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Salvage treatments after focal therapy for prostate cancer - a comprehensive review. 前列腺癌病灶治疗后的挽救治疗--全面回顾。
IF 5.1 2区 医学 Q1 ONCOLOGY Pub Date : 2024-08-01 DOI: 10.1038/s41391-024-00875-3
Lorenzo Storino Ramacciotti, Andre Luis Abreu, Sébastien Crouzet, Petr Macek, Brian J Miles, Rahim Horuz, Diogo Nunes-Carneiro, Phillip Stricker, Stephen Scionti, M Pilar Laguna

Objective: To review the literature on salvage treatments after focal therapy (FT) for prostate cancer (PCa).

Materials and methods: A non-systematic literature review was conducted on PubMed, Scopus, and Web of Science up to March 15, 2024, for studies that assessed salvage treatment outcomes in patients with recurrent PCa after primary FT. Original prospective and retrospective studies with more than 10 patients were included. Reviews, editorial comments, conference abstracts, and studies focusing solely on whole-gland treatments were excluded.

Results: Twenty-one studies with a total of 1012 patients were included. The most reported salvage treatments were salvage radical prostatectomy followed by re-do ablation therapy. Only one study evaluated salvage radiation therapy. Except for one prospective study, all studies were retrospective. Oncological outcomes showed acceptable biochemical recurrence rates. Functional outcomes varied, with significant impacts observed on erectile function across modalities, though continence rates were less impacted. Complications were generally low across all treatment options.

Conclusion: Salvage treatment post-primary FT is feasible, safe, and has reasonable oncologic outcomes. However, significant declines in sexual function are common, while continence is comparatively less affected. The literature primarily consists of retrospective studies; hence, future research should focus on large-scale prospective evaluations to better define treatment protocols and improve patient outcomes.

目的回顾前列腺癌(PCa)病灶治疗(FT)后挽救治疗的文献:截至 2024 年 3 月 15 日,我们在 PubMed、Scopus 和 Web of Science 上对评估原发性前列腺癌病灶治疗后复发 PCa 患者挽救治疗结果的研究进行了非系统性文献综述。纳入患者人数超过 10 人的原创前瞻性和回顾性研究。综述、编辑评论、会议摘要以及仅关注全腺治疗的研究均被排除在外:结果:共纳入 21 项研究,患者总数达 1012 人。报道最多的挽救治疗方法是挽救性前列腺癌根治术,然后再进行消融治疗。只有一项研究对挽救性放射治疗进行了评估。除一项前瞻性研究外,其他研究均为回顾性研究。肿瘤学结果显示生化复发率可以接受。功能性结果各不相同,各种模式对勃起功能都有显著影响,但对尿失禁率的影响较小。所有治疗方案的并发症普遍较低:结论:原发性前列腺癌术后的挽救治疗是可行的、安全的,并具有合理的肿瘤治疗效果。结论:原发性前列腺癌术后的挽救性治疗是可行的、安全的,并且具有合理的肿瘤治疗效果。然而,性功能明显下降是常见现象,而尿失禁受到的影响相对较小。文献主要由回顾性研究组成;因此,未来的研究应侧重于大规模的前瞻性评估,以更好地确定治疗方案并改善患者的预后。
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引用次数: 0
Reply to RE: Can ChatGPT provide high-quality patient information on male lower urinary tract symptoms suggestive of benign prostate enlargement? 回复 RE:ChatGPT 能否为提示良性前列腺增生的男性下尿路症状提供高质量的患者信息?
IF 5.1 2区 医学 Q1 ONCOLOGY Pub Date : 2024-07-31 DOI: 10.1038/s41391-024-00877-1
Angie K Puerto Nino, Valentina Garcia Perez, Silvia Secco, Cosimo De Nunzio, Riccardo Lombardo, Kari A O Tikkinen, Dean S Elterman
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引用次数: 0
Cardiovascular risks of androgen receptor targeted agents in prostate cancer: a systematic review and meta-analysis "PCAN-23-0763R". 雄激素受体靶向药物治疗前列腺癌的心血管风险:"PCAN-23-0763R "系统综述和荟萃分析。
IF 5.1 2区 医学 Q1 ONCOLOGY Pub Date : 2024-07-29 DOI: 10.1038/s41391-024-00873-5
J W Yaxley, B Fitzgerald
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引用次数: 0
Refining clinically relevant cut-offs of prostate specific antigen density for risk stratification in patients with PI-RADS 3 lesions. 完善前列腺特异性抗原密度的临床相关临界值,对 PI-RADS 3 病变患者进行风险分层。
IF 5.1 2区 医学 Q1 ONCOLOGY Pub Date : 2024-07-24 DOI: 10.1038/s41391-024-00872-6
Georges Mjaess, Laura Haddad, Teddy Jabbour, Arthur Baudewyns, Henri-Alexandre Bourgeno, Yolène Lefebvre, Mariaconsiglia Ferriero, Giuseppe Simone, Alexandre Fourcade, Georges Fournier, Marco Oderda, Paolo Gontero, Adrian Bernal-Gomez, Alessandro Mastrorosa, Jean-Baptiste Roche, Rawad Abou Zahr, Guillaume Ploussard, Gaelle Fiard, Adam Halinski, Katerina Rysankova, Charles Dariane, Gina Delavar, Julien Anract, Nicolas Barry Delongchamps, Alexandre Patrick Bui, Fayek Taha, Olivier Windisch, Daniel Benamran, Gregoire Assenmacher, Jan Benijts, Karsten Guenzel, Thierry Roumeguère, Alexandre Peltier, Romain Diamand

Background: Prostate Imaging Reporting and Data System (PI-RADS) 3 lesions, identified through multiparametric magnetic resonance imaging (mpMRI), present a clinical challenge due to their equivocal nature in predicting clinically significant prostate cancer (csPCa). Aim of the study is to improve risk stratification of patients with PI-RADS 3 lesions and candidates for prostate biopsy.

Methods: A cohort of 4841 consecutive patients who underwent MRI and subsequent MRI-targeted and systematic biopsies between January 2016 and April 2023 were retrospectively identified from independent prospectively maintained database. Only patients who have PI-RADS 3 lesions were included in the final analysis. A multivariable logistic regression analysis was performed to identify covariables associated with csPCa defined as International Society of Urological Pathology (ISUP) grade group ≥2. Performance of the model was evaluated using the area under the receiver operating characteristic curve (AUC), calibration, and net benefit. Significant predictors were then selected for further exploration using a Chi-squared Automatic Interaction Detection (CHAID) analysis.

Results: Overall, 790 patients had PI-RADS 3 lesions and 151 (19%) had csPCa. Significant associations were observed for age (OR: 1.1 [1.0-1.1]; p = 0.01) and PSA density (OR: 1643 [2717-41,997]; p < 0.01). The CHAID analysis identified PSAd as the sole significant factor influencing the decision tree. Cut-offs for PSAd were 0.13 ng/ml/cc (csPCa detection rate of 1% vs. 18%) for the two-nodes model and 0.09 ng/ml/cc and 0.16 ng/ml/cc for the three-nodes model (csPCa detection rate of 0.5% vs. 2% vs. 17%).

Conclusions: For individuals with PI-RADS 3 lesions on prostate mpMRI and a PSAd below 0.13, especially below 0.09, prostate biopsy can be omitted, in order to avoid unnecessary biopsy and overdiagnosis of non-csPCa.

背景:前列腺成像报告和数据系统(PI-RADS)3病变是通过多参数磁共振成像(mpMRI)确定的,由于其在预测有临床意义的前列腺癌(csPCa)方面的不确定性,给临床带来了挑战。该研究旨在改进对 PI-RADS 3 病变患者和前列腺活检候选者的风险分层:方法:从独立的前瞻性数据库中回顾性地确定了 2016 年 1 月至 2023 年 4 月间接受磁共振成像及随后接受磁共振成像靶向和系统性活检的 4841 例连续患者。只有 PI-RADS 3 病变的患者才被纳入最终分析。进行了多变量逻辑回归分析,以确定与国际泌尿病理学会(ISUP)分级组≥2的csPCa相关的协变量。使用接收者操作特征曲线下面积 (AUC)、校准和净效益评估了模型的性能。然后使用卡方自动交互检测(CHAID)分析选出重要的预测因子进行进一步探讨:共有 790 名患者有 PI-RADS 3 病变,其中 151 人(19%)患有 csPCa。年龄(OR:1.1 [1.0-1.1];P = 0.01)和 PSA 密度(OR:1643 [2717-41,997];P 结论:PI-RADS 3 级病变的患者中,151 人(19%)患有 csPCa:对于前列腺 mpMRI 显示 PI-RADS 3 病变且 PSAd 低于 0.13(尤其是低于 0.09)的患者,可以不进行前列腺活检,以避免不必要的活检和非前列腺癌的过度诊断。
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引用次数: 0
Intraoperative technologies to assess margin status during radical prostatectomy - a narrative review. 根治性前列腺切除术中评估边缘状态的术中技术 - 综述。
IF 5.1 2区 医学 Q1 ONCOLOGY Pub Date : 2024-07-18 DOI: 10.1038/s41391-024-00868-2
O Windisch, M Diana, D Tilki, G Marra, A Martini, M Valerio

Positive surgical margin (PSM) is a frequent concern for surgeons performing radical prostatectomy for prostate cancer (PCa). PSM are recognized as risk factors for earlier biochemical recurrence and expose patients to adjuvant or salvage treatments such as external radiotherapy and hormonotherapy. Several strategies have been established to reduce PSM rate, while still allowing safe nerve-sparing surgery. Precise preoperative staging by multiparametric magnetic resonance imaging (mpMRI) and fusion biopsy is recommended to identify suspicious areas of extracapsular extension (ECE) that warrant special attention during dissection. However, even with optimal imaging, ECE can be missed, some cancers are not well defined or visible, and capsular incision during surgery remains an issue. Hence, intraoperative frozen section techniques, such as the neurovascular structure-adjacent frozen section examination (NeuroSAFE) have been developed and lately widely disseminated. The NeuroSAFE technique reduces PSM rate while allowing higher rate of nerve-sparing surgery. However, its use is limited to high volume or expert center because of its high barrier-to-entry in terms of logistics, human resources and expertise, as well as cost. Also, NeuroSAFE is a time-consuming process, even in expert hands. To address these issues, several technologies have been developed for an ex vivo and in vivo use. Ex vivo technology such as fluorescent confocal microscopy and intraoperative PET-CT require the extraction of the specimen for preparation, and digital images acquisition. In vivo technology, such as augmented reality based on mpMRI images and PSMA-fluorescent guided surgery have the advantage to provide an intracorporeal analysis of the completeness of the resection. The current manuscript provides a narrative review of established techniques, and details several new and promising techniques for intraoperative PSM assessment.

手术切缘阳性(PSM)是外科医生对前列腺癌(PCa)进行根治性前列腺切除术时经常会遇到的问题。手术切缘阳性被认为是早期生化复发的风险因素,并使患者面临辅助或挽救治疗,如体外放射治疗和激素治疗。目前已制定了几种策略来降低 PSM 发生率,同时仍能进行安全的保留神经手术。建议通过多参数磁共振成像(mpMRI)和融合活检进行精确的术前分期,以确定可疑的囊外扩展(ECE)区域,从而在解剖时给予特别关注。然而,即使采用了最佳的成像技术,ECE 仍有可能被遗漏,有些癌症的定义不清或不可见,手术中的囊切口仍是一个问题。因此,术中冰冻切片技术(如神经血管结构邻近冰冻切片检查(NeuroSAFE))应运而生,并在近期得到广泛传播。NeuroSAFE 技术可降低 PSM 发生率,同时提高神经保留手术率。然而,由于其在物流、人力资源和专业知识以及成本方面的高门槛,其使用仅限于高容量或专家中心。此外,即使在专家手中,NeuroSAFE 也是一个耗时的过程。为了解决这些问题,已经开发出几种体内外使用的技术。体外技术,如荧光共聚焦显微镜和术中 PET-CT,需要提取标本进行准备,并获取数字图像。体内技术,如基于 mpMRI 图像的增强现实技术和 PSMA 荧光引导手术,则具有提供切除完整性体内分析的优势。本手稿对已有技术进行了叙述性回顾,并详细介绍了几种用于术中 PSM 评估的前景广阔的新技术。
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引用次数: 0
Body composition as a determinant of the therapeutic index with androgen signaling inhibition. 身体成分是雄激素信号抑制治疗指数的决定因素。
IF 5.1 2区 医学 Q1 ONCOLOGY Pub Date : 2024-07-17 DOI: 10.1038/s41391-024-00870-8
Andrew W Hahn, Rebecca S Tidwell, Patrick G Pilie, Yao Yu, Jingjing Liu, Devaki Shilpa Surasi, Mark Titus, Jianhua Zhang, Neha Venkatesh, Theocharis Panaretakis, Justin R Gregg, Amado J Zurita, Bilal A Siddiqui, Paul G Corn, Sumit K Subudhi, Pavlos Msaouel, Efstratios Koutroumpakis, Chad D Huff, Ana Aparicio, Jennifer L McQuade, Daniel E Frigo, Christopher J Logothetis

Background: Androgen signaling is central to prostate cancer and men's health. Prior data indicates that increasing body fat is unfavorable in the localized setting yet associated with favorable outcomes in men with metastatic disease. Understanding the biological links between adiposity and prostate cancer may optimize the therapeutic index with ASI. We hypothesized that host adiposity and androgen synthesis are linked to the efficacy and toxicity of ASI for men with metastatic castration-resistant prostate cancer (mCRPC).

Methods: A post-hoc analysis was done of NCT02703623 where men with mCRPC (n = 186) were treated for 8 weeks with abiraterone acetate, prednisone, and apalutamide (AAPA), and a satisfactory response was defined as a PSA decline >50%. Body composition was measured on baseline CT scans. Germline DNA WES was performed with a focus on variants in steroidogenic genes. Adipokine levels were measured in pre-treatment plasma.

Results: Germline polymorphisms in 3 genes involved in androgen synthesis (AKR1C3 rs12529, CYP17A1 rs6162, SRD5A2 rs523349) were associated with differences in body composition at baseline on ADT alone (prior to receipt of AAPA). Elevated subcutaneous adipose tissue index (SATi, p = 0.02), visceral adipose tissue index (VATi, p = 0.03), and BMI (p = 0.04) were associated with satisfactory response to AAPA. Leptin had positive correlation with VATi (r = 0.47) and SATi (r = 0.48).

Conclusion: Inherited polymorphisms in androgen synthesis correlated with differences in body composition after exposure to ADT and warrant further investigation as candidate markers for body composition toxicity. Elevated subcutaneous and visceral adiposity were associated with improved response to ASI.

背景:雄激素信号对前列腺癌和男性健康至关重要。先前的数据表明,增加体内脂肪不利于局部治疗,但却与男性转移性疾病的良好预后有关。了解脂肪与前列腺癌之间的生物学联系可优化 ASI 的治疗指数。我们假设,宿主脂肪和雄激素合成与 ASI 对转移性耐受性前列腺癌(mCRPC)患者的疗效和毒性有关:对NCT02703623进行了事后分析,mCRPC男性患者(n = 186)接受了为期8周的醋酸阿比特龙、泼尼松和阿帕鲁胺(AAPA)治疗,PSA下降>50%即为满意反应。通过基线CT扫描测量身体成分。进行了种系 DNA WES 检测,重点是类固醇生成基因的变异。对治疗前血浆中的脂肪因子水平进行了测量:结果:3个参与雄激素合成的基因(AKR1C3 rs12529、CYP17A1 rs6162、SRD5A2 rs523349)的种系多态性与单用ADT时(接受AAPA治疗前)基线身体成分的差异有关。皮下脂肪组织指数(SATi,p = 0.02)、内脏脂肪组织指数(VATi,p = 0.03)和体重指数(BMI,p = 0.04)的升高与对 AAPA 的满意反应相关。瘦素与VATi(r = 0.47)和SATi(r = 0.48)呈正相关:结论:雄激素合成的遗传多态性与暴露于 ADT 后身体成分的差异相关,值得作为身体成分毒性的候选标记进一步研究。皮下和内脏脂肪含量升高与 ASI 反应改善有关。
{"title":"Body composition as a determinant of the therapeutic index with androgen signaling inhibition.","authors":"Andrew W Hahn, Rebecca S Tidwell, Patrick G Pilie, Yao Yu, Jingjing Liu, Devaki Shilpa Surasi, Mark Titus, Jianhua Zhang, Neha Venkatesh, Theocharis Panaretakis, Justin R Gregg, Amado J Zurita, Bilal A Siddiqui, Paul G Corn, Sumit K Subudhi, Pavlos Msaouel, Efstratios Koutroumpakis, Chad D Huff, Ana Aparicio, Jennifer L McQuade, Daniel E Frigo, Christopher J Logothetis","doi":"10.1038/s41391-024-00870-8","DOIUrl":"https://doi.org/10.1038/s41391-024-00870-8","url":null,"abstract":"<p><strong>Background: </strong>Androgen signaling is central to prostate cancer and men's health. Prior data indicates that increasing body fat is unfavorable in the localized setting yet associated with favorable outcomes in men with metastatic disease. Understanding the biological links between adiposity and prostate cancer may optimize the therapeutic index with ASI. We hypothesized that host adiposity and androgen synthesis are linked to the efficacy and toxicity of ASI for men with metastatic castration-resistant prostate cancer (mCRPC).</p><p><strong>Methods: </strong>A post-hoc analysis was done of NCT02703623 where men with mCRPC (n = 186) were treated for 8 weeks with abiraterone acetate, prednisone, and apalutamide (AAPA), and a satisfactory response was defined as a PSA decline >50%. Body composition was measured on baseline CT scans. Germline DNA WES was performed with a focus on variants in steroidogenic genes. Adipokine levels were measured in pre-treatment plasma.</p><p><strong>Results: </strong>Germline polymorphisms in 3 genes involved in androgen synthesis (AKR1C3 rs12529, CYP17A1 rs6162, SRD5A2 rs523349) were associated with differences in body composition at baseline on ADT alone (prior to receipt of AAPA). Elevated subcutaneous adipose tissue index (SATi, p = 0.02), visceral adipose tissue index (VATi, p = 0.03), and BMI (p = 0.04) were associated with satisfactory response to AAPA. Leptin had positive correlation with VATi (r = 0.47) and SATi (r = 0.48).</p><p><strong>Conclusion: </strong>Inherited polymorphisms in androgen synthesis correlated with differences in body composition after exposure to ADT and warrant further investigation as candidate markers for body composition toxicity. Elevated subcutaneous and visceral adiposity were associated with improved response to ASI.</p>","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":null,"pages":null},"PeriodicalIF":5.1,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141634342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clinical implications of Wnt pathway genetic alterations in men with advanced prostate cancer. 晚期前列腺癌男性 Wnt 通路基因改变的临床意义。
IF 5.1 2区 医学 Q1 ONCOLOGY Pub Date : 2024-07-17 DOI: 10.1038/s41391-024-00869-1
Amanda Broderick, Elizabeth Pan, Jinju Li, Alec Chu, Clara Hwang, Pedro C Barata, Frank Cameron Cackowski, Matthew Labriola, Alyssa Ghose, Mehmet Asim Bilen, Deepak Kilari, Bicky Thapa, Michael Piero, Laura Graham, Abhishek Tripathi, Rohan Garje, Vadim S Koshkin, Erik Hernandez, Tanya B Dorff, Michael Thomas Schweizer, Ajjai Shivaram Alva, Rana R McKay, Andrew J Armstrong

Background: Aberrant Wnt signaling has been implicated in prostate cancer tumorigenesis and metastasis in preclinical models but the impact of genetic alterations in Wnt signaling genes in men with advanced prostate cancer is unknown.

Methods: We utilized the Prostate Cancer Precision Medicine Multi-Institutional Collaborative Effort (PROMISE) clinical-genomic database for this retrospective analysis. Patients with activating mutations in CTNNB1 or RSPO2 or inactivating mutations in APC, RNF43, or ZNRF3 were defined as Wnt-altered, while those lacking such alterations were defined as Wnt non-altered. We compared patient characteristics and clinical outcomes as well as co-occurring genetic alterations according to Wnt alteration status.

Results: Of the 1498 patients included, 193 (12.9%) were Wnt-altered. These men had a statistically significant 2-fold increased prevalence of liver and lung metastases as compared with Wnt non-altered patients at the time of initial diagnosis, (4.66% v 2.15% ; 6.22% v 3.07%), first metastatic disease diagnosis (10.88% v 5.29%; 13.99% v 6.21%), and CRPC development (11.40% v 6.36%; 12.95% v 5.29%). Wnt alterations were associated with more co-occurring alterations in RB1 (10.4% v 6.2%), AR (38.9% vs 25.7%), SPOP (13.5% vs 4.1%), FOXA1 (6.7% vs 2.8%), and PIK3CA (10.9% vs 5.1%). We found no significant differences in overall survival or other clinical outcomes from initial diagnosis, first metastatic disease, diagnosis of CRPC, or with AR inhibition for mCRPC between the Wnt groups.

Conclusions: Wnt-altered patients with prostate cancer have a higher prevalence of visceral metastases and are enriched in RB1, AR, SPOP, FOXA1, and PIK3CA alterations. Despite these associations, Wnt alterations were not associated with worse survival or treatment outcomes in men with advanced prostate cancer.

背景:在临床前模型中,Wnt 信号转导异常与前列腺癌的肿瘤发生和转移有关,但 Wnt 信号转导基因的遗传改变对晚期前列腺癌男性患者的影响尚不清楚:我们利用前列腺癌精准医学多机构协作努力(PROMISE)临床基因组数据库进行了这项回顾性分析。CTNNB1或RSPO2发生激活突变或APC、RNF43或ZNRF3发生灭活突变的患者被定义为Wnt改变患者,而没有发生此类改变的患者被定义为Wnt非改变患者。我们根据 Wnt 改变状态比较了患者特征、临床结果以及并发遗传改变:在纳入的 1498 名患者中,有 193 人(12.9%)发生了 Wnt 改变。与未发生 Wnt 改变的患者相比,这些男性患者在初次诊断(4.66% 对 2.15%;6.22% 对 3.07%)、首次转移性疾病诊断(10.88% 对 5.29%;13.99% 对 6.21%)和 CRPC 发展(11.40% 对 6.36%;12.95% 对 5.29%)时的肝脏和肺部转移发生率在统计学上显著增加了 2 倍。Wnt改变与更多的RB1(10.4% vs 6.2%)、AR(38.9% vs 25.7%)、SPOP(13.5% vs 4.1%)、FOXA1(6.7% vs 2.8%)和PIK3CA(10.9% vs 5.1%)共存改变相关。我们发现,从最初诊断、首次转移性疾病、诊断为CRPC或使用AR抑制剂治疗mCRPC开始,Wnt组之间的总生存期或其他临床结果没有明显差异:结论:Wnt改变的前列腺癌患者内脏转移率较高,且富含RB1、AR、SPOP、FOXA1和PIK3CA改变。尽管存在这些关联,但Wnt改变与晚期前列腺癌男性患者更差的生存期或治疗效果无关。
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引用次数: 0
Effect of metformin on incidence, recurrence, and mortality in prostate cancer patients: integrating evidence from real-world studies. 二甲双胍对前列腺癌患者发病率、复发率和死亡率的影响:整合来自真实世界研究的证据。
IF 5.1 2区 医学 Q1 ONCOLOGY Pub Date : 2024-07-16 DOI: 10.1038/s41391-024-00871-7
Yuchen Liu, Qingfang Zhang, Xuan Huang

Purpose: Metformin has been suggested to reduce the risk of cancer. However, previous studies have been inconsistent regarding the relationship between metformin use and the risk of occurrence of prostate cancer (PCa). The purpose of this study was to assess the effect of metformin on clinical outcomes in patients with PCa in a meta-analysis and to explore the possible dose-response relationship.

Methods: A systematic literature search was conducted in 10 electronic databases and 4 registries. The combined relative risks (RRs) were calculated using a random-effects model with 95% confidence interval (CIs) to assess the effect of metformin on the risk of PCa. Relevant subgroup analyses and sensitivity analyses were performed.

Results: The across studies results show that metformin use associated with lower incidence of PCa (RR: 0.82, 95% CI: 0.74-0.91). Metformin use was also found to reduce PCa recurrence, but the results were not statistically significant (RR: 0.97, 95% CI: 0.81-1.15). Metformin use was not associated with PCa mortality (RR: 0.94, 95% CI: 0.81-1.09). The results of subgroup analyses indicated that the type of study was a cohort study and the population came from both Asia and Europe showed that taking metformin reduced the incidence of PCa. A linear correlation was found between the duration of metformin use and its protective effect.

Conclusions: This meta-analysis revealed an independent correlation between metformin use and reduced incidence of PCa. Metformin use was not associated with either PCa recurrence rate or mortality. Furthermore, the effect of metformin on PCa incidence was found to be related to duration.

目的:二甲双胍被认为可以降低患癌风险。然而,关于二甲双胍的使用与前列腺癌(PCa)发病风险之间的关系,以往的研究结果并不一致。本研究旨在通过一项荟萃分析评估二甲双胍对PCa患者临床预后的影响,并探讨可能存在的剂量-反应关系:在10个电子数据库和4个登记处进行了系统性文献检索。采用随机效应模型计算合并相对风险(RRs)和95%置信区间(CIs),以评估二甲双胍对PCa风险的影响。研究还进行了相关的亚组分析和敏感性分析:各项研究结果表明,服用二甲双胍可降低 PCa 的发病率(RR:0.82,95% CI:0.74-0.91)。使用二甲双胍还能降低 PCa 复发率,但结果在统计学上并不显著(RR:0.97,95% CI:0.81-1.15)。二甲双胍与 PCa 死亡率无关(RR:0.94,95% CI:0.81-1.09)。亚组分析结果表明,研究类型为队列研究,研究对象来自亚洲和欧洲,结果显示服用二甲双胍可降低 PCa 的发病率。服用二甲双胍的时间长短与其保护作用呈线性相关:这项荟萃分析表明,服用二甲双胍与降低 PCa 发病率之间存在独立的相关性。使用二甲双胍与 PCa 复发率或死亡率均无关。此外,二甲双胍对 PCa 发病率的影响还与持续时间有关。
{"title":"Effect of metformin on incidence, recurrence, and mortality in prostate cancer patients: integrating evidence from real-world studies.","authors":"Yuchen Liu, Qingfang Zhang, Xuan Huang","doi":"10.1038/s41391-024-00871-7","DOIUrl":"https://doi.org/10.1038/s41391-024-00871-7","url":null,"abstract":"<p><strong>Purpose: </strong>Metformin has been suggested to reduce the risk of cancer. However, previous studies have been inconsistent regarding the relationship between metformin use and the risk of occurrence of prostate cancer (PCa). The purpose of this study was to assess the effect of metformin on clinical outcomes in patients with PCa in a meta-analysis and to explore the possible dose-response relationship.</p><p><strong>Methods: </strong>A systematic literature search was conducted in 10 electronic databases and 4 registries. The combined relative risks (RRs) were calculated using a random-effects model with 95% confidence interval (CIs) to assess the effect of metformin on the risk of PCa. Relevant subgroup analyses and sensitivity analyses were performed.</p><p><strong>Results: </strong>The across studies results show that metformin use associated with lower incidence of PCa (RR: 0.82, 95% CI: 0.74-0.91). Metformin use was also found to reduce PCa recurrence, but the results were not statistically significant (RR: 0.97, 95% CI: 0.81-1.15). Metformin use was not associated with PCa mortality (RR: 0.94, 95% CI: 0.81-1.09). The results of subgroup analyses indicated that the type of study was a cohort study and the population came from both Asia and Europe showed that taking metformin reduced the incidence of PCa. A linear correlation was found between the duration of metformin use and its protective effect.</p><p><strong>Conclusions: </strong>This meta-analysis revealed an independent correlation between metformin use and reduced incidence of PCa. Metformin use was not associated with either PCa recurrence rate or mortality. Furthermore, the effect of metformin on PCa incidence was found to be related to duration.</p>","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":null,"pages":null},"PeriodicalIF":5.1,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141627475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
RE: "Can ChatGPT provide high-quality patient information on male lower urinary tract symptoms suggestive of benign prostate enlargement?" RE: "ChatGPT 能否为男性下尿路症状提示良性前列腺增生提供高质量的患者信息?
IF 5.1 2区 医学 Q1 ONCOLOGY Pub Date : 2024-07-16 DOI: 10.1038/s41391-024-00874-4
Hinpetch Daungsupawong, Viroj Wiwanitkit
{"title":"RE: \"Can ChatGPT provide high-quality patient information on male lower urinary tract symptoms suggestive of benign prostate enlargement?\"","authors":"Hinpetch Daungsupawong, Viroj Wiwanitkit","doi":"10.1038/s41391-024-00874-4","DOIUrl":"10.1038/s41391-024-00874-4","url":null,"abstract":"","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":null,"pages":null},"PeriodicalIF":5.1,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141627476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effects of high-intensity interval training on cardiometabolic biomarkers in patients with prostate cancer undergoing active surveillance: a randomized controlled trial. 高强度间歇训练对接受主动监测的前列腺癌患者心脏代谢生物标志物的影响:随机对照试验。
IF 5.1 2区 医学 Q1 ONCOLOGY Pub Date : 2024-07-15 DOI: 10.1038/s41391-024-00867-3
Dong-Woo Kang, Catherine J Field, Dhruvesh Patel, Adrian S Fairey, Normand G Boulé, Christina M Dieli-Conwright, Kerry S Courneya

Purpose: To report the effects of a 12-week high-intensity interval training (HIIT) program on cardiometabolic biomarkers in patients with prostate cancer on active surveillance (AS) from the Exercise During Active Surveillance for Prostate Cancer (ERASE) Trial.

Methods: Fifty-two men with prostate cancer on AS were randomized to either an exercise (HIIT; n = 26) or usual care (UC; n = 26) group. The HIIT intervention consisted of progressive, supervised, aerobic HIIT at an intensity of 85 to 95% VO2peak for 28 to 40 min per session performed three times/week for 12 weeks. Blood samples were collected at baseline and postintervention to analyze cardiometabolic biomarkers. Analysis of covariance was used to examine between-group mean differences.

Results: Blood data were obtained from 49/52 (94%) participants at postintervention. Participants were aged 63.4 ± 7.1 years and 40% were obese. The HIIT group attended 96% of the planned exercise sessions. No significant between-group changes in weight were observed after the intervention. Compared to UC, HIIT significantly improved total cholesterol (-0.40 mmol/L; 95% confidence interval[CI], -0.70 to -0.10; p = 0.011), non-high-density lipoprotein-c (-0.35 mmol/L; 95% CI, -0.60 to -0.11; p = 0.006), insulin (-13.6 pmol/L; 95% CI, -25.3 to -1.8; p = 0.025), insulin-like growth factor (IGF)-1 (-15.0 ng/mL; 95% CI, -29.9 to -0.1; p = 0.048), and IGF binding protein (IGFBP)-3 (152.3 ng/mL; 95% CI, 12.6 to 292.1; p = 0.033). No significant differences were observed for fasting glucose, HbA1c, other lipid markers, IGFBP-1, adiponectin, and leptin.

Conclusions: The ERASE Trial showed that a 12-week aerobic HIIT program improved several cardiometabolic biomarkers in patients with prostate cancer on AS that may contribute to cardiovascular health benefits and potentially influence signaling pathways in the progression of prostate cancer. Further research is needed to confirm the effects of exercise on cardiometabolic markers in men with prostate cancer on AS and determine if these effects are associated with improved long-term clinical outcomes.

目的:报告为期12周的高强度间歇训练(HIIT)计划对前列腺癌患者心脏代谢生物标志物的影响:52名接受主动监测的前列腺癌男性患者被随机分配到运动组(HIIT;26人)或常规护理组(UC;26人)。HIIT干预包括循序渐进、有监督的有氧HIIT,强度为85%至95% VO2peak,每次28至40分钟,每周三次,持续12周。在基线和干预后收集血液样本以分析心脏代谢生物标志物。采用协方差分析法检验组间平均差异:49/52(94%)名参与者在干预后获得了血液数据。参与者的年龄为(63.4 ± 7.1)岁,40%为肥胖。HIIT 组参加了计划运动课程的 96%。干预后,组间体重无明显变化。与 UC 相比,HIIT 显著改善了总胆固醇(-0.40 mmol/L;95% 置信区间[CI],-0.70 至 -0.10;p = 0.011)、非高密度脂蛋白-c(-0.35 mmol/L;95% CI,-0.60 至 -0.11;p = 0.006)、胰岛素(-13.6 pmol/L;95% CI,-25.3 至 -1.8;p = 0.025)、胰岛素样生长因子(IGF)-1(-15.0 ng/mL;95% CI,-29.9 至 -0.1;p = 0.048)和 IGF 结合蛋白(IGFBP)-3(152.3 ng/mL;95% CI,12.6 至 292.1;p = 0.033)。空腹血糖、HbA1c、其他血脂指标、IGFBP-1、脂肪连素和瘦素均无明显差异:ERASE试验表明,为期12周的有氧HIIT计划改善了前列腺癌患者在AS治疗过程中的多种心脏代谢生物标志物,这可能有助于心血管健康,并可能影响前列腺癌进展的信号通路。还需要进一步的研究来证实运动对前列腺癌男性患者心血管代谢标志物的影响,并确定这些影响是否与长期临床结果的改善有关。
{"title":"Effects of high-intensity interval training on cardiometabolic biomarkers in patients with prostate cancer undergoing active surveillance: a randomized controlled trial.","authors":"Dong-Woo Kang, Catherine J Field, Dhruvesh Patel, Adrian S Fairey, Normand G Boulé, Christina M Dieli-Conwright, Kerry S Courneya","doi":"10.1038/s41391-024-00867-3","DOIUrl":"https://doi.org/10.1038/s41391-024-00867-3","url":null,"abstract":"<p><strong>Purpose: </strong>To report the effects of a 12-week high-intensity interval training (HIIT) program on cardiometabolic biomarkers in patients with prostate cancer on active surveillance (AS) from the Exercise During Active Surveillance for Prostate Cancer (ERASE) Trial.</p><p><strong>Methods: </strong>Fifty-two men with prostate cancer on AS were randomized to either an exercise (HIIT; n = 26) or usual care (UC; n = 26) group. The HIIT intervention consisted of progressive, supervised, aerobic HIIT at an intensity of 85 to 95% VO<sub>2peak</sub> for 28 to 40 min per session performed three times/week for 12 weeks. Blood samples were collected at baseline and postintervention to analyze cardiometabolic biomarkers. Analysis of covariance was used to examine between-group mean differences.</p><p><strong>Results: </strong>Blood data were obtained from 49/52 (94%) participants at postintervention. Participants were aged 63.4 ± 7.1 years and 40% were obese. The HIIT group attended 96% of the planned exercise sessions. No significant between-group changes in weight were observed after the intervention. Compared to UC, HIIT significantly improved total cholesterol (-0.40 mmol/L; 95% confidence interval[CI], -0.70 to -0.10; p = 0.011), non-high-density lipoprotein-c (-0.35 mmol/L; 95% CI, -0.60 to -0.11; p = 0.006), insulin (-13.6 pmol/L; 95% CI, -25.3 to -1.8; p = 0.025), insulin-like growth factor (IGF)-1 (-15.0 ng/mL; 95% CI, -29.9 to -0.1; p = 0.048), and IGF binding protein (IGFBP)-3 (152.3 ng/mL; 95% CI, 12.6 to 292.1; p = 0.033). No significant differences were observed for fasting glucose, HbA1c, other lipid markers, IGFBP-1, adiponectin, and leptin.</p><p><strong>Conclusions: </strong>The ERASE Trial showed that a 12-week aerobic HIIT program improved several cardiometabolic biomarkers in patients with prostate cancer on AS that may contribute to cardiovascular health benefits and potentially influence signaling pathways in the progression of prostate cancer. Further research is needed to confirm the effects of exercise on cardiometabolic markers in men with prostate cancer on AS and determine if these effects are associated with improved long-term clinical outcomes.</p>","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":null,"pages":null},"PeriodicalIF":5.1,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141620786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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Prostate Cancer and Prostatic Diseases
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