which are not prioritised in the PIONEER core outcome set were excluded. DATA EXTRACTION AND SYNTHESIS After initial screening, we extracted data following the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of prognostic factor studies (CHARMS-PF) criteria and discussed the identified factors with a multidisciplinary expert group. The quality of the included papers was scored for applicability and risk of bias using validated tools such as PROBAST, Quality in Prognostic Studies and Quality Assessment of Diagnostic Accuracy Studies 2. RESULTS The search identified 6604 studies, from which 489 DPFs were included. Sixty-four of those were internally or externally validated. However, only three studies on diagnostic and seven studies on prognostic factors had a low risk of bias and a low risk concerning applicability. CONCLUSION Most of the DPFs identified require additional evaluation and validation in properly designed studies before they can be recommended for use in clinical practice. The PIONEER online search tool for DPFs for PCa will enable researchers to understand the quality of the current research and help them design future studies. ETHICS AND DISSEMINATION There are no ethical implications.
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Affiliation(s)
- Katharina Beyer
- Translational and Oncology Research (TOUR), King's College London, Faculty of Life Sciences and Medicine, London, UK
| | - Lisa Moris
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Michael Lardas
- Department of Urology, Metropolitan Hospital, Athens, Greece
| | - Anna Haire
- Translational and Oncology Research (TOUR), King's College London, Faculty of Life Sciences and Medicine, London, UK
| | - Francesco Barletta
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Simone Scuderi
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | | | - Abdul Rauf
- Department of Urology, Mid Cheshire Hospitals, NHS Foundation Trust, Crewe, UK
| | - Riccardo Campi
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, University of Florence, Florence, Italy
| | - Isabella Greco
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, University of Florence, Florence, Italy
| | | | - Saeed Dabestani
- Dept. of Translational Medicine, Division of Urological Cancers, Lund University, Kristianstad Central Hospital, Malmo, Sweden
| | | | | | - Mauro Gacci
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, University of Florence, Florence, Italy
| | - Giorgio Gandaglia
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | | | - Monique J Roobol
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | | | | | | | - Jihong Zong
- Global Medical Affairs Oncology, Real World Evidence, Bayer HealthCare Pharmaceuticals Inc, Whippany, New Jersey, USA
| | | | | | - James NDow
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Department of Urology, University Vita e Salute-San Raffaele, Milan, Italy
| | - Anders Bjartell
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Mieke Van Hemelrijck
- Translational and Oncology Research (TOUR), King's College London, Faculty of Life Sciences and Medicine, London, UK
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Cassim N, Rebbeck TR, Glencross DK, George JA. Retrospective analysis to describe trends in first-ever prostate-specific antigen (PSA) testing for primary healthcare facilities in the Gauteng Province, South Africa, between 2006 and 2016. BMJ Open 2022; 12:e050646. [PMID: 35314469 PMCID: PMC8938704 DOI: 10.1136/bmjopen-2021-050646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES The objective of our study was to use laboratory data to describe prostate-specific antigen (PSA) testing trends for primary healthcare (PHC) services from a single province. PHC is a basic package of services offered to local communities, serving as the first point of contact within the health system. These services are offered at clinics and community health centres (CHC), the latter providing additional maternity, accident and emergency services. DESIGN The retrospective descriptive study design was used. METHODS We analysed national laboratory data between 2006 and 2016 for men ≥30 years in the Gauteng Province. We used the probabilistic matching algorithm to create first-ever PSA cohort. We used the hot-deck imputation to assign missing race group values and the district health information system facility descriptors to identify PHC testing. We reported patient numbers by calendar year, age category and race group as well as descriptive statistics. We used multivariable logistic regression to assess any association for race group and age with a PSA ≥4 µg/L. RESULTS Between 2006 and 2016, numbers of men tested increased from 1782 to 67 025, respectively, with 186 984/239 506 (78.1%) tests were from clinics. The majority of testing was for men in the 50-59 age category (31.5%) and Black Africans (86.4%). We reported a median of 0.9 µg/L that increased with age. A PSA ≥4 µg/L was reported for 11.7% of men, increasing to 35.5% for the ≥70 age category. The logistic regression reported that the adjusted odds of having a PSA ≥4 µg/L was significantly lower for Indian/Asians, multiracials and whites than for Black Africans (p value<0.0001). CONCLUSIONS Our study has shown a marked increase in PSA testing from clinics and CHC suggestive of screening for prostate cancer. The approaches reported in this study can be extended for national data.
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Affiliation(s)
- Naseem Cassim
- Faculty of Health Sciences, Department of Molecular Medicine and Haematology, University of the Witwatersrand, Johannesburg-Braamfontein, Gauteng, South Africa
- Department of Molecular Medicine and Haematology, National Health Laboratory Service, Johannesburg, Gauteng, South Africa
| | - Timothy R Rebbeck
- Dana Farber Cancer Institute, Harvard TH Chan School of Public Health, Harvard University, Cambridge, Massachusetts, USA
| | - Deborah K Glencross
- Faculty of Health Sciences, Department of Molecular Medicine and Haematology, University of the Witwatersrand, Johannesburg-Braamfontein, Gauteng, South Africa
- Department of Molecular Medicine and Haematology, National Health Laboratory Service, Johannesburg, Gauteng, South Africa
| | - Jaya A George
- Department of Molecular Medicine and Haematology, National Health Laboratory Service, Johannesburg, Gauteng, South Africa
- Department of Chemical Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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Rouvière O, Souchon R, Lartizien C, Mansuy A, Magaud L, Colom M, Dubreuil-Chambardel M, Debeer S, Jaouen T, Duran A, Rippert P, Riche B, Monini C, Vlaeminck-Guillem V, Haesebaert J, Rabilloud M, Crouzet S. Detection of ISUP ≥2 prostate cancers using multiparametric MRI: prospective multicentre assessment of the non-inferiority of an artificial intelligence system as compared to the PI-RADS V.2.1 score (CHANGE study). BMJ Open 2022; 12:e051274. [PMID: 35140147 PMCID: PMC8830410 DOI: 10.1136/bmjopen-2021-051274] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Prostate multiparametric MRI (mpMRI) has shown good sensitivity in detecting cancers with an International Society of Urological Pathology (ISUP) grade of ≥2. However, it lacks specificity, and its inter-reader reproducibility remains moderate. Biomarkers, such as the Prostate Health Index (PHI), may help select patients for prostate biopsy. Computer-aided diagnosis/detection (CAD) systems may also improve mpMRI interpretation. Different prototypes of CAD systems are currently developed under the Recherche Hospitalo-Universitaire en Santé / Personalized Focused Ultrasound Surgery of Localized Prostate Cancer (RHU PERFUSE) research programme, tackling challenging issues such as robustness across imaging protocols and magnetic resonance (MR) vendors, and ability to characterise cancer aggressiveness. The study primary objective is to evaluate the non-inferiority of the area under the receiver operating characteristic curve of the final CAD system as compared with the Prostate Imaging-Reporting and Data System V.2.1 (PI-RADS V.2.1) in predicting the presence of ISUP ≥2 prostate cancer in patients undergoing prostate biopsy. METHODS This prospective, multicentre, non-inferiority trial will include 420 men with suspected prostate cancer, a prostate-specific antigen level of ≤30 ng/mL and a clinical stage ≤T2 c. Included men will undergo prostate mpMRI that will be interpreted using the PI-RADS V.2.1 score. Then, they will undergo systematic and targeted biopsy. PHI will be assessed before biopsy. At the end of patient inclusion, MR images will be assessed by the final version of the CAD system developed under the RHU PERFUSE programme. Key secondary outcomes include the prediction of ISUP grade ≥2 prostate cancer during a 3-year follow-up, and the number of biopsy procedures saved and ISUP grade ≥2 cancers missed by several diagnostic pathways combining PHI and MRI findings. ETHICS AND DISSEMINATION Ethical approval was obtained from the Comité de Protection des Personnes Nord Ouest III (ID-RCB: 2020-A02785-34). After publication of the results, access to MR images will be possible for testing other CAD systems. TRIAL REGISTRATION NUMBER NCT04732156.
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Affiliation(s)
- Olivier Rouvière
- Université Lyon 1, Université de Lyon, Lyon, France
- Department of Urinary and Vascular Imaging, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- LabTau, INSERM U1032, Lyon, France
| | | | - Carole Lartizien
- CREATIS, INSERM U1294, Villeurbanne, France
- CNRS UMR 5220, INSA-Lyon, Villeurbanne, France
| | - Adeline Mansuy
- Department of Urinary and Vascular Imaging, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Laurent Magaud
- Service Recherche et Epidémiologie Cliniques, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - Matthieu Colom
- Direction de la Recherche Clinique et de l'Innovation, Hospices Civils de Lyon, Lyon, France
| | - Marine Dubreuil-Chambardel
- Department of Urinary and Vascular Imaging, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Sabine Debeer
- Department of Urinary and Vascular Imaging, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | | | - Audrey Duran
- CREATIS, INSERM U1294, Villeurbanne, France
- CNRS UMR 5220, INSA-Lyon, Villeurbanne, France
| | - Pascal Rippert
- Service Recherche et Epidémiologie Cliniques, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - Benjamin Riche
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
- Laboratoire de Biométrie et Biologie Évolutive CNRS UMR 5558, Équipe Biostatistiques Santé, Université de Lyon, Lyon, France
| | | | - Virginie Vlaeminck-Guillem
- Université Lyon 1, Université de Lyon, Lyon, France
- Service de Biochimie et Biologie Moléculaire Sud, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Julie Haesebaert
- Université Lyon 1, Université de Lyon, Lyon, France
- Service Recherche et Epidémiologie Cliniques, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
| | - Muriel Rabilloud
- Université Lyon 1, Université de Lyon, Lyon, France
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
- Laboratoire de Biométrie et Biologie Évolutive CNRS UMR 5558, Équipe Biostatistiques Santé, Université de Lyon, Lyon, France
| | - Sébastien Crouzet
- Université Lyon 1, Université de Lyon, Lyon, France
- LabTau, INSERM U1032, Lyon, France
- Department of Urology, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
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Yates P, Carter R, Cockerell R, Cowan D, Dixon C, Lal A, Newton RU, Hart N, Galvão DA, Baguley B, Denniston N, Skinner T, Couper J, Emery J, Frydenberg M, Liu WH. Evaluating a multicomponent survivorship programme for men with prostate cancer in Australia: a single cohort study. BMJ Open 2022; 12:e049802. [PMID: 35110307 PMCID: PMC8811561 DOI: 10.1136/bmjopen-2021-049802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate the implementation of a multicomponent survivorship programme for men with prostate cancer and their carers. DESIGN A single cohort study, guided by the RE-AIM framework. SETTING Multiple health services in Australia. PARTICIPANTS Men with prostate cancer and their carers, and health professionals. INTERVENTION A 12-month telehealth programme that provided centralised and coordinated decision and information support, exercise and nutrition management, specialised clinical support and practical support to men and their carers. DATA COLLECTION Multiple sources of data including participant-reported health outcomes and experience of care, qualitative interviews, records of the programme were collected at different time points. RESULTS Reach: Of 394 eligible men at various stages of survivorship, 142 consented (36% consent rate) and 136 (96%) completed the programme. Adoption: All men participated in general care coordination and more than half participated in exercise and/or nutrition management interventions. Participation in the specialised support component (ie, psychosocial and sexual health support, continence management) was low despite the high level of need reported by men. Effectiveness: Overall, the men reported improvements in their experience of care. Implementation: Factors such as addressing service gaps, provision of specialised services, care coordination, adoption of needs-based and telehealth-based approaches were identified as enablers to the successful implementation of the programme. Issues such as insufficient integration with existing services, lack of resources and high caseload of the intervention team, men's reluctance to discuss needs and lack of confidence with technology were barriers in implementing the programme. CONCLUSION Survivorship interventions are relevant to men regardless of the stage of their disease and treatments undertaken. It is possible to provide access to a comprehensive model of survivorship care to promote the health and quality of life for men with prostate cancer. TRIAL REGISTRATION NUMBER This study was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12617000174381).
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Affiliation(s)
- Patsy Yates
- Cancer and Palliative Care Outcomes Centre, Queensland University of Technology Faculty of Health, Kelvin Grove, Queensland, Australia
| | - Rob Carter
- Deakin Health Economics, Institute for Health Transformation, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Robyn Cockerell
- Cancer and Palliative Care Outcomes Centre, Queensland University of Technology Faculty of Health, Kelvin Grove, Queensland, Australia
| | | | - Cyril Dixon
- Movember, Richmond, Victoria, Australia
- Dixon Healthcare Consulting, Melbourne, Victoria, Australia
| | - Anita Lal
- Deakin Health Economics, Institute for Health Transformation, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Human Movement and Nutrition Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Nicolas Hart
- Cancer and Palliative Care Outcomes Centre, Queensland University of Technology Faculty of Health, Kelvin Grove, Queensland, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Brenton Baguley
- School of Human Movement and Nutrition Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | | | - Tina Skinner
- School of Human Movement and Nutrition Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Jeremy Couper
- Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University Faculty of Medicine, Nursing and Health Sciences, Melbourne, Victoria, Australia
| | - Jon Emery
- Centre for Cancer Research, Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mark Frydenberg
- Department of Surgery, Cabrini Institute, Cabrini Health, Monash University Faculty of Medicine, Nursing and Health Sciences, Melbourne, Victoria, Australia
| | - Wei-Hong Liu
- Cancer and Palliative Care Outcomes Centre, Queensland University of Technology Faculty of Health, Kelvin Grove, Queensland, Australia
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Wang J, Han Y, Lin L, Zhang L, Li J, Gao H, Fu P. Systematic review & meta-analysis of positron emission tomography/computed tomography and bone scan in the diagnosis of prostate lesions. Transl Androl Urol 2022; 10:4231-4240. [PMID: 34984188 PMCID: PMC8661258 DOI: 10.21037/tau-21-912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/03/2021] [Indexed: 01/17/2023] Open
Abstract
Background To date, the results of studies into the effectiveness of positron emission tomography (PET) combined with computed tomography (CT) and bone scan (BS) in the diagnosis of malignant prostate lesions have been inconsistent, and the advantages and disadvantages of the two methods cannot be accurately judged. Methods Articles were retrieved from the China National Knowledge Infrastructure (CNKI) database, Wan Fang Medical Network, PubMed, Excerpta Medica data BASE (EMBASE), Medline, and Cochrane database. The keywords used in the search were: 68Ga-prostate specific membrane antibody (68Ga-PSMA), PET/CT, prostate lesions, prostate adenocarcinoma, bone metastasis, and BS. Results Ultimately, 3 publications were selected for inclusion in the meta-analysis. A total of 215 patients were considered in the 3 articles that met the inclusion criteria. All of the included articles were small sample studies, with sample sizes ranging from 28 to 113 cases. In this study, from the 3 randomized controlled trials, only 2 (66.67%) randomized controls described the correct randomized allocation method, and only 1 (33.33%) described the hidden allocation scheme in detail. The highest sensitivity for 68Ga-PSMA PET/CT was 0.96, with 95% CI: 0.87, 1.00, and the highest specificity was 1.00, with 95% CI: 0.96, 1.00. The highest sensitivity and specificity of BS were 0.92 with 95% CI: 0.81, 0.98 and 0.96 with 95% CI: 0.78, 1.00, respectively. The results of meta-analysis of 68Ga-PSMA PET/CT diagnosis with confirmation by surgical and histopathological examination showed that the area under the summary receiver operating characteristics (SROC) curve (AUC) =0.826 and standard error (SE) (AUC) =0.0425. The results of meta-analysis of BS diagnosis with confirmation by surgical and histopathological examination showed that the area under the SROC curve (AUC) =0.714 and SE (AUC) =0.0034. Discussion The meta-analysis showed that 68Ga-PSMA PET/CT has clear advantages over BS in the diagnosis of bone metastases of malignant prostate tumors, and could improve the diagnostic accuracy of bone metastases.
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Affiliation(s)
- Jiafu Wang
- Department of Nuclear Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yue Han
- Department of Ultrasound, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Lin Lin
- Department of Nuclear Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Linhan Zhang
- Department of Nuclear Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jin Li
- Department of Integrative Medicine Oncology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Huiqi Gao
- Department of Nuclear Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Peng Fu
- Department of Nuclear Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
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23
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Satish P, Freeman A, Kelly D, Kirkham A, Orczyk C, Simpson BS, Giganti F, Whitaker HC, Emberton M, Norris JM. Relationship of prostate cancer topography and tumour conspicuity on multiparametric magnetic resonance imaging: a protocol for a systematic review and meta-analysis. BMJ Open 2022; 12:e050376. [PMID: 34987040 PMCID: PMC8734010 DOI: 10.1136/bmjopen-2021-050376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Multiparametric magnetic resonance imaging (mpMRI) has improved the triage of men with suspected prostate cancer, through precision prebiopsy identification of clinically significant disease. While multiple important characteristics, including tumour grade and size have been shown to affect conspicuity on mpMRI, tumour location and association with mpMRI visibility is an underexplored facet of this field. Therefore, the objective of this systematic review and meta-analysis is to collate the extant evidence comparing MRI performance between different locations within the prostate in men with existing or suspected prostate cancer. This review will help clarify mechanisms that underpin whether a tumour is visible, and the prognostic implications of our findings. METHODS AND ANALYSIS The databases MEDLINE, PubMed, Embase and Cochrane will be systematically searched for relevant studies. Eligible studies will be full-text English-language articles that examine the effect of zonal location on mpMRI conspicuity. Two reviewers will perform study selection, data extraction and quality assessment. A third reviewer will be involved if consensus is not achieved. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines will inform the methodology and reporting of the review. Study bias will be assessed using a modified Newcastle-Ottawa scale. A thematic approach will be used to synthesise key location-based factors associated with mpMRI conspicuity. A meta-analysis will be conducted to form a pooled value of the sensitivity and specificity of mpMRI at different tumour locations. ETHICS AND DISSEMINATION Ethical approval is not required as it is a protocol for a systematic review. Findings will be disseminated through peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER CRD42021228087.
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Affiliation(s)
- Pranav Satish
- UCL Division of Surgery & Interventional Science, UCL Medical School, London, UK
| | - Alex Freeman
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Daniel Kelly
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Alex Kirkham
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Clement Orczyk
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Francesco Giganti
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Hayley C Whitaker
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Mark Emberton
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Joseph M Norris
- Division of Surgery and Interventional Science, University College London, London, UK
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24
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Zhao Y, Morka N, Simpson BSS, Freeman A, Kirkham A, Kelly D, Whitaker HC, Emberton M, Norris JM. Prostate-specific membrane antigen positron emission tomography compared to multiparametric MRI for prostate cancer diagnosis: a protocol for a systematic review and meta-analysis. BMJ Open 2021; 11:e052277. [PMID: 34893484 PMCID: PMC8666885 DOI: 10.1136/bmjopen-2021-052277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION The introduction of multiparametric MRI (mpMRI) has improved almost every aspect of the prostate cancer diagnostic pathway. However, the novel imaging technique, prostate-specific membrane antigen positron emission tomography (PSMA PET) may have demonstrable accuracy in detecting and staging prostate cancer. Here, we describe a protocol for a systematic review and meta-analysis comparing mpMRI to PSMA PET for the diagnosis of suspected prostate cancer. METHODS AND ANALYSIS A systematic search of MEDLINE, EMBASE, PubMed and Cochrane databases will be conducted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines will be followed for screening, data extraction, statistical analysis and reporting. Included papers will be full-text articles providing original data, written in English articles and comparing the use of PSMA PET with mpMRI in the diagnosis of prostate cancer. All studies published between July 1977 and March 2021 will be eligible for inclusion. Study bias and quality will be assessed using Quadas-2 score. To ensure the quality of the reporting of studies, this protocol is written following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 checklist. ETHICS AND DISSEMINATION Ethical approval will not be required for this systematic review. Findings will be disseminated through peer-reviewed publications and presentations at both national and international conferences. PROSPERO REGISTRATION NUMBER CRD42021239296.
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Affiliation(s)
- Yi Zhao
- Imperial College London, London, UK
| | - Naomi Morka
- University College London Medical School, London, UK
| | | | - Alex Freeman
- Department of Histopathology, University College Hospital London, London, UK
| | - Alex Kirkham
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Daniel Kelly
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Hayley C Whitaker
- UCL Division of Surgery and Interventional Science, University College London, London, UK
| | - Mark Emberton
- Division of Surgery and Interventional Sciences, University College London, London, UK
- Department of Urology, University College London Hospital, London, UK
| | - Joseph M Norris
- UCL Division of Surgery & Interventional Science, University College London, London, UK
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Kobayashi H, Kosaka T, Mikami S, Kimura T, Hongo H, Kosugi M, Sato Y, Oya M. Vasohibin-1 expression as a biomarker of aggressive nature in ductal adenocarcinoma of the prostate: a retrospective cohort study at two centres in Japan. BMJ Open 2021; 11:e056439. [PMID: 34819292 PMCID: PMC8614138 DOI: 10.1136/bmjopen-2021-056439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Vasohibin-1 (VASH1) is an endogenous angiogenesis regulator expressed in activated vascular endothelial cells. We previously reported that high VASH1 expression is a predictor of progression in acinar adenocarcinoma of the prostate. In this study, we evaluated the characteristics of ductal adenocarcinoma of the prostate by comparing the level of VASH1 expression between ductal and acinar adenocarcinoma specimens. DESIGN AND SETTING A retrospective cohort study at two centres in Japan. PARTICIPANTS Among the 1495 patients who underwent radical prostatectomy or transurethral resection for the past 15 years, a total of 14 patients diagnosed with ductal adenocarcinoma and 20 patients diagnosed with acinar adenocarcinoma with a Gleason score of 4+4 were included. INTERVENTIONS We immunohistochemically examined the CD34 expression as the microvessel density (MVD) and activated endothelial cells as the VASH1 density (vessels per mm2). PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the association of MVD and VASH1 density between ductal and acinar adenocarcinoma, and the secondary outcome was their oncological outcomes. RESULTS Nine patients (64.3%) with ductal adenocarcinoma were diagnosed at an advanced clinical stage, and five patients (35.7%) died from cancer during a median follow-up of 56.0 months. The VASH1 densities (mean±SD) in ductal and acinar adenocarcinoma were 45.1±18.5 vs 16.1±21.0 (p<0.001), respectively, while the MVD (mean±SD) in ductal and acinar adenocarcinoma were 65.3±21.9 vs 80.8±60.7 (p=0.666), respectively. The 5-year cancer-specific survival rates for high and low VASH1 expression were 70.0% and 100.0% (p=0.006), respectively. High VASH1 expression and a diagnosis of ductal adenocarcinoma were significant predictors of cancer-specific survival. CONCLUSIONS Ductal adenocarcinoma was more aggressive and had higher VASH1 expression than acinar adenocarcinoma, although MVD was equivalent. These results indicate that VASH1 expression may serve as a novel biomarker for the aggressive nature of ductal adenocarcinoma.
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Affiliation(s)
- Hiroaki Kobayashi
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
- Department of Urology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Takeo Kosaka
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Shuji Mikami
- Division of Diagnostic Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Tokuhiro Kimura
- Division of Diagnostic Pathology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Hiroshi Hongo
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Michio Kosugi
- Department of Urology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Yasufumi Sato
- Department of Vascular Biology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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Connor MJ, Genie MG, Gonzalez M, Sarwar N, Thippu Jayaprakash K, Horan G, Hosking-Jervis F, Klimowska-Nassar N, Sukumar J, Pokrovska T, Basak D, Robinson A, Beresford M, Rai B, Mangar S, Khoo V, Dudderidge T, Falconer A, Winkler M, Watson V, Ahmed HU. Metastatic prostate cancer men's attitudes towards treatment of the local tumour and metastasis evaluative research (IP5-MATTER): protocol for a prospective, multicentre discrete choice experiment study. BMJ Open 2021; 11:e048996. [PMID: 34794989 PMCID: PMC8603288 DOI: 10.1136/bmjopen-2021-048996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Systemic therapy with androgen deprivation therapy (ADT) and intensification with agents such as docetaxel, abiraterone acetate and enzalutamide has resulted in improved overall survival in men with de novo synchronous metastatic hormone-sensitive prostate cancer (mHSPC). Novel local cytoreductive treatments and metastasis-directed therapy are now being evaluated. Such interventions may provide added survival benefit or delay the requirement for further systemic agents and associated toxicity but can confer additional harm. Understanding men's preferences for treatment options in this disease state is crucial for patients, clinicians, carers and future healthcare service providers. METHODS Using a prospective, multicentre discrete choice experiment (DCE), we aim to determine the attributes associated with treatment that are most important to men with mHSPC. Furthermore, we plan to determine men's preferences for, and trade-offs between, the attributes (survival and side effects) of different treatment options including systemic therapy, local cytoreductive approaches (external beam radiotherapy, cytoreductive radical prostatectomy or minimally invasive ablative therapy) and metastases-directed therapies (metastasectomy or stereotactic ablative body radiotherapy). All men with newly diagnosed mHSPC within 4 months of commencing ADT and WHO performance status 0-2 are eligible. Men who have previously consented to a cytoreductive treatment or have developed castrate-resistant disease will be excluded. This study includes a qualitative analysis component, with patients (n=15) and healthcare professionals (n=5), to identify and define the key attributes associated with treatment options that would warrant trade-off evaluation in a DCE. The main phase component planned recruitment is 300 patients over 1 year, commencing in January 2021, with planned study completion in March 2022. ETHICS AND DISSEMINATION Ethical approval was obtained from the Health Research Authority East of England, Cambridgeshire and Hertfordshire Research Ethics Committee (Reference: 20/EE/0194). Project information will be reported on the publicly available Imperial College London website and the Heath Economics Research Unit (HERU website including the HERU Blog). We will use the social media accounts of IP5-MATTER, Imperial Prostate London, HERU and the individual researchers to disseminate key findings following publication. Findings from the study will be presented at national/international conferences and peer-reviewed journals. Authorship policy will follow the recommendations of the International Committee of Medical Journal Editors. TRIAL REGISTRATION NUMBER NCT04590976.
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Affiliation(s)
- Martin John Connor
- Imperial Prostate, Divison of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Mesfin G Genie
- Health Economics Research Unit (HERU), Faculty of Medicine, University of Aberdeen, Aberdeen, UK
- Economics, Ca' Foscari University of Venice, Venezia, Italy
| | - Michael Gonzalez
- Department of Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Naveed Sarwar
- Department of Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Kamalram Thippu Jayaprakash
- Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
- Department of Oncology, Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, UK
| | - Gail Horan
- Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
| | - Feargus Hosking-Jervis
- Imperial Prostate, Divison of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Natalia Klimowska-Nassar
- Imperial Prostate, Divison of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial College Clinical Trials Unit (ICTU), Imperial College London, London, UK
| | - Johanna Sukumar
- Imperial Prostate, Divison of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial College Clinical Trials Unit (ICTU), Imperial College London, London, UK
| | - Tzveta Pokrovska
- Department of Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Dolan Basak
- Department of Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Angus Robinson
- Department of Oncology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Mark Beresford
- Department of Oncology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Bhavan Rai
- Department of Urology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Stephen Mangar
- Department of Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Vincent Khoo
- Department of Oncology, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
| | - Tim Dudderidge
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Alison Falconer
- Department of Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Mathias Winkler
- Imperial Prostate, Divison of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Verity Watson
- Health Economics Research Unit (HERU), Faculty of Medicine, University of Aberdeen, Aberdeen, UK
| | - Hashim Uddin Ahmed
- Imperial Prostate, Divison of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
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Svarc P, Stroomberg HV, Juhl Jensen R, Frevert S, Håkan Lindh M, Taudorf M, Brasso K, Lönn L, Røder MA. Efficacy of dexamethasone in reducing the postembolisation syndrome in men undergoing prostatic artery embolisation for benign prostatic hyperplasia: protocol for a single-centre, randomised, double-blind, placebo-controlled trial-the 'DEXAPAE' study. BMJ Open 2021; 11:e047878. [PMID: 34725072 PMCID: PMC8562514 DOI: 10.1136/bmjopen-2020-047878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Postembolisation syndrome (PES) is the most common side effect of vascular embolisation of solid organs. Although prophylactic corticosteroids are known to reduce the incidence and severity of PES, no trials investigating their efficacy have been conducted in men undergoing prostatic artery embolisation (PAE). We postulate that steroids can have a similar effect in reducing PES after PAE. This paper describes the rationale and detailed protocol for a randomised controlled trial evaluating the efficacy of dexamethasone (DEXA) in reducing PES after PAE. METHODS AND ANALYSIS In this single-centre, randomised, double-blind, placebo-controlled trial, we will enrol 60 individuals undergoing PAE for benign prostatic hyperplasia. Participants will be randomised to receive IV DEXA (24 mg) or placebo (saline). The primary outcomes will be postprocedural fever, pain and quality of life. The secondary outcomes will include postprocedural nausea, postprocedural medicine usage, laboratory parameters (C reactive protein, prostate-specific antigen) and early PAE results. ETHICS AND DISSEMINATION Ethics approval was obtained from the Danish Committee on Health Research Ethics in the Capital Region (H-20025910). The results from this trial will be disseminated through publication in peer-reviewed journals and national and international presentations. TRIAL REGISTRATION NUMBER Clinicaltrials.gov identifier: NCT04588857; EudraCT number: 2020-000915-53.
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Affiliation(s)
- Petra Svarc
- Department of Radiology, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hein Vincent Stroomberg
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Prostate Cancer Center (CPC), Department of Urology, Rigshospitalet, Copenhagen, Denmark
| | | | - Susanne Frevert
- Department of Radiology, Rigshospitalet, Copenhagen, Denmark
| | | | - Mikkel Taudorf
- Department of Radiology, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Brasso
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Prostate Cancer Center (CPC), Department of Urology, Rigshospitalet, Copenhagen, Denmark
| | - Lars Lönn
- Department of Radiology, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Martin Andreas Røder
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Prostate Cancer Center (CPC), Department of Urology, Rigshospitalet, Copenhagen, Denmark
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Johansson P, Jonéus P, Langenskiöld S. Study protocol for a comparative effectiveness evaluation of abiraterone acetate against enzalutamide: a longitudinal study based on Swedish administrative registers. BMJ Open 2021; 11:e052610. [PMID: 34697119 PMCID: PMC8547362 DOI: 10.1136/bmjopen-2021-052610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION This paper presents a study protocol for a comparative effectiveness evaluation of abiraterone acetate against enzalutamide in clinical practice, two cancer drugs given to patients suffering from advanced prostate cancer. METHOD AND ANALYSIS The protocol designs a comparative-effectiveness analysis of abiraterone acetate against enzalutamide. With the substantial number of covariates a two-step procedure is suggested in choosing relevant covariates in the matching design. In the first step, an exploratory factor analysis reduces the dimension of a large set of continuous covariates to nine factors. In the second step, we reduce the dimension of the covariates, interactions and second order terms for the continuous covariates using propensity score estimation. The final design makes use of a genetic matching algorithm. The study protocol provides a detailed statistical analysis plan of the analysis sample derived from the matching design. The analysis will make use of linear regression and robust inference adjusted for multisignificance testing. DISCUSSION As in a randomised experiment the focus is on the design of the assignment to treatment. This allows the publication of this preanalysis plan before having access to outcome data. This means that the p values will be correct if the maintained assumption of uncounfoundedness is valid. Given that is p-hacking is substantial problem in empirical research, this is a substantial strength of this study. However, while design yields, balance on the observed covariates one cannot discard the possibility that unobserved confounders are not balanced. For that reason, sensitivity tests for the maintained assumption of uncounfoundedness are presented. ETHICS AND DISSEMINATION The study was approved by the Regional Ethical Review Board in Uppsala, Sweden (Dnr 2017/482). Results will be published in a peer-reviewed journal and distributed to relevant stakeholders in healthcare.
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Affiliation(s)
- Per Johansson
- Statistics, Uppsala University, Uppsala, Sweden
- YMSC, Tsinghua University, Beijing, China
| | - Paulina Jonéus
- Department of Statistics, Uppsala University, Uppsala, Sweden
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Marsden T, Lomas DJ, McCartan N, Hadley J, Tuck S, Brown L, Haire A, Moss CL, Green S, Van Hemelrijck M, Coolen T, Santaolalla A, Isaac E, Brembilla G, Kopcke D, Giganti F, Sidhu H, Punwani S, Emberton M, Moore CM. ReIMAGINE Prostate Cancer Screening Study: protocol for a single-centre feasibility study inviting men for prostate cancer screening using MRI. BMJ Open 2021; 11:e048144. [PMID: 34593491 PMCID: PMC8487192 DOI: 10.1136/bmjopen-2020-048144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The primary objective of the ReIMAGINE Prostate Cancer Screening Study is to explore the uptake of an invitation to prostate cancer screening using MRI. METHODS AND ANALYSIS The ReIMAGINE Prostate Cancer Screening Study is a prospective single-centre feasibility study. Eligible men aged 50-75 years with no prior prostate cancer diagnosis or treatment will be identified through general practitioner practices and randomly selected for invitation. Those invited will be offered an MRI scan and a prostate-specific antigen (PSA) blood test. The screening MRI scan consists of T2-weighted, diffusion-weighted and research-specific sequences, without the use of intravenous contrast agents. Men who screen positive on either MRI or PSA density will be recommended to have standard of care (National Health Service) tests for prostate cancer assessment, which includes multiparametric MRI. The study will assess the acceptability of an MRI-based prostate screening assessment and the prevalence of cancer detected in MRI-screened men. Summary statistics will be used to explore baseline characteristics in relation to acceptance rates and prevalence of cancer. ETHICS AND DISSEMINATION ReIMAGINE Prostate Cancer Screening is a single-site screening study to assess the feasibility of MRI as a screening tool for prostate cancer. Ethical approval was granted by London-Stanmore Research Ethics Committee Heath Research Authority (reference 19/LO/1129). Study results will be published in peer-reviewed journals after completion of data analysis and used to inform the design of a multicentre screening study in the UK. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT04063566).
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Affiliation(s)
- Teresa Marsden
- Division of Surgical and Interventional Sciences, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Derek J Lomas
- Department of Urology, Mayo Clinic, Rochester, New York, USA
| | - Neil McCartan
- Division of Surgical and Interventional Sciences, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Joanna Hadley
- Division of Surgical and Interventional Sciences, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Steve Tuck
- ReIMAGINE Consortium Patient Representative, University College London, London, UK
| | - Louise Brown
- MRC Clinical Trials Unit, University College London, London, UK
| | - Anna Haire
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | | | - Saran Green
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | | | - Ton Coolen
- London Institute for Mathematical Sciences, London, UK
| | - Aida Santaolalla
- Cancer Epidemiology Group, Division of Cancer Studies, King's College London, London, UK
| | - Elizabeth Isaac
- Centre for Medical Imaging, University College London, London, UK
| | | | - Douglas Kopcke
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Francesco Giganti
- Division of Surgical and Interventional Sciences, University College London, London, UK
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Harbir Sidhu
- Centre for Medical Imaging, University College London, London, UK
| | - Shonit Punwani
- Centre for Medical Imaging, University College London, London, UK
| | - Mark Emberton
- Division of Surgical and Interventional Sciences, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Caroline M Moore
- Division of Surgical and Interventional Sciences, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
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Uemura H, Matsushima H, Yokomizo A, Kobayashi K, Arai G, Satoh T, Grillo V, Chen Y, Singh S, Ledesma DA. Unmet needs in non-metastatic castration-resistant prostate cancer from the Japanese patient perspective: a discrete choice experiment. BMJ Open 2021; 11:e052471. [PMID: 34400460 PMCID: PMC8370498 DOI: 10.1136/bmjopen-2021-052471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES With novel antiandrogen treatments of varying clinical benefits and risks becoming available, this study investigates how patients with castration-resistant prostate cancer (CRPC) value differences in treatment characteristics. DESIGN Cross-sectional observational study. SETTING A discrete choice experiment was conducted. Patients chose between two hypothetical non-metastatic CRPC (nmCRPC) treatments defined by six attributes: risk of fatigue, falls or fracture, cognitive impairment, hypertension, rashes as side effects to treatment and extension of time until cancer-related pain occurs. PARTICIPANTS A total of 137 adult male patients with CRPC with no prior experience with chemotherapy and with Eastern Cooperative Oncology Group status 0-1 were recruited. Patients were excluded if they participated in an investigational programme outside of routine clinical practice, had a clinically relevant medical or psychiatric condition, or diagnosis of visceral/other metastases not related to the prostate, or were otherwise deemed ineligible by the referring physician. PRIMARY OUTCOME MEASURES Relative preference weights and relative importance of the attributes was estimated by hierarchical Bayesian logistic regression. RESULTS Among the treatment attributes, 'risk of cognitive impairment as a side effect of treatment' was the most important attribute (relative importance (RI) (95% CI): 27.47% (24.80% to 30.14%)), followed by 'extension of time until cancer-related pain occurs' (RI (95% CI): 17.87% (15.49% to 20.25%)) and the 'risk of falls or fracture' (RI (95% CI): 15.99% (14.73% to 17.25%)). The 'risk of hypertension as a side effect of treatment' (RI (95% CI): 13.77% (12.73% to 14.81%)) had similar RI as 'risk of rashes as a side effect of treatment' (RI (95% CI): 13.17% (12.15% to 14.19%)), followed by the 'risk of fatigue as a side effect of treatment' (RI (95% CI): 11.74% (10.75% to 12.73%)). CONCLUSIONS Patients consider the risk of cognitive impairment as a side effect of treatment as the most important attribute in nmCRPC, followed by the extension of time until cancer-related pain occurs, and the risk of falls and fracture. These features should be considered in treatment decision making for nmCRPC in Japan.
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Affiliation(s)
- Hiroji Uemura
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | | | - Akira Yokomizo
- Department of Urology, Harasanshin Hospital, Fukuoka, Japan
| | - Kazuki Kobayashi
- Department of Urology, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Gaku Arai
- Department of Urology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
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Freedland SJ, De Giorgi U, Gleave M, Rosbrook B, Shen Q, Sugg J, Haas GP, Shore ND. A phase 3 randomised study of enzalutamide plus leuprolide and enzalutamide monotherapy in high-risk non-metastatic hormone-sensitive prostate cancer with rising PSA after local therapy: EMBARK study design. BMJ Open 2021; 11:e046588. [PMID: 34385241 PMCID: PMC8362713 DOI: 10.1136/bmjopen-2020-046588] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Limited data from controlled clinical trials are available for men who experience biochemical recurrence after definitive therapy for prostate cancer. In the absence of overt metastases, patients with non-metastatic castration-sensitive prostate cancer (nmCSPC) often receive androgen deprivation therapy (ADT). There is no standard-of-care consensus on optimal ADT timing, although most men are treated prior to metastases, especially those with high-risk features (Gleason score 8-10 or prostate-specific antigen doubling time (PSADT) <9-12 months). Given data that ADT plus novel hormonal agents improve survival in men with metastatic CSPC, there is a desire to evaluate these agents earlier in the disease course. The main objective of EMBARK is the comparative assessment of enzalutamide plus leuprolide (luteinising hormone-releasing hormone agonist (LHRHa)) or enzalutamide monotherapy versus monotherapy LHRHa to improve metastasis-free survival (MFS) in patients with high-risk nmCSPC PSA recurrence after definitive therapy. METHODS AND ANALYSIS EMBARK is a randomised, phase 3 study of high-risk patients with nmCSPC, a PSADT of ≤9 months and a screening PSA of ≥2 ng/mL above the nadir after radiotherapy (RT) or ≥1 ng/mL after radical prostatectomy (RP) with or without postoperative RT. Men (n=1050) are randomised 1:1:1 to enzalutamide 160 mg/day plus LHRHa or placebo plus LHRHa (double-blind arms) or enzalutamide monotherapy (open-label arm). Treatment is suspended at week 37 if PSA concentrations are <0.2 ng/mL and reinstated if levels rise to ≥2.0 ng/mL with RP or ≥5.0 ng/mL without RP. Patients with PSA ≥0.2 ng/mL at week 37 continue until treatment discontinuation criteria are met. The primary endpoint is MFS comparing enzalutamide plus LHRHa versus placebo plus LHRHa. ETHICS AND DISSEMINATION The study is conducted under the guiding principles of the World Medical Association Declaration of Helsinki. The results will be disseminated at research conferences and in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT02319837.
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Affiliation(s)
- Stephen J Freedland
- Division of Urology, Department of Surgery, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Section of Urology, Durham VA Medical Center, Durham, North Carolina, USA
| | - Ugo De Giorgi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Martin Gleave
- Department of Urologic Sciences, Vancouver Prostate Centre, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Brad Rosbrook
- Department of Global Biometrics and Data Management, Pfizer, New York, New York, USA
| | - Qi Shen
- Department of Product Development, Pfizer, New York, New York, USA
| | - Jennifer Sugg
- Department of Biostatistics, Astellas Pharma US, Northbrook, Illinois, USA
| | - Gabriel P Haas
- Astellas Pharma Global Development, Northbrook, Illinois, USA
| | - Neal D Shore
- Carolina Urologic Research Center, Myrtle Beach, South Carolina, USA
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Drevinskaite M, Patasius A, Kincius M, Urbonas V, Smailyte G. Retrospective cohort study of androgen deprivation therapy and the risk of diabetes in men with prostate cancer in Lithuania. BMJ Open 2021; 11:e045797. [PMID: 34321292 PMCID: PMC8319979 DOI: 10.1136/bmjopen-2020-045797] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To examine the risk of type 2 diabetes in patients with prostate cancer and its association with androgen deprivation therapy (ADT). DESIGN AND PARTICIPANTS We performed a retrospective cohort study of patients diagnosed with prostate cancer in the Lithuanian male population between 1 January 2003 and 31 December 2012 who were identified through the Lithuanian Cancer registry. All prostate cancer cases were linked to the National Health Insurance Fund database to obtain information regarding the diagnosis of diabetes mellitus and information on prescriptions of antiandrogens and gonadotropin-releasing hormone (GnRH) agonists. Patients with prostate cancer were followed up until the diagnosis of type 2 diabetes, or 31 December 2017, or date of death, whichever came first. Cox proportional hazard models were used to estimate the risk of type 2 diabetes in patients with prostate cancer with or without ADT exposure. RESULTS 27 580 men were diagnosed with prostate cancer, out of whom 14 502 (52.6%) did not receive ADT and 13 078 (47.4%) were treated with ADT. The incidence of type 2 diabetes for all patients with prostate cancer was 7.4/1000 person-years, for men on GnRH agonists 9.0/1000 person-years and 5.8/1000 person-years for men on antiandrogens. There was an increased risk of developing type 2 diabetes comparing ADT users and non-users (HR=1.49, 95% CI 1.34 to 1.66). CONCLUSION This study showed an increased risk of diabetes in patients with prostate cancer treated with ADT in comparison to ADT-free patient cohort. GnRH agonist users showed higher susceptibility, while the group on antiandrogen monotherapy showed no such increase.
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Affiliation(s)
- Mingaile Drevinskaite
- Laboratory of Cancer Epidemiology, Nacionalinis Vėžio Institutas, Vilnius, Lithuania
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Ausvydas Patasius
- Laboratory of Cancer Epidemiology, Nacionalinis Vėžio Institutas, Vilnius, Lithuania
- Faculty of Medicine, Institute of Health Sciences, Vilniaus Universitetas, Vilnius, Lithuania
| | - Marius Kincius
- Laboratory of Clinical Oncology, Nacionalinis Vėžio Institutas, Vilnius, Lithuania
| | - Vincas Urbonas
- Laboratory of Clinical Oncology, Nacionalinis Vėžio Institutas, Vilnius, Lithuania
| | - Giedre Smailyte
- Laboratory of Cancer Epidemiology, Nacionalinis Vėžio Institutas, Vilnius, Lithuania
- Faculty of Medicine, Institute of Health Sciences, Vilniaus Universitetas, Vilnius, Lithuania
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Morka N, Simpson BS, Ball R, Freeman A, Kirkham A, Kelly D, Whitaker HC, Emberton M, Norris JM. Clinical outcomes associated with prostate cancer conspicuity on biparametric and multiparametric MRI: a protocol for a systematic review and meta-analysis of biochemical recurrence following radical prostatectomy. BMJ Open 2021; 11:e047664. [PMID: 33952556 PMCID: PMC8103365 DOI: 10.1136/bmjopen-2020-047664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION There is an increasing body of evidence to suggest that visibility of prostate cancer on magnetic resonance (MRI) may be related to likelihood of adverse pathological outcomes. Biochemical recurrence (BCR) after radical prostatectomy remains a significant clinical challenge and a means of predicting likelihood of this prior to surgery could inform treatment choice. It appears that MRI could be a potential candidate strategy for BCR prediction, and as such, there is a need to review extant literature on the prognostic capability of MRI. Here, we describe a protocol for a systematic review and meta-analysis of the utility of biparametric MRI (bpMRI) and multiparametric MRI (mpMRI) in predicting BCR following radical prostatectomy for prostate cancer treatment. METHODS AND ANALYSIS PubMed, MEDLINE, Embase and Cochrane databases will be searched and screening will be guided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. In order to meet the inclusion criteria, papers must be English-language articles involving patients who have had bpMRI or mpMRI for suspected prostate cancer and have undergone radical prostatectomy as definitive therapy. Patients must have had prostate-specific antigen monitoring before and after surgery. All relevant papers published from July 1977 to October 2020 will be eligible for inclusion. The Newcastle-Ottawa score will be used to determine the quality and bias of the studies. This protocol is written in-line with the PRISMA protocol 2015 checklist. ETHICS AND DISSEMINATION There are no relevant ethical concerns. Dissemination of this protocol will be via peer-reviewed journals as well as national and international conferences. PROSPERO REGISTRATION NUMBER CRD42020206074.
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Affiliation(s)
- Naomi Morka
- University College London Medical School, London, UK
| | - Benjamin S Simpson
- UCL Division of Surgery & Interventional Science, University College London, London, UK
| | - Rhys Ball
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London, London, UK
| | - Alex Freeman
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London, London, UK
| | - Alex Kirkham
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Daniel Kelly
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Hayley C Whitaker
- UCL Division of Surgery & Interventional Science, University College London, London, UK
| | - Mark Emberton
- UCL Division of Surgery & Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospital, London, UK
| | - Joseph M Norris
- UCL Division of Surgery & Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospital, London, UK
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Müllhaupt G, Güsewell S, Schmid HP, Zumstein V, Betschart P, Engeler DS, Abt D. Aquablation versus holmium laser enucleation of the prostate in the treatment of benign prostatic hyperplasia in medium-to-large-sized prostates (ATHLETE): protocol of a prospective randomised trial. BMJ Open 2021; 11:e046973. [PMID: 33941632 PMCID: PMC8098986 DOI: 10.1136/bmjopen-2020-046973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION A novel method for the surgical treatment of benign prostatic hyperplasia (BPH) called Aquablation has become commercially available. Previous studies have been able to show similar functional results when compared with transurethral resection of the prostate and a high efficacy has been demonstrated when this approach is applied to patients with a prostate size of 80-150 cm3.Holmium laser enucleation of the prostate (HoLEP) is a well-established procedure in the surgical treatment of BPH in prostate glands larger than 30 mL and a first-line therapy in glands over 80 mL. To date, no data are available whether Aquablation is non-inferior compared with HoLEP in the treatment of patients with medium-to-large-sized prostates regarding safety and efficacy. METHODS AND ANALYSIS This is a prospective, randomised, open-label, non-inferiority clinical trial conducted at a Swiss centre of tertiary care. The primary outcome is assessment of non-inferiority of Aquablation compared with HoLEP in reducing lower urinary tract symptoms due to benign prostatic obstruction measured by the International Prostate Symptom Score (IPSS). Randomisation will be performed using secuTrial, stratifying on age (<70 years, 70+ years) and prostate volume (<100 mL, 100+ mL). Both interventions are performed in an inpatient setting and regular follow-up controls starting 8 weeks after intervention and continuing up to 5 years will be performed. The primary outcome (change in IPSS from baseline to 6 months) will be tested for non-inferiority with a one-sided t-test. Secondary outcomes, such as efficacy parameters, several patient-reported outcome measures, and periprocedural and safety parameters will be described by calculating means or relative frequencies for each treatment group and testing differences with two-sided standard superiority tests. ETHICS AND DISSEMINATION The study was approved by the local ethics committee (EKOS 2020-02353). Results of the primary endpoint and each of the secondary endpoints will be published in an international peer-reviewed journal. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT04560907).
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Affiliation(s)
- Gautier Müllhaupt
- Department of Urology, School of Medicine, University of St. Gallen, St Gallen, Switzerland
| | - Sabine Güsewell
- Clinical Trials Unit, School of Medicine, University of St. Gallen, St Gallen, Switzerland
| | - Hans-Peter Schmid
- Department of Urology, School of Medicine, University of St. Gallen, St Gallen, Switzerland
| | - Valentin Zumstein
- Department of Urology, School of Medicine, University of St. Gallen, St Gallen, Switzerland
| | - Patrick Betschart
- Department of Urology, School of Medicine, University of St. Gallen, St Gallen, Switzerland
| | - Daniel S Engeler
- Department of Urology, School of Medicine, University of St. Gallen, St Gallen, Switzerland
| | - Dominik Abt
- Department of Urology, School of Medicine, University of St. Gallen, St Gallen, Switzerland
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Pham Q, Hearn J, Bender JL, Berlin A, Brown I, Bryant-Lukosius D, Feifer AH, Finelli A, Gotto G, Hamilton R, Rendon R, Cafazzo JA. Virtual care for prostate cancer survivorship: protocol for an evaluation of a nurse-led algorithm-enhanced virtual clinic implemented at five cancer centres across Canada. BMJ Open 2021; 11:e045806. [PMID: 33883153 PMCID: PMC8061848 DOI: 10.1136/bmjopen-2020-045806] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Prostate cancer (PCa) is the most common cancer in Canadian men. Current models of survivorship care are no longer adequate to address the chronic and complex survivorship needs of patients today. Virtual care models for cancer survivorship have recently been associated with comparable clinical outcomes and lower costs to traditional follow-up care, with patients favouring off-site and on-demand visits. Building on their viability, our research group conceived the Ned Clinic-a virtual PCa survivorship model that provides patients with access to lab results, collects patient-reported outcomes, alerts clinicians to emerging issues, and promotes patient self-care. Despite the promise of the Ned Clinic, the model remains limited by its dependence on oncology specialists, lack of an autonomous triage algorithm, and has only been implemented among PCa survivors living in Ontario. METHODS AND ANALYSIS Our programme of research comprises two main research objectives: (1) to evaluate the process and cost of implementing and sustaining five nurse-led virtual PCa survivorship clinics in three provinces across Canada and identify barriers and facilitators to implementation success and (2) to assess the impact of these virtual clinics on implementation and effectiveness outcomes of enrolled PCa survivors. The design phase will involve developing an autonomous triage algorithm and redesigning the Ned Clinic towards a nurse-led service model. Site-specific implementation plans will be developed to deploy a localised nurse-led virtual clinic at each centre. Effectiveness will be evaluated using a historical control study comparing the survivorship outcomes of 300 PCa survivors enrolled in the Ned Clinic with 300 PCa survivors receiving traditional follow-up care. ETHICS AND DISSEMINATION Appropriate site-specific ethics approval will be secured prior to each research phase. Knowledge translation efforts will include diffusion, dissemination, and application approaches to ensure that knowledge is translated to both academic and lay audiences.
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Affiliation(s)
- Quynh Pham
- Centre for Global eHealth Innovation, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jason Hearn
- Centre for Global eHealth Innovation, University Health Network, Toronto, Ontario, Canada
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Jacqueline L Bender
- ELLICSR Cancer Rehabilitation and Survivorship Program, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Alejando Berlin
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Ian Brown
- Division of Urology, Niagara Health System, Saint Catharines, Ontario, Canada
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Denise Bryant-Lukosius
- Faculty of Health Sciences, School of Nursing and Department of Oncology, McMaster University, Hamilton, Ontario, Canada
- Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Andrew H Feifer
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Department of Surgery, Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | - Antonio Finelli
- Department of Surgery, Division of Urology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Geoffrey Gotto
- Department of Surgery, Division of Urology, University of Calgary, Calgary, Alberta, Canada
| | - Robert Hamilton
- Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Ricardo Rendon
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Joseph A Cafazzo
- Centre for Global eHealth Innovation, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Tang S, Jiang H, Cao Z, Zhou Q. Down-regulation of miR-219-5p increase the risk of cancer-related mortality in patients with prostate cancer. Postgrad Med J 2021; 98:577-583. [PMID: 33879548 DOI: 10.1136/postgradmedj-2021-139981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/09/2021] [Accepted: 03/25/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Prostate cancer is a common malignancy in men that is difficult to treat and carries a high risk of death. miR-219-5p is expressed in reduced amounts in many malignancies. However, the prognostic value of miR-219-5p for patients with prostate cancer remains unclear. METHODS We retrospectively analysed data from 213 prostate cancer patients from 10 June 2012 to 9 May 2015. Overall survival was assessed by Kaplan-Meier analysis and Cox regression models. Besides, a prediction model was constructed, and calibration curves evaluated the model's accuracy. RESULTS Of the 213 patients, a total of 72 (33.8%) died and the median survival time was 60.0 months. We found by multifactorial analysis that miR-219-5p deficiency increased the risk of death by nearly fourfold (HR: 3.86, 95% CI): 2.01 to 7.44, p<0.001) and the risk of progression by twofold (HR: 2.79, 95% CI: 1.68 to 4.64, p<0.001). To quantify each covariate's weight on prognosis, we screened variables by cox model to construct a predictive model. The Nomogram showed excellent accuracy in estimating death's risk, with a corrected C-index of 0.778. CONCLUSIONS miR-219-5p can be used as a biomarker to predict death risk in prostate cancer patients. The mortality risk prediction model constructed based on miR-219-5p has good consistency and validity in assessing patient prognosis.
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Affiliation(s)
- Shimin Tang
- Department of Oncology, Suining Central Hospital, Suining, China
| | - Hao Jiang
- Department of Urology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zhijun Cao
- Department of Urology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.,Department of Urology, The Ninth People's Hospital of Suzhou, Suzhou, China
| | - Qiang Zhou
- Department of Oncology, Suining Central Hospital, Suining, China
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Nair-Shalliker V, Smith DP, Gebski V, Patel MI, Frydenberg M, Yaxley JW, Gardiner R, Espinoza D, Kimlin MG, Fenech M, Gillatt D, Woo H, Armstrong BK, Rasiah K, Awad N, Symons J, Gurney H. High-dose vitamin D supplementation to prevent prostate cancer progression in localised cases with low-to-intermediate risk of progression on active surveillance (ProsD): protocol of a phase II randomised controlled trial. BMJ Open 2021; 11:e044055. [PMID: 33653757 PMCID: PMC7929872 DOI: 10.1136/bmjopen-2020-044055] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
INTRODUCTION Active surveillance (AS) for patients with prostate cancer (PC) with low risk of PC death is an alternative to radical treatment. A major drawback of AS is the uncertainty whether a patient truly has low risk PC based on biopsy alone. Multiparametric MRI scan together with biopsy, appears useful in separating patients who need curative therapy from those for whom AS may be safe. Two small clinical trials have shown short-term high-dose vitamin D supplementation may prevent PC progression. There is no substantial evidence for its long-term safety and efficacy, hence its use in the care of men with PC on AS needs assessment. This protocol describes the ProsD clinical trial which aims to determine if oral high-dose vitamin D supplementation taken monthly for 2 years can prevent PC progression in cases with low-to-intermediate risk of progression. METHOD AND ANALYSIS This is an Australian national multicentre, 2:1 double-blinded placebo-controlled phase II randomised controlled trial of monthly oral high-dose vitamin D supplementation (50 000 IU cholecalciferol), in men diagnosed with localised PC who have low-to-intermediate risk of disease progression and are being managed by AS. This trial will assess the feasibility, efficacy and safety of supplementing men with an initial oral loading dose of 500 000 IU cholecalciferol, followed by a monthly oral dose of 50 000 IU during the 24 months of AS. The primary trial outcome is the commencement of active therapy for clinical or non-clinical reason, within 2 years of AS. ETHICS AND DISSEMINATION This trial is approved by Bellberry Ethics Committee (2016-06-459). All results will be reported in peer-reviewed journals. TRIAL REGISTRATION NUMBER ACTRN12616001707459.
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Affiliation(s)
- Visalini Nair-Shalliker
- Cancer Research Division, Cancer Council New South Wales, Woolloomooloo, New South Wales, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - David P Smith
- Cancer Research Division, Cancer Council New South Wales, Woolloomooloo, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Val Gebski
- Clinical Trials Center, The University of Sydney, Sydney, New South Wales, Australia
| | - Manish I Patel
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Discipline of Surgery, The University of Sydney, Sydney, New South Wales, Australia
| | | | - John W Yaxley
- Centre for Clinical Research, The University of Queensland, Saint Lucia, Queensland, Australia
- Wesley Urology Clinic, Wesley Hospital, Brisbane, Queensland, Australia
| | - Robert Gardiner
- Centre for Clinical Research, The University of Queensland, Saint Lucia, Queensland, Australia
| | - David Espinoza
- Clinical Trials Center, The University of Sydney, Sydney, New South Wales, Australia
| | - Michael G Kimlin
- Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Michael Fenech
- Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - David Gillatt
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Henry Woo
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Sydney Adventist Hospital Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Bruce K Armstrong
- School of Public Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Krishan Rasiah
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Urology, North Shore Private Hospital, St Leonards, New South Wales, Australia
| | - Nader Awad
- Urology Centre, Port Macquarie, New South Wales, Australia
- Rural Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - James Symons
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Sydney Adventist Hospital Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Howard Gurney
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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Connor MJ, Shah TT, Smigielska K, Day E, Sukumar J, Fiorentino F, Sarwar N, Gonzalez M, Falconer A, Klimowska-Nassar N, Evans M, Naismith OF, Thippu Jayaprakash K, Price D, Gayadeen S, Basak D, Horan G, McGrath J, Sheehan D, Kumar M, Ibrahim A, Brock C, Pearson RA, Anyamene N, Heath C, Shergill I, Rai B, Hellawell G, McCracken S, Khoubehi B, Mangar S, Khoo V, Dudderidge T, Staffurth JN, Winkler M, Ahmed HU. Additional Treatments to the Local tumour for metastatic prostate cancer-Assessment of Novel Treatment Algorithms (IP2-ATLANTA): protocol for a multicentre, phase II randomised controlled trial. BMJ Open 2021; 11:e042953. [PMID: 33632752 PMCID: PMC7908915 DOI: 10.1136/bmjopen-2020-042953] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 01/08/2021] [Accepted: 01/28/2021] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Survival in men diagnosed with de novo synchronous metastatic prostate cancer has increased following the use of upfront systemic treatment, using chemotherapy and other novel androgen receptor targeted agents, in addition to standard androgen deprivation therapy (ADT). Local cytoreductive and metastasis-directed interventions are hypothesised to confer additional survival benefit. In this setting, IP2-ATLANTA will explore progression-free survival (PFS) outcomes with the addition of sequential multimodal local and metastasis-directed treatments compared with standard care alone. METHODS A phase II, prospective, multicentre, three-arm randomised controlled trial incorporating an embedded feasibility pilot. All men with new histologically diagnosed, hormone-sensitive, metastatic prostate cancer, within 4 months of commencing ADT and of performance status 0 to 2 are eligible. Patients will be randomised to Control (standard of care (SOC)) OR Intervention 1 (minimally invasive ablative therapy to prostate±pelvic lymph node dissection (PLND)) OR Intervention 2 (cytoreductive radical prostatectomy±PLND OR prostate radiotherapy±pelvic lymph node radiotherapy (PLNRT)). Metastatic burden will be prespecified using the Chemohormonal Therapy Versus Androgen Ablation Randomized Trial for Extensive Disease (CHAARTED) definition. Men with low burden disease in intervention arms are eligible for metastasis-directed therapy, in the form of stereotactic ablative body radiotherapy (SABR) or surgery. Standard systemic therapy will be administered in all arms with ADT±upfront systemic chemotherapy or androgen receptor agents. Patients will be followed-up for a minimum of 2 years. PRIMARY OUTCOME PFS. Secondary outcomes include predictive factors for PFS and overall survival; urinary, sexual and rectal side effects. Embedded feasibility sample size is 80, with 918 patients required in the main phase II component. Study recruitment commenced in April 2019, with planned follow-up completed by April 2024. ETHICS AND DISSEMINATION Approved by the Health Research Authority (HRA) Research Ethics Committee Wales-5 (19/WA0005). Study results will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03763253; ISCRTN58401737.
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Affiliation(s)
- Martin John Connor
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Taimur Tariq Shah
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Katarzyna Smigielska
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Imperial College Clinical Trials Unit, Imperial College London, London, UK
| | - Emily Day
- Imperial College Clinical Trials Unit, Imperial College London, London, UK
| | - Johanna Sukumar
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Imperial College Clinical Trials Unit, Imperial College London, London, UK
| | | | - Naveed Sarwar
- Department of Oncology, Imperial College Healthcare NHS Trust, London, UK
| | - Michael Gonzalez
- Department of Oncology, Imperial College Healthcare NHS Trust, London, UK
| | - Alison Falconer
- Department of Oncology, Imperial College Healthcare NHS Trust, London, UK
| | - Natalia Klimowska-Nassar
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Imperial College Clinical Trials Unit, Imperial College London, London, UK
| | - Martin Evans
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Olivia Frances Naismith
- Radiotherapy Trials Quality Assurance (RTTQA), Royal Marsden NHS Foundation Trust, London, UK
| | | | - Derek Price
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Shiva Gayadeen
- Department of Oncology, Imperial College Healthcare NHS Trust, London, UK
| | - Dolan Basak
- Department of Oncology, Imperial College Healthcare NHS Trust, London, UK
| | - Gail Horan
- Department of Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, UK
| | - John McGrath
- Department of Urology, Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, UK
| | - Denise Sheehan
- Department of Oncology, Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, UK
| | - Manal Kumar
- Department of Urology, Arrowe Park Hospital, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | - Azman Ibrahim
- Department of Clinical Oncology, Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral, UK
| | - Cathryn Brock
- Department of Oncology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Rachel A Pearson
- Department of Oncology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Nicola Anyamene
- Department of Oncology, London North West University Healthcare NHS Trust, Harrow, London, UK
| | - Catherine Heath
- Department of Radiotherapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Iqbal Shergill
- Department of Urology, Wrexham Maelor Hospital, Wrexham, UK
| | - Bhavan Rai
- Department of Urology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Giles Hellawell
- Department of Urology, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, London, UK
| | - Stuart McCracken
- Department of Urology, Sunderland Royal Hospital, Sunderland, UK
| | - Bijan Khoubehi
- Department of Urology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Stephen Mangar
- Department of Oncology, Imperial College Healthcare NHS Trust, London, UK
| | - Vincent Khoo
- Department of Oncology, The Royal Marsden NHS Foundation and Institute of Cancer Research, London, UK
| | - Tim Dudderidge
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - John Nicholas Staffurth
- Research, Velindre Cancer Centre, Cardiff, UK
- Division of Cancer and Genetics, Cardiff University School of Medicine, Cardiff, UK
| | - Mathias Winkler
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Hashim Uddin Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
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Andreis F, Bryant R, Giorgi E, Williamson AE, Ward A. Prescribing patterns for medical treatment of suspected prostatic obstruction: a longitudinal register-based study of the Scottish Health and Social Care Open Data. BMJ Open 2021; 11:e042606. [PMID: 33589459 PMCID: PMC7887341 DOI: 10.1136/bmjopen-2020-042606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The diagnosis of lower urinary tract symptoms related to suspected bladder outflow obstruction from benign prostate hyperplasia/enlargement in men is increasing. This is leading to high demand on healthcare services; however, there is limited knowledge of differences in pharmacotherapy prescribing for this condition based on geography. OBJECTIVE To investigate potential variation in drug prescribing for suspected bladder outflow obstruction in Scotland, based on analysis of publicly available data, to identify trends and inform future prescribing. STUDY DESIGN A longitudinal register-based data study of prescribing and patient data publicly available from Scottish registries. All information is available as monthly aggregates at the level of single general practices. SETTING AND PARTICIPANTS 903 (97%) general practices in Scotland, over a 50-month period (October 2015 to November 2019). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We analysed numbers of daily doses of drugs for suspected bladder outflow obstruction prescribed per month using a Bayesian Poisson regression analysis, incorporating random effects to account for spatial and temporal elements. RESULTS Prescriptions for suspected bladder outflow obstruction medications increased during the observation period (overall average rate of change 1.24±0.28, ranging from 0.893 in Orkney to 1.95 in Lanarkshire). While some determinants of health inequality regarding prescribing practices across health boards are consistent with those known from the literature, other inequalities remain unexplained after accounting for practice-specific and patient-specific characteristics such as deprivation and rurality. CONCLUSIONS Inequalities in prescribing for suspected bladder outflow obstruction medications exist in Scotland, partially ascribable to accepted sociodemographic and geographic factors.
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Affiliation(s)
| | - Richard Bryant
- Department of Surgical Sciences, University of Oxford Nuffield, Oxford, UK
- Urology, Churchill Hospital, Oxford, UK
| | - Emanuele Giorgi
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Andrea E Williamson
- GPPC, School of Medicine, Dentistry and Nursing, MVLS, University of Glasgow, Glasgow, UK
| | - Ashleigh Ward
- School of Health Sciences, University of Dundee, Dundee, UK
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Merriel SWD, Ingle SM, May MT, Martin RM. Retrospective cohort study evaluating clinical, biochemical and pharmacological prognostic factors for prostate cancer progression using primary care data. BMJ Open 2021; 11:e044420. [PMID: 33579772 PMCID: PMC7883851 DOI: 10.1136/bmjopen-2020-044420] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES To confirm the association of previously reported prognostic factors with future progression of localised prostate cancer using primary care data and identify new potential prognostic factors for further assessment in prognostic model development and validation. DESIGN Retrospective cohort study, employing Cox proportional hazards regression controlling for age, prostate specific antigen (PSA), and Gleason score, was stratified by diagnostic stage. SETTING Primary care in England. PARTICIPANTS Males with localised prostate cancer diagnosedbetween 01/01/1987 and 31/12/2016 within the Clinical Practice ResearchDatalink database, with linked data from the National Cancer Registration andAnalysis Service and Office for National Statistics. PRIMARY AND SECONDARY OUTCOMES Primary outcome measure was prostate cancer mortality. Secondary outcome measures were all-cause mortality and commencing systemic therapy. Up-staging after diagnosis was not used as a secondary outcome owing to significant missing data. RESULTS 10 901 men (mean age 74.38±9.03 years) with localised prostate cancer were followed up for a mean of 14.12 (±6.36) years. 2331 (21.38%) men underwent systemic therapy and 3450 (31.65%) died, including 1250 (11.47%) from prostate cancer. Factors associated with an increased risk of prostate cancer mortality included age; high PSA; current or ex-smoker; ischaemic heart disease; high C reactive protein; high ferritin; low haemoglobin; high blood glucose and low albumin. CONCLUSIONS This study identified several new potential prognostic factors for prostate cancer progression, as well as confirming some known prognostic factors, in an independent primary care data set. Further research is needed to develop and validate a prognostic model for prostate cancer progression.
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Affiliation(s)
| | - Suzanne Marie Ingle
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Margaret T May
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Richard M Martin
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
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Beyer K, Moris L, Lardas M, Haire A, Barletta F, Scuderi S, Vradi E, Gandaglia G, Omar MI, MacLennan S, Zong J, Farahmand B, Maclennan SJ, Devecseri Z, Asiimwe A, Collette L, Bjartell A, Ndow J, Briganti A, Van Hemelrijck M. Diagnostic and prognostic factors in patients with prostate cancer: a systematic review protocol. BMJ Open 2021; 11:e040531. [PMID: 33574142 PMCID: PMC7880102 DOI: 10.1136/bmjopen-2020-040531] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION As part of the PIONEER (Prostate Cancer Diagnosis and Treatment Enhancement Through the Power of Big Data in Europe) Consortium, we will explore which diagnostic and prognostic factors (DPFs) are currently being researched to previously defined clinical and patient-reported outcomes for prostate cancer (PCa). METHODS AND ANALYSIS This research project will follow the following four steps: (1) a broad systematic literature review of DPFs for all stages of PCa, covering evidence from 2014 onwards; (2) discussion of systematic review findings by a multidisciplinary expert panel; (3) risk of bias assessment and applicability with Prediction model Risk Of Bias Assessment Tool criteria, Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) and the Quality In Prognosis Studies tool (QUIPS) and (4) additional quantitative assessments if required. ETHICS AND DISSEMINATION We aim to develop an online tool to present the DPFs identified in this research and make them available across all stakeholders. There are no ethical implications.
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Affiliation(s)
- Katharina Beyer
- Translational Oncology and Urology Research (TOUR), King's College London, London, UK
| | - Lisa Moris
- Department of Urology, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Michael Lardas
- Department of Urology, Metropolitan Hospital Athens, Athens, Attike, Greece
| | - Anna Haire
- Translational Oncology and Urology Research (TOUR), King's College London, London, UK
| | - Francesco Barletta
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milano, Lombardia, Italy
| | - Simone Scuderi
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milano, Lombardia, Italy
| | - Eleni Vradi
- Medical Affairs and PV, Bayer Pharma AG, Berlin, Germany
| | - Giorgio Gandaglia
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milano, Lombardia, Italy
| | - Muhammad Imran Omar
- Academic Urology Unit, Health Services Research Unit, University of Aberdeen, Aberdeen, Aberdeen, UK
| | - Steven MacLennan
- Academic Urology Unit, Health Services Research Unit, University of Aberdeen, Aberdeen, Aberdeen, UK
| | - Jihong Zong
- Epidemiology, Bayer U.S, Whippany, New Jersey, USA
| | | | - Sara J Maclennan
- Academic Urology Unit, Health Services Research Unit, University of Aberdeen, Aberdeen, Aberdeen, UK
| | | | - Alex Asiimwe
- Medical Affairs and PV, Bayer Pharma AG, Berlin, Germany
| | | | | | - James Ndow
- Guidelines Office, European Association of Urology, Arnhem, Netherlands
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milano, Lombardia, Italy
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, Vita-Salute University San Raffaele, RCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research (TOUR), King's College London, London, UK
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He B, Li R, Li D, Huang L, Wen X, Yang G, Wang H. Study protocol for a single-centre non-inferior randomised controlled trial on a novel three-dimensional matrix positioning-based cognitive fusion-targeted biopsy and software-based fusion-targeted biopsy for the detection rate of clinically significant prostate cancer in men without a prior biopsy. BMJ Open 2021; 11:e041427. [PMID: 33550242 PMCID: PMC7925935 DOI: 10.1136/bmjopen-2020-041427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
INTRODUCTION The classical pathway for diagnosing prostate cancer is systematic 12-core biopsy under the guidance of transrectal ultrasound, which tends to underdiagnose the clinically significant tumour and overdiagnose the insignificant disease. Another pathway named targeted biopsy is using multiparametric MRI to localise the tumour precisely and then obtain the samples from the suspicious lesions. Targeted biopsy, which is mainly divided into cognitive fusion method and software-based fusion method, is getting prevalent for its good performance in detecting significant cancer. However, the preferred targeted biopsy technique in detecting clinically significant prostate cancer between cognitive fusion and software-based fusion is still beyond consensus. METHODS AND ANALYSIS This trial is a prospective, single-centre, randomised controlled and non-inferiority study in which all men suspicious to have clinically significant prostate cancer are included. This study aims to determine whether a novel three-dimensional matrix positioning cognitive fusion-targeted biopsy is non-inferior to software-based fusion-targeted biopsy in the detection rate of clinically significant cancer in men without a prior biopsy. The main inclusion criteria are men with elevated serum prostate-specific antigen above 4-20 ng/mL or with an abnormal digital rectal examination and have never had a biopsy before. A sample size of 602 participants allowing for a 10% loss will be recruited. All patients will undergo a multiparametric MRI examination, and those who fail to be found with a suspicious lesion, with the anticipation of half of the total number, will be dropped. The remaining participants will be randomly allocated to cognitive fusion-targeted biopsy (n=137) and software-based fusion-targeted biopsy (n=137). The primary outcome is the detection rate of clinically significant prostate cancer for cognitive fusion-targeted biopsy and software-based fusion-targeted biopsy in men without a prior biopsy. The clinically significant prostate cancer will be defined as the International Society of Urological Pathology grade group 2 or higher. ETHICS AND DISSEMINATION Ethical approval was obtained from the ethics committee of Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China. The results of the study will be disseminated and published in international peer-reviewed journals. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT04271527).
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Affiliation(s)
- Biming He
- Department of Urology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Rongbing Li
- Department of Urology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Dongyang Li
- Department of Urology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Liqun Huang
- Department of Urology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaofei Wen
- Department of Urology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guosheng Yang
- Department of Urology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Haifeng Wang
- Department of Urology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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Keerty D, Eaton KC, Trejo K, Strosberg C, Haynes EJ. Malignant epistaxis: a case wandering prostate cancer metastasis. Postgrad Med J 2021; 98:e45-e46. [PMID: 37066551 DOI: 10.1136/postgradmedj-2020-138794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 12/19/2020] [Accepted: 12/28/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Dinesh Keerty
- Internal Medicine, Moffitt Cancer Center, Tampa, Florida, USA
| | - Kevin C Eaton
- Internal Medicine, Moffitt Cancer Center, Tampa, Florida, USA
| | - Karina Trejo
- Internal Medicine, Moffitt Cancer Center, Tampa, Florida, USA
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Abstract
OBJECTIVES To conduct a systematic review with meta-analysis of cohort studies to evaluate the association of coffee consumption with the risk of prostate cancer. DATA SOURCES PubMed, Web of Science and Embase were searched for eligible studies up to September 2020. STUDY SELECTION Cohort studies were included. DATA EXTRACTION AND SYNTHESIS Two researchers independently reviewed the studies and extracted the data. Data synthesis was performed via systematic review and meta-analysis of eligible cohort studies. Meta-analysis was performed with the "metan" and "glst" commands in Stata 14.0. MAIN OUTCOMES AND MEASURES Prostate cancer was the main outcome. It was classified as localised prostate cancer which included localised or non-aggressive cancers; advanced prostate cancer which included advanced or aggressive cancers; or fatal prostate cancer which included fatal/lethal cancers or prostate cancer-specific deaths. RESULTS Sixteen prospective cohort studies were finally included, with 57 732 cases of prostate cancer and 1 081 586 total cohort members. Higher coffee consumption was significantly associated with a lower risk of prostate cancer. Compared with the lowest category of coffee consumption, the pooled relative risk (RR) was 0.91 (95% CI 0.84 to 0.98), I2= 53.2%) for the highest category of coffee consumption. There was a significant linear trend for the association (p=0.006 for linear trend), with a pooled RR of 0.988 (95% CI 0.981 to 0.995) for each increment of one cup of coffee per day. For localised, advanced and fatal prostate cancer, the pooled RRs were 0.93 (95% CI 0.87 to 0.99), 0.88 (95% CI 0.71 to 1.09) and 0.84 (95% CI 0.66 to 1.08), respectively. No evidence of publication bias was indicated in this meta-analysis. CONCLUSIONS This study suggests that a higher intake of coffee may be associated with a lower risk of prostate cancer.
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Affiliation(s)
- Xiaonan Chen
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yiqiao Zhao
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Zijia Tao
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Kefeng Wang
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
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Kawa SM, Benzon Larsen S, Helgstrand JT, Iversen P, Brasso K, Røder MA. What is the risk of prostate cancer mortality following negative systematic TRUS-guided biopsies? A systematic review. BMJ Open 2020; 10:e040965. [PMID: 33371032 PMCID: PMC7751212 DOI: 10.1136/bmjopen-2020-040965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To investigate the risk of prostate cancer-specific mortality (PCSM) following initial negative systematic transrectal ultrasound-guided (TRUS) prostate biopsies. DESIGN Systematic review. DATA SOURCES PubMed and Embase were searched using a string combination with keywords/Medical Subject Headings terms and free text in the search builder. Date of search was 13 April 2020. STUDY SELECTION Studies addressing PCSM following initial negative TRUS biopsies. Randomised controlled trials and population-based studies including men with initial negative TRUS biopsies reported in English from 1990 until present were included. DATA EXTRACTION Data extraction was done using a predefined form by two authors independently and compared with confirm data; risk of bias was assessed using the Newcastle-Ottawa Scale for cohort studies when applicable. RESULTS Four eligible studies were identified. Outcomes were reported differently in the studies as both cumulative incidence and Kaplan-Meier estimates have been used. Regardless of the study differences, all studies reported low estimated incidence of PCSM of 1.8%-5.2% in men with negative TRUS biopsies during the following 10-20 years. Main limitation in all studies was limited follow-up. CONCLUSION Only a few studies have investigated the risk of PCSM following initial negative biopsies and all studies included patients before the era of MRI of the prostate. However, the studies point to the fact that the risk of PCSM is low following initial negative TRUS biopsies, and that the level of prostate-specific antigen before biopsies holds prognostic information. This may be considered when advising patients about the need for further diagnostic evaluation. PROSPERO REGISTRATION NUMBER CRD42019134548.
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Affiliation(s)
- Sandra Miriam Kawa
- Copenhagen Prostate Cancer Center, Urological Department, Rigshospitalet, Copenhagen, Denmark
| | - Signe Benzon Larsen
- Copenhagen Prostate Cancer Center, Urological Department, Rigshospitalet, Copenhagen, Denmark
| | - John Thomas Helgstrand
- Copenhagen Prostate Cancer Center, Urological Department, Rigshospitalet, Copenhagen, Denmark
| | - Peter Iversen
- Copenhagen Prostate Cancer Center, Urological Department, Rigshospitalet, Copenhagen, Denmark
| | - Klaus Brasso
- Copenhagen Prostate Cancer Center, Urological Department, Rigshospitalet, Copenhagen, Denmark
| | - Martin Andreas Røder
- Copenhagen Prostate Cancer Center, Urological Department, Rigshospitalet, Copenhagen, Denmark
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Fiard G, Kelly D, Yap T, Emberton M. Detailing sexual outcomes after treatment of localised prostate cancer with focal therapy using various energy sources: protocol for a mixed-methods study. BMJ Open 2020; 10:e045500. [PMID: 33323452 PMCID: PMC7745515 DOI: 10.1136/bmjopen-2020-045500] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Focal therapy has emerged as a promising treatment option for men with localised prostate cancer. However, most of the evaluation of postoperative function has taken place at a relatively high, non-granular level. Most of the data we use to provide informed consent for our patients is obtained from retrospective series, or derived from prospective studies whose primary outcome was oncological. Finally, most studies have focused on erectile function and overlooked other, presumably important, elements of male sexual function. The present study aims at studying in-depth the sexual consequences of focal therapy with various energy sources. METHODS AND ANALYSIS This will be a mixed-methods research study based on a retrospective and prospective cohort, recruited in parallel. The retrospective cohort will consist of patients treated with focal irreversible electroporation, and the prospective cohort of patients treated with three focal therapy energies. Participants will be recruited from two UK urology centres, one National Health Service and one private. On consent, patients will fill in self-administered validated questionnaires (International Index of Erectile Function-15 (IIEF-15), Male Sexual Health Questionnaire-Ejaculatory Dysfunction-Short Form (MSHQ-EjD-SF)) and semistructured interviews will be organised to collect patients' expectations and postoperative changes in domains such as erection, ejaculation, orgasm, libido/sexual desire, masculinity/virility, penile morphology, pain or discomfort, regret, shame, cancer-related stress, overall impact and partner satisfaction. An exploratory thematic analysis will be performed to detail recurring themes that will be grouped into clusters of experiences. We will then be able to find clusters of agreement and disagreement that will be illustrated using exemplar patient quotations. ETHICS AND DISSEMINATION Ethical approval was obtained (Regional Ethics Committee reference 20/NW/0335), as well as Health Research Authority approval. Results will be published in open-access peer-reviewed journals. Findings will also be translated into patient information resources (leaflets, online information sheets). TRIAL REGISTRATION NUMBER ISRCTN11634296; Pre-results.
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Affiliation(s)
- Gaelle Fiard
- UCL Division of Surgery & Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
- Department of Urology, Grenoble Alpes University Hospital, Grenoble, France
- Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France
| | - Daniel Kelly
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Tet Yap
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mark Emberton
- UCL Division of Surgery & Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
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Protopapa E, van der Meulen J, Moore CM, Smith SC. Assessment of a patient-reported outcome measure in men with prostate cancer who had radical surgery: a Rasch analysis. BMJ Open 2020; 10:e035436. [PMID: 33191249 PMCID: PMC7668365 DOI: 10.1136/bmjopen-2019-035436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To evaluate the psychometric properties (and identify specific anomalies to be resolved) of urinary and sexual function scales of the Symptom Tracking and Reporting (STAR) instrument for use in clinical practice with individual men using Rasch analysis. DESIGN Prospective cohort study. SETTING 9 UK surgery centres in secondary care. PARTICIPANTS 403 men diagnosed with prostate cancer and completed at least one questionnaire immediately before and at 1 or 3 months after radical prostatectomy. PRIMARY AND SECONDARY OUTCOMES STAR instrument before surgery and 1 and 3 months afterwards. RESULTS Neither scale fitted the Rasch model (both scales p<0.001). Both urinary (seven items) and sexual function (six items) had disordered thresholds, suggesting response categories are not working as intended. Both scales (three urinary items; five sexual function items) showed problems with item fit (large fit residuals, significant χ2, an inspection of item characteristic curves). Both scales showed items that were unstable over time (differential item functioning (DIF) by time). Both scales (four pairs of items in each scale) showed local response dependency (residual correlations >0.2 above the average). Internal consistency was acceptable at the group level for both scales. Targeting was poor for both scales, indicating an inadequate match between the location of items and the distribution of the patients, suggesting that the underlying constructs that the scales purport to measure are not clear. CONCLUSION Using Rasch analysis as a diagnostic tool, we identified that both the urinary and the sexual function scales have issues that need to be resolved before STAR can be used with confidence in clinical practice. The sexual function scale, in particular, is unlikely to provide precise estimates for the outcomes experienced by men after radical prostatectomy. These results demonstrate the need to evaluate the suitability of any patient-reported outcome measure before implementation in routine clinical practice, preferably using modern psychometric methods.
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Affiliation(s)
- Eva Protopapa
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Jan van der Meulen
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Caroline M Moore
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Sarah C Smith
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
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Norris JM, Carmona Echeverria LM, Simpson BS, Ball R, Freeman A, Kelly D, Kirkham A, Whitaker HC, Emberton M. Histopathological features of prostate cancer conspicuity on multiparametric MRI: protocol for a systematic review and meta-analysis. BMJ Open 2020; 10:e039735. [PMID: 33093035 PMCID: PMC7583062 DOI: 10.1136/bmjopen-2020-039735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Multiparametric MRI (mpMRI) has improved risk stratification for men with suspected prostate cancer. Indeed, mpMRI-visible tumours tend to be larger and of higher pathological grade than mpMRI-invisible tumours; however, concern remains around significant cancer that is undetected by mpMRI. There has been considerable recent interest to investigate whether tumour conspicuity on mpMRI is associated with additional histopathological features (including cellular density, microvessel density and unusual prostate cancer subtypes), which may have important clinical implications in both diagnosis and prognosis. Furthermore, analysis of these features may help reveal the radiobiology that underpins the actual mechanisms of mpMRI visibility (and invisibility) of prostate tumours. Here, we describe a protocol for a systematic review of the histopathological basis of prostate cancer conspicuity on mpMRI. METHODS AND ANALYSIS A systematic search of the MEDLINE, PubMed, Embase and Cochrane databases will be conducted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines will be used to guide screening, thematic reporting and conclusions drawn from all eligible studies. Included papers will be full-text, English-language articles, comparing the histopathological characteristics of mpMRI-visible lesions and mpMRI-invisible tumours. All studies published between January 1950 and January 2020 will be eligible for inclusion. Studies using confirmatory immunohistochemistry for the identification of immune subsets or structural components will be included. Study bias and quality will be assessed using a modified Newcastle-Ottawa scale. To ensure methodological rigour, this protocol is written in accordance with the PRISMA Protocol 2015 checklist. If appropriate, a meta-analysis will be conducted comparing histopathological feature frequency between mpMRI-visible and mpMRI-invisible disease. ETHICS AND DISSEMINATION No ethical approval will be required as this is an academic review of published literature. Findings will be disseminated through publications in peer-reviewed journals and presentations at national and international conferences. PROSPERO REGISTRATION NUMBER CRD42020176049.
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Affiliation(s)
- Joseph M Norris
- UCL Division of Surgery and Interventional Science, University College London, London, UK
| | | | - Benjamin S Simpson
- UCL Division of Surgery and Interventional Science, University College London, London, UK
| | - Rhys Ball
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Alex Freeman
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Daniel Kelly
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, South Glamorgan, UK
| | - Alex Kirkham
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Hayley C Whitaker
- UCL Division of Surgery and Interventional Science, University College London, London, UK
| | - Mark Emberton
- UCL Division of Surgery and Interventional Science, University College London, London, UK
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Wade J, Donovan J, Lane A, Davis M, Walsh E, Neal D, Turner E, Martin R, Metcalfe C, Peters T, Hamdy F, Kockelbergh R, Catto J, Paul A, Holding P, Rosario D, Kynaston H, Rowe E, Hughes O, Bollina P, Gillatt D, Doherty A, Gnanapragasam VJ, Paez E. Strategies adopted by men to deal with uncertainty and anxiety when following an active surveillance/monitoring protocol for localised prostate cancer and implications for care: a longitudinal qualitative study embedded within the ProtecT trial. BMJ Open 2020; 10:e036024. [PMID: 32907896 PMCID: PMC7482454 DOI: 10.1136/bmjopen-2019-036024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 04/20/2020] [Accepted: 07/14/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Active surveillance (AS) enables men with low risk, localised prostate cancer (PCa) to avoid radical treatment unless progression occurs; lack of reliable AS protocols to determine progression leaves uncertainties for men and clinicians. This study investigated men's strategies for coping with the uncertainties of active monitoring (AM, a surveillance strategy within the Prostate testing for cancer and Treatment, ProtecT trial) over the longer term and implications for optimising supportive care. DESIGN Longitudinal serial in-depth qualitative interviews every 2-3 years for a median 7 (range 6-14) years following diagnosis. SETTING Four centres within the UK Protect trial. PARTICIPANTS Purposive sample of 20 men with localised PCa: median age at diagnosis 64 years (range 52-68); 15 (75%) had low-risk PCa; 12 randomly allocated to, 8 choosing AM. Eleven men continued with AM throughout the study period (median 7 years). Nine received radical treatment after a median 4 years (range 0.8-13.8 years). INTERVENTION AM: 3-monthly serum prostate-specific antigen (PSA)-level assessment (year 1), 6-12 monthly thereafter; increase in PSA ≥50% during previous 12 months or patient/clinician concern triggered review. MAIN OUTCOMES Thematic analysis of 73 interviews identified strategies to accommodate uncertainty and anxiety of living with untreated cancer; implications for patient care. RESULTS Men sought clarity, control or reassurance, with contextual factors mediating individual responses. Trust in the clinical team was critical for men in balancing anxiety and facilitating successful management change/continued monitoring. Only men from ProtecT were included; men outside ProtecT may have different experiences. CONCLUSION Men looked to clinicians for clarity, control and reassurance. Where provided, men felt comfortable continuing AM or having radical treatments when indicated. Clinicians build patient trust by clearly describing uncertainties, allowing patients control wherever possible and being aware of how context influences individual responses. Insights indicate need for supportive services to build trust and patient engagement over the long term. TRIAL REGISTRATION NUMBER ISRCTN20141297; Pre-results.
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Affiliation(s)
- Julia Wade
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jenny Donovan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Athene Lane
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Michael Davis
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Eleanor Walsh
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - David Neal
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Emma Turner
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Richard Martin
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Chris Metcalfe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tim Peters
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Freddie Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Roger Kockelbergh
- Department of Urology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - James Catto
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - Alan Paul
- Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Peter Holding
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Derek Rosario
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | | | - Edward Rowe
- Department of Urology, North Bristol NHS Trust, Bristol, UK
| | - Owen Hughes
- Department of Urology, Cardiff and Vale University Health Board, Cardiff, UK
| | | | - David Gillatt
- Faculty of Medicine, Health and Human Science, Macquarie University, Sydney, New South Wales, Australia
| | - Alan Doherty
- Department of Urology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Vincent J Gnanapragasam
- Department of Surgery, University of Cambridge, Cambridge, UK
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Edgar Paez
- Department of Urology, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, UK
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Abstract
OBJECTIVE To identify risk prediction models for prostate cancer (PCa) that can be used in the primary care and community health settings. DESIGN Systematic review. DATA SOURCES MEDLINE and Embase databases combined from inception and up to the end of January 2019. ELIGIBILITY Studies were included based on satisfying all the following criteria: (i) presenting an evaluation of PCa risk at initial biopsy in patients with no history of PCa, (ii) studies not incorporating an invasive clinical assessment or expensive biomarker/genetic tests, (iii) inclusion of at least two variables with prostate-specific antigen (PSA) being one of them, and (iv) studies reporting a measure of predictive performance. The quality of the studies and risk of bias was assessed by using the Prediction model Risk Of Bias ASsessment Tool (PROBAST). DATA EXTRACTION AND SYNTHESIS Relevant information extracted for each model included: the year of publication, source of data, type of model, number of patients, country, age, PSA range, mean/median PSA, other variables included in the model, number of biopsy cores to assess outcomes, study endpoint(s), cancer detection, model validation and model performance. RESULTS An initial search yielded 109 potential studies, of which five met the set criteria. Four studies were cohort-based and one was a case-control study. PCa detection rate was between 20.6% and 55.8%. Area under the curve (AUC) was reported in four studies and ranged from 0.65 to 0.75. All models showed significant improvement in predicting PCa compared with being based on PSA alone. The difference in AUC between extended models and PSA alone was between 0.06 and 0.21. CONCLUSION Only a few PCa risk prediction models have the potential to be readily used in the primary healthcare or community health setting. Further studies are needed to investigate other potential variables that could be integrated into models to improve their clinical utility for PCa testing in a community setting.
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Affiliation(s)
- Mohammad Aladwani
- Division of Population Health, Health Services Research and Primary Care School of Health Sciences Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Artitaya Lophatananon
- Division of Population Health, Health Services Research and Primary Care School of Health Sciences Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - William Ollier
- Division of Population Health, Health Services Research and Primary Care School of Health Sciences Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- School of Healthcare Science, Manchester Metropolitan University Faculty of Science and Engineering, Manchester, UK
| | - Kenneth Muir
- Division of Population Health, Health Services Research and Primary Care School of Health Sciences Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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