Systematic review and meta‐analysis of acupuncture to reduce cancer‐related pain

We conducted a systematic review and meta‐analysis to evaluate the effects of acupuncture on malignancy‐related, chemotherapy (CT)‐ or radiation therapy (RT)‐induced, surgery‐induced, and hormone therapy (HT)‐induced pain. Randomised controlled trials (RCTs) examining the effects of acupuncture on cancer‐related pain were reached from the EMBASE, PubMed, PsycINFO, Cochrane Central Register of Controlled Trials, CINAHL, Airiti library, Taiwan Electrical Periodical Service, Wanfang Data (a Chinese database) and China Knowledge Resource Integrated Database from inception through June 2014. Heterogeneity, moderator analysis, publication bias and risk of bias associated with the included studies were examined. A total of 29 RCTs yielding 36 effect sizes were included. The overall effect of acupuncture on cancer‐related pain was ?0.45 [95% confidence interval (CI) = ?0.63 to ?0.26]. The subanalysis indicated that acupuncture relieved malignancy‐related and surgery‐induced pain [effect size (g) = ?0.71, and ?0.40; 95% CI = ?0.94 to ?0.48, and ?0.69 to ?0.10] but not CT‐ or RT‐induced and HT‐induced pain (g = ?0.05, and ?0.64, 95% CI = ?0.33 to 0.24, and ?1.55 to 0.27). Acupuncture is effective in relieving cancer‐related pain, particularly malignancy‐related and surgery‐induced pain. Our findings suggest that acupuncture can be adopted as part of a multimodal approach for reducing cancer‐related pain.     

Prostate cancer‐specific mortality and the extent of therapy in healthy elderly men with high‐risk prostate cancer

BACKGROUND:

The risk of prostate cancer‐specific mortality (PCSM) in healthy elderly men may depend on extent of treatment. The authors of this report compared the use of brachytherapy alone with combined brachytherapy, external‐beam radiation to the prostate and seminal vesicles, and androgen‐suppression therapy (CMT) in this population.

METHODS:

The study cohort comprised 764 men aged ≥65 years with high‐risk prostate cancer (T3 or T4N0M0, prostate‐specific antigen >20 ng/mL, and/or Gleason score 8‐10) who received either brachytherapy alone (n = 206) or CMT (n = 558) at the Chicago Prostate Cancer Center or at a 21st Century Oncology facility. Men either had no history of myocardial infarction (MI) or had a history of MI treated with a stent or surgical intervention. Fine and Gray regression analysis was used to identify the factors associated with PCSM.

RESULTS:

The median patient age was 73 years (interquartile range, 70‐77 years). After a median follow‐up of 4.9 years, 25 men died of prostate cancer. After adjusting for age and prostate cancer prognostic factors, the risk of PCSM was significantly less (adjusted hazard ratio, 0.29; 95% confidence interval, 0.12‐0.68; P = .004) for men who received CMT than for men who received brachytherapy alone. Other factors that were associated significantly with an increased risk of PCSM included a Gleason score of 8 to 10 (P = .017).

CONCLUSIONS:

Elderly men who had high‐risk prostate cancer without cardiovascular disease or with surgically corrected cardiovascular disease had a lower risk of PCSM when they received CMT than when they received brachytherapy alone. These results support aggressive locoregional treatment in healthy elderly men with high‐risk prostate cancer. Cancer 2010. © 2010 American Cancer Society.     

Psychotropic drugs for the management of cancer‐related fatigue: a systematic review and meta‐analysis

Cancer‐related fatigue (CRF) is a common symptom affecting 60–90% of cancer survivors, and effective management for CRF is not yet available. Recently, an increasing number of trials examining the use of psychotropic drugs for the treatment of CRF have been performed, but these trials have yielded inconsistent results. Therefore, we conducted a meta‐analysis aimed at assessing the effect and safety of psychotropic drugs for the management of CRF. Ten eligible trials of the psychotropic drugs methylphenidate and modafinil in a total of 1582 participants treated for CRF were subjected to statistical analyses. A meta‐analysis of seven of these studies indicated that methylphenidate was superior to placebo for the treatment of CRF. Another meta‐analysis of three studies evaluating modafinil found that this drug was no better than placebo. Adverse events were similar between both methylphenidate and modafinil and the placebo groups. Our meta‐analysis indicated that the treatment of CRF with methylphenidate appears to be effective, whereas modafinil provides no benefit. These results of this analysis warrant further trials to confirm the efficacy and safety of psychotropic drugs for the treatment of CRF.     

Optimizing skeletal‐related events prevention in patients with advanced prostate cancer

In patients with metastatic castration‐resistant prostate cancer (mCRPC), bone is a dominant site of metastasis. Bone metastases often lead to skeletal‐related events (SREs), which include pain, spinal cord compression and fractures. The treatment of bone metastases in men with mCRPC aims to improve SRE‐free survival, quality of life and clinical outcomes. Effective treatment options include antiresorptive bone‐targeted agents such as zoledronic acid and denosumab, and radium‐223, a bone‐targeting radiopharmaceutical. Although overseas and local guidelines have widely recommended using either zoledronic acid or denosumab for the prevention of SREs in men with mCRPC and associated bone metastases, current evidence suggests that denosumab is superior to zoledronic acid in terms of longer SRE‐free time and fewer total SREs observed in patients.     

前列腺癌患者血清睾酮水平、前列腺雄激素受体表达与精索静脉曲张相关研究

目的：研究血清睾酮水平、前列腺雄激素受体（AR）表达与精索静脉曲张的相关性,为临床前列腺疾病诊治提供一定理论依据。方法选取未经药物治疗的64例前列腺癌患者,其中实验组为32例前列腺癌合并精索静脉曲张患者,对照组为32例前列腺癌不伴精索静脉曲张患者,记录两组患者一般情况,并行血清睾酮水平、前列腺雄激素受体检测及病理组织学检查。结果对照组血清睾酮水平为（5.89±1.32）ng/ml,实验组血清睾酮值为（6.07±1.16）ng/ml,差异无统计学意义（P﹥0.05）。实验组前列腺雄激素受体的阳性表达率为62.5%,低于对照组84.4%,差异有统计学意义（P﹤0.05）。AR的表达均与伴精索静脉曲张前列腺癌分期呈负相关（r=-0.318, P﹤0.05）。结论前列腺雄激素受体表达在前列腺癌精索静脉曲张的发病及病情进展中发挥了重要的作用。     

Association between human papillomavirus infection and prostate cancer: A global systematic review and meta‐analysis

Although an increasing number of studies have been conducted to evaluate the association between human papillomavirus (HPV) infections and distribution of HPV types worldwide with the risk of prostate cancer (PC), the results remain inadequate. Hence, we investigated the association between HPV infection and PC risk using a meta‐analysis. Relevant studies from January 1990 to December 2016 were searched in PubMed, Web of sciences, and Scopus databases. Pooled odds ratio (OR) and their corresponding 95% confidence interval (CI) were calculated to find the association between the prevalence of HPV and prostate cancer risk. To do so, data from 24 studies with 5546 prostate cancer cases were pooled in order to evaluate the heterogeneity of chief parameters including study region, specimen type, HPV DNA source, detection technique, publication calendar period, and Gleason score. All statistical analyses were performed using STATA 11 and MedCalc 13. A significant positive association was found between HPV infection and PC risk (OR = 1.281; P = 0.026). The genotype 16 was more frequently found in patients with PC which significantly increased the cancer risk (OR = 1.60; P < 0.001). Age 65 and older could significantly escalate PC risk (OR = 3.564; P < 0.001). Our results clearly favor the potential pathogenetic link between HPV infection and increased risk of PC affirming that HPV infections could play a part in the risk of PC.     

Quo vadis: Advanced prostate cancer—clinical care and clinical research in the era of multiple androgen receptor‐directed therapies

The novel androgen receptor‐directed therapies abiraterone acetate and enzalutamide, having demonstrated improved survival in randomized phase 3 studies of men with metastatic castration‐resistant prostate cancer, have ushered in a new era in the treatment of this disease. Additional novel androgen receptor‐directed therapies, such as ARN‐509 and orteronel, are in various phases of clinical trials and development. However, the emergence of therapeutic resistance and clinical disease progression is inevitable. Although advances in genomic technologies have led to unprecedented understanding of the biology of castration‐resistant prostate cancer, efforts only now are underway to elucidate the mechanisms of resistance associated with abiraterone and enzalutamide. A tremendous challenge in the near future will be to determine the optimal sequence or combination of therapies to overcome resistance mechanisms. In this review, the current landscape of androgen receptor‐directed therapies and future directions necessary to enhance their clinical efficacy for the maximal benefit of patients are discussed. Cancer 2015;121:361–371. © 2014 American Cancer Society.     

Identification and prediction of health‐related quality of life trajectories after a prostate cancer diagnosis

The aim of our study was to identify physical and mental health‐related quality of life (HRQoL) trajectories after a prostate cancer diagnosis and systematically characterize trajectories by behaviours and prognostic factors. Prostate cancer survivors (n = 817) diagnosed between 1997 and 2000 were recruited between 2000 and 2002 into a prospective repeated measurements study. Behavioural/prognostic data were collected through in‐person interviews and questionnaires. HRQoL was collected at three post‐diagnosis time‐points, approximately 2 years apart using the Short Form (SF)?36 validated questionnaire. To identify physical and mental HRQoL trajectories, group‐based trajectory modelling was undertaken. Differences between groups were evaluated by assessing influential dropouts (mortality/poor health), behavioural/prognostic factors at diagnosis or during the follow‐up. Three trajectories of physical HRQoL were identified including: average‐maintaining HRQoL (32.2%), low‐declining HRQoL (40.5%) and very low‐maintaining HRQoL (27.3%). In addition, three trajectories for mental HRQoL were identified: average‐increasing HRQoL (66.5%), above average‐declining HRQoL (19.7%) and low‐increasing HRQoL (13.8%). In both physical and mental HRQoL, dropout from mortality/poor health differed between trajectories, thus confirming HRQoL and mortality were related. Furthermore, increased Charlson comorbidity index score was consistently associated with physical and mental HRQoL group membership relative to average maintaining groups, while behaviours such as time‐varying physical activity was associated with physical HRQoL trajectories but not mental HRQoL trajectories. It was possible to define three trajectories of physical and mental HRQoL after prostate cancer. These data provide insights regarding means for identifying subgroups of prostate cancer survivors with lower or declining HRQoL after diagnosis whom could be targeted for interventions aimed at improving HRQoL.     

Exercise for the management of cancer‐related fatigue in lung cancer: a systematic review

Cancer‐related fatigue is a common, persistent and disabling side‐effect of the cancer and its treatments. Exercise, once was contraindicated, is now the key non‐pharmacological management for cancer‐related fatigue. However, the role of exercise in lung cancer cohort is not clear. A computerised database search was undertaken using keyword search in the CENTRAL, PubMed, EMBASE, CINAHL, SPORTDiscus, AMED and Web of Science. Ten relevant articles were reviewed; the evidence on this cohort was found to be limited, warrants further research. However, the available evidence from other than lung cancer groups shows significant beneficial effects of exercises on cancer‐related fatigue. Hence, exercises could possibly be used in the management of cancer‐related fatigue in this cohort with due caution until more robust evidences are available.