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Ajay Aggarwal Daniel Lewis Susan C. Charman Malcolm Mason Noel Clarke Richard Sullivan Jan van der Meulen 《European urology》2018,73(6):822-825
Many countries have introduced policies that enable patients to select a health care provider of their choice with the aim of improving the quality of care. However, there is little information about the drivers or the impact of patient mobility. Using administrative hospital data (n = 19 256) we analysed the mobility of prostate cancer patients who had radical surgery in England between 2010 and 2014. Our analysis, using geographic information systems and multivariable choice modelling, found that 33·5% (n = 6465) of men bypassed their nearest prostate cancer surgical centre. Travel time had a strong impact on where patients moved to but was less of a factor for men who were younger, fitter, and more affluent (p always < 0.001). Men were more likely to move to hospitals that provided robotic prostate cancer surgery (odds ratio: 1.42, p < 0.001) and to hospitals that employed surgeons with a strong media reputation (odds ratio: 2.18, p < 0.001). Patient mobility occurred in the absence of validated measures of the quality of care, instead influenced by the adoption of robotic surgery and the reputation of individual clinicians. National policy based on patient choice and provider competition may have had a negative impact on equality of access, service capacity, and health system efficiency.
Patient summary
In this study, we assessed the reasons why men would choose to have prostate cancer surgery at a centre other than their nearest. We found that in England men were attracted to centres that carried out robotic surgery and employed surgeons with a national reputation. 相似文献3.
Daniel J. Canter Julia Reid Maria Latsis Margaret Variano Shams Halat Saradha Rajamani Kristen E. Gurtner Zaina Sangale Michael Brawer Steven Stone Stephen Bardot 《European urology》2019,75(3):515-522
Background
Better prostate cancer risk stratification is necessary to inform medical management, especially for African American (AA) men, for whom outcomes are particularly uncertain.Objective
To evaluate the utility of both a cell cycle progression (CCP) score and a clinical cell-cycle risk (CCR) score to predict clinical outcomes in a large cohort of men with prostate cancer highly enriched in an AA patient population.Design, setting, and participants
Patients were diagnosed with clinically localized adenocarcinoma of the prostate and treated at The Ochsner Clinic (New Orleans, LA, USA) from January 2006 to December 2011. CCP scores were derived from archival formalin-fixed, paraffin-embedded biopsy tissue. CCR scores were calculated as the combination of molecular (CCP score) and clinical (Cancer of the Prostate Risk Assessment [CAPRA] score) components.Intervention
Active treatment (radical prostatectomy, radiation therapy alone, or radiation and hormone therapy) or watchful waiting.Outcome measurements and statistical analysis
The primary outcome was progression to metastatic disease. Association with outcomes was evaluated via Cox proportional hazards survival analysis and likelihood ratio tests.Results and limitations
The final cohort included 767 men, of whom 281 (36.6%) were AA. After accounting for ancestry, treatment, and CAPRA in multivariable analysis, the CCP score remained a significant predictor of metastatic disease (hazard ratio [HR] 2.04; p < 0.001), and there was no interaction with ancestry (p = 0.20) or treatment (p = 0.09). The CCR score was highly prognostic (HR 3.86; p < 0.001), and as with the CCP score, there was no interaction with ancestry (p = 0.24) or treatment (p = 0.32). Limitations include the retrospective study design and the use of self-reported ancestry information.Conclusions
A CCR score provided significant prognostic information regardless of ancestry. The findings demonstrate that AA men in this study cohort appear to have similar prostate cancer outcomes to non-AA patients after accounting for all available molecular and clinicopathologic variables.Patient summary
In this study we evaluated the ability of a combined molecular and clinical score to predict the progression of localized prostate cancer. We found that the combined molecular and clinical score predicted progression to metastasis regardless of patient ancestry or treatment. This suggests that the combined molecular and clinical score may be a valuable tool for determining the risk of metastasis in men with newly diagnosed prostate cancer in order to make appropriate treatment decisions. 相似文献4.
Tommy Nyberg Koveela Govindasami Goska Leslie Tokhir Dadaev Elizabeth Bancroft Holly Ni Raghallaigh Mark N. Brook Nafisa Hussain Diana Keating Andrew Lee Romayne McMahon Angela Morgan Andrea Mullen Andrea Osborne Reshma Rageevakumar Zsofia Kote-Jarai Rosalind Eeles Antonis C. Antoniou 《European urology》2019,75(5):834-845
Background
The homeobox B13 (HOXB13) G84E mutation has been recommended for use in genetic counselling for prostate cancer (PCa), but the magnitude of PCa risk conferred by this mutation is uncertain.Objective
To obtain precise risk estimates for mutation carriers and information on how these vary by family history and other factors.Design, setting, and participants
Two-fold: a systematic review and meta-analysis of published risk estimates, and a kin-cohort study comprising pedigree data on 11 983 PCa patients enrolled during 1993–2014 from 189 UK hospitals and who had been genotyped for HOXB13 G84E.Outcome measurements and statistical analysis
Relative and absolute PCa risks. Complex segregation analysis with ascertainment adjustment to derive age-specific risks applicable to the population, and to investigate how these vary by family history and birth cohort.Results and limitations
A meta-analysis of case-control studies revealed significant heterogeneity between reported relative risks (RRs; range: 0.95–33.0, p < 0.001) and differences by case selection (p = 0.007). Based on case-control studies unselected for PCa family history, the pooled RR estimate was 3.43 (95% confidence interval [CI] 2.78–4.23). In the kin-cohort study, PCa risk for mutation carriers varied by family history (p < 0.001). There was a suggestion that RRs decrease with age, but this was not significant (p = 0.068). We found higher RR estimates for men from more recent birth cohorts (p = 0.004): 3.09 (95% CI 2.03–4.71) for men born in 1929 or earlier and 5.96 (95% CI 4.01–8.88) for men born in 1930 or later. The absolute PCa risk by age 85 for a male HOXB13 G84E carrier varied from 60% for those with no PCa family history to 98% for those with two relatives diagnosed at young ages, compared with an average risk of 15% for noncarriers. Limitations include the reliance on self-reported cancer family history.Conclusions
PCa risks for HOXB13 G84E mutation carriers are heterogeneous. Counselling should not be based on average risk estimates but on age-specific absolute risk estimates tailored to individual mutation carriers’ family history and birth cohort.Patient summary
Men who carry a hereditary mutation in the homeobox B13 (HOXB13) gene have a higher than average risk for developing prostate cancer. In our study, we examined a large number of families of men with prostate cancer recruited across UK hospitals, to assess what other factors may contribute to this risk and to assess whether we could create a precise model to help in predicting a man's prostate cancer risk. We found that the risk of developing prostate cancer in men who carry this genetic mutation is also affected by a family history of prostate cancer and their year of birth. This information can be used to assess more personalised prostate cancer risks to men who carry HOXB13 mutations and hence better counsel them on more personalised risk management options, such as tailoring prostate cancer screening frequency. 相似文献5.
Masakatsu Oishi Inderbir S. Gill Akbar N. Ashrafi Michael Lin-Brande Nima Nassiri Toshitaka Shin Alfredo Bove Giovanni E. Cacciamani Osamu Ukimura Duke K. Bahn Andre Luis de Castro Abreu 《European urology》2019,75(2):208-214
We retrospectively evaluated complications and functional and oncologic outcomes of 94 consecutive men who underwent primary whole-gland cryoablation for localized prostate cancer (PCa) from 2002 to 2012. Kaplan-Meier and multivariable Cox regression analyses were performed using a landmark starting at 6 mo of follow-up. In total, 75% patients had D’Amico intermediate- (48%) or high- (27%) risk PCa. Median follow-up was 5.6 yr. Median time to prostate-specific antigen (PSA) nadir was 3.3 mo, and 70 patients reached PSA <0.2 ng/ml postcryoablation. The 90-d high-grade (Clavien Grade IIIa) complication rate was 3%, with no rectal fistulas reported. Continence and potency rates were 96% and 11%, respectively. The 5-yr biochemical failure-free survival (PSA nadir + 2 ng/ml) was 81% overall and 89% for low-, 78% for intermediate-, and 80% for high-risk PCa (p = 0.46). The median follow-up was 5.6 and 5.1 yr for patients without biochemical failure and with biochemical failure, respectively. The 5-yr clinical recurrence-free survival was 83% overall and 94% for low-, 84% for intermediate-, and 69% for high-risk PCa (p = 0.046). Failure to reach PSA nadir <0.2 ng/ml within 6 mo postcryoablation was an independent predictor for biochemical failure (p = 0.006) and clinical recurrence (p = 0.03). The 5-yr metastases-free survival was 95%. Main limitation is retrospective evaluation. Primary whole-gland cryoablation for PCa provides acceptable medium-term oncologic outcomes and could be an alternative for radiation therapy or radical prostatectomy.
Patient summary
Cryoablation is a safe, minimally-invasive procedure that uses cold temperatures delivered via probes through the skin to kill prostate cancer (PCa) cells. Whole-gland cryoablation may offer an alternative treatment option to surgery and radiotherapy. We found that patients had good cancer outcomes 5 yr after whole-gland cryoablation, and those with a prostate-specific antigen value ≥0.2 ng/ml within 6 mo after treatment were more likely to have PCa recurrence. 相似文献6.
H. Ballentine Carter Brian Helfand Mufaddal Mamawala Yishuo Wu Patricia Landis Hongjie Yu Kathleen Wiley Rong Na Zhuqing Shi Jacqueline Petkewicz Sameep Shah Richard J. Fantus Kristian Novakovic Charles B. Brendler S. Lilly Zheng William B. Isaacs Jianfeng Xu 《European urology》2019,75(5):743-749
Background
Mutations in DNA repair genes are associated with aggressive prostate cancer (PCa).Objective
To assess whether germline mutations are associated with grade reclassification (GR) in patients undergoing active surveillance (AS).Design, setting, and participants
Two independent cohorts of PCa patients undergoing AS; 882 and 329 patients from Johns Hopkins and North Shore, respectively.Outcome measurements and statistical analysis
Germline DNA was sequenced for DNA repair genes, including BRCA1/2 and ATM (three-gene panel). Pathogenicity of mutations was defined according to the American College of Medical Genetics guidelines. Association of mutation carrier status and GR was evaluated by a competing risk analysis.Results and limitations
Of 1211, 289 patients experienced GR; 11 of 26 with mutations in a three-gene panel and 278 of 1185 noncarriers; adjusted hazard ratio (HR) = 1.96 (95% confidence interval [CI] = 1.004–3.84, p = 0.04). Reclassification occurred in six of 11 carriers of BRCA2 mutations and 283 of 1200 noncarriers; adjusted HR = 2.74 (95% CI = 1.26–5.96, p = 0.01). The carrier rates of pathogenic mutations in the three-gene panel, and BRCA2 alone, were significantly higher in those reclassified (3.8% and 2.1%, respectively) than in those not reclassified (1.6% and 0.5%, respectively; p = 0.04 and 0.03, respectively). Carrier rates for BRCA2 were greater for those reclassified from Gleason score (GS) 3 + 3 at diagnosis to GS ≥4 + 3 (4.1% vs 0.7%, p = 0.01) versus GS 3 + 4 (2.1% vs 0.6%; p = 0.03). Results are limited by the small number of mutation carriers and an intermediate end point.Conclusions
Mutation status of BRCA1/2 and ATM is associated with GR among men undergoing AS.Patient summary
Men on active surveillance with inherited mutations in BRCA1/2 and ATM are more likely to harbor aggressive prostate cancer. 相似文献7.
Fabian Lohaus Klaus Zöphel Steffen Löck Manfred Wirth Jörg Kotzerke Mechthild Krause Michael Baumann Esther G.C. Troost Tobias Hölscher 《European urology》2019,75(4):548-551
In prostate cancer, disease progression after primary treatment and subsequent androgen deprivation therapy is common. Intensification of systemic treatment is the standard of care. Recently, 68Ga prostate-specific membrane antigen positron emission tomography (PSMA-PET) imaging was introduced to identify oligometastatic prostate cancer patients. In this retrospective, exploratory study, we report on the efficacy of PSMA-PET-guided local ablative radiotherapy (aRT) in 15 oligometastatic castration-resistant prostate cancer (CRPC) patients, selected from our prospective institutional database and treated between 2013 and 2016. After multidisciplinary discussion, aRT was delivered with two different schedules. Androgen deprivation therapy remained unchanged. Prostate-specific antigen (PSA) response and time to PSA progression were analysed. For comparison, individual time to PSA progression without aRT was estimated by individual PSA doubling time (PSADT). PSA response was observed in 11 patients (73%). Mean time to PSA progression or last follow-up was 17.9 mo, as opposed to 2.9 mo estimated from the PSADT without aRT (p < 0.001). A relevant subset of CRPC patients had a PSA response with aRT to PET-positive lead metastases. A prospective trial is in preparation.
Patient summary
In selected patients with prostate-specific antigen (PSA) increase during androgen deprivation, metastases were detected with prostate-specific membrane antigen positron emission tomography imaging. Fifteen patients with three or fewer metastases were treated with high-dose radiotherapy. Subsequently, PSA values dropped in 11 patients and in six patients no PSA progression was detected for >12 mo. 相似文献8.
Olivier Wegelin Leonie Exterkate Marloes van der Leest Jean A. Kummer Willem Vreuls Peter C. de Bruin J.L.H.Ruud Bosch Jelle O. Barentsz Diederik M. Somford Harm H.E. van Melick 《European urology》2019,75(4):582-590
Background
Guidelines advise multiparametric magnetic resonance imaging (mpMRI) before repeat biopsy in patients with negative systematic biopsy (SB) and a suspicion of prostate cancer (PCa), enabling MRI targeted biopsy (TB). No consensus exists regarding which of the three available techniques of TB should be preferred.Objective
To compare detection rates of overall PCa and clinically significant PCa (csPCa) for the three MRI-based TB techniques.Design, setting, and participants
Multicenter randomised controlled trial, including 665 men with prior negative SB and a persistent suspicion of PCa, conducted between 2014 and 2017 in two nonacademic teaching hospitals and an academic hospital.Intervention
All patients underwent 3-T mpMRI evaluated with Prostate Imaging Reporting and Data System (PIRADS) version 2. If imaging demonstrated PIRADS ≥3 lesions, patients were randomised 1:1:1 for one TB technique: MRI-transrectal ultrasound (TRUS) fusion TB (FUS-TB), cognitive registration TRUS TB (COG-TB), or in-bore MRI TB (MRI-TB).Outcome measurements and statistical analysis
Primary (overall PCa detection) and secondary (csPCa detection [Gleason score ≥3 + 4]) outcomes were compared using Pearson chi-square test.Results and limitations
On mpMRI, 234/665 (35%) patients had PIRADS ≥3 lesions and underwent TB. There were no significant differences in the detection rates of overall PCa (FUS-TB 49%, COG-TB 44%, MRI-TB 55%, p = 0.4). PCa detection rate differences were ?5% between FUS-TB and MRI-TB (p = 0.5, 95% confidence interval [CI] ?21% to 11%), 6% between FUS-TB and COG-TB (p = 0.5, 95% CI ?10% to 21%), and ?11% between COG-TB and MRI-TB (p = 0.17, 95% CI ?26% to 5%). There were no significant differences in the detection rates of csPCa (FUS-TB 34%, COG-TB 33%, MRI-TB 33%, p > 0.9). Differences in csPCa detection rates were 2% between FUS-TB and MRI-TB (p = 0.8, 95% CI ?13% to 16%), 1% between FUS-TB and COG-TB (p > 0.9, 95% CI ?14% to 16%), and 1% between COG-TB and MRI-TB (p > 0.9, 95% CI ?14% to 16%). The main study limitation was a low rate of PIRADS ≥3 lesions on mpMRI, causing underpowering for primary outcome.Conclusions
We found no significant differences in the detection rates of (cs)PCa among the three MRI-based TB techniques.Patient summary
In this study, we compared the detection rates of (aggressive) prostate cancer among men with prior negative biopsies and a persistent suspicion of cancer using three different techniques of targeted biopsy based on magnetic resonance imaging. We found no significant differences in the detection rates of (aggressive) prostate cancer among the three techniques. 相似文献9.
D.E. Orakwe K.H. Tijani E.A. Jeje M.A. Ogunjimi R.W. Ojewola 《The African Journal of Urology》2017,23(2):105-108
Objectives
To compare serum testosterone and prostate specific antigen (PSA) levels of patients diagnosed of prostate cancer to those with benign prostatic hyperplasia (BPH).Subjects and methods
One hundred and thirteen male patients with or without LUTS who had indication(s) for prostate biopsies were recruited. Blood samples were analysed for serum testosterone and serum PSA. Prostate sizes were measured and PSA densities calculated before trans-rectal prostate biopsies were performed.Results
On histology of prostate biopsy specimens, 54 patients (47.8%) had prostate adenocarcinoma while 59 patients (52.2%) had BPH. Serum testosterone levels were lower in the prostate cancer group (23.09 ± 2.31 nmol/L versus 24.37 ± 1.94 nmol/L in the BPH group) but this difference was not statistically significant (p = 0.671). Serum testosterone also did not differ significantly with Gleason grade and Gleason score in patients with prostate cancer.Serum PSA and PSA density (PSAD) values were significantly higher in men with prostate cancer, and also in prostate cancer patients with high grade disease.Conclusion
Serum testosterone levels of patients with prostate cancer did not significantly differ from those of patients with BPH and were not related to grade in prostate cancer patients. 相似文献10.
Peter K.-F. Chiu Chi-Fai Ng Axel Semjonow Yao Zhu Sébastien Vincendeau Alain Houlgatte Massimo Lazzeri Giorgio Guazzoni Carsten Stephan Alexander Haese Ilse Bruijne Jeremy Yuen-Chun Teoh Chi Ho Leung Paola Casale Chih Hung Chiang Lincoln Guan-Lim Tan Edmund Chiong Chao Yuan Huang Monique J. Roobol 《European urology》2019,75(4):558-561
Asians have a lower incidence of prostate cancer (PC). We compared the performance of the Prostate Health Index (PHI) for 2488 men in different ethnic groups (1688 Asian and 800 European men from 9 sites) with PSA 2–20 ng/ml and PHI test and transrectal ultrasound-guided biopsy results available. Of these, 1652 men had PSA 2–10 ng/ml and a normal digital rectal examination and underwent initial biopsy. The proportions of PC (Gleason ≥6) and higher-grade PC (HGPC, Gleason ≥7) across different PHI ranges were compared. The performance of PSA and PHI was compared using the area under the receiver operating characteristic curve (AUC) and decision curve analyses (DCA). Among Asian men, HGPC would be diagnosed in 1.0%, 1.9%, 13%, and 30% of men using PHI thresholds of <25, 25–35, 35–55, and >55, respectively. At 90% sensitivity for HGPC (PHI >30), 56% of biopsies and 33% of Gleason 6 PC diagnoses could have been avoided. Among European men, HGPC would be diagnosed in 4.1%, 4.3%, 30%, and 34% of men using PHI thresholds of <25, 25–35, 35–55, and >55, respectively. At 90% sensitivity for HGPC (PHI >40), 40% of biopsies and 31% of Gleason 6 PC diagnoses could have been avoided. AUC and DCA confirmed the benefit of PHI over PSA. The benefit of PHI was also seen at repeat biopsy (n = 397) and for PSA 10–20 ng/ml (n = 439). PHI is effective in cancer risk stratification for both European and Asian men. However, population-specific PHI reference ranges should be used.
Patient summary
The Prostate Health Index (PHI) blood test helps to identify individuals at higher risk of prostate cancer among Asian and European men, and could significantly reduce unnecessary biopsies and overdiagnosis of prostate cancer. Different PHI reference ranges should be used for different ethnic groups. 相似文献11.
Sebastian Berg Alexander P. Cole Marieke J. Krimphove Junaid Nabi Maya Marchese Stuart R. Lipsitz Joachim Noldus Toni K. Choueiri Adam S. Kibel Quoc-Dien Trinh 《European urology》2019,75(4):552-555
A previous study comparing external beam radiation therapy with/without brachytherapy (EBRT ± BT) and radical prostatectomy (RP) for high-risk localized prostate cancer (PCa) did not find a difference in overall survival (OS) between the treatments. However, this study was limited by short follow-up and assessment of OS in patients of divergent age and comorbidities. We therefore compared OS of EBRT + BT versus RP in comparatively young (≤65 yr) and healthy men (Charlson Comorbidity Index = 0) with high-risk localized PCa in the National Cancer Database. Inverse probability of treatment weighting (IPTW) adjustment was used to balance baseline characteristics. Median follow-up was 92 mo (interquartile range 78–108). Using IPTW-adjusted Cox regression analysis, EBRT + BT was associated with a higher risk of all-cause mortality compared with RP (hazard ratio = 1.22, 95% confidence interval 1.05–1.43). In young and healthy men presenting with high-risk localized PCa, RP showed statistically significant OS benefit compared with EBRT + BT.
Patient summary
In an analysis restricted to young and healthy men presenting with high-risk localized prostate cancer, initial radical prostatectomy is associated with an overall survival benefit compared with external beam radiation therapy plus brachytherapy. 相似文献12.
Jacob A. Burns Adam B. Weiner William J. Catalona Eric V. Li Edward M. Schaeffer Stephen B. Hanauer Scott Strong James Burns Maha H.A. Hussain Shilajit D. Kundu 《European urology》2019,75(5):846-852
Background
There are limited data examining the risk of prostate cancer (PCa) in patients with inflammatory bowel disease (IBD).Objective
To compare the incidence of PCa between men with and those without IBD.Design, setting, and participants
This was a retrospective, matched-cohort study involving a single academic medical center and conducted from 1996 to 2017. Male patients with IBD (cases = 1033) were randomly matched 1:9 by age and race to men without IBD (controls = 9306). All patients had undergone at least one prostate-specific antigen (PSA) screening test.Outcome measurements and statistical analysis
Kaplan-Meier and multivariable Cox proportional hazard models, stratified by age and race, evaluated the relationship between IBD and the incidence of any PCa and clinically significant PCa (Gleason grade group ≥2). A mixed-effect regression model assessed the association of IBD with PSA level.Results and limitations
PCa incidence at 10 yr was 4.4% among men with IBD and 0.65% among controls (hazard ratio [HR] 4.84 [3.34–7.02] [3.19–6.69], p < 0.001). Clinically significant PCa incidence at 10 yr was 2.4% for men with IBD and 0.42% for controls (HR 4.04 [2.52–6.48], p < 0.001). After approximately age 60, PSA values were higher among patients with IBD (fixed-effect interaction of age and patient group: p = 0.004). Results are limited by the retrospective nature of the analysis and lack of external validity.Conclusions
Men with IBD had higher rates of clinically significant PCa when compared with age- and race-matched controls.Patient summary
This study of over 10 000 men treated at a large medical center suggests that men with inflammatory bowel disease may be at a higher risk of prostate cancer than the general population. 相似文献13.
Daniël F. Osses Sebastiaan Remmers Fritz H. Schröder Theo van der Kwast Monique J. Roobol 《European urology》2019,75(3):374-377
We assessed the effect of screening in the European Randomized study of Screening for Prostate Cancer (ERSPC) Rotterdam pilot 1 study cohort with men randomized in 1991–1992. A total of 1134 men were randomized on a 1:1 basis to a screening (S) and control (C) arm after prostate-specific antigen (PSA) testing (PSA ≥10.0 ng/ml was excluded from randomization). Further PSA testing was offered to all men in the S-arm with 4-yr intervals starting at age 55 yr and screened up to the age of 74 yr. Overall, a PSA level of ≥3.0 ng/ml triggered biopsy. At time of analysis, 63% of men had died. Overall relative risk of metastatic (M+) disease and prostate cancer (PCa) death was 0.46 (95% confidence interval [CI]: 0.19–1.11) and 0.48 (95% CI: 0.17–1.36), respectively, in favor of screening. This ERSPC Rotterdam pilot 1 study cohort, screened in a period without noteworthy contamination, shows that PSA-based screening could result in considerable reductions of M+ disease and mortality which if confirmed in larger datasets should trigger further discussion on pros/cons of PCa screening.
Patient summary
In a cohort with 19 yr of follow-up, we found indications for a more substantial reduction in metastatic disease and cancer-specific mortality in favor of prostate cancer screening than previously reported. If confirmed in larger cohorts, these findings should be considered in the ongoing discussion on harms and benefits of prostate cancer screening. 相似文献14.
K.A. Gautam A.N. Singh A.N. Srivastav S.N. Sankhwar 《The African Journal of Urology》2018,24(2):98-103
Introduction
Prostate carcinoma is still a dreaded disease wanting more effective treatment and definitive early detection for a better prognosis and cure of life.Objective
The present study was planned to investigate the correlation of vascular endothelial growth factor (VEGF) expression level and microvessel density (MVD) between the BPH and prostate cancer subjects to analyze their diagnostic and prognostic value.Subjects and methods
Freshly diagnosed histopathologically confirmed 50 cases of prostate cancer and 50 cases of BPH were included. Expression level of VEGF was measured using Immunohistochemistry (IHC), while MVD was determined via CD34 endothelium-specific antibodies. In the case group, we have also recorded the Gleason's score of prostate cancer and investigated its correlation with angiogenic factor VEGF and MVD CD34.Results
The study showed a statistically significant difference value of VEGF expression level between the prostate cancer and BPH group (p < 0.001). The mean MVD CD34 in the prostate cancer and BPH groups were 29.66 ± 0.21 and 9.96 ± 0.25, respectively. The difference of MVD CD34 expression between the groups was also found significant (p < 0.001). VEGF scoring was significantly correlated with Gleason's scores of prostate cancer (p = 0.005).Conclusions
The present findings may support the assumption that VEGF and CD34 expression level might have an important role in the prediction of prostate cancer as it was significantly differed with BPH. In addition, VEGF expression level showed intense staining in the tissue samples with higher grading of prostate cancer which reveals its importance as prognostic marker. 相似文献15.
Vincenza Conteduca Anuradha Jayaram Nuria Romero-Laorden Daniel Wetterskog Samanta Salvi Giorgia Gurioli Emanuela Scarpi Elena Castro Mercedes Marin-Aguilera Cristian Lolli Giuseppe Schepisi Antonio Maugeri Anna Wingate Alberto Farolfi Valentina Casadio Ana Medina Javier Puente Mª José Méndez Vidal Ugo De Giorgi 《European urology》2019,75(3):368-373
Plasma androgen receptor (AR) gain identifies metastatic castration-resistant prostate cancer (mCRPC) patients with worse outcome on abiraterone/enzalutamide, but its relevance in the context of taxane chemotherapy is unknown. We aimed to evaluate whether docetaxel is active regardless of plasma AR and to perform an exploratory analysis to compare docetaxel with abiraterone/enzalutamide. This multi-institutional study was a pooled analysis of AR status, determined by droplet digital polymerase chain reaction, on pretreatment plasma samples. We evaluated associations between plasma AR and overall/progression-free survival (OS/PFS) and prostate-specific antigen (PSA) response rate in 163 docetaxel-treated patients. OS was significantly shorter in case of AR gain (hazard ratio [HR] = 1.61, 95% confidence interval [CI] = 1.08–2.39, p = 0.018), but not PFS (HR = 1.04, 95% CI 0.74–1.46, p = 0.8) or PSA response (odds ratio = 1.14, 95% CI = 0.65–1.99, p = 0.7). We investigated the interaction between plasma AR and treatment type after incorporating updated data from our prior study of 73 chemotherapy-naïve, abiraterone/enzalutamide-treated patients, with data from 115 first-line docetaxel patients. In an exploratory analysis of mCRPC patients receiving first-line therapies, a significant interaction was observed between plasma AR and docetaxel versus abiraterone/enzalutamide for OS (HR = 0.16, 95% CI = 0.06–0.46, p < 0.001) and PFS (HR = 0.31, 95% CI = 0.12–0.80, p = 0.02). Specifically, we reported a significant difference for OS favoring abiraterone/enzalutamide for AR-normal patients (HR = 1.93, 95% CI = 1.19–3.12, p = 0.008) and a suggestion favoring docetaxel for AR-gained patients (HR = 0.53, 95% CI = 0.24–1.16, p = 0.11). These data suggest that AR-normal patients should receive abiraterone/enzalutamide and AR-gained could benefit from docetaxel. This treatment selection merits prospective evaluation in a randomized trial.
Patient summary
We investigated whether plasma androgen receptor (AR) predicted outcome in metastatic castration-resistant prostate cancer (mCRPC) patients treated with docetaxel, and we performed an exploratory analysis in patients treated with docetaxel or AR-directed drugs as first-line mCRPC therapy. We showed that plasma AR normal favored hormonal treatment, whilst plasma AR-gained patients may have had a longer response to docetaxel, suggesting that plasma AR status could be a useful treatment selection biomarker. 相似文献16.
Sami Hamid Ian A. Donaldson Yipeng Hu Rachael Rodell Barbara Villarini Ester Bonmati Pamela Tranter Shonit Punwani Harbir S. Sidhu Sarah Willis Jan van der Meulen David Hawkes Neil McCartan Ingrid Potyka Norman R. Williams Chris Brew-Graves Alex Freeman Caroline M. Moore Hashim U. Ahmed 《European urology》2019,75(5):733-740
Background
Multiparametric magnetic resonance imaging (mpMRI)-targeted prostate biopsies can improve detection of clinically significant prostate cancer and decrease the overdetection of insignificant cancers. It is unknown whether visual-registration targeting is sufficient or augmentation with image-fusion software is needed.Objective
To assess concordance between the two methods.Design, setting, and participants
We conducted a blinded, within-person randomised, paired validating clinical trial. From 2014 to 2016, 141 men who had undergone a prior (positive or negative) transrectal ultrasound biopsy and had a discrete lesion on mpMRI (score 3–5) requiring targeted transperineal biopsy were enrolled at a UK academic hospital; 129 underwent both biopsy strategies and completed the study.Intervention
The order of performing biopsies using visual registration and a computer-assisted MRI/ultrasound image-fusion system (SmartTarget) on each patient was randomised. The equipment was reset between biopsy strategies to mitigate incorporation bias.Outcome measurements and statistical analysis
The proportion of clinically significant prostate cancer (primary outcome: Gleason pattern ≥3 + 4 = 7, maximum cancer core length ≥4 mm; secondary outcome: Gleason pattern ≥4 + 3 = 7, maximum cancer core length ≥6 mm) detected by each method was compared using McNemar's test of paired proportions.Results and limitations
The two strategies combined detected 93 clinically significant prostate cancers (72% of the cohort). Each strategy detected 80/93 (86%) of these cancers; each strategy identified 13 cases missed by the other. Three patients experienced adverse events related to biopsy (urinary retention, urinary tract infection, nausea, and vomiting). No difference in urinary symptoms, erectile function, or quality of life between baseline and follow-up (median 10.5 wk) was observed. The key limitations were lack of parallel-group randomisation and a limit on the number of targeted cores.Conclusions
Visual-registration and image-fusion targeting strategies combined had the highest detection rate for clinically significant cancers. Targeted prostate biopsy should be performed using both strategies together.Patient summary
We compared two prostate cancer biopsy strategies: visual registration and image fusion. A combination of the two strategies found the most clinically important cancers and should be used together whenever targeted biopsy is being performed. 相似文献17.
Liselotte M.S. Boevé Maarten C.C.M. Hulshof André N. Vis Aeilko H. Zwinderman Jos W.R. Twisk Wim P.J. Witjes Karl P.J. Delaere R. Jeroen A. van Moorselaar Paul C.M.S. Verhagen George van Andel 《European urology》2019,75(3):410-418
Background
The cornerstone of standard treatment for patients with primary bone metastatic prostate cancer (mPCa) is androgen deprivation therapy (ADT). Retrospective studies suggest a survival benefit for treatment of the primary prostatic tumour in mPCa, but to date, no randomised-controlled-trials (RCTs) have been published addressing this issue.Objective
To determine whether overall survival is prolonged by adding local treatment of the primary prostatic tumour with external beam radiation therapy (EBRT) to ADT.Design, setting, and participants
The HORRAD trial is a multicentre RCT recruiting 432 patients with prostate-specific antigen (PSA) >20 ng/ml and primary bone mPCa on bone scan between 2004 and 2014.Intervention
Patients were randomised to either ADT with EBRT (radiotherapy group) or ADT alone (control group).Outcome measurements and statistical analysis
Primary endpoint was overall survival. Secondary endpoint was time to PSA progression. Crude and adjusted analyses were applied to evaluate treatment effect.Results and limitations
Median PSA level was 142 ng/ml and 67% of patients had more than five osseous metastases. Median follow up was 47 mo. Median overall survival was 45 mo (95% confidence interval [CI], 40.4–49.6) in the radiotherapy group and 43 mo (95% CI: 32.6–53.4) in the control group (p = 0.4). No significant difference was found in overall survival (hazard ratio [HR]: 0.90; 95% CI: 0.70–1.14; p = 0.4). Median time to PSA progression in the radiotherapy group was 15 mo (95% CI: 11.8–18.2), compared with 12 mo (95% CI: 10.6–13.4) in the control group. The crude HR (0.78; 95% CI: 0.63–0.97) was statistically significant (p = 0.02).Conclusions
The current RCT comparing ADT to ADT with EBRT to the prostate in patients with primary bone mPCa did not show a significant difference in overall survival, although the CI cannot exclude a substantial survival benefit. Further research is needed to confirm our findings.Patient summary
This study investigated the effect of adding radiation therapy to the prostate to hormonal therapy in prostate cancer patients with metastasis to the bone at diagnosis. In our patient group, additional radiotherapy did not improve overall survival. Further research is needed to confirm our findings.Twitter summary
Adding radiotherapy to the prostate in patients with bone metastatic prostate cancer does not improve overall survival. 相似文献18.
Brent K. Hollenbeck Samuel R. Kaufman Phyllis Yan Lindsey A. Herrel Tudor Borza Florian R. Schroeck Bruce L. Jacobs Ted A. Skolarus Vahakn B. Shahinian 《European urology》2018,73(4):491-498
Background
Prostate cancer treatment is a significant source of morbidity and spending. Some men with prostate cancer, particularly those with significant health problems, are unlikely to benefit from treatment.Objective
To assess relationships between financial incentives associated with urologist ownership of radiation facilities and treatment for prostate cancer.Design, setting, and participants
A retrospective cohort of Medicare beneficiaries with prostate cancer diagnosed between 2010 and 2012. Patients were further classified by their risk of dying from noncancer causes in the 10 yr following their cancer diagnosis by using a mortality model derived from comparable patients known to be cancer-free.Intervention
Urologists were categorized by their practice affiliation (single-specialty groups by size, multispecialty group) and ownership of a radiation facility.Outcome measurements and analysis
Use of intensity-modulated radiation therapy (IMRT) and use of any treatment within 1 yr of diagnosis. Generalized estimating equations were used to adjust for patient differences.Results
Among men with newly diagnosed prostate cancer, use of IMRT ranged from 24% in multispecialty groups to 37% in large urology groups (p < 0.001). Patients managed in groups with IMRT ownership (n = 5133) were more likely to receive IMRT than those managed by single-specialty groups without ownership (43% vs 30%, p < 0.001), regardless of group size. Among patients with a very high risk (> 75%) of noncancer mortality within 10 yr of diagnosis, both IMRT use (42% vs 26%, p < 0.001) and overall treatment (53% vs 44%, p < 0.001) were more likely in groups with ownership than in those without, respectively.Conclusions
Urologists practicing in single-specialty groups with an ownership interest in radiation therapy are more likely to treat men with prostate cancer, including those with a high risk of noncancer mortality.Patient summary
We assessed treatment for prostate cancer among urologists with varying levels of financial incentives favoring intervention. Those with stronger incentives, as determined by ownership interest in a radiation facility, were more likely to treat prostate cancer, even when treatment was unlikely to provide a survival benefit to the patient. 相似文献19.
C. Ludes A. Labani F. Severac M.Y. Jeung P. Leyendecker C. Roy M. Ohana 《Diagnostic and interventional imaging》2019,100(2):85-93
Purpose
To qualitatively and quantitatively compare unenhanced ultra-low-dose chest computed tomography (ULD-CT) acquired at 80 kVp and 135 kVp.Materials and methods
Fifty-one patients referred for unenhanced chest CT were prospectively included. There were 29 men and 22 women, with a mean age of 64.7 ± 11.6 (SD) years (range: 35–91 years) and a mean body mass index of 26.2 ± 6.3 (SD) (range: 17–54.9). All patients underwent two different ULD-CT protocols (80 kVp-40 mA and 135 kVp-10 mA). Image quality of both ULD-CT examinations using a 5-level scale as well as assessability of 6 predetermined lung parenchyma lesions were blindly evaluated by three radiologists and compared using a logistic regression model. Image noise of the two protocols was compared with Wilcoxon signed-rank test.Results
The mean dose-length product at 80 kVp and at 135 kVp were 14.7 ± 1.8 (SD) mGy.cm and 15.6 ± 1.9 (SD) mGy.cm, respectively (P < 0.001). Image noise was significantly lower at 135 kVp (58.9 ± 12.4) than at 80 kVp (74.7 ± 14.5) (P < 0.001). For all readers and for all examinations, the 135 kVp protocol yielded better image quality than 80 kVp protocol, with a mean qualitative score of 4.5 ± 0.7 versus 3.9 ± 0.8 (P < 0.001). The 135 kVp protocol was significantly more often of diagnostic quality than the 80 kvp protocol (92.3% versus 77.8%, respectively) (P < 0.001) and was less prone to image quality deterioration in obese patients. Parenchymal lesions were never better depicted on the 80 kVp protocol than with the 135 kVp protocol.Conclusion
Unenhanced chest ULD-CT should be acquired at a high kilovoltage and low current, such as 135 kVp-10 mA, over a low kilovoltage and high current protocol. 相似文献20.
Paolo Capogrosso Emily A. Vertosick Nicole E. Benfante James A. Eastham Peter J. Scardino Andrew J. Vickers John P. Mulhall 《European urology》2019,75(2):221-228