Taxane-based chemohormonal therapy for metastatic hormone-sensitive prostate cancer: a Cochrane Review

To provide a precis of the Cochrane Collaboration Review of taxane-based chemohormonal therapy for metastatic hormone-sensitive prostate cancer by Sathianathen NJ, Philippou YA, Kuntz GM et al. Cochrane Database of Systematic Reviews 2018, Issue 10. Art. No.: CD012816. https://doi.org/10.1002/14651858.cd012816.pub2 .     

Evidence of cancer progression as the cause of death in men with prostate cancer in Sweden

Objective

To assess the strength of the evidence indicative of prostate cancer (PCa) progression as the adjudicated cause of death, according to age at death and PCa risk category.

Patients and Methods

Using data from the Prostate Cancer data Base Sweden, we identified a study frame of 5543 men with PCa registered as the cause of death according to the Cause of Death Register. We assessed the evidence of PCa progression through a review of healthcare records for a stratified sample of 495/5543. We extracted data on prostate-specific antigen levels, presence of metastases on imaging, and PCa treatments, and quantified the evidence of disease progression using a points system.

Results

Both no evidence and moderate evidence for PCa progression was more common in men aged >85 years at death than those aged <85 years (29% vs 14%). Among the latter, the proportion with no evidence or moderate evidence for PCa progression was 21% for low-risk, 14% for intermediate-risk, 8% for high-risk, and 0% for metastatic PCa. In contrast, in men aged >85 years, there was little difference in the proportion with no evidence or moderate evidence of PCa progression between PCa risk categories; 31% for low-risk, 29% for intermediate-risk, 29% for high-risk, and 21% for metastatic PCa. Of the 5543 men who died from PCa, 13% (95% confidence interval 5–19%) were estimated to have either no evidence or moderate evidence of PCa progression.

Conclusions

Weak evidence for PCa progression as cause of death was more common in older men with PCa and in those with low-risk PCa. This has implications for interpretation of mortality statistics especially when assessing screening and early treatment of PCa because the beneficial effect of earlier diagnosis could be masked by erroneous adjudication of PCa as cause of death in older men, particular those with localised disease at diagnosis.     

Screening for prostate cancer: an updated Cochrane systematic review

OBJECTIVE

? To determine whether screening for prostate cancer reduces prostate cancer‐specific mortality, impact on all‐cause mortality and patient health‐related quality of life.

MATERIALS AND METHODS

? An update to our 2006 Cochrane systematic review was performed by re‐running an updated search of several databases, including MEDLINE and the Cochrane CENTRAL Register of Controlled Trials. ? Articles were included if they were a randomized controlled trial (RCT) examining screening vs no screening for prostate cancer. Data was collected and analysed according to the methods outlined in the Cochrane Handbook for Systematic Reviews of Interventions.

RESULTS

? Five RCTs with a total of 341 351 participants were included in this updated Cochrane systematic review. All involved PSA testing, although the interval and threshold for further evaluation varied across trials. The age of participants was 50–74 years, with durations of patient follow‐up of 7–15 years. ? The methodological quality of three of the studies was assessed as posing a high risk of bias. ? Meta‐analysis of the five included studies indicated no statistically significant difference in prostate cancer‐specific mortality between men randomized to screening and control [relative risk (RR) 0.95, 95% CI 0.85–1.07]. Sub‐group analyses indicated that prostate cancer‐specific mortality was not affected by age at which participants were screened. A pre‐planned analysis of a ‘core’ age group of men aged 55–69 years from the largest RCT (European Randomised Study of Screening for Prostate Cancer) reported a significant 20% relative reduction in prostate cancer‐specific mortality; (95% CI 0.65–0.98; absolute risk 0.71 per 1000 men). The number of men diagnosed with prostate cancer was significantly greater in men randomized to screening, compared with those randomized to control (RR 1.35, 95% CI 1.06–1.72). ? Harms of screening included high rates of false‐positive results for the PSA test, over‐diagnosis and adverse events associated with transrectal ultrasonography guided biopsies such as infection, bleeding and pain.

CONCLUSIONS

? Prostate cancer screening did not significantly decrease all‐cause or prostate cancer‐specific mortality in a combined meta‐analysis of five RCTs. ? Any benefits from prostate cancer screening may take >10 years to accrue; therefore, men who have a life expectancy of <10–15 years should be informed that screening for prostate cancer is not beneficial and has harms.     

男性脱发与前列腺癌发病风险的相关性:一项系统回顾和荟萃分析

目的:通过开展基于既往相关队列研究和病例对照研究的荟萃分析,研究男性脱发与前列腺癌发病风险的相关性。方法:文献检索自PubMed、Web of Science和中国知网数据库,检索截止时间为2017年5月30日。DerSimonian-Laird随机效应模型被用于计算合并后的RR和95%CI。结果:本项荟萃分析共纳入15项研究。在总体分析中,男性脱发(任何类型)与前列腺癌发病风险之间无相关性(RR=1.03,95%CI:0.96～1.11)。纳入研究之间存在显著的异质性(P=0.078,I^2=36.4%)。对脱发类型进行亚组分析,发现头顶脱发和前列腺癌发病风险显著相关(RR=1.24,95%CI:1.05～1.46),而其他类型的脱发则无相关性。结论:头顶脱发的男性可能具有较高的前列腺癌发病风险,但由于总体分析以及大多数的亚组分析结果阴性,并且研究之间存在一定的异质性,本研究结果还需进一步设计良好的前瞻性队列研究来验证。