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BACKGROUND: Researchers have shown that using next-generation hormonal agents (NHA) for castration-resistant prostate cancer (CRPC) would lead to increased risk of cardiac adverse effects, making clinician choices more complex. METHODS: We systematically searched Pubmed, Cochrane Library, and Embase databases for research published before October 2022. Agents were ranked according to their effectiveness based on cardiac adverse effects using the surface under the cumulative ranking curve. RESULTS: A total of 21 Randomized Controlled Trials (RCT) with 19, 083 patients were included in present study. Our results showed that abiraterone and enzalutamide could lead to a significantly higher hypertension rate compared with placebo; whereas no significant difference was detected between four NHAs and placebo in ischemic heart disease incidence. All four NHAs could significantly increase the risk of cardiotoxicity. CONCLUSIONS: NHAs are generally acceptable in terms of cardiovascular disease compared to placebo in patients with CRPC.

Asunto(s)

Neoplasias de la Próstata Resistentes a la Castración , Humanos , Masculino , Neoplasias de la Próstata Resistentes a la Castración/tratamiento farmacológico , Neoplasias de la Próstata Resistentes a la Castración/patología , Antineoplásicos Hormonales/uso terapéutico , Antineoplásicos Hormonales/efectos adversos , Cardiotoxicidad/etiología , Cardiotoxicidad/epidemiología , Ensayos Clínicos Controlados Aleatorios como Asunto

RESUMEN

BACKGROUND: This study aims to compare the clinical outcomes after performing radical prostatectomy (RP) or low-dose-rate brachytherapy (LDR) for patients with intermediate-risk prostate cancer (IRPC). METHODS: We performed a retrospective analysis on 361 IRPC patients who underwent treatment in Peking Union Medical College Hospital from January 2014 to August 2021, of which 160 underwent RP and 201 underwent Iodine-125 LDR. Patients were followed in clinic monthly during the first three months and at three-month intervals thereafter. Univariate and multivariate regression analyses were conducted to predict biochemical relapse-free survival (bRFS), clinical relapse-free survival (cRFS), cancer-specific survival (CSS), and overall survival (OS). Biochemical recurrence was defined using the Phoenix definition for LDR and the surgical definition for RP. The log-rank test was applied to compare bRFS between the two modalities, and Cox regression analysis was performed to identify factors associated with bRFS. RESULTS: Median follow-up was 54 months for RP and 69 months for LDR. According to log-rank test, the differences of 5-year bRFS (70.2% vs 83.2%, P = 0.003) and 8-year bRFS (63.1% vs 68.9%, P < 0.001) between RP and LDR groups were statistically significant. Our results also indicated that there was no significant difference in terms of cRFS, CSS, or OS between the two groups. With multivariate analysis of the entire cohort, prostate volume ≤ 30 ml (P < 0.001), positive margin (P < 0.001), and percentage positive biopsy cores > 50% (P < 0.001) were independent factors suggestive of worse bRFS. CONCLUSIONS: LDR is a reasonable treatment option for IRPC patients, yielding improved bRFS and equivalent rates of cRFS, CSS and OS when compared with RP.

Asunto(s)

Braquiterapia , Laparoscopía , Neoplasias de la Próstata , Masculino , Humanos , Próstata/cirugía , Estudios Retrospectivos , Recurrencia Local de Neoplasia , Neoplasias de la Próstata/radioterapia , Neoplasias de la Próstata/cirugía , Neoplasias de la Próstata/patología , Pronóstico , Prostatectomía/métodos

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BACKGROUND: Current prostate cancer (PCa) screening may detect nonprogressive lesion, leading to overdiagnosis and overtreatment. The purpose of the present study is to investigate whether the tumor pathological origin of latent prostate cancer (lPCa) and clinical prostate cancer (cPCa) are consistent, and to verify the current clinically significant prostate cancer criteria. METHODS: Prostate specimens were obtained from postmortem autopsy between 2014 and 2021 and patients who went through radical prostatectomy from 2013 to 2021. The pathological characteristics and spatial distribution of the lPCa group and cPCa group were compared and analyzed through SPSS software with P < 0.05 representing statistical significant. RESULTS: In lPCa group, a total of 45 tumor lesions from 24 lPCa cases were included, 54.2% of lPCa patients were ISUP ≥ 2, 12.5% had tumor volume ≥ 0.5 ml, and 16.7% had extraprostatic extension (EPE). In cPCa group, there were a total of 429 tumor lesions in 126 cases, 92.1% of cPCa patients were ISUP ≥ 2, and 82.5% had tumor volume of ≥ 0.5 ml. 36.3% had EPE. LPCa and cPCa have the same spatial distribution characteristics, and no significant difference was detected between the anterior and posterior zone. Peripheral zone tumors were significantly more common than transitional zone tumors. Tumors in apical 1/3 and middle 1/3 were significantly more common than basal 1/3. CONCLUSION: The malignancy of cPCa is significantly higher than that of lPCa, and the spatial distribution of cPCa and lPCa is consistent. ISUP grade 2 is not sufficient to determine clinical significance of tumor.

Asunto(s)

Neoplasias de la Próstata , Autopsia , Biopsia , Humanos , Masculino , Próstata/patología , Próstata/cirugía , Prostatectomía , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/cirugía

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Latent prostate cancer is defined as prostate cancer that was undiagnosed during life and then detected through autopsy. As a complement to clinical data of diagnosed prostate cancer, autopsy studies provide us with epidemiological and pathological characteristics of latent prostate cancer and facilitate our understanding of this disease. Though differences in time, population, methods, and reporting of results across studies exist, we managed to integrate findings of global autopsy studies on latent prostate cancer, analyze the effect of methodology on the results and propose deficiencies as well as directions for further research.

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Radical prostatectomy, radiotherapy and active surveillance are three widely used treatment options for patients with low-risk prostate cancer, but the relative effects are controversial. We searched PubMed, Embase and Web of Science until June 2020, focusing on the studies comparing the effect of radical prostatectomy, radiotherapy and active surveillance in patients with low-risk prostate cancer. Through the random-effects model, dichotomous data were extracted and summarised by odds ratio with a 95% confidence interval. Twenty-two studies containing 185,363 participants were pooled for the comprehensive comparison. The Bayesian mixed network estimate demonstrated the cancer-specific mortality of radical prostatectomy was significantly lower than active surveillance (OR, 0.46; 95% CI 0.34-0.64) and external beam radiation therapy (OR, 0.66; 95% CI 0.46-0.96), but not brachytherapy (OR, 0.63; 95% CI 0.41-1.03). The brachytherapy demonstrated the best treatment ranking probability results in terms of all-cause mortality, while no significant difference was observed when compared with other three treatment modalities. Brachytherapy and radical prostatectomy were associated with a similar risk of cancer-specific mortality, and both of them were significantly superior to active surveillance and external beam radiation therapy; nevertheless, there was no significant difference among the aforementioned treatment methods in all-cause mortality.

Asunto(s)

Braquiterapia , Neoplasias de la Próstata , Teorema de Bayes , Humanos , Masculino , Metaanálisis en Red , Prostatectomía , Neoplasias de la Próstata/radioterapia , Neoplasias de la Próstata/cirugía

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Objective: To analyze the equity of benefit for inpatient services under the three basic medical insurance programs in China.Methods: Using the baseline survey data collected by China Family Panel Studies (CFPS) in 2010, and the two-part model was applied to explore whether the insured groups with different income levels had different aspects on inpatient rate and the compensation of hospitalization expenses in health insurance coverage.Results: There was no significant difference in the inpatient service utilization rate for different income groups, but the highest and second highest income groups reimburse more expenses than the lowest income group, that is 36.5% and 26.3%, respectively.Specifically, the income level and the compensation amount are not significantly correlated in the Urban Employer Medical Insurance (UEMI) program;the compensation amounts to be paid by urban residents are basically increasing with the increase of the income level;and there is a moderate discrepancy between the highest and the lowest income groups in the New Rural Cooperative Medical System (NCMS).Conclusion: The benefit equity is obviously fair in terms of inpatient service utilization rate, but the benefit degree increases for higher income groups, which shows that there are unfair inequalities related to the income at the level of reimbursement.In terms of program comparison, the benefit degree equity is higher for the UEMI program, followed by the URMI program and the NCMS program is the worst.Besides, the impatient rate and reimbursement amounts are significantly lower for NCMS program participants.The government should merge URMI and NCMS programs, actively promote the integration of basic medical insurance system by strengthening the construction of the medical assistance system and improving the system of catastrophic disease medical expenditure insurance in order to achieve better benefit equity.

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From August 2007 to January 2009 a total of 95 patients with complex renal calculi were treated with CT ( n = 32 ), X-ray ( n = 33 ) or ultrasound ( n = 30 ) guided percutaneous nephrostomy and ureteroscopic holmium laser lithotripsy respectively. The CT guided procedure had lower positioning time,positioning failure rate, complication rate and residual stone rate than those of X-ray and ultrasound localization, particularly had advantages in the stone clearance rate and complications rate ( all P ＜ 0. 05 ).CT guided localization can be chosen in the following conditions: higher kidney position, large staghorn calculi or renal pelvis stones without hydronephrosis, with congenital renal malformations or failure of ultrasound or X-ray localization.

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Objective:To observe the clinically curative effects of Qingwen Baidu drink(清瘟败毒饮) on epidemic hemorrhagic fever (EHF).Methods:One hundred and eighty cases with EHF who were admitted to hospital within 5 days after onset were randomly divided into two groups.The control group (n=60) was treated with Ribavirin infused intravenously and liquid therapy,and treating complications simultaneously,meanwhile the treated group (n=120) based on the same therapy as control group treated with Qingwen Baidu drink number Ⅰ,Ⅱ or Ⅲtaken orally two times a day according to different course.Results:In treated group all the days of fever,polyuria,recovering platelet to normal,and transforming proteinuria to negative were significantly shorter than those in control group (both P<0.01),otherwise the overphase rates of oliguria and hypotension shock were higher than those in control group too (all P<0.01).The occurance rate of complications in treated group was lower than that in control group(P<0.05).Conclusions:The curative effects adding Qingwen Baidu drink on EHF are significant and worth spreading.