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.
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.
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.
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.
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.
Image fusion currently plays an important role in the diagnosis of prostate cancer (PCa). Selecting and developing a good image fusion algorithm is the core task of achieving image fusion, which determines whether the fusion image obtained is of good quality and can meet the actual needs of clinical application. In recent years, it has become one of the research hotspots of medical image fusion. In order to make a comprehensive study on the methods of medical image fusion, this paper reviewed the relevant literature published at home and abroad in recent years. Image fusion technologies were classified, and image fusion algorithms were divided into traditional fusion algorithms and deep learning (DL) fusion algorithms. The principles and workflow of some algorithms were analyzed and compared, their advantages and disadvantages were summarized, and relevant medical image data sets were introduced. Finally, the future development trend of medical image fusion algorithm was prospected, and the development direction of medical image fusion technology for the diagnosis of prostate cancer and other major diseases was pointed out.
ObjectiveTo investigate the expression of tumor necrosis factor-α (TNF-α) in prostate cancer tissue and explore its relations with tumor angiogenesis. MethodsThe expression of TNF-α and CD105 were detected with two-step immunohistochemical staining technique in 20 cases of benign prostatic hyperplasia and 50 cases of prostate cancer between January 2010 and January 2012, and microvessel density (MVD) marked with CD105 was also measured. ResultsThe expressions of TNF-α and CD105 were higher in prostate cancer (41.72±8.67, 20.15±2.67) than those in benign prostatic hyperplasia (21.01±3.85, 4.34±1.67) (t'=13.990, P<0.001; t'=29.771, P<0.001). TNF-α and MVD were not correlated with age and size of tumor, but were positively correlated with tumor differentiation degree (rs=0.847, P<0.001; rs=0.776, P<0.001) and negatively correlated with clinical grades (rs=-0.769, P<0.001; rs=-0.842, P<0.001). ConclusionThe result indicates that over expression of TNF-α exists in prostate cancer. It may play an important role in the anginogenesis and carcinogenesis of prostate cancer.
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.
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.
ObjectiveTo compare the effectiveness of magnetic resonance spectroscopy (MRS) and Dynamic Contrast-enhancement (DCE-MRI) with 1.5 T MR scanner in diagnosing prostate cancer. MethodsFrom April 2011 to December 2012, based on the results of biopsy, we measured 216 regions of interest (ROIs) in images of MRS and DCE-MRI, comprised of 131 ROIs from cancer zone and 85 ROIs from non-cancer zone. The data were analyzed with statistical methods, including receiver operating characteristic (ROC) curve. ResultsThere were significant differences between the malignant group and the benign group (P<0.05) in Cit integral, Cho integral, CC/Cit ratio, the type of time-signal intensity curve, initial value, enhancement rate and ratio of enhancement. According to ROC curve, the area under curve (AUC) of CC/Cit and enhancement rate was 0.853 and 0.719, respectively. AUC of time to peak, time difference, enhancement rate and Cit integral was lower than 0.400. The optimal operating point (OOP) of CC/Cit was 0.775, with a specificity of 0.85 and a sensitivity of 0.79, and the AUC was 0.853. The OOP of the ratio of enhancement was 60.89, with a specificity of 0.66 and a sensitivity of 0.71, and the AUC was 0.719. ConclusionMRS is more sensitive and specific than DCE-MRI to diagnose prostate cancer when an 1.5 T MR scanner is used. On the other hand, MRS is susceptible to interference, but DCE-MRI can make up for these deficiencies.