International variation in prostate cancer incidence and mortality rates

Context

Wide variation exists internationally for prostate cancer (PCa) rates due to differences in detection practices, treatment, and lifestyle and genetic factors.

Objective

We present contemporary variations in PCa incidence and mortality patterns across five continents using the most recent data from the International Agency for Research on Cancer.

Evidence acquisition

PCa incidence and mortality estimates for 2008 from GLOBOCAN are presented. We also examine recent trends in PCa incidence rates for 40 countries and mortality rates for 53 countries from 1985 and onward via join-point analyses using an augmented version of Cancer Incidence in Five Continents and the World Health Organization mortality database.

Evidence synthesis

Estimated PCa incidence rates remain most elevated in the highest resource counties worldwide including North America, Oceania, and western and northern Europe. Mortality rates tend to be higher in less developed regions of the world including parts of South America, the Caribbean, and sub-Saharan Africa. Increasing PCa incidence rates during the most recent decade were observed in 32 of the 40 countries examined, whereas trends tended to stabilize in 8 countries. In contrast, PCa mortality rates decreased in 27 of the 53 countries under study, whereas rates increased in 16 and remained stable in 10 countries.

Conclusions

PCa incidence rates increased in nearly all countries considered in this analysis except in a few high-income countries. In contrast, the increase in PCa mortality rates mainly occurred in lower resource settings, with declines largely confined to high-resource countries.     

细胞增殖核抗原在前列腺上皮内瘤中的表达

目的:研究细胞增殖核抗原(PCNA)在前列腺上皮内瘤(PIN)组织中的表达,探讨细胞增殖在前列腺肿瘤形成过程中的作用.方法:采用免疫组织化学方法检测12例PIN和12例良性前列腺增生(BPH)组织中PCNA的表达.结果:PIN组织中PCNA阳性细胞主要分布于腺上皮的基底细胞层与分泌细胞层,在BPH组织中主要见于腺上皮基底细胞层.PIN和BPH组织中细胞增殖指数分别为(15.92±4.40)%和(8.33±2.93)%,两组间比较差异有统计学意义(P＜0.01).结论:PIN组织中细胞增殖活性显著高于BPH,增强的细胞增殖活性参与了前列腺上皮的恶性转化,在前列腺肿瘤的发生、发展中起重要作用.     

Substratification of high-risk localised prostate cancer treated by radical prostatectomy

AIM: To evaluate the clinical outcome of high-risk prostate cancer (PC) treated by radical prostatectomy (RP) according to risk factors. METHODS: Patients with stage cT1-T3 PC were stratified in high and low/intermediate risk groups using D'Amico's criteria: PSA>or=20 ng/ml or Gleason score>or=8 or clinical stage>or=T2c. The Kaplan Meier and Log rank test were used to generate estimates of biochemical free-survival (BFS) and PC specific mortality (PCSM). RESULTS: We analysed 1,109 patients with a median age of 64.1 years, a mean PSA of 12.8 and a median follow-up of 8.18 years (max. 17.5 years). Overall PSA failures (PSAF) were observed in 23.4%, mortality by all causes in 11.4% and PCSM in 2.9%. The 10-year BFS of the 290 high-risk was 45 versus 75.5% for low/intermediate risk patients and the 10-year PCSM was 10.3 versus 1.4%, respectively. Of the 290 high-risk PC, 25% had organ-confined disease at surgery with 28% PSAF compared to 55% PSAF for non-organ-confined PC irrespective of nodal status. High-risk patients with 1 or>or=2 high risk criteria had 2.6 and 3.86 times increased risk of PSAF compared to low/intermediate risk. Ten-year PCSM for PC individual risk criteria was 4.5% for PSA>or=20, 9.2% for stage>or=T2c and 18.2% for Gleason>or=8. CONCLUSION: Patients with high-risk PC treated by RP by experienced surgeons can have a favourable long-term survival. Further substratification should take into account the variable prognostic implication of the different individual risk factors.     

番茄红素抑制前列腺癌LnCaP细胞增殖

目的:探讨人体血清中番茄红素(1ycopene)水平与前列腺癌发病相关性.方法:将在加入0.5μmol/L,5 μmol/L,10μmol/L,15 μmol/L不同浓度番茄红素溶液的培养基中生长48 h后的LnCaP细胞,与在相对应浓度番茄红素溶剂-四氢叶酸酯中以及RPMI1640培养基中生长的各组细胞增殖率进行比较.观察体外培养条件下不同浓度番茄红素对前列腺癌LnCaP细胞系增殖的影响.结果:与在相对应浓度溶剂中生长的细胞相比,番茄红素溶液的培养基中生长的LnCaP细胞,细胞增殖分别减少了2.66%,4.29%,3.73%,13.66%(P＜0.05).与在RPMI培养基中生长的细胞相比,在加入5μmol/L,10μmol/L,15 μmol/L番茄红素溶液的培养基中生长的LnCaP细胞,细胞增殖分别减少了8.12%,6.33%,12.00%(P＜0.05).结论:番茄红素在体外培养条件下对前列腺癌LnCaP细胞的增殖有显著的抑制作用.     

Indication for nuclear medicine therapy in advanced cancer of the prostate

Summary For patients with advanced prostate cancer efficient therapy of painfull bony lesions is the primary goal of interdisciplinary treatment strategies. Preservation of quality of life appears to be the main aim rather than prolongation of life. Apart from oral pain relief and local irradiation systemic treatment with radionuclides offers low-risk radiotherapeutic strategies for the palliation of painful, multifocal osteoplastic bone metastases. Depending on the radiopharmaceutical substance chosen response and reduction of pain are described in 65–80 %. The duration of pain relief lasts between 6–12 weeks. During this time the morphine based medication can be reduced and in some cases withdrawn which positively effects quality of life. After improvement of myelosuppression treatment with radionuclides can be repeated. Patients have to be hospitalized for two days because of protection from radiation procedures.      

Cancers de la prostate de score de Gleason supérieur ou égal à 8: Evaluation de la survie des patients

ObjectivesTo evaluate the oncological outcomes of patients treated for prostate cancer Gleason score ≥ 8 using as criteria: total PSA, overall survival and progression-free survival.Patients and methodsThis was a retrospective study in the Urology-andrology department of the Aristide Le Dantec hospital in Dakar, from 1st June 2010 - to October 31, 2014. We compiled the data of 30 patients with prostate cancer with a Gleason score ≥ 8. The treatments used were hormonal therapy and radical prostatectomy.ResultsThe median initial PSA level was 97.7 ng/ml (2-32,047 ng/ml). Prostate cancer was found in the metastatic phase in over half the cases (83.3%). The treatment was hormonal in 82.8% of cases. Median survival was 14 months and the average overall survival time was 13.18 months. The overall survival of the standard 6, 12, and 24 months was respectively 72.7, 54.5 and 0.9%. PFS at 3, 14 and 21 months was respectively 50, 16.7 and 8.3%.ConclusionProstate cancer with Gleason score ≥ 8 has a poor prognosis in our practice.     

A guide to interpreting estimated median age of survival in cystic fibrosis patient registry reports

Survival statistics, estimated using data collected by national cystic fibrosis (CF) patient registries, are used to inform the CF community and monitor survival of CF populations. Annual registry reports typically give the median age of survival, though different registries use different estimation approaches and terminology, which has created confusion for the community. In this article we explain how median age of survival is estimated, what its interpretation is, and what assumptions and limitations are involved. Information on survival from birth is less useful for individuals who have already reached a certain age and we propose use of conditional survivor curves to address this. We provide recommendations for CF registries with the aim of facilitating clear and consistent reporting of survival statistics. Our recommendations are illustrated using data from the UK Cystic Fibrosis Registry.     

National and international variation in the registration of bladder cancer

OBJECTIVE: To determine whether variations exist in the methods by which different cancer registries record information on bladder cancers. METHODS: The registration practices of the various cancer registries within the UK, Europe and the USA were investigated by consulting the available publications and by correspondence with registry staff. In addition, a telephone survey was carried out within the UK to determine whether the national guidelines on bladder cancer coding were being followed. RESULTS: There is variation in the registration of bladder cancers both among regions within the UK and between the UK and other regions. The telephone survey showed that only four of the 11 UK regional registries were correctly following the national bladder cancer coding guidelines. Bladder cancer registration also varies between the cancer registries within mainland Europe. When comparing registration practices in the UK and the USA the major difference is that cases of bladder carcinoma in situ and pTa transitional cell carcinoma are included in the North American cancer statistics but not in the British cancer statistics. CONCLUSION: Much needs to be done before it can be claimed that the registration of bladder cancers has been standardized either nationally or internationally. In particular, the differences in registration practices between the UK and the USA will tend to give a falsely low impression of British incidence and survival rates compared with the equivalent North American figures. This confounding factor must be considered if these incidence and survival values are to be compared.     

Prognostic value of nuclear area index in patients with bladder cancer

BACKGROUND: To assess the prognostic usefulness of the nuclear area index (NAI), a new nuclear morphometric parameter expressed as the mean nuclear area (MNA) ratio of cancer to normal transitional cells in patients with bladder cancer, who have undergone radical cystectomy. METHODS: Measurements of the nuclear areas of cancer and normal transitional cells were carried out on the histological slides of 73 patients with bladder cancer. The clinical usefulness of MNA, NAI, grade, and TNM categories for the prediction of the cause-specific survival of the patients was examined. RESULTS: The median values of MNA and NAI in the 73 patients were 39 micro m2 and 1.2, respectively. Cause-specific survival rates of the patients were calculated according to stage (T1-2 vs T3-4), grade (grade 2 vs grade 3), MNA (<39 micro m2 vs>/=39 micro m2) and NAI value (<1.2 vs>/=1.2). Using univariate analysis, all these parameters were statistically significant prognostic factors. However, by multivariate analysis, NAI was the only independent variable for the survival of the patients (P < 0.01). Cause-specific survival rates of patients with NAI values of less than 1.2 were significantly higher than those with NAI values of 1.2 or more, in both grade 2 and grade 3 tumors. CONCLUSIONS: These results suggest that NAI could provide improved prognostic information for patients with bladder cancer.     

Explanted malignancies after lung transplantation: the University of Michigan experience

The management of patients with an explanted malignancy after lung transplantation is not well understood. We reviewed our institutional experience and outcomes at a single academic medical centre between December 1997 and April 2021 for patients with malignancies of all histologic types identified on explant pathology. Primary lung cancers were reclassified using the 8th Edition TNM staging and the 2021 World Health Organization histologic classification of lung cancers. Of the 733 patients undergoing lung transplantation, 15 (2.05%) were found to have malignancy on the explanted lungs, including 6 (0.82%) primary lung cancers. Four patients were found to have early-stage lung cancers, while 2 patients had advanced-stage IV disease. Survival ranged from 0 to 109 months for the entire cohort with median 23.2 [49.9] months in those with primary lung cancers. There were 2 recurrences following explanted stage I (15 months) and stage IV (53 months) diseases. Other explant pathologies included carcinoid tumourlets in 6 patients, lymphoma in 2 and metastatic leiomyosarcoma in 1. In conclusion, explanted lung malignancies are an infrequent but significant finding on explant pathology. Further data are needed to better characterize and stratify this patient cohort.     

异甘草素对人前列腺癌细胞体外增殖的抑制作用

目的:观察异甘草素(ISL)对人前列腺癌细胞体外增殖的抑制作用。方法:采用MTT法测定细胞增殖。结果:ISL浓度依赖性(0~20μm)抑制人前列腺癌细胞增殖,IC50为12.58μm,且呈时间依赖性,ISL20μm作用3天时的抑制率为85.26%。结论:异甘草素能有效地抑制前列腺癌细胞的增生,异甘草素有可能成为一种治疗前列腺癌的新药。     

Outcomes of men on active surveillance for low-risk prostate cancer at a safety-net hospital

Purpose

To characterize demographic, disease, and cancer outcomes of men on active surveillance (AS) at a safety-net hospital and characterize those who were lost to follow-up (LTFU).

askMUSIC: Leveraging a Clinical Registry to Develop a New Machine Learning Model to Inform Patients of Prostate Cancer Treatments Chosen by Similar Men

BackgroundClinical registries provide physicians with a means for making data-driven decisions but few opportunities exist for patients to interact with registry data to help make decisions.ObjectiveWe sought to develop a web-based system that uses a prostate cancer (CaP) registry to provide newly diagnosed men with a platform to view predicted treatment decisions based on patients with similar characteristics.Design, setting, and participantsThe Michigan Urological Surgery Improvement Collaborative (MUSIC) is a quality improvement consortium of urology practices that maintains a prospective registry of men with CaP. We used registry data from 45 MUSIC urology practices from 2015 to 2017 to develop and validate a random forest machine learning model. After fitting the random forest model to a derivation cohort consisting of a random two-thirds sample of patients after stratifying by practice location, we evaluated the model performance in a validation cohort consisting of the remaining one-third of patients using a multiclass area under the curve (AUC) measure and calibration plots.Results and limitationsWe identified 7543 men diagnosed with CaP, of whom 45% underwent radical prostatectomy, 30% surveillance, 17% radiation therapy, 5.6% androgen deprivation, and 1.8% watchful waiting. The personalized prediction for patients in the validation cohort was highly accurate (AUC 0.81).ConclusionsUsing clinical registry data and machine learning methods, we created a web-based platform for patients that generates accurate predictions for most CaP treatments.Patient summaryWe have developed and tested a tool to help men newly diagnosed with prostate cancer to view predicted treatment decisions based on similar patients from our registry. We have made this tool available online for patients to use.     

RPS7 promotes cell migration through targeting epithelial-mesenchymal transition in prostate cancer

Objectives

Small ribosomal protein subunit 7 (RPS7) is an important structural components of the ribosome involved in protein synthesis, previous studies demonstrated that RPS7 was associated with several malignancies, but the role of RPS7 in prostate cancer (PCa) remains unclear. To decipher such a puzzle, in the current study, we deciphered the role and mechanism of RPS7 during the progression of PCa.

Development and validation of a nomogram for predicting the overall survival of prostate cancer patients: a large population-based cohort study

BackgroundProstate cancer (PC) is the second most common malignant tumor, and its survival is of great concern. However, the assessment of survival risk in current studies is limited. This study is to develop and validate a nomogram for the prediction of survival in PC patients using data from the Surveillance, Epidemiology, and End Results (SEER) database.MethodsA total of 153,796 PC patients were included in this cohort study. Patients were divided into a training set (n=107,657) and a testing set (n=46,139). The 3-, 5- and 10-year survival of the PC patients were regarded as the outcomes. Predictors based on the demographic and pathological data for survival were identified by multivariate Cox regression analysis to develop the predictive nomogram. Internal and subgroup validations were performed to assess the predictive performance of the nomogram. The C-index, time-dependent receiver operating characteristic (ROC) curves, and corresponding areas under the ROC curves (AUCs) were used to estimate the predictive performance of the nomogram.ResultsAge at diagnosis, race, marital status, tumor node metastasis (TNM) stage, prostate specific antigen (PSA) status, Gleason score, and pathological stage were identified as significantly associated with the survival of PC patients (P<0.05). The C-index of the nomogram indicated a moderate predictive ability [training set: C-index =0.782, 95% confidence interval (CI): 0.779–0.785; testing set: C-index =0.782, 95% CI: 0.777–0.787]. The AUCs of this nomogram for the 3-, 5-, and 10-year survival were 0.757 (95% CI: 0.756–0.758), 0.741 (95% CI: 0.740–0.742), and 0.716 (95% CI: 0.715–0.717), respectively. The results of subgroup validation showed that all the AUCs for the nomogram at 3, 5, and 10 years were more than 0.70, regardless of marital status and race.ConclusionsWe developed a nomogram with the moderate predictive ability for the long-term survival (3-, 5-, and 10-year survival) of patients with PC.     

基于苯丙氨酸的聚酯酰胺纳米递药系统制备及其体外抗前列腺癌的研究

目的探究基于苯丙氨酸的聚酯酰胺的纳米递药系统的制备及其对体外培养前列腺癌细胞的抑制效果。 方法采用纳米沉淀法制备聚酯酰胺纳米粒,利用透射电镜和纳米电位仪测量纳米粒的形貌和大小分布,利用破碎沉淀法与荧光磷光光谱仪测定其载药量和包封率。采用四甲基偶氮唑盐微量酶反应比色法测定载药纳米粒对前列腺癌细胞LNCaP的抑制效果,采用膜联蛋白V-APC/7AAD双染法并用流式细胞仪测定其对肿瘤细胞的凋亡诱导作用。 结果采用纳米沉淀法成功制备了空白及包载多柔吡星（DOX）的载药聚酯酰胺纳米粒,粒径约为90～110 nm,大小分布较为均匀。空白纳米粒在不同浓度下均显示出良好的生物相容性,高浓度100 μg/ml的材料作用下,LNCaP的细胞活力仍保持在（95.32±3.97）%。与DOX组的IC50 （3.29±0.63）μg/ml相比,载药纳米粒对前列腺癌细胞活性抑制明显,IC50为（1.21±0.43）μg/ml,差异具有统计学意义（t=6.693,P<0.001）。流式细胞仪检测载药纳米粒能有效诱导前列腺癌细胞进入中晚期凋亡,对照组、DOX组与DOX@8p6组凋亡率分别为2.32%、29.16%和61.62%,后两组间差异具有统计学意义（χ²=2217,P<0.001）,且DOX@8p6组凋亡情况多于DOX组（t=11.238,P<0.001）,显示出载药纳米粒对前列腺癌细胞LNCaP更高的促凋亡效率。 结论基于苯丙氨酸的聚酯酰胺纳米粒具有良好的生物相容性,其作为递送抗肿瘤药物多柔吡星的纳米药物载体时能有效地直接抑制前列腺癌肿瘤细胞活性及诱导肿瘤细胞凋亡。     

Lymphadenectomy in Gleason 7 prostate cancer: Adherence to guidelines and effect on clinical outcomes

Background

To examine usage trends, guideline adherence, and survival data for patients undergoing lymphadenectomy (LND) at the time of radical prostatectomy (RP) for Gleason 7 prostate cancer (PCa).

Bone turnover markers as predictors of mortality risk in prostate cancer patients with bone metastases following treatment with zoledronic acid

Background

Clinical data have limited validity for predicting the survival of prostate cancer (PCa) patients with bone metastases. There is a need to improve the predictive evidence both for clinicians and patients.

Objective

To evaluate the predictive ability of serum bone markers for mortality risk in PCa patients with bone metastases.

Design, setting, and participants

We conducted a survival analysis in relation to bone markers in a subgroup of 52 patients treated with zoledronic acid (4 mg every 4 wk for 15 mo) in a prospective, multicentre trial during 2002–2005, about 4 yr after the end of the trial.

Measurements

Serum levels of total and bone-specific alkaline phosphatase, amino-terminal procollagen propeptides of type I collagen (PINP), cross-linked N-terminal (NTx) and cross-linked C-terminal telopeptides of type I collagen (ICTP), C-terminal telopeptides of type I collagen, prostate-specific antigen from the last visit of the treatment study, and clinical data were related to the overall survival (OS) status of patients in the follow-up. Univariate and multivariate Cox regression analyses with internal bootstrapping validation and concordance index calculations were performed.

Results and limitations

Out of the 52 patients followed, 34 died within a median follow-up of 13.8 mo, and 18 patients were alive at a median follow-up of 43.8 mo. The patients who died within the follow-up period had significantly higher concentrations of ICTP, NTx, and PINP than the surviving patients. Cox regression models with clinical data and bone markers showed that ICTP and PINP were most predictive for mortality risk in addition to the occurrence of skeletal-related complications and the continuation of treatment with zoledronic acid. Internal validation confirmed the reliability of the results, although the sample size was small.

Conclusions

PINP and ICTP can be considered suitable predictors for the OS of PCa patients with bone metastases.