Background:At present,biopsy is essential for the diagnosis of prostate cancer(PCa)before radical prostatectomy(RP).However,with the development of prostate-specific membrane antigen positron emission tomography/compu...Background:At present,biopsy is essential for the diagnosis of prostate cancer(PCa)before radical prostatectomy(RP).However,with the development of prostate-specific membrane antigen positron emission tomography/computed tomography(PSMA PET/CT)and multiparametric magnetic resonance imaging(mpMRI),it might be feasible to avoid biopsy before RP.Herein,we aimed to explore the feasibility of avoiding biopsy before RP in patients highly suspected of having PCa after assessment of PSMA PET/CT and mpMRI.Methods:Between December 2017 and April 2022,56 patients with maximum standardized uptake value(SUVmax)of≥4 and Prostate Imaging Reporting and Data System(PI-RADS)≥4 lesions who received RP without preoperative biopsy were enrolled from two tertiary hospitals.The consistency between clinical and pathological diagnoses was evaluated.Preoperative characteristics were compared among patients with different pathological types,T stages,International Society of Urological Pathology(ISUP)grades,and European Association of Urology(EAU)risk groups.Results:Fifty-five(98%)patients were confirmed with PCa by pathology,including 49(89%)with clinically significant prostate cancer(csPCa,defined as ISUP grade≥2 malignancy).One patient was diagnosed with high-grade prostatic intraepithelial neoplasia(HGPIN).CsPCa patients,compared with clinically insignificant prostate cancer(cisPCa)and HGPIN patients,were associated with a higher level of prostate-specific antigen(22.9 ng/mL vs.10.0 ng/mL,P=0.032),a lower median prostate volume(32.2 mL vs.65.0 mL,P=0.001),and a higher median SUVmax(13.3 vs.5.6,P<0.001).Conclusions:It might be feasible to avoid biopsy before RP for patients with a high probability of PCa based on PSMA PET/CT and mpMRI.However,the diagnostic efficacy of csPCa with PI-RADS≥4 and SUVmax of≥4 is inadequate for performing a procedure such as RP.Further prospective multicenter studies with larger sample sizes are necessary to confirm our perspectives and establish predictive models with PSMA PET/CT and mpMRI.展开更多
With the development and introduction of immune checkpoint inhibitors(ICIs)in cancer patients,immune-related side effects have increasingly attracted attention.However,the risks of immune-related renal toxicity are po...With the development and introduction of immune checkpoint inhibitors(ICIs)in cancer patients,immune-related side effects have increasingly attracted attention.However,the risks of immune-related renal toxicity are poorly characterized.In this study,we performed a network meta-analysis(NMA)of ICI-related randomized clinical trials(RCTs)to elucidate the comparative risk of acute kidney injury(AKI)in cancer patients receiving different ICIs.We also sought to identify other factors potentially affecting the risk of AKI.PubMed and EMBASE were searched for peer-reviewed trial reports published between January 2000 and May 2021.Eligible studies were RCTs studying ICIs in cancer patients and reporting AKI data.We performed a frequentist NMA to evaluate the risk ratios for grade 1-5 and grade 3-5 AKI between the treatment groups.We also assessed the absolute incidence of AKI in the ICI-containing arm using traditional direct meta-analysis.Once significant heterogeneity was detected in a traditional direct meta-analysis,multivariable meta-regression analysis was applied to identify factors that significantly affected the absolute incidence of AKI.A total of 85 RCTs were included in this study.In the NMA for the risk of grade 1-5 and 3-5 AKI,ipilimumab showed a significantly higher risk than avelumab and durvalumab,whereas 1 mg/kg nivolumab plus 3 mg/kg ipilimumab(N1I3)showed a significantly higher risk than other groups.In terms of treatment ranking,durvalumab±low-dose tremelimumab and avelumab were consistently among the top three safest treatments for grade 1-5 or 3-5 AKI,whereas N1I3,ipilimumab and tremelimumab were consistently among the top three treatments with the highest risk for grade 1-5 or 3-5 AKI.Compared with other cancers,renal cell carcinoma and urothelial carcinoma showed a significantly higher risk of AKI.The incidence of AKI was significantly higher with ICI+chemotherapy than with ICI monotherapy.In this NMA involving largescale up-to-date ICI trials,we demonstrated the comparative safety of existing ICI drugs for grade 1-5 and grade 3-5 AKI.Based on data from the ICI arms of these trials,we also revealed several potential risk factors for immune-related AKI,including tumor type and treatment paradigm.展开更多
Androgen deprivation therapy(ADT)is an important treatment strategy that can be used to delay the progression of prostate cancer.However,after an initial response,which varies significantly among patients,the disease ...Androgen deprivation therapy(ADT)is an important treatment strategy that can be used to delay the progression of prostate cancer.However,after an initial response,which varies significantly among patients,the disease eventually progresses despite the low levels of testosterone in the systemic circulation.1 The mechanism underlying the progression of prostate cancer to castration-resistant prostate cancer(CRPC)is not yet clear,and further investigation is needed.展开更多
Background:Cardiovascular disease(CVD)has emerged as the leading cause of death from prostate cancer(PCa)in recent decades,bringing a great disease burden worldwide.Men with preexisting CVD have an increased risk for ...Background:Cardiovascular disease(CVD)has emerged as the leading cause of death from prostate cancer(PCa)in recent decades,bringing a great disease burden worldwide.Men with preexisting CVD have an increased risk for major adverse cardiovascular events when treated with androgen deprivation therapy(ADT).The present study aimed to explore the prevalence and risk evaluation of CVD among people with newly diagnosed PCa in China.Methods:Clinical data of newly diagnosed PCa patients were retrospectively collected from 34 centers in China from 2010 to 2022 through convenience sampling.CVD was defined as myocardial infarction,arrhythmia,heart failure,stroke,ischemic heart disease,and others.CVD risk was estimated by calculating Framingham risk scores(FRS).Patients were accordingly divided into low-,medium-,and high-risk groups.χ2 or Fisher’s exact test was used for comparison of categorical variables.Results:A total of 4253 patients were enrolled in the present study.A total of 27.0%(1147/4253)of patients had comorbid PCa and CVD,and 7.2%(307/4253)had two or more CVDs.The enrolled population was distributed in six regions of China,and approximately 71.0%(3019/4253)of patients lived in urban areas.With imaging and pathological evaluation,most PCa patients were diagnosed at an advanced stage,with 20.5%(871/4253)locally progressing and 20.5%(871/4253)showing metastasis.Most of them initiated prostatectomy(46.6%,1983/4253)or regimens involving ADT therapy(45.7%,1944/4253)for prostate cancer.In the present PCa cohort,43.1%(1832/4253)of patients had hypertension,and half of them had poorly controlled blood pressure.With FRS stratification,as expected,a higher risk of CVD was related to aging and metabolic disturbance.However,we also found that patients with treatment involving ADT presented an originally higher risk of CVD than those without ADT.This was in accordance with clinical practice,i.e.,aged patients or patients at advanced oncological stages were inclined to accept systematic integrative therapy instead of surgery.Among patients who underwent medical castration,only 4.0%(45/1118)received gonadotropin releasing hormone antagonists,in stark contrast to the grim situation of CVD prevalence and risk.Conclusions:PCa patients in China are diagnosed at an advanced stage.A heavy CVD burden was present at the initiation of treatment.Patients who accepted ADT-related therapy showed an original higher risk of CVD,but the awareness of cardiovascular protection was far from sufficient.展开更多
Prostate cancer(PCa)is one of the most prevalent malignant tumors in men,accompanied by high incidence and mortality rates.Novel hormonal therapy(NHT)has emerged as the primary treatment for advanced PCa,providing not...Prostate cancer(PCa)is one of the most prevalent malignant tumors in men,accompanied by high incidence and mortality rates.Novel hormonal therapy(NHT)has emerged as the primary treatment for advanced PCa,providing noticeable clinical benefits.However,the diverse range of adverse events(AEs)associated with NHT may influence both treatment efficacy and patients'quality of life.In light of the latest international clinical research evidence and recommendations from domestic and foreign guidelines,this consensus aims to provide a comprehensive overview of the common AEs experienced during NHT for advanced PCa patients.Additionally,it seeks to develop a hierarchical approach to more efficiently manage AEs,presenting valuable insights for clinical medication and adverse reaction management.展开更多
Prostate cancer is one of the most common solid tumors in men,and its incidence continues to rise in China.Several guidelines have been developed and published to facilitate the standardization of diagnosis and treatm...Prostate cancer is one of the most common solid tumors in men,and its incidence continues to rise in China.Several guidelines have been developed and published to facilitate the standardization of diagnosis and treatment of prostate cancer.However,there are still many challenges and issues in clinical practice that lack high-level evidence.A panel of recognized domestic experts including urologists,medical oncologists,and radiologists was organized and invited to discuss and vote on the key issues of lacking high-level evidence and unified guideline recommendations questions.Following careful selection and voting processes,19 questions were identified,leading to the establishment of a consensus based on collective agreement regarding these hot issues.The aim of this consensus is to provide a reference for managing the whole patient journey of prostate cancer for Chinese clinicians.展开更多
基金supported by the National Key R&D Program of China(No.2022YFE0200800)the Key Project of Tianjin Municipal Science and Technology Commission(No.19ZXDBSY00050)+2 种基金the National Natural Science Foundation of China(Nos.81972400 and 82202962)the CAMS Initiative for Innovative Medicine(Nos.2022-I2M-1-008,2021-I2M-1-015,2022-I2M-2-002,and 2023-I2M-QJ-006)the Capital Health Research and Development of Special Funding(No.2022-1-4021).
文摘Background:At present,biopsy is essential for the diagnosis of prostate cancer(PCa)before radical prostatectomy(RP).However,with the development of prostate-specific membrane antigen positron emission tomography/computed tomography(PSMA PET/CT)and multiparametric magnetic resonance imaging(mpMRI),it might be feasible to avoid biopsy before RP.Herein,we aimed to explore the feasibility of avoiding biopsy before RP in patients highly suspected of having PCa after assessment of PSMA PET/CT and mpMRI.Methods:Between December 2017 and April 2022,56 patients with maximum standardized uptake value(SUVmax)of≥4 and Prostate Imaging Reporting and Data System(PI-RADS)≥4 lesions who received RP without preoperative biopsy were enrolled from two tertiary hospitals.The consistency between clinical and pathological diagnoses was evaluated.Preoperative characteristics were compared among patients with different pathological types,T stages,International Society of Urological Pathology(ISUP)grades,and European Association of Urology(EAU)risk groups.Results:Fifty-five(98%)patients were confirmed with PCa by pathology,including 49(89%)with clinically significant prostate cancer(csPCa,defined as ISUP grade≥2 malignancy).One patient was diagnosed with high-grade prostatic intraepithelial neoplasia(HGPIN).CsPCa patients,compared with clinically insignificant prostate cancer(cisPCa)and HGPIN patients,were associated with a higher level of prostate-specific antigen(22.9 ng/mL vs.10.0 ng/mL,P=0.032),a lower median prostate volume(32.2 mL vs.65.0 mL,P=0.001),and a higher median SUVmax(13.3 vs.5.6,P<0.001).Conclusions:It might be feasible to avoid biopsy before RP for patients with a high probability of PCa based on PSMA PET/CT and mpMRI.However,the diagnostic efficacy of csPCa with PI-RADS≥4 and SUVmax of≥4 is inadequate for performing a procedure such as RP.Further prospective multicenter studies with larger sample sizes are necessary to confirm our perspectives and establish predictive models with PSMA PET/CT and mpMRI.
基金National Key R&D Program of China,Grant/Award Number:2020AAA0109500National Natural Science Foundation of China,Grant/Award Numbers:82030025,32100631,82003269,82122053+3 种基金Young Elite Scientists Sponsorship Program by the China Association for Science and Technology,Grant/Award Number:YESS20210056CAMS Innovation Fund for Medical Sciences,Grant/Award Number:2021-I2M-1-067Central Research Institute Fund of Chinese Academy of Medical Sciences,Grant/Award Number:2021-PT310-001Key-Area Research and Development Program of Guangdong Province,Grant/Award Number:2021B0101420005。
文摘With the development and introduction of immune checkpoint inhibitors(ICIs)in cancer patients,immune-related side effects have increasingly attracted attention.However,the risks of immune-related renal toxicity are poorly characterized.In this study,we performed a network meta-analysis(NMA)of ICI-related randomized clinical trials(RCTs)to elucidate the comparative risk of acute kidney injury(AKI)in cancer patients receiving different ICIs.We also sought to identify other factors potentially affecting the risk of AKI.PubMed and EMBASE were searched for peer-reviewed trial reports published between January 2000 and May 2021.Eligible studies were RCTs studying ICIs in cancer patients and reporting AKI data.We performed a frequentist NMA to evaluate the risk ratios for grade 1-5 and grade 3-5 AKI between the treatment groups.We also assessed the absolute incidence of AKI in the ICI-containing arm using traditional direct meta-analysis.Once significant heterogeneity was detected in a traditional direct meta-analysis,multivariable meta-regression analysis was applied to identify factors that significantly affected the absolute incidence of AKI.A total of 85 RCTs were included in this study.In the NMA for the risk of grade 1-5 and 3-5 AKI,ipilimumab showed a significantly higher risk than avelumab and durvalumab,whereas 1 mg/kg nivolumab plus 3 mg/kg ipilimumab(N1I3)showed a significantly higher risk than other groups.In terms of treatment ranking,durvalumab±low-dose tremelimumab and avelumab were consistently among the top three safest treatments for grade 1-5 or 3-5 AKI,whereas N1I3,ipilimumab and tremelimumab were consistently among the top three treatments with the highest risk for grade 1-5 or 3-5 AKI.Compared with other cancers,renal cell carcinoma and urothelial carcinoma showed a significantly higher risk of AKI.The incidence of AKI was significantly higher with ICI+chemotherapy than with ICI monotherapy.In this NMA involving largescale up-to-date ICI trials,we demonstrated the comparative safety of existing ICI drugs for grade 1-5 and grade 3-5 AKI.Based on data from the ICI arms of these trials,we also revealed several potential risk factors for immune-related AKI,including tumor type and treatment paradigm.
基金The National Natural Science Foundation of China(81472397 to S.R.and 81773154 to C.W.)The Top-level Clinical Discipline Project of Shanghai Pudong(PWYgf2018-03,C.W.)+1 种基金The Shanghai Natural Science Foundation(20ZR1449600,C.W.)The Leadership Program in Science and Technology of Beijing Municipal Science and Technology Commission(181100006318007,N.X.).
文摘Androgen deprivation therapy(ADT)is an important treatment strategy that can be used to delay the progression of prostate cancer.However,after an initial response,which varies significantly among patients,the disease eventually progresses despite the low levels of testosterone in the systemic circulation.1 The mechanism underlying the progression of prostate cancer to castration-resistant prostate cancer(CRPC)is not yet clear,and further investigation is needed.
基金National Natural Science Foundation of China(No.82071777)China Urological Cancer Research Foundation from Beijing Life Oasis Public Service Center(No.2023-Z-16)
文摘Background:Cardiovascular disease(CVD)has emerged as the leading cause of death from prostate cancer(PCa)in recent decades,bringing a great disease burden worldwide.Men with preexisting CVD have an increased risk for major adverse cardiovascular events when treated with androgen deprivation therapy(ADT).The present study aimed to explore the prevalence and risk evaluation of CVD among people with newly diagnosed PCa in China.Methods:Clinical data of newly diagnosed PCa patients were retrospectively collected from 34 centers in China from 2010 to 2022 through convenience sampling.CVD was defined as myocardial infarction,arrhythmia,heart failure,stroke,ischemic heart disease,and others.CVD risk was estimated by calculating Framingham risk scores(FRS).Patients were accordingly divided into low-,medium-,and high-risk groups.χ2 or Fisher’s exact test was used for comparison of categorical variables.Results:A total of 4253 patients were enrolled in the present study.A total of 27.0%(1147/4253)of patients had comorbid PCa and CVD,and 7.2%(307/4253)had two or more CVDs.The enrolled population was distributed in six regions of China,and approximately 71.0%(3019/4253)of patients lived in urban areas.With imaging and pathological evaluation,most PCa patients were diagnosed at an advanced stage,with 20.5%(871/4253)locally progressing and 20.5%(871/4253)showing metastasis.Most of them initiated prostatectomy(46.6%,1983/4253)or regimens involving ADT therapy(45.7%,1944/4253)for prostate cancer.In the present PCa cohort,43.1%(1832/4253)of patients had hypertension,and half of them had poorly controlled blood pressure.With FRS stratification,as expected,a higher risk of CVD was related to aging and metabolic disturbance.However,we also found that patients with treatment involving ADT presented an originally higher risk of CVD than those without ADT.This was in accordance with clinical practice,i.e.,aged patients or patients at advanced oncological stages were inclined to accept systematic integrative therapy instead of surgery.Among patients who underwent medical castration,only 4.0%(45/1118)received gonadotropin releasing hormone antagonists,in stark contrast to the grim situation of CVD prevalence and risk.Conclusions:PCa patients in China are diagnosed at an advanced stage.A heavy CVD burden was present at the initiation of treatment.Patients who accepted ADT-related therapy showed an original higher risk of CVD,but the awareness of cardiovascular protection was far from sufficient.
文摘Prostate cancer(PCa)is one of the most prevalent malignant tumors in men,accompanied by high incidence and mortality rates.Novel hormonal therapy(NHT)has emerged as the primary treatment for advanced PCa,providing noticeable clinical benefits.However,the diverse range of adverse events(AEs)associated with NHT may influence both treatment efficacy and patients'quality of life.In light of the latest international clinical research evidence and recommendations from domestic and foreign guidelines,this consensus aims to provide a comprehensive overview of the common AEs experienced during NHT for advanced PCa patients.Additionally,it seeks to develop a hierarchical approach to more efficiently manage AEs,presenting valuable insights for clinical medication and adverse reaction management.
文摘Prostate cancer is one of the most common solid tumors in men,and its incidence continues to rise in China.Several guidelines have been developed and published to facilitate the standardization of diagnosis and treatment of prostate cancer.However,there are still many challenges and issues in clinical practice that lack high-level evidence.A panel of recognized domestic experts including urologists,medical oncologists,and radiologists was organized and invited to discuss and vote on the key issues of lacking high-level evidence and unified guideline recommendations questions.Following careful selection and voting processes,19 questions were identified,leading to the establishment of a consensus based on collective agreement regarding these hot issues.The aim of this consensus is to provide a reference for managing the whole patient journey of prostate cancer for Chinese clinicians.
