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.
Objective To comprehensively evaluate the association between TNF-α gene −308 G/A polymorphism and the risk of prostate cancer. Methods A meta-analysis was performed to analyze the association between −308 G/A polymorphism and the risk of prostate cancer risk. Results A total of 11 case-control studies (4 919 cases and 5 210 controls) were included in this meta-analysis. The result showed no statistically significant differences in all genotype distribution between prostate cancer cases and controls: dominant model (OR=1.11, 95%CI 0.90 to 1.36, P=0.33), recessive model (OR=0.91, 95%CI 0.70 to 1.18, P=0.47), GA versus GG (OR=1.11, 95%CI 0.90 to 1.37, P=0.33), AA versus GG (OR=0.92, 95%CI 0.71 to 1.20, P=0.55), A versus G (OR=1.07, 95%CI 0.91 to 1.26, P=0.39). In the subgroup analysis by ethnicity, no statistically differences were found between prostate cancer cases and controls. Conclusion This results of meta-analysis suggests that TNF-α gene –308G/A polymorphism may not be a risk factor of prostate cancer. Due to the limited quantity of the includied studies, further studies are needed to validate the above conclusion.
Objective To systemically evaluate the accuracy of f/t-PSA for diagnosing prostate cancer with a t-PSA level of 4-10ng/mL through meta-analysis. Methods A literature search of CBM, VIP, CNKI and Wanfang Data from 1999 to 2009 was performed. Related journals were also searched manually. Two reviewers independently assessed trial quality according to QUADAS items. Heterogenous studies and meta-analysis were conducted by Meta-Disc1.4 software. The analysis was based on different critical values of f/t-PSA (0.1, 0.15, 0.2, 0.25, and 0.3). Results Total 18 studies involving 2217 subjects were included. No threshold effect was found. But there was heterogeneity due to other factors. The meta–analysis showed that, the sensitivity of f/t-PSA with the critical value of 0.15 for the diagnosis of prostate cancer with a t-PSA level of 4-10ng/mL was 75% (95%CI 70%-79%), and the specificity was 81% (95%CI 78%-84%). The area under SROC curve was 0.883 5, and the Q index was 0.814 0. Conclusion The f/t-PSA is a better index for diagnosing prostate cancer with t-PSA levels between 4 and 10ng/mL. And it is reasonable to consider 0.15 as a more suitable critical value.
Through searching and evaluating the evidence on advanced prostate cancer, we found that different types of androgen deprivation had similar effect, and immediate androgen deprivation had survival benefit. For the patient with hormone-refractory prostate cancer, therapies including mitoxantrone, prednisone, docetaxel and surmine were more effective. Strontium-89 provided more effective pain relief than external beam radiation. And bisphophonate had no effect. Antiandrogen withdrawal suggested prostate specific antigen would decline, but the clinical outcome wasn’t reported.
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.
目的 应用基于链式方程的填补方法处理医学研究中的数据缺失，并以填补后完全数据构建联合指标的logistic判别函数，判断其在前列腺癌的预测诊断中的应用价值。 方法 采用模拟研究，针对现实数据缺失情况模拟不同填补集结果，并以此对现实数据进行填补，以完整数据构建logistic判别，进行分析预测。 结果 填补结果随着填补次数的增加而逐渐接近真实值并趋于稳定。联合年龄、血清前列腺特异性抗原值、血流阻力指数及经直肠前列腺超声检查指标的logistic判别分析结果的灵敏度为82.39%，特异度为74.86%。 结论 联合指标分析可提高前列腺癌的诊断预测水平，以减轻患者穿刺痛苦。
目的 应用判别分析探讨不同指标对前列腺癌预测诊断中的应用价值。 方法 收集2008年1月－2011年9月经直肠超声检查并行经直肠超声引导下经会阴前列腺穿刺活检术，具有前列腺特异性抗原（PSA）、超声图像特征的941例患者以及其中含有血流阻力指数（RI）指标的200例患者的临床资料，采用最近距离及极大似然判别分析两种方法分别拟合患者年龄、血清PSA、经直肠前列腺超声声像图特征以及RI指标预测前列腺癌。 结果 最近距离判别分析显示RI对前列腺癌的判别无临床意义。联合患者年龄、超声检查和血清PSA值，判别结果提示超声、超声+年龄、年龄+超声+PSA三种判别的灵敏度逐渐增加。年龄+超声+PSA联合指标的灵敏度为88.89%，其错判率在20.00%以内。 结论 年龄+超声+PSA联合指标的极大似然判别分析可提高前列腺癌的诊断预测水平，避免前列腺穿刺给患者带来的痛苦，并给临床医生的临床诊断提供参考，有较好的应用价值。
【摘要】 目的 观察低频超声（20 kHz）辐照联合静脉注射微泡造影剂SonoVue对裸鼠前列腺癌（Du145）移植瘤的抑瘤效应，并探讨其可能的抑瘤机制。 方法 通过细胞移植和瘤块移植方法建立24只裸鼠前列腺癌Du145移植瘤模型，随机分为超声微泡组、单纯超声组、单纯微泡组和对照组，每组各6只。超声微泡组：尾静脉注射0.2 mL SonoVue的同时对瘤体行20 kHz超声辐照，辐照强度200 mW/cm2；单纯超声组：尾静脉注射生理盐水0.2 mL，同时超声辐照2 min；单纯微泡组：尾静脉注射SonoVue 0.2 mL同时行假照，各组均隔天1次，共3次，对照组不做任何处理。治疗后测量瘤体大小，绘制瘤体生长曲线，计算抑瘤率。首次治疗后14 d剥离瘤体，通过光学显微镜、电子显微镜观察肿瘤组织病理改变。免疫组织化学方法观察CD34阳性染色血管，计算肿瘤微血管密度（micro vessel density，MVD），比较各组间MVD的差异。 结果 24只裸鼠均成功植瘤。治疗后超声微泡组瘤体体积均数明显小于其他3组（Plt;0.05），抑瘤率为62.7%。光学显微镜下超声微泡组瘤体组织大部分损伤坏死，电子显微镜下超声微泡组肿瘤内微血管的内皮细胞损伤，线粒体肿大，基底膜断裂。超声微泡组瘤体内CD34阳性染色微血管数减少，其MVD值显著低于其他各组。 结论 20 kHz低频超声辐照联合微泡造影剂SonoVue可有效抑制裸鼠人前列腺癌移植瘤的生长，其抑瘤机制可能是通过超声空化效应破坏肿瘤的微血管实现的。【Abstract】 Objective To investigate the anti-tumor effect induced by low-frequency ultrasound (20 kHz) radiation combined with intravenous injection of microbubbles on human prostate carcinoma xenograft in nude mice, and to discuss its probable mechanism. Methods Human prostate carcinoma xenograft model in 24 nude mice were established with human prostate carcinoma Du145 cells inoculation and sub-graft through mice, which were randomly divided into ultrasound+microbubble, ultrasound, microbubble, and control group, with 6 mice in each group. In the ultrasound+microbubble group, 0.2 mL SonoVue was injected intravenously, followed by 20 kHz ultrasound exposure of 200 mW/cm2 at every other day for 3 times totally. Mice in the ultrasound group and the microbubbles group were only treated with ultrasound radiation and microbubbles injection, respectively. The volume of gross tumors was measured, and tumor growth curve was drawn. The ratio of anti-tumor growth was calculated. The mice were sacrificed 14 days after the last ultrasound exposure. Specimens of the exposed tumor tissues were obtained and observed pathologically under light microscope and transmission electron microscope. CD34 positive vessels were counted in all the tumor slices by immunohistochemistry, and the micro-vessels density（MVD）of the tumor was also calculated. Results Du145 prostate tumor model was successfully established in all the mice. The average gross tumor volume of the ultrasound+microbubble group was significant lower compared with the other two groups after treatment (Plt;0.05), and the ratio of anti-tumor growth was 62.7%. Histological examination showed signs cell injury in the ultrasound+microbubble group. Electron microscopic examination revealed that the endothelium of vessels in the tumor was injured. The amount of CD34 positive vessels and MVD of the ultrasound+microbubble group was less than that of the other two groups. Conclusion The low-frequency ultrasound of 20 kHz exposure combined with microbubbles can be used to ablate human prostate carcinoma xenograft in nude mice, which is probably realized through micro-vessels destroyed by cavitation effect of ultrasound.