N. Sathianathen, M. Furrer, C. Weight, D. Murphy, Shilpa Gupta, N. Lawrentschuk
Background Approximately 15% to 20% of patients will experience disease recurrence following surgical removal of renal cell carcinoma. A range of pharmacological agents is prescribed for metastatic renal cell carcinoma, but there are trials testing whether these have an earlier role in the adjuvant setting. We aim to assess the efficacy of adjuvant systemic treatment following surgery in patients with renal cell carcinoma and to determine the most effective treatment. Methods The protocol for this review was published in PROSPERO (CRD42021281588). We searched multiple databases up to August 2021. We included only randomized trials of patients with renal cell carcinoma that had been completely resected. We included patients with locoregional nodal disease if it was surgically removed, and excluded all cases of metastatic disease. We included all adjuvant systemic therapies that were commenced within 90 days of renal surgery. A network meta-analysis was performed using a frequentist approach. Results A total of 13 studies with 8103 patients were included for analysis. Only pembrolizumab (HR 0.74; 95%CI 0.57 to 0.96) and pazopanib (HR 0.80; 95%CI 0.68 to 0.95) improved disease-free survival compared with observation. These 2 treatments were the 2 highest ranked comparisons with a P-score of 0.87 and 0.80. No agent improved overall survival. All agents increased the risk of severe adverse events compared with observation. Conclusions Pembrolizumab and pazopanib were the only 2 adjuvant agents that improved time to disease recurrence compared with observation, with the former likely being the more efficacious. None of the treatments improved overall survival and almost all increased severe adverse events. Introduction
{"title":"Adjuvant Systemic Treatment for Renal Cancer After Surgery: A Network Meta-Analysis","authors":"N. Sathianathen, M. Furrer, C. Weight, D. Murphy, Shilpa Gupta, N. Lawrentschuk","doi":"10.48083/wixm2804","DOIUrl":"https://doi.org/10.48083/wixm2804","url":null,"abstract":"Background Approximately 15% to 20% of patients will experience disease recurrence following surgical removal of renal cell carcinoma. A range of pharmacological agents is prescribed for metastatic renal cell carcinoma, but there are trials testing whether these have an earlier role in the adjuvant setting. We aim to assess the efficacy of adjuvant systemic treatment following surgery in patients with renal cell carcinoma and to determine the most effective treatment. Methods The protocol for this review was published in PROSPERO (CRD42021281588). We searched multiple databases up to August 2021. We included only randomized trials of patients with renal cell carcinoma that had been completely resected. We included patients with locoregional nodal disease if it was surgically removed, and excluded all cases of metastatic disease. We included all adjuvant systemic therapies that were commenced within 90 days of renal surgery. A network meta-analysis was performed using a frequentist approach. Results A total of 13 studies with 8103 patients were included for analysis. Only pembrolizumab (HR 0.74; 95%CI 0.57 to 0.96) and pazopanib (HR 0.80; 95%CI 0.68 to 0.95) improved disease-free survival compared with observation. These 2 treatments were the 2 highest ranked comparisons with a P-score of 0.87 and 0.80. No agent improved overall survival. All agents increased the risk of severe adverse events compared with observation. Conclusions Pembrolizumab and pazopanib were the only 2 adjuvant agents that improved time to disease recurrence compared with observation, with the former likely being the more efficacious. None of the treatments improved overall survival and almost all increased severe adverse events. Introduction","PeriodicalId":21961,"journal":{"name":"Société Internationale d’Urologie Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77117921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mohammed Lotfi Amer, H. Mumtaz, B. Russell, Jason Gan, Z. Rehman, Rajesh M. Nair, R. Thurairaja, Muhammad S. Khan
Objective To report changing practice in the management of intra-diverticular bladder tumours. Methods We undertook a review of all intra-diverticular bladder tumours in our prospectively maintained institutional database. Results A total of 28 patients (male = 27, female = 1) with a median age of 71 years (IQR 61 to 76) were diagnosed with intra-diverticular bladder tumours (IDBT) between March 2013 and February 2021. Fourteen had visible and 3 had non-visible haematuria, while 11 patients had lower urinary tract symptoms. Median axial diameter of the diverticula was 46 mm (IQR 35 to 69), and median neck diameter was 9 mm (IQR 7 to 11). All patients had CT-urography and 5 patients also had an MRI. Surgical treatment consisted of diverticulectomy (n = 11), diverticulectomy and ipsilateral ureteric reimplantation (n = 11), radical cystectomy and ileal conduit (n = 4), or radical cystectomy and orthotopic bladder (n = 2). Eleven patients had open procedures, and 17 had robotic assisted surgery. Final pathological stages were T0 (n = 2), Ta (n = 5), T1 (n = 7), T3a (n = 8) and T3b (n = 6). Twenty-four patients had urothelial carcinoma (including one nested variant and 4 with squamous differentiation) and 2 had small cell carcinoma. Three patients had neoadjuvant systemic chemotherapy, 2 had intravesical bacillus Calmette-Guerin (BCG) with mitomycin, and one had BCG monotherapy preoperatively. Five patients had adjuvant systemic chemotherapy while 7 had adjuvant intravesical therapies. Mean follow-up period was 37.8 months (±25.3). Mean recurrence-free survival was 61.5% (CI 45.7 to 77.4) and mean overall survival 71.6 % (CI 57.4 to 85.8). Ten patients (37%) died of cancer. Conclusion Management of intra-diverticular bladder tumours is evolving. Bladder-sparing approaches are gaining popularity. Robot-assisted diverticulectomy is preferable as it reduces the morbidity resulting from treatment.
{"title":"Intra-Diverticular Bladder Tumours: How to Manage Rationally","authors":"Mohammed Lotfi Amer, H. Mumtaz, B. Russell, Jason Gan, Z. Rehman, Rajesh M. Nair, R. Thurairaja, Muhammad S. Khan","doi":"10.48083/jclw6772","DOIUrl":"https://doi.org/10.48083/jclw6772","url":null,"abstract":"Objective To report changing practice in the management of intra-diverticular bladder tumours. Methods We undertook a review of all intra-diverticular bladder tumours in our prospectively maintained institutional database. Results A total of 28 patients (male = 27, female = 1) with a median age of 71 years (IQR 61 to 76) were diagnosed with intra-diverticular bladder tumours (IDBT) between March 2013 and February 2021. Fourteen had visible and 3 had non-visible haematuria, while 11 patients had lower urinary tract symptoms. Median axial diameter of the diverticula was 46 mm (IQR 35 to 69), and median neck diameter was 9 mm (IQR 7 to 11). All patients had CT-urography and 5 patients also had an MRI. Surgical treatment consisted of diverticulectomy (n = 11), diverticulectomy and ipsilateral ureteric reimplantation (n = 11), radical cystectomy and ileal conduit (n = 4), or radical cystectomy and orthotopic bladder (n = 2). Eleven patients had open procedures, and 17 had robotic assisted surgery. Final pathological stages were T0 (n = 2), Ta (n = 5), T1 (n = 7), T3a (n = 8) and T3b (n = 6). Twenty-four patients had urothelial carcinoma (including one nested variant and 4 with squamous differentiation) and 2 had small cell carcinoma. Three patients had neoadjuvant systemic chemotherapy, 2 had intravesical bacillus Calmette-Guerin (BCG) with mitomycin, and one had BCG monotherapy preoperatively. Five patients had adjuvant systemic chemotherapy while 7 had adjuvant intravesical therapies. Mean follow-up period was 37.8 months (±25.3). Mean recurrence-free survival was 61.5% (CI 45.7 to 77.4) and mean overall survival 71.6 % (CI 57.4 to 85.8). Ten patients (37%) died of cancer. Conclusion Management of intra-diverticular bladder tumours is evolving. Bladder-sparing approaches are gaining popularity. Robot-assisted diverticulectomy is preferable as it reduces the morbidity resulting from treatment.","PeriodicalId":21961,"journal":{"name":"Société Internationale d’Urologie Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91553007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Urology in Syria: A View From Inside","authors":"Khaled Altopajee, M. Shahait","doi":"10.48083/irjo4841","DOIUrl":"https://doi.org/10.48083/irjo4841","url":null,"abstract":"None available.","PeriodicalId":21961,"journal":{"name":"Société Internationale d’Urologie Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90805700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Saad, R. Shanmugasundaram, D. Ashrafi, D. Gilbourd
Objectives Many people are turning to alternatives to the conventional doctor-patient relationship, such as webbased search engines and video forums for their health care information. We undertook this study to investigate the quality of videos and information on renal cancer available on the streaming platform YouTube. Methods We completed a search of YouTube (www.YouTube.com) in September 2021 with the term “kidney cancer.” The first 120 videos found which met the inclusion criteria (English speaking, duration greater than one minute, greater than 500 views, renal cancer addressed) were selected. We recorded information including duration, view count, likes, dislikes, comments, publisher, and author. The modified DISCERN tool and Global Quality Score (GQS) questionnaire were used to assess the quality of the included videos. The level of misinformation was assessed using a Likert 5-point scale. Descriptive statistics were used to analyse the collected data. A 2-sample t test was used to further analyse the quality assessment tool results before, during, and after 2016. Results Most videos were published during or after 2016 (63.3%), were predominantly created in North America (77.5%), and were presented by health care professionals (60%). The median length of the videos was 4.23 (1.01 to 65.55) minutes, and the median number of views was 3087 (514 to 228 152). The median number of likes and dislikes was 24 and 5, respectively. The median modified DISCERN score was 3, the median GQS score was 3, and the grading for overall level of misinformation was moderate. Conclusion The quality of information accessed from YouTube on kidney cancer is of a low to moderate overall standard with significant levels of misinformation. YouTube should not be used alone for educational purposes on renal cancer by patients or the public. It is best used in conjunction with information and advice from a medical practitioner and the health care system.
{"title":"A Quality Assessment of Information Available on Renal Cancer on YouTube","authors":"J. Saad, R. Shanmugasundaram, D. Ashrafi, D. Gilbourd","doi":"10.48083/hmug9514","DOIUrl":"https://doi.org/10.48083/hmug9514","url":null,"abstract":"Objectives Many people are turning to alternatives to the conventional doctor-patient relationship, such as webbased search engines and video forums for their health care information. We undertook this study to investigate the quality of videos and information on renal cancer available on the streaming platform YouTube. Methods We completed a search of YouTube (www.YouTube.com) in September 2021 with the term “kidney cancer.” The first 120 videos found which met the inclusion criteria (English speaking, duration greater than one minute, greater than 500 views, renal cancer addressed) were selected. We recorded information including duration, view count, likes, dislikes, comments, publisher, and author. The modified DISCERN tool and Global Quality Score (GQS) questionnaire were used to assess the quality of the included videos. The level of misinformation was assessed using a Likert 5-point scale. Descriptive statistics were used to analyse the collected data. A 2-sample t test was used to further analyse the quality assessment tool results before, during, and after 2016. Results Most videos were published during or after 2016 (63.3%), were predominantly created in North America (77.5%), and were presented by health care professionals (60%). The median length of the videos was 4.23 (1.01 to 65.55) minutes, and the median number of views was 3087 (514 to 228 152). The median number of likes and dislikes was 24 and 5, respectively. The median modified DISCERN score was 3, the median GQS score was 3, and the grading for overall level of misinformation was moderate. Conclusion The quality of information accessed from YouTube on kidney cancer is of a low to moderate overall standard with significant levels of misinformation. YouTube should not be used alone for educational purposes on renal cancer by patients or the public. It is best used in conjunction with information and advice from a medical practitioner and the health care system.","PeriodicalId":21961,"journal":{"name":"Société Internationale d’Urologie Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85237341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
presented with lower urinary tract (LUTS) including frequency, urgency urge incontinence. She had a 2-year history of recurrent urinary tract infections (UTI) with Escherichia coli of varying susceptibility. Background included rheumatoid arthritis treated with corticosteroids, and kidney to hypertensive nephrosclerosis.
{"title":"Malakoplakia Causing Poor Bladder Compliance and Bilateral Hydroureteronephrosis","authors":"C. Pham, A. Chung, V. Chalasani","doi":"10.48083/qfcw5582","DOIUrl":"https://doi.org/10.48083/qfcw5582","url":null,"abstract":"presented with lower urinary tract (LUTS) including frequency, urgency urge incontinence. She had a 2-year history of recurrent urinary tract infections (UTI) with Escherichia coli of varying susceptibility. Background included rheumatoid arthritis treated with corticosteroids, and kidney to hypertensive nephrosclerosis.","PeriodicalId":21961,"journal":{"name":"Société Internationale d’Urologie Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75785793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Korkes, J. H. Santiago, G. Peixoto, F. Timóteo, S. Martins, N. P. Leite, Daisy Barreiros, S. Glina
Muscle-invasive bladder cancer (MIBC) is an aggressive disease with a complex treatment. In Brazil, as in most developing countries, data are scarce, but mortality seems exceedingly high. We have created a centralized program involving a multidisciplinary clinic in a region comprising 7 municipalities. Helping patients with adequate performance status get the right treatment helped to reduce 90-day mortality after radical cystectomy from 37% to 1.9%.
{"title":"The CABEM Initiative: Saving Patients With Muscle-invasive Bladder Cancer","authors":"F. Korkes, J. H. Santiago, G. Peixoto, F. Timóteo, S. Martins, N. P. Leite, Daisy Barreiros, S. Glina","doi":"10.48083/dfbq7749","DOIUrl":"https://doi.org/10.48083/dfbq7749","url":null,"abstract":"Muscle-invasive bladder cancer (MIBC) is an aggressive disease with a complex treatment. In Brazil, as in most developing countries, data are scarce, but mortality seems exceedingly high. We have created a centralized program involving a multidisciplinary clinic in a region comprising 7 municipalities. Helping patients with adequate performance status get the right treatment helped to reduce 90-day mortality after radical cystectomy from 37% to 1.9%.","PeriodicalId":21961,"journal":{"name":"Société Internationale d’Urologie Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85001021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The objective of this study is to assess the value of disclosure slide reporting at major urology conferences. In total, 557 speakers were evaluated from the conferences of the Canadian Urology Association (n = 36), American Urology Association (n = 160), and European Association of Urology (n = 361) in 2020. Overall, 49.0% of speakers had no disclosure slide. Among speakers presenting a disclosure slide, the median number of conflicts was 5, median time spent on the slide was 4.4 seconds, and 34.8% gave context to disclosures. Overall disclosure slide reporting seems inconsistent, and given how little time is spent on them and the lack of contextualization, their value is unclear.
{"title":"The Value of Conflicts of Interest Disclosures in Oral Presentations at Major Urological Conferences","authors":"Anique Le Roux, N. Touma","doi":"10.48083/spql8302","DOIUrl":"https://doi.org/10.48083/spql8302","url":null,"abstract":"The objective of this study is to assess the value of disclosure slide reporting at major urology conferences. In total, 557 speakers were evaluated from the conferences of the Canadian Urology Association (n = 36), American Urology Association (n = 160), and European Association of Urology (n = 361) in 2020. Overall, 49.0% of speakers had no disclosure slide. Among speakers presenting a disclosure slide, the median number of conflicts was 5, median time spent on the slide was 4.4 seconds, and 34.8% gave context to disclosures. Overall disclosure slide reporting seems inconsistent, and given how little time is spent on them and the lack of contextualization, their value is unclear.","PeriodicalId":21961,"journal":{"name":"Société Internationale d’Urologie Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77841350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Hensley, N. Lobo, K. Bree, W. Tan, P. Gontero, S. Williams, C. C. Guo, G. Giannarini, L. Dyrskjøt, A. Kamat
Bladder cancer (BC) is a heterogeneous disease with prognosis and therapeutic strategies highly dependent on tumor grade and stage. Predictive biomarkers of therapeutic response have been studied to guide selection of intravesical and/or systemic therapy. A predictive biomarker is measured before the start of treatment and provides information on the likelihood of response to a specific therapy. Many candidate predictive biomarkers for BC have been identified, but few have been rigorously validated or distinguished from simply having treatment-agnostic prognostic capacity. Identifying predictive biomarkers tailored to therapeutic mechanism of action has considerable implications for the sequencing of therapies, as well as bladder preservation strategies in advanced disease states. We evaluate predictive tissue-based, urine-based, and serum-based biomarkers across the spectrum of non–muscle-invasive and muscle-invasive BC and preview predictive biomarkers for emerging targeted therapies.
{"title":"Predictive Biomarkers in the Management of Bladder Cancer: Perspectives in an Evolving Therapeutic Landscape","authors":"P. Hensley, N. Lobo, K. Bree, W. Tan, P. Gontero, S. Williams, C. C. Guo, G. Giannarini, L. Dyrskjøt, A. Kamat","doi":"10.48083/rvzv1144","DOIUrl":"https://doi.org/10.48083/rvzv1144","url":null,"abstract":"Bladder cancer (BC) is a heterogeneous disease with prognosis and therapeutic strategies highly dependent on tumor grade and stage. Predictive biomarkers of therapeutic response have been studied to guide selection of intravesical and/or systemic therapy. A predictive biomarker is measured before the start of treatment and provides information on the likelihood of response to a specific therapy. Many candidate predictive biomarkers for BC have been identified, but few have been rigorously validated or distinguished from simply having treatment-agnostic prognostic capacity. Identifying predictive biomarkers tailored to therapeutic mechanism of action has considerable implications for the sequencing of therapies, as well as bladder preservation strategies in advanced disease states. We evaluate predictive tissue-based, urine-based, and serum-based biomarkers across the spectrum of non–muscle-invasive and muscle-invasive BC and preview predictive biomarkers for emerging targeted therapies.","PeriodicalId":21961,"journal":{"name":"Société Internationale d’Urologie Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80481907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The relationship between plant-based dietary patterns and bladder cancer has not been extensively studied. Our objective was to perform a systematic review of the relationship between plant-based diets and bladder cancer risk and/or outcomes. We searched the literature for all relevant papers published before October 2020 was conducted. Of 74 identified records, only 2 references were included in the final qualitative analysis. These publications found that vegetarian diets are associated with a lower risk of bladder cancer diagnosis. We did not identify any studies investigating the impact of plant-based dietary patterns on outcomes for individuals diagnosed with bladder cancer, which represents an important area for further study.
{"title":"A Systematic Review of Plant-Based Diets and Bladder Cancer: A Call for Further Research","authors":"Jacob Taylor, N. Gupta, J. Blanck, S. Loeb","doi":"10.48083/gbma2534","DOIUrl":"https://doi.org/10.48083/gbma2534","url":null,"abstract":"The relationship between plant-based dietary patterns and bladder cancer has not been extensively studied. Our objective was to perform a systematic review of the relationship between plant-based diets and bladder cancer risk and/or outcomes. We searched the literature for all relevant papers published before October 2020 was conducted. Of 74 identified records, only 2 references were included in the final qualitative analysis. These publications found that vegetarian diets are associated with a lower risk of bladder cancer diagnosis. We did not identify any studies investigating the impact of plant-based dietary patterns on outcomes for individuals diagnosed with bladder cancer, which represents an important area for further study.","PeriodicalId":21961,"journal":{"name":"Société Internationale d’Urologie Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82861931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: Substantial evidence indicates that men with prostate cancer are at an increased risk for cardiovascular disease, and medical and surgical androgen deprivation therapy is associated with further increased cardiovascular risk. There are conflicting reports of differences in cardiovascular safety between gonadotropin-releasing hormone (GnRH) agonists and antagonists. The purpose of this narrative review is to compare data on the cardiovascular risks and safety outcomes associated with different hormonal treatment options in prostate cancer patients and to provide guidance on how to manage the increased risk associated with the condition. Methods: A PubMed search was conducted for papers published in the last 15 years using the following MeSH terms: “prostate neoplasms,” “gonadotropin-releasing hormone,” “androgen agonist,” “androgen antagonists,” “cardiovascular disease,” “epidemiology.” Results: Evidence regarding the risk of cardiovascular events during treatment with GnRH agonists and antagonists is conflicting. Some retrospective studies have shown that agonists are associated with a greater risk of cardiovascular disease and cardiovascular mortality and morbidity, and a similar risk with agonists and combined androgen blockade. Some studies have reported that antagonists are associated with a decreased risk of cardiovascular mortality and morbidity compared with agonists. With respect to coronary heart disease, ischemic heart disease, myocardial infarction, stroke, or sudden cardiac death, current evidence has failed to demonstrate a significant difference between antagonists and agonists. Cardiovascular risks in patients should be mitigated by regular monitoring of blood pressure, blood glucose, and lipids, as well as counseling patients to abstain from alcohol and improve their diet and exercise. Statins, metformin, and aspirin should also be considered. Conclusions: The evidence for the increased cardiovascular risk of GnRH agonists over antagonists for androgen deprivation therapy is unclear. Differences in methodology, population sizes, risk stratification, and outcomes between studies make direct comparisons problematic. The single prospective, randomized prostate cancer trial with a primary cardiovascular end point in men with pre-existing cardiovascular disease comparing GnRH agonist to antagonist was stopped early due to an interim futility analysis. The results are inconclusive.
{"title":"Impact of Androgen Deprivation Therapy on Cardiovascular Outcomes in Prostate Cancer","authors":"L. Klotz, S. van Komen, Sanja Dragnic, W. White","doi":"10.48083/vdnp9678","DOIUrl":"https://doi.org/10.48083/vdnp9678","url":null,"abstract":"Purpose: Substantial evidence indicates that men with prostate cancer are at an increased risk for cardiovascular disease, and medical and surgical androgen deprivation therapy is associated with further increased cardiovascular risk. There are conflicting reports of differences in cardiovascular safety between gonadotropin-releasing hormone (GnRH) agonists and antagonists. The purpose of this narrative review is to compare data on the cardiovascular risks and safety outcomes associated with different hormonal treatment options in prostate cancer patients and to provide guidance on how to manage the increased risk associated with the condition.\u0000\u0000Methods: A PubMed search was conducted for papers published in the last 15 years using the following MeSH terms: “prostate neoplasms,” “gonadotropin-releasing hormone,” “androgen agonist,” “androgen antagonists,” “cardiovascular disease,” “epidemiology.”\u0000\u0000Results: Evidence regarding the risk of cardiovascular events during treatment with GnRH agonists and antagonists is conflicting. Some retrospective studies have shown that agonists are associated with a greater risk of cardiovascular disease and cardiovascular mortality and morbidity, and a similar risk with agonists and combined androgen blockade. Some studies have reported that antagonists are associated with a decreased risk of cardiovascular mortality and morbidity compared with agonists. With respect to coronary heart disease, ischemic heart disease, myocardial infarction, stroke, or sudden cardiac death, current evidence has failed to demonstrate a significant difference between antagonists and agonists. Cardiovascular risks in patients should be mitigated by regular monitoring of blood pressure, blood glucose, and lipids, as well as counseling patients to abstain from alcohol and improve their diet and exercise. Statins, metformin, and aspirin should also be considered.\u0000\u0000Conclusions: The evidence for the increased cardiovascular risk of GnRH agonists over antagonists for androgen deprivation therapy is unclear. Differences in methodology, population sizes, risk stratification, and outcomes between studies make direct comparisons problematic. The single prospective, randomized prostate cancer trial with a primary cardiovascular end point in men with pre-existing cardiovascular disease comparing GnRH agonist to antagonist was stopped early due to an interim futility analysis. The results are inconclusive.","PeriodicalId":21961,"journal":{"name":"Société Internationale d’Urologie Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90118053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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