Objective To systematically review the effectiveness and safety of radiotherapy combined with short-term or long-term hormonal therapy for prostate cancer. Methods Databases including EMbase, PubMed, Web of Science, CENTRAL and CBM were searched from inception to August 2012 to collect the randomized controlled trials (RCTs) on radiotherapy combined with short-term or long-term hormonal therapy for prostate cancer. According to the inclusion and exclusion criteria, data of the included studies were extracted, and the methodological quality was evaluated. Then meta-analysis was performed using RevMan 5.1, and the evidence qualities and recommendation levels were determined according to the GRADE System. Results A total of 6 RCTs involving 3157 patients were included. The results of meta-analysis showed that there were no significant differences in the overall survival rate (RR=0.95, 95%CI 0.91 to 1.00) and the disease-free survival rate (RR=0.73, 95%CI 0.46 to 1.13) between the radiotherapy plus short-term hormonal therapy group (the short-term group) and the radiotherapy plus long-term hormonal therapy group (the long-term group). The long-term group was superior to the short-term group in biochemical failure-free survival rate (RR=0.81, 95%CI 0.68 to 0.97), clinical progression rate (RR=1.61, 95%CI 1.44 to 1.80), and prostate cancer-specific mortality (RR=1.44, 95%CI 1.16 to 1.80). Based on the GRADE system, the evidence level of biochemical failure-free survival was moderate with a weak recommendation; the evidence level of disease-free survival was low with a weak recommendation; the evidence level of overall survival was high with a weak recommendation; and the evidence levels of clinical progression rate and prostate cancer-specific mortality were high with a b recommendation. Conclusion Currently, the limited evidence shows extending the length of hormone therapy is beneficial for patients with localized prostate cancer and locally advanced prostate cancer, especially for patients with high Gleason score, but it cannot raise overall survival rate and disease-free survival rate. This conclusion still needs to be further proved by more high-quality and large-scale RCTs.
ObjectiveTo analyze the disease burden of prostate, bladder and kidney cancers attributable to smoking in China from 1990 to 2019. MethodsBased on the global burden of disease study 2019, the current situation of the disease burden of prostate, bladder and kidney cancers attributable to smoking was analyzed by using the population attributable fraction (PAF), deaths and disability-adjusted life years (DALYs). Furthermore, the annual percent change (APC) and the average annual percent change (AAPC) were calculated by joinpoint regression analysis to describe the long-term trends of the smoking-attributable burden of these three cancers from 1990 to 2019. ResultsThere were an estimated 18 800 cases of deaths and 393 106 person-years of DALYs for bladder cancer caused by smoking in 2019. The age-standardized mortality and DALY rate decreased by 0.41% and 0.39% per year from 1990 to 2019, respectively. For prostate cancer, smoking was estimated to have caused 5 016 cases of deaths and 98 276 person-years of DALYs in 2019. The age-standardized mortality and DALY rate decreased by 0.28% and 0.25% per year from 1990 to 2019, respectively. For kidney cancer, the deaths and DALYs attributable to smoking were 4 935 cases and 120 620 person-years, respectively. The standardized mortality and DALY rates increased by 3.03% and 2.98% per year from 1990 to 2019. Additionally, males suffered from a higher disease burden of these three cancers attributable to smoking than females. The elderly population had a higher smoking-attributable disease burden than the younger population. ConclusionThe situation of the disease burden of bladder, prostate and kidney cancers attributable to smoking is still serious in China, which has substantial disparities in different groups. Specifically, males and the elderly are the high-risk groups for the smoking-attributable burden. Among the three cancers, bladder cancer has the highest burden and kidney cancer has the largest burden increase during 1990-2019.
Objective To analyze the epidemic trend of prostate cancer in China from 1992 to 2021, and predict its epidemic trends from 2022 to 2032. Methods Based on the data of Chinese population and prostate cancer incidence and mortality from Global Burden of Disease Database, the Joinpoint log-linear model was used to analyze the trends of prostate cancer incidence and mortality, use the age-period-cohort model to analyze the effects of age, period and cohort on changes in incidence and mortality, and the gray prediction model was used to predict the trends of prostate cancer. Results From 1992 to 2021, the incidence and mortality of prostate cancer in China showed an upward trend, with AAPC of 5.652% (P<0.001) and 3.466% (P<0.001), and the AAPC of age-standardized incidence decreased to 1.990% (P<0.001), the age-standardized mortality showed a downward trend and was not statistically significant. The results of the age-period-cohort model showed that the net drift values of prostate cancer incidence and mortality were 3.03% and ?1.06%, respectively, and the risk of incidence and mortality gradually increased with age and period. The results of the grey prediction model showed that the incidence and mortality of prostate cancer showed an upward trend from 2022 to 2032, and the incidence trend was more obvious. Conclusion The incidence and mortality of prostate cancer in China showed an increasing trend, with a heavy disease burden and severe forms of prevention and control, so it is necessary to do a good job in monitoring the incidence and mortality of prostate cancer, and strengthen the efficient screening, early diagnosis and treatment of prostate cancer.
ObjectivesTo systematically review the association between the variants of HNF1B gene and the risk of prostate cancer.MethodsPubMed, EMbase, The Cochrane Library, CNKI, CBM and WanFang Data databases were electronically searched to collect case-control studies on the association between the variants of HNF1B gene and risk of prostate cancer from inception to December, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using Stata 14.0 software.ResultsA total of 15 case-control studies involving 30 532 patients and 38 832 controls were included. The results of meta-analysis showed that: there was a strong significant association between rs4430796 variants (Gvs.A: OR=0.802, 95%CI 0.784 to 0.821, P<0.001; GGvs.AA: OR=0.659, 95%CI 0.606 to 0.717, P<0.001; AGvs.AA: OR=0.762, 95%CI 0.714 to 0.814, P<0.001), rs11649743 variants (Avs.G: OR=0.875, 95%CI 0.820 to 0.941, P<0.001; AAvs.GG: OR=0.669, 95%CI 0.564 to 0.792, P<0.001; AGvs.GG: OR=0.855, 95%CI 0.798 to 0.916, P<0.001), rs7501939 variants (Avs.G: OR=0.833, 95%CI 0.807 to 0.859, P<0.001), rs3760511 variants (Avs.C: OR=0.834, 95%CI 0.803 to 0.868, P<0.001) and risk of prostate cancer.ConclusionsCurrent evidence shows that HNF1B gene variants are associated with risk of prostate cancer. Due to limited quantity and quality of the included studies, more high quality studies are required to verify the above conclusion.
ObjectiveTo systematically review the correlation between E-cadherin expression and prostate cancer, as well as its clinicopathologic features in Chinese population. MethodsSuch databases as PubMed, EMbase, CBM, CNKI, VIP and WanFang Data were electronically searched from their inception to December, 2015 to collect case-control studies about the correlation between E-cadherin expression and prostate cancer, as well as its clinically pathologic features in Chinese population. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. ResultsA total of 21 studies were included, involving 920 prostate cancer cases, 415 benign prostatic hyperplasia cases, and 48 controls. The results of meta-analysis showed that the prostate cancer group had a lower E-cadherin expression level when compared with the benign prostatic hyperplasia group (OR=0.07, 95%CI 0.05 to 0.11, P<0.00001) or the control group (OR=0.04, 95%CI 0.01 to 0.18, P<0.00001). Moreover, the expression level of E-cadherin was lower in the low and medium differentiation group than in the high differentiation group (OR=0.13, 95%CI 0.08 to 0.23, P<0.00001), lower in the stage of C+D than in the stage of A+B (OR=0.23, 95%CI 0.15 to 0.34, P<0.00001), and lower in the prostate cancer with metastasis (OR=0.46, 95%CI 0.27 to 0.79, P=0.005) and it was decreased gradually with the increment of pathological differentiation and clinical stage of prostate cancer and with the decrement of lymph node or bone metastasis and serum PSA level. ConclusionCurrent evidence indicates that the expression level of E-cadherin is significantly correlated with prostate cancer and its clinicopathologic features in Chinese population. Due to limited sample size and quality of included studies, the conclusion needs to be verified by conducting more high quality studies.
Prostate cancer is a common disease in the USA and Europe, with a gradually increasing incidence in China, and presents a significant health burden for older men. The lack of modifiable risk factors has made early detection as a strategy to reduce mortality. Current methods of screening involve the measurement of serum prostate-specific antigen (PSA) and digital rectal examination followed by biopsy. With PSA screening evidence of level I absent, the evidence on the use of PSA as a screening test is still highly controversial. Furthermore, there is controversy over whether screen-detected lesions will become clinically significant. There are three major treatment options for localized disease: radical prostatectomy, radical radiotherapy and monitoring with treatment if required. There is no evidence of randomized controlled trial (RCT) to suggest a survival advantage of any of these treatments. Opinions about the related benefits and risks of screening vary widely. In the absence of RCT of benefit for screening, many now suggest “informed consensus” screening, which encourages a discussion between the patient and his physician with both sides informed of all of the issues.
ObjectiveTo evaluate the efficacy and safety of prostat in combination with antibiotic on the treatment of chronic proatatitis. MethodsWe searched the literatures which were randomized controlled trials (RCT) on the treatment of combination of prostat and antibiotic for chronic prostatitis published between January 2003 and August 2013 in the Databases including CNKI, Wanfang database, VIP, CBM, PubMed, according to the demand of Cochrane Colloboration, combining computer retrieval with manual retrieval. The quality of literature was assessed by using Jadad scale and extract data from literature. Meta-analyses were performed by using the RevMan 5.1 Software. ResultsA total of 12 clinical RCT, involving 3 947 patients were identified. One study was double-blind and three studies were single-blind. Only one study had a Jadad scale score of 3, belonging to high quality document; the rest had a score of 2 or 1, and all were low quality documents. The results of the Meta-analysis showed that compared with the control groups, the treatment of combination of prostat with gatifloxacin on chronic prostatitis had a significant difference in total effective rate[OR=3.98, 95%CI (2.67, 5.94), P<0.000 01], NIH-CPSI score[WMD=-6.45, 95%CI(-7.55, -5.34), P<0.000 01]; the treatment of combination of prostat with Levofloxacin on chronic prostatitis had a significant difference in total effective rate[OR=1.71, 95%CI (1.43, 2.05), P<0.000 01], NIH-CPSI score[WMD=-2.85, 95%CI(-3.39, -2.31), P<0.000 01]. ConclusionThe treatment of combination of prostat with antibiotic was superior to the treatment of prostat or antibiotics on chronic prostatitis. It is an effective therapeutic schedule. But the safety of the treatment of combination of prostat and antibiotic on chronic prostatitis needs further evaluation.
The incidence of prostate cancer ranks the second in malignant tumors among elderly males. Multi-parametric MRI (Mp-MRI) is an important mean for detection, staging, and grading of prostate cancer. In order to standardize the collection, interpretation, and reporting of prostate MRI data, the European Urogenital Radiology Society launched the Prostate Imaging Reporting and Data System (PI-RADS) in 2012. Due to some limitations in the application process, the Joint Committee of the American Society of Radiology and the European Society of Radiology issued an updated version of PI-PADS V2 in 2014. In recent years, some studies have been carried out on the effectiveness, accuracy, and consistency of the diagnosis of prostate cancer. This article will review the application and research status of PI-RADS V2 system in the diagnosis of Mp-MRI for prostate cancer.
Objective To determine whether antibiotic prophylaxis can reduce the risk of postoperative bacteriuria in men undergoing transurethral resection of prostate (TURP) who have sterile preoperative urine. Method MEDLINE, EMBASE and Cochrane Library were searched for RCTs comparing antibiotic prophylaxis and placebo/blank controls for men undergoing TURP with preoperative sterile urine. The search strategy was established according to the Cochrane Prostatic Diseases and Urologic Cancers Group search strategy. Data was extracted by two reviewers using the designed extraction form. RevMan were used for data management and analysis. Results Fifty three relevant trials were searched, of which 27 trials were included and 26 were excluded. Antibiotic prophylaxis significantly decreased the rate of post-TURP bacteriuria.The pooled relative risk (RR) and 95% confidence interval were 0.36 (0.28, 0.46). Conclusions Prophylactic antibiotics could significantly decrease the incidence of post-TURP bacteriuria. Further comparative RCTs and cost-effective should be performed analysis to establish the optimal antibiotic regimes for the benefit of patients undergoing TURP.
ObjectiveTo compare the effectiveness of T2 weighted image (T2WI) and some compounded MRI techniques, including T2WI combined with magnetic resonance spectroscopy (T2WI+MRS), T2WI combined with diffusion weighted imaging (T2WI+DWI) and T2WI combined with dynamic contrast-enhancement [T2WI+(DCE-MRI)] respectively, with 1.5 T MR scanner in diagnosing prostate cancer through a blinding method. MethodsBetween March 2011 and April 2013, two observers diagnosed 59 cases with a blinding method. The research direction of radiologist A was to diagnose prostate cancer. The observers diagnosed and scored the cases with T2WI, T2WI+(DCE-MRI), T2WI+MRS, T2WI+DWI and compositive method respectively. The data were statistically analyzed with receiver operating characteristic (ROC) curve. ResultsAccording to the ROC curve, both observers got the sequence of area under curve (AUC) as T2WI+DWI > T2WI+(DCE-MRI) > T2WI+MRS > T2WI. On the basis of the result from observer A, the AUC from each technique was similar. The AUC of T2+DWI was slightly bigger than others. The specificity of single T2WI was the lowest; the sensitivity of T2WI was slightly higher. The AUC of the compositive method was marginally larger than T2WI+DWI. According to the result from observer B, the AUC of T2WI+DWI was obviously larger than the others. The AUC of single T2WI was much smaller than the other techniques. The single T2WI method had the lowest sensitivity and the highest specificity. The AUC of T2WI+DWI was slightly larger than the compositive method. The AUC of T2WI+(DCE-MRI), T2WI+MRS, single T2WI methods from observer A was obviously higher than those from the score of observer B. The AUC of T2WI+DWI from the two observers was similar. ConclusionThe method of combined T2WI and functional imaging sequences can improve the diagnosing specificity when a 1.5 T MR scanner is used. T2WI+DWI is the best method in diagnosing prostate cancer with least influence from the experience of observers in this research. The compositive method can improve the diagnosis of prostate cancer effectively, but when there are contradictions between different methods, the T2WI+DWI should be considered as a key factor.