Regional location of lymph node metastases predicts survival in patients with de novo metastatic prostate cancer

To report the regional locations of metastases and to estimate the prognostic value of the pattern of regional metastases inmen with metastatic hormone-sensitive prostate cancer (mHSPC), we retrospectively analyzed 870 mHSPC patients betweenNovember 28, 2009, and February 4, 2021, from West China Hospital in Chengdu, China. The patients were initially classifiedinto 5 subgroups according to metastatic patterns as follows: simple bone metastases (G1), concomitant bone and regional lymphnode (LN) metastases (G2), concomitant bone and nonregional LN (NRLN) metastases (G3), lung metastases (G4), and livermetastases (G5). In addition, patients in the G3 group were subclassified as G3a and G3b based on the LN metastatic plane(below or above the diaphragm, respectively). The associations of different metastatic patterns with castration-resistant prostatecancer-free survival (CFS) and overall survival (OS) were analyzed by univariate and multivariate analyses. The results showedthat patients in G1 and G2 had relatively favorable clinical outcomes, patients in G3a and G4 had intermediate prognoses, andpatients in G3b and G5 had the worst survival outcomes. We observed that patients in G3b had outcomes comparable to those inG5 but had a significantly worse prognosis than patients in G3a (median CFS: 8.2 months vs 14.3 months, P = 0.015;medianOS: 38.1 months vs 45.8 months, P = 0.038). In conclusion, metastatic site can predict the prognosis of patients with mHSPC,and the presence of concomitant bone and NRLN metastases is a valuable prognostic factor. Furthermore, our findings indicatethat the farther the NRLNs are located, the more aggressive the disease is.

The safety of radium-223 combined with new-generation hormonal agents in bone metastatic castration-resistant prostate cancer: a systematic review and network meta-analysis

Patients with bone metastatic castration-resistant prostate cancer (mCRPC) might benefit from radium-223 (^(223)Ra) combined withnew-generation hormonal agents (NHAs) in terms of survival and quality of life (QoL). However, the safety of combination therapiesremains unclear. Therefore, we aimed to perform a network meta-analysis by reviewing the literature about the combination of^(223)Ra with abiraterone acetate plus prednisone (AAP) or enzalutamide and to evaluate the safety of combination therapy in bonemCRPC patients. Ultimately, ten studies (2835 patients) were selected, including four randomized controlled trials (RCTs), fiveretrospective cohort studies, and one single-arm study. Overall, there was no difference in the incidence of fracture between the^(223)Ra+NHA combination group and the ^(223)Ra monotherapy group (odds ratio [OR]: 1.46, 95% confidence interval [CI]: 0.91–2.34,P = 0.66), but the incidences in both the ^(223)Ra+NHA combination group (OR: 3.22, 95% CI: 2.24–4.63, P < 0.01) and the ^(223)Ramonotherapy group (OR: 2.24, 95% CI: 1.23–4.08, P < 0.01) were higher than that in the NHA monotherapy group. However, inthe meta-analysis involving only RCTs, there was no difference between the ^(223)Ra monotherapy group and the NHA monotherapygroup (OR: 1.14, 95% CI: 0.22–5.95, P = 0.88), while the difference between the ^(223)Ra+NHA combination group and the NHAmonotherapy group remained significant (OR: 3.22, 95% CI: 2.24–4.63, P < 0.01). Symptomatic skeletal events (SSEs), SSE-freesurvival (SSE-FS), all grades of common adverse events (AEs), and ≥grade 3 AEs among all groups did not show any significantdifference. Our results indicate that the combination of ^(223)Ra with NHAs was well tolerated in bone mCRPC patients compared to ^(223)Ra monotherapy, even though the incidence of fracture was higher in patients who received ^(223)Ra than that among those whoreceived NHA monotherapy. More evidence is needed to explore the safety and efficiency of ^(223)Ra combination therapies.

Intraductal carcinoma of the prostate in prostate biopsy samples: correlation with aggressive pathological features after radical prostatectomy and prognostic value in high-risk prostate cancer

Intraductal carcinoma of the prostate(IDC-P)is an aggressive pathological pattern of prostate cancer(PCa).We investigated the association of IDC-P in prostate biopsy(PBx)with several pathological features after radical prostatectomy(RP)and its prognostic value in high-risk PCa.A total of 418 patients with high-risk PCa after RP were included in this study.IDC-P and its architectural patterns were identified according to the 2016 World Health Organization Classification.Chi-squared test and logistic regression were used to investigate the correlation between IDC-P and post-RP pathological features.Kaplan-Meier curves and Cox regression were applied to explore the prognostic value of IDC-P.IDC-P was identified in PBx in 36/418(8.6%)patients.Logistic regression indicated that IDC-P in PBx was independently associated with several pathological features of RP,including Gleason score 8-10(P<0.001),seminal vesicular invasion(P<0.001),and pathological T(pT)3a(P=0.043).Patients with IDC-P in PBx manifested poorer biochemical-free survival(BFS)than those without IDC-P(37.47 months vs not reached,P<0.001).The addition of IDC-P in several prognostic nomograms could improve the predictive accuracy of these tools.We conclude that IDC-P in PBx is positively associated with several aggressive pathological features after RP in high-risk PCa.In addition,IDC-P in PBx could effectively predict the BFS of high-risk PCa patients after RP.

Peptide-Based Electrochemical Biosensors and Their Applications in Disease Detection

Biosensors based on small molecule peptides have developed rapidly in the detection of disease markers with the characteristics of high sensitivity, rapid analysis speed and easy miniaturization. The properties of the sensor, such as the sensitivity and detection range, are closely related to the material and structure of the electrodes. The electrodes mainly used in peptidebased biosensors are gold electrodes, glassy carbon electrodes(GCE), indium tin oxide(ITO) conductive glass electrodes and screen-printed electrodes. In addition, to improve the biomolecule loading rate, antifouling performance, electrical conductivity of the biosensor, a variety of nanomaterials and organic molecules are used to construct the biosensor for disease detection. This review summarizes the properties of several commonly used electrodes for peptide-based electrochemical biosensors, and introduces some modified materials of the electrode and their effects on sensor performance. In the future,the peptide-based biosensors will be widely used in clinical detection and other related fields.

Predictors of efficacy of corticosteroid switching from abiraterone plus prednisone to dexamethasone in patients with metastatic castration-resistant prostate cancer

Corticosteroid switching can reverse abiraterone resistance in some patients with metastatic castration-resistant prostate cancer(mCRPC).Here,we investigated the potential biomarkers for predicting the efficacy of corticosteroid switching during treatment with abiraterone acetate(AA).We retrospectively analyzed 101 mCRPC patients receiving corticosteroid switching from West China Hospital and Sun Yat-Sen University Cancer Center between January 2016 and December 2018.All cases received AA plus prednisone as first-line therapy during mCRPC.Primary end points were biochemical progression-free survival(bPFS)and overall survival(OS).The risk groups were defined based on multivariate analysis.A total of 42(41.6%)and 25(24.8%)patients achieved 30%and 50%decline in prostate-specific antigen(PSA),respectively,after corticosteroid switching.The median bPFS and median OS on AA plus dexamethasone were 4.9(95%confidence interval[CI]:3.7–6.0)months and 18.8(95%CI:16.2–30.2)months,respectively.Aldo-keto reductase family 1 member C3(AKR1C3)expression(hazard ratio[HR]:2.15,95%Cl:1.22–3.80,P=0.008)and baseline serum alkaline phosphatase(ALP;HR:4.95,95%Cl:2.40–10.19,P<0.001)were independent predictors of efficacy before corticosteroid switching in the multivariate analysis of bPFS.Only baseline serum ALP>160 IU l−1(HR:3.41,95%Cl:1.57–7.38,P=0.002)together with PSA level at switch≥50 ng ml−1(HR:2.59,95%Cl:1.22–5.47,P=0.013)independently predicted poorer OS.Based on the predictive factors in multivariate analysis,we developed two risk stratification tools to select candidates for corticosteroid switching.Detection of serum ALP level,PSA level,and tissue AKR1C3 expression in mCRPC patients could help make clinical decisions for corticosteroid switching.

Clinical and oncologic findings of extraprostatic extension on needle biopsy in de novo metastatic prostate cancer

This study aimed to explore the clinical and oncologic findings in patients with de novo metastatic prostate cancer(mPCa)and extraprostatic extension(EPE)on biopsy.We retrospectively evaluated data on 630 patients with de novo mPCa between January 2009 and December 2017 in the West China Hospital(Chengdu,China),including evaluating the relationships between EPE and other variables and the association of EPE with survival outcomes by the Chi-square test,Kaplan–Meier curves,and the Cox proportional-hazards model.EPE was found in 70/630 patients,making a prevalence of 11.1%.The presence of EPE on biopsy was associated with higher Gleason scores and higher incidence of neuroendocrine differentiation(NED),intraductal carcinoma of the prostate(IDC-P),and perineural invasion(PNI).Compared with those without EPE,patients with EPE had shorter castration-resistant prostate cancer-free survival(CFS;median:14.1 vs 17.1 months,P=0.015)and overall survival(OS;median:43.7 vs 68.3 months,P=0.032).According to multivariate analysis,EPE was not an independent predictor for survival.Subgroup analyses demonstrated that patients with favorable characteristics,including negative NED or IDC-P status,Eastern Cooperative Oncology Group(ECOG)score<2,and prostate-specific antigen(PSA)<50 ng ml−1,had worse prognoses if EPE was detected.In patients with PSA<50 ng ml−1,EPE was a negative independent predictor for OS(hazard ratio[HR]:4.239,95%confidence interval[CI]:1.218–14.756,P=0.023).EPE was strongly associated with other aggressive clinicopathological features and poorer CFS and OS.These data suggest that EPE may be an indicator of poor prognosis,particularly in patients,otherwise considered likely to have favorable survival outcomes.