Targeted and Systematic Prostate Biopsy in Biopsy-naive Men With Positive Multiparameter Magnetic Resonance Imaging Findings: A Meta-analysis

We assessed the difference in the detection rate of prostate cancer, specifically clinically significant prostate cancer, using targeted biopsy (TB), systematic biopsy (SB), and the combination of these 2 (CB) in biopsy-naive men with positive multiparameter magnetic resonance imaging results. We performed a literature review in September 2018 using PubMed and the Web of Science. Relevant studies acquired from specific articles’ references were also reviewed. Only those studies that had provided the detection rate of TB, SB, and CB in biopsy-naive men with positive multiparameter magnetic resonance imaging findings were included for a total of 11 studies with 2099 patients. The combined strategy was better than TB or SB alone, with an odds ratio (OR) of 1.47 (95% confidence interval [CI], 1.30-1.67; P < .001) and 1.45 (95% CI, 1.28-1.65; P < .001), respectively, in the overall detection rate. Also, TB was not better than SB, with an OR of 0.99 (95% CI, 0.87-1.12; P = .825). For the clinically significant prostate cancer detection rate, CB was still better than TB or SB alone, with an OR of 1.25 (95% CI, 1.11-1.42; P < .001) and an OR of 1.23 (95% CI, 1.08-1.40; P = .002), respectively. Again, TB was not better than SB, with an OR of 0.98 (95% CI, 0.86-1.12; P = .768). In conclusion, CB resulted in a better detection rate than TB or SB alone for both the overall prostate cancer detection rate and the clinically significant prostate cancer detection rate.     

Active Surveillance for Intermediate-Risk Prostate Cancer: Systematic Review and Meta-analysis of Current Protocols and Outcomes

IntroductionCurrent guidelines allow active surveillance for intermediate-risk prostate cancer patients but do not provide comprehensive recommendations for selection. We performed a systematic review and meta-analysis of outcomes for active surveillance in intermediate- and low-risk groups.MethodsWe performed a systematic literature search of intermediate-risk localized prostate cancer patients undergoing active surveillance using 3 literature search engines (Medline, Web of Science, and Scopus) over the past 10 years. The primary outcome was the percentage of patients who remain under surveillance. Secondary outcomes included cancer-specific survival, overall survival, and metastasis-free survival. For articles including both low- and intermediate-risk patients undergoing active surveillance, comparisons between the two groups were made.ResultsThe proportion of patients who remained on active surveillance was comparable between the low- and intermediate-risk groups after 10 and 15 years’ follow-up (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.83–1.14; and OR, 0.86; 95% CI, 0.65–1.13). Cancer-specific survival was worse in the intermediate-risk group after 10 years (OR, 0.47; 95% CI, 0.31–0.69) and 15 years (OR, 0.34; 95% CI, 0.2–0.58). The overall survival rate showed no statistical difference at 5 years’ follow-up (OR, 0.84; 95% CI, 0.45–1.57) but was worse in the intermediate-risk group after 10 years (OR, 0.43; 95% CI, 0.35–0.53). Metastases-free survival did not significantly differ after 5 years (OR, 0.55; 95% CI, 0.2–1.53) and was worse in the intermediate-risk group after 10 years (OR, 0.46; 95% CI, 0.28–0.77).ConclusionActive surveillance could be offered to patients with intermediate-risk prostate cancer. However, they should be informed of the need for regular monitoring and the possibility of discontinuation as a result of a higher rate of progression. Available data indicate that 5-year survival rates between intermediate- and low-risk patients do not differ; 10-year survival rates are worse. To assess the long-term effectiveness and safety of active surveillance, it is necessary to develop unified algorithms for patient selection and management, and to prospectively conduct studies with long-term surveillance.     

Utility of Anterior Zone Biopsy in Men Enrolled in Active Surveillance for Prostate Cancer

Background

Anterior zone (AZ) disease is present in one-fifth of men with newly diagnosed prostate cancer and has been associated with poor pathologic features. However, anterior targeted biopsies are not a routine part of active surveillance (AS) protocols. Our purpose is to assess the utility of AZ sampling for prostate biopsy in patients undergoing surveillance for low-risk prostate cancer.

Diagnostic Performance of the Prostate Cancer Antigen 3 Test in Prostate Cancer: Systematic Review and Meta-analysis

PurposeTo explore the diagnostic accuracy of prostate cancer antigen 3 (PCA3) test for the diagnosis of prostate cancer in this systematic review and meta-analysis.Patients and MethodsA systematic literature search of Medline, Embase, and Cochrane Library databases up to October 2019 was performed. The sensitivity, specificity, and diagnostic odds ratio with 95% confidence intervals (CIs) were calculated. The summary receiver operator characteristic graph came from individual studies. We also conducted metaregression analysis to identify the moderated factors.ResultsAcross 54 studies (17,575 patients), the pooled sensitivity, specificity, and diagnostic odds ratio of PCA3 were 0.71 (95% CI, 0.67-0.74), 0.68 (95% CI, 0.63-0.74), and 5.28 (95% CI, 4.28-6.51), respectively. The area under the summary receiver operator characteristic curve was 0.75 (95% CI, 0.71-0.79).ConclusionPooled data indicated that the PCA3 test had moderate sensitivity and specificity in the diagnosis of prostate cancer. PCA3 could be used as a noninvasive method for the diagnosis of prostate cancer.     

Franzán Transrectal Fine-Needle Biopsy Versus Ultrasound-Guided Transrectal Core Biopsy of the Prostate Gland

Digitally-guided transrectal fine-needle aspiration biopsy was compared with ultrasound-guided transrectal core biopsy of the prostate gland. Both biopsy techniques were equally effective in detecting prostate cancer. Core biopsies were generally graded higher than fine-needle aspirations. the reproducibility was approximately 80% for both methods.     

Fine-Needle Aspiration Biopsy with A New Automatic Fine-Needle Gun Versus Histological Core in Ultrasonically-Guided Transrectal Biopsy for Detection of Prostate Cancer

In connection with a health control study of 2 400 men for early detection of prostate cancer the authors have compared fine-needle aspiration biopsy using a new automatic he-needle gun with histological cores obtained by the Biopty gun. Both procedures were ultrasonically guided. Prostate cancer was found in 62 patients and in 46 of these both biopsy methods were used on the same occasion. There was no essential difference in sensitivity between the two methods. the authors recommend fine-needle aspiration biopsy as the primary method but regard the histological core technique as a valuable supplement.     

Comparison of Cancer Detection Rates Between TRUS-Guided Biopsy and MRI-Targeted Biopsy According to PSA Level in Biopsy-Naive Patients: A Propensity Score Matching Analysis

Background

The purpose of the study was to compare cancer detection rates between 12-core transrectal ultrasound-guided prostate biopsy (TRUS-Bx) and multiparametric magnetic resonance imaging (mpMRI)-guided target prostate biopsy (MRI-TBx) according to prostate-specific antigen (PSA) level in biopsy-naive patients.

经会阴饱和穿刺对前列腺癌的诊断价值

目的探讨经会阴饱和穿刺对前列腺癌的诊断价值。方法 184例符合入选标准的患者随机分为观察组和对照组。观察组96例采用经会阴饱和穿刺活检,对照组88例采用经直肠穿刺活检,对比分析2组患者的穿刺活检阳性率和安全性。结果观察组的总阳性率比对照组高,差异有统计学意义(P<0.05)。当PSA<10.0μg/L和≥10.0~20.0μg/L时,观察组的阳性率比对照组高,差异有统计学意义(P<0.05);当PSA>20.0~50.0μg/L和>50.0μg/L时,观察组的阳性率与对照组相比无显著差异(P>0.05)。观察组的发热、尿路感染、肉眼血尿、血便、直肠出血这些并发症的发生率均比对照组低,差异有统计学意义(P<0.05)。而观察组的尿潴留的发生率和对照组比较,差异无统计学意义(P>0.05)。结论经会阴饱和穿刺活检能提高前列腺癌的检出率,并发症发生率低,值得临床推广。     

Ultrasound of the Prostate and Its use for Guided Biopsy

The development of ultrasound diagnostics of the prostate is described. With modern ultrasound technique in combination with guided biopsy transrectal ultrasound (TRUS) is a powerful diagnostic means and very likely today's best screening tool (if screening would be regarded as feasible). the author advocates transrectal core biopsy instead of fine-needle aspiration biopsy as histology does not have false positives and forms a firmer basis for grading.     

乳腺癌患者原发性肺癌发生风险的系统评价和Meta分析

目的 系统评价乳腺癌患者发生原发性肺癌的风险.方法 通过计算机检索Medline、Scopus以及Embase数据库中有关乳腺癌患者发生原发性肺癌风险的英文文献.由两位研究者独立完成筛选文献、提取资料以及评估偏倚风险后,采用Stata 15.5软件进行统计分析.结果 共纳入7篇文献,女性乳腺癌患者发生原发性肺癌的总体风...     

Bisphosphonates for Osteoporosis in Nonmetastatic Prostate Cancer Patients Receiving Androgen-deprivation Therapy: A Systematic Review and Meta-analysis

This systematic review was conducted to assess the efficacy and safety of bisphosphonates for preventionand treatment of osteopenia or osteoporosis in men with non-metastatic prostate cancer receiving androgendeprivationtherapy. We searched for randomised controlled trials (RCTs) of bisphosphonates compared withplacebo from Pubmed, Embase, the Cochrane Library, and ISI - Science Citation Index. Meta-analyses of prespecifiedoutcomes (bone mineral density, fractures, and adverse events) were performed using Review Manager.Ten RCTs with a total patient population of 1,017 were identified. There was generally more improvement in bonemineral density of the lumbar spine for patients who received bisphosphonate treatment than placebo or othermedical treatment at 12 months (WMD 6.02,95%CI 5.39 to 6.65). Similar effects were also observed for totalhip, trochanter or femoral neck bone mineral density. However, there was no significant reduction in fractures.Fever and gastrointestinal symptoms were the most common adverse events (10.4% vs. 1.2%; 0.10% vs. 0.03%).Currently, our meta-analysis suggested that oral and intravenous bisphosphonates caused a rapid increasein spine and hip or femoral BMD in non-metastatic prostate cancer patients receiving androgen-deprivationtherapy. Fever and gastrointestinal symptoms were common with the use of bisphosphonates. These short-termtrials (maximum of 12 months) did not show fracture reduction. In future, more efficient performance of higherquality, more rigorous, large sample, long-term randomised controlled trials (>12 months) are needed whereoutcomes are detailed.     

Laparoscopic Versus Open Surgery for Rectal Cancer: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Background and Aim: Laparoscopic and open rectum surgery for rectal cancer remains controversial.This systematic review compared the short-term and long-term efficiency and complications associated withlaparoscopic and open resection for rectal cancer. Materials and Methods: We searched PubMed, Embase,Cochrane Library, ISI Web of Knowledge and the China Biology Medicine Database to identify potentialrandomized controlled trials from their inception to March 31, 2014 without language restriction. Additionalarticles were identified from searching bibliographies of retrieved articles. Two reviewers independently assessedthe full-text articles according to the pre-specified inclusion and exclusion criteria as well as the methodologicalquality of included trials. The meta-analysis was performed using RevMan 5.2. Results: A total of 16 randomizedcontrolled trials involving 3,045 participants (laparoscopic group, 1,804 cases; open group, 1,241 cases) werereviewed. Laparoscopic surgery was associated with significantly lower intraoperative blood loss, earlier returnof bowel movement and reduced length of hospital stay as compared to open surgery, although with increasedoperative time. It also showed an obvious advantage for minimizing late complications of adhesion-related bowelobstruction. Importantly, there were no significant differences in other postoperative complications, oncologicalclearance, 3-year and 5-year or 10 year recurrence and survival rates between two procedures. Conclusions: Onthe basis of this meta-analysis we conclude that laparoscopic surgery has advantages of earlier postoperativerecovery, less blood loss and lower rates of adhesion-related bowel obstruction. In addition, oncological outcomeis comparable after laparoscopic and open resection for rectal cancer.     

Active Surveillance Versus Radical Prostatectomy in Favorable-risk Localized Prostate Cancer

BackgroundActive surveillance (AS) and radical prostatectomy (RP) are both accepted treatments for men with favorable-risk localized prostate cancer (PCa) (ie, clinical tumor category 1-2b, Gleason Grade Group 1-2, and prostate-specific antigen < 20 ng/mL). However, head-to-head studies comparing oncologic outcomes and survival between these 2 treatment strategies are warranted. The objective of this study was to compare the use of prostate cancer treatments and PCa death in men managed on AS and men who underwent immediate RP.Patients and MethodsThis was an observational study including 647 men on AS and 647 men treated with RP propensity score matched. We examined the 10-year cumulative incidence of salvage radiotherapy, hormonal therapy, castration-resistant PCa, and PCa death.ResultsThe 10-year curative treatment-free survival for men on AS was 61% (95% confidence interval [CI], 57%-65%). No differences in use of salvage radiotherapy (AS, 2.7%; 95% CI, 1.4%-4.1% vs. RP 5.4%; 95% CI, 3.4%-7.3%), hormonal therapy (AS, 6.9%; 95% CI, 4.4%-9.4% vs. RP, 4.1%; 95% CI, 2.5%-5.6%), developing castration-resistant PCa (AS, 1.7%; 95% CI, 0.5%-2.9% vs. RP, 2.0%; 95% CI, 0.7%-3.4%), or cumulative PCa mortality (AS, 0.4%; 95% CI, 0%-1.0% vs. RP, 0.5%; 95% CI, 0%-1.5%) were observed between the treatment strategies. The main limitation was the non-random allocation to treatment strategy.ConclusionIn this observational study on men with favorable-risk localized PCa, we found similar PCa mortality at 10 years between men on AS and men who underwent immediate RP. Moreover, there were no differences in the use of PCa therapies between the groups. Our study supports active surveillance as a treatment strategy for men with favorable-risk localized PCa.     

Targeted and Systematic Biopsy for Diagnosis and Management of Prostate Cancer

The value of multi-parametric magnetic resonance imaging in the detection of clinically-significant prostate cancer is increasingly well-established, and has been adopted in current diagnostic pathways and clinical guidelines. Concurrently, the role of conventional ultrasound-guided systematic prostate biopsy is increasingly questioned. In this brief review, we evaluate the continued value of systematic biopsy including a review of prospective studies on targeted and systemic biopsies in the same patients. We also address current limitations of multi-parametric magnetic resonance imaging of the prostate.     

Prognostic Value of Lactate Dehydrogenase in Metastatic Prostate Cancer: A Systematic Review and Meta-analysis

The purpose of this study was to assess the prognostic value of lactate dehydrogenase (LDH) in patients with metastatic prostate cancer (PC). A systematic review and meta-analysis was performed in March 2019 according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. Studies were deemed eligible if they compared patients with PC with high versus low LDH to determine the predictive value of LDH for overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS). We performed a formal meta-analysis for both OS and PFS. A total of 59 articles with 14,851 patients were included in the systematic review and 45 studies with 12,224 patients for the qualitative assessment. High LDH was associated with both worse OS (pooled hazard ratio [HR], 2.07; 95% confidence interval [CI], 1.75-2.44) and PFS (pooled HR, 1.08; 95% CI, 1.01-1.16). In subgroup analyses of both patients with castration-resistant prostate cancer (CRPC) and those with hormone-sensitive prostate cancer (HSPC), LDH was associated with OS (pooled HR, 2.02; 95% CI, 1.69-2.42 and pooled HR, 2.25; 95% CI, 1.78-2.84, respectively). In patients with CRPC, LDH was associated with OS in those treated with docetaxel systemic chemotherapy and androgen receptor–axis-targeting agents (pooled HR, 2.03; 95% CI, 1.37-3.00 and pooled HR, 1.79; 95% CI, 1.25-2.57, respectively). Elevated serum levels of LDH were associated with an increased risk of mortality and progression in patients with metastatic PC. LDH was independently associated with OS in both patients with CRPC and HSPC. LDH could be integrated into prognostic tools that help guide treatment strategy, thereby facilitating the shared decision-making process.     

Prognostic Value of Vascular Endothelial Growth Factor Expression in Patients with Prostate Cancer: a Systematic Review with Meta-analysis

Background: The vascular endothelial growth factor (VEGF) mediates vasculogenesis and angiogenesisthrough promoting endothelial cell growth, migration and mitosis, and has involvement in cancer pathogenesis,progression and metastasis. However, the prognostic value of VEGF in patients with prostate cancer remainscontroversial. Objectives: The aim of our study was to evaluate the prognostic value of VEGF in prostate cancer,and summarise the results of related research on VEGF. Methods: In accordance with an established searchstrategy, 11 studies with 1,529 patients were included in our meta-analysis. The correlation of VEGF-expressionwith overall survival and progression-free survival was evaluated by hazard ratio, either given or calculated.Results: The studies were categorized by introduction of the author, demographic data in each study, prostatecancer-relatived information, VEGF cut-off value, VEGF subtype, methods of hazard ratio (HR) estimationand its 95% confidence interval (CI). High VEGF-expression in prostate cancer is a poor prognostic factor withstatistical significance for OS (HR=2.32, 95%CI: 1.40–3.24). However, high VEGF-expression showed no effecton poor PFS (HR=1.30, 95%CI: 0.88–1.72). Using Begg’s, Egger’s test and funnel plots, we confirmed lack ofpublication bias in our analysis. Conclusion: VEGF might be regarded as a prognostic maker for prostate cancer,as supported by our meta-analysis. To achieve a more definitive conclusion enabling the clinical use of VEGF inprostate cancer, we need more high-quality interventional original studies following agreed research approachesor standards.     

Effectiveness of Platinum-Based Chemotherapy in Patients With Metastatic Prostate Cancer: Systematic Review and Meta-analysis

BackgroundTaxanes are the only cytotoxic drugs that have demonstrated a survival benefit for patients with castration-resistant prostate cancer (CRPC), but there is some evidence that platinum compounds may also benefit such patients.MethodsWe performed a systematic search on electronic databases. We sought prospective clinical studies testing platinum compounds for CRPC. Platinum compounds could be delivered alone or in combination with other drugs. Both randomized and nonrandomized studies were included for qualitative synthesis, only randomized studies were included for meta-analyses. Clinical overall response rate (cORR), prostate-specific antigen overall response rate (sORR), progression-free survival (PFS), overall survival (OS), and toxicity were the outcomes of interest.ResultsWe identified 53 studies delivering platinum agents for patients with CRPC. cORR varied from 0 to 82%, while sORR varied from 2% to 100%. Response rates were higher in patients who received combination treatments rather than platinum compounds alone. Pooled data from randomized trials demonstrated a statistically significant increase in both cORR (odds ratio = 5.3; 95% confidence interval, 1.89-14.92) and sORR (odds ratio = 2.07; 95% confidence interval, 1.33-3.22) when adding platinum compounds to chemotherapy. PFS varied from 2.1 to 12 months and OS 4.2 to 28 months with platinum-containing chemotherapy. Nausea and myelosuppression were the most common adverse effects. Toxicity was manageable in most studies.ConclusionPlatinum compounds are a safe and active treatment for CRPC. Response rates are higher when cytotoxic chemotherapy containing platinum agents are compared to nonplatinum chemotherapy. Data on OS and PFS are inconclusive. More research is needed to evaluate whether platinum-based chemotherapy results in a survival benefit for patients with CRPC, as well as to establish predictive biomarkers.     

Abiraterone for Treatment of Metastatic Castration-resistant Prostate Cancer: a Systematic Review and Meta-analysis

Introduction: Although most prostate cancers initially respond to castration with luteinizing hormonereleasinganalogues or bilateral orchiectomy, progression eventually occurs. Based on the exciting results ofseveral randomized controlled trials (RCTs), it seems that patients with metastatic castration-resistant prostatecancer (mCRPC) might benefit more from treatment withabiraterone. Therefore we conducted a systematicreview to evaluate the efficacy and toxicity of abiraterone in the treatment of mCRPC. Methods: Literaturewas searched from Embase, PubMed, Web of Science, and Cochrane Library up to July, 2013. Quality of thestudy was evaluated according to the Cochrane’s risk of bias of randomized controlled trial (RCT) tool, then theGrading of Recommendations Assessment, Development and Evaluation (GRADE) System was used to rate thelevel of evidence. Stata 12.0 was used for statistical analysis. Summary data from RCTs comparing abirateroneplus prednisone versus placebo plus prednisone for mCRPC were meta-analyzed. Pooled hazard ratios (HRs)for overall survival (OS), radiographic progression-free survival (RPFS) and time to PSA progression (TTPP);Pooled risk ratios (RR) for PSA response rate, objective response rate and adverse event were calculated. Results:Ten trials were included in the systematic review; Data of 2,283 patients (1,343 abiraterone; 940 placebo) fromtwo phase 3 trials: COU-AA-301 and COU-AA-302 were meta-analyzed. Compared with placebo, abirateronesignificantly prolonged OS (HR, 0.74; 95% confidence interval [CI], 0.66 to 0.84), RPFS (HR, 0.59; 95% CI,0.48 to 0.74) and time to PSA progression (HR, 0.55; 95% CI, 0.43 to 0.70); it also significantly increased PSAresponse rate (RR, 3.63; 95% CI, 1.72 to 7.65) and objective response rate (RR, 3.05; 95% CI, 1.51 to 6.15). Thismeta-analysis suggested that the adverse events caused by abiraterone are acceptable and can be controlled.Conclutios: Abiraterone significantly prolonged OS, RPFS and time to progression patients with mCRPC,regardless of prior chemotherapy or whether chemotherapy-naïve, and no unexpected toxicity was evident.Abiraterone can serve as a new standard therapy for mCRPC.     

Overexpression of Periostin in Tumor Biopsy Samples Is Associated With Prostate Cancer Phenotype and Clinical Outcome

Background

Overexpression of periostin (POSTN) is associated with prostate cancer (PCa) aggressiveness. We investigated the prognostic significance of POSTN expression in tumor biopsy samples of patients with PCa.