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Volume 67, Issue 1 (4-2009)
The prostate is a small gland located below the bladder and upper part of the urethra. In developed countries prostate cancer is the second common cancer (after skin cancer), and also the second leading cause of cancer death (after lung cancer) among men. The several studies have been shown prostate cancer familial aggregation. The main reason for this aggregation is inheritance included genes. The family history is an important risk factor for developing the disease. The genes AR, CYP17, SRD5A2, HSD3B1 and HSD3B2 are all intimately involved in androgen metabolism and cell proliferation in the prostate. Each shows intraspecific polymorphism and variation among racial-ethnic groups that is associated with the risk of prostate cancer. Some of genes expressed in the prostate are in association with the production of seminal fluid and also with prostate cancer. Epigenetic modifications, specifically DNA hypermethylation, are believed to play an important role in the down-regulation of genes important for protection against prostate cancer. In prostate cancer numerous molecular and genetic aberrations have been described. It is now well established that cancer cells exhibit a number of genetic defects in apoptotic pathways. In this review article, the most recent data in molecular genetic, prevention and especially gene therapy in prostate cancer are introduced.
Volume 70, Issue 5 (8-2012)
Background: Multifocality, multicentricity and extension beyond the prostate capsule are all characteristics of prostatic adenocarcinoma that may escape diagnosis by conventional CT scanning or MRI. This study was designed to assess the diagnostic value of magnetic resonance spectroscopy (MRS) in prostatic carcinoma and its compatibility with prostatic specific antigen (PSA) as the conventional method.
Methods: In this cross-sectional study, we recruited 139 patients with previous radical prostatectomy referring to Radiology department of Hazrate-e-Rasul Hospital during the first half of 2011 for the evaluation of local recurrence. Traditionally, local recurrence is defined as serum PSA concentration >0.2 ng/dl. We used 1.5-tesla Siemens Avanto MRI unit with endorectal coil and measured creatine, choline and citrate levels before calculating choline-creatine/citrate ratio. Correlation between MRS findings with PSA concentration was evaluated in regards to the multiple levels of the previously mentioned ratio.
Results: Local recurrence was found in 107 (77%) patients based on PSA levels. The mean values for serum PSA levels and creatine-choline/citrate ratio were significantly different in patients with and without local recurrence. Creatine-choline/citrate ratios greater than 50, 100 and 150 (as different cut-off points of recurrence) were respectively seen in 104, 102 and 97 patients and agreement ratio between MRS and PSA in these levels were 94.1%, 94.4% and 85.1%, respectively. Correlation coefficient between these two methods was 0.481.
Conclusion: MRS is a valuable tool for evaluating recurrence inpatients with prostate cancer treated by radical prostatectomy and it is in good agreement with serum PSA levels.
Volume 70, Issue 9 (12-2012)
Background: Prostate cancer is the most common cancer and the second cause of cancer mortality in men. Although histopathological examination is the gold-standard for its diagnosis, tendency toward less invasive methods is growing. The purpose of this study was to evaluate the relationship between choline plus creatine- to-citrate ratio in magnetic resonance spectroscopy (MRS) with the invasion of prostate cancer in a series of patients with prostate cancer.
Methods: Totally, 200 patients with pathologically proven prostate cancer were enrolled in this cross-sectional study by a non-probability sampling method in Hazrat Rasul Akram Hospital in Tehran, Iran during 2009-2010. Pathological staging was the gold standard for the diagnosis of prostate cancer while the patients underwent MRS for choline plus creatine- to-citrate ratio determination. MRS and pathological results were compared and analyzed.
Results: The mean (±SD) values of choline plus creatine- to-citrate ratio in patients with Gleason scores less than 3, 3 to 4 and greater than 4 were 245.8±146.8, 427.1±173.6 and 427.1±173.6, respectively (P<0.001). The mean (±SD) values of choline plus creatine- to-citrate ratio in patients with PSA levels less than 4, 4 to 10 and greater than 10 were 180.7±58.3, 247±93.5 and 385.1±106.6, respectively (P<0.001).
Conclusion: Choline plus creatine- to-citrate ratio determined by magnetic resonance spectroscopy has a significant relationship with the degree of invasion of prostate cancer and can be used for the staging of the disease.
Volume 71, Issue 6 (9-2013)
Background: Prostate cancer is the third leading cause of death and is the most common cause of cancer in elderly men. Regarding to the low accuracy of screening methods such as prostate-specific antigen (PSA), Digital Rectal Examination (DRE) and trans rectal ultrasound (TRUS) in detection and localization of tumor, Magnetic Resonance Imaging (MRI) and Diffusion Weighted Imaging (DWI) attracted many attentions in the past years. DWI reveals micro-molecular diffusion, which is the Brownian motion of the spins in biologic tissues. This technique can delineate pathologic lesions with high tissue contrast against generally suppressed background signal. In this paper, the value of DWI in detection of prostate cancer is studied.
Methods: In this cross-sectional study, the studied population are suspicious patients to prostate cancer based on high Prostatic Specific Antigen level or abnormal Digital Rectal Examination who refered for prostate biopsy to radiology department of Hazrat-e- Rasoul Hospital during the year 2011. The results of DWI are compared to biopsy results for all patients.
Results: Eighty five patients are selected. The DWI sensitivity in detecting of prostate cancer is 100%, specificity 97.1% and positive and negative predictive values are 89.5% and 100%, respectively. The results showed that if DWI reports the prostate cancer as negative, the result was highly reliable and if it reports as positive, although the report was not 100% reliable, but it still had high reliability, more than 90%.
Conclusion: DWI had high accuracy in detecting prostate cancer for patients with cancer. Also the accuracy of this method for patients without prostate cancer was acceptable compared to the other common methods.
Volume 75, Issue 10 (1-2018)
Methods: In this case study, 50 prostate cancer urine samples from patients and 50 urine samples from normal individuals who were referred to Mehr Hospital of Tehran (from December 2014 to February 2016) were obtained and stored in the central research laboratory of Shahid Beheshti University of Medical Sciences, Tehran, till tests were being done. The age of collected samples between the 46 up to 71 years. RNA of samples were extracted, and then cDNA was synthesized by using M-MuLV enzyme, Oligo dt, and Random hexamer primers. KLK2 specific primers designed by Primer Express software, version 3.0 (Applied Biosystems, Foster City, CA, USA), and KLK2 gene expression evaluated by using ∆∆ct methods.
Results: In comparison with patients and normal sample`s gene expression, the mean increase expression of KLK2 gene in patients less than 50 years was 2.32 and in patients more than 50 years, it was 5.79, P<0.0001. In addition, gene expression results with respect to GS (Gleason grading system) classification shown that patients with GS6 had the lowest gene expression (3.40) and in the patients with GS8, had the highest gene expression (10.74) in comparison with normal group (P<0.0001).
Conclusion: The expression of KLK2 gene in people with prostate cancer is the higher than the healthy person; finally, according to the results, it could be mentioned that the KLK2 gene considered as a useful factor in prostate cancer, whose expression is associated with progression and development of the prostate cancer.
Volume 77, Issue 2 (5-2019)
Methods: This research was a cross-sectional, analytical, and quantitative study that was carried out from April 2016 to June 2018 at the radiotherapy and oncology center of Shoheday-e-Tajrish Hospital and Medical Physics Department of Tarbiat Modarres University Tehran, Iran. Four various prostate IMRT techniques (9, 7 and 5 fields and automatic) were planned on 63 prostate cancer patients CT scans. Radiobiological effects were calculated using Relative Seriality model for the organs at risk (bladder and rectum) and target tissue. Results of mentioned prostate IMRT techniques were compared based on the patient’s anatomical parameter.
Results: For the patients with joint volumes ranged from 0 to 15%, statistical differences were not observed among various IMRT techniques. The tumor control probability and complication free tumor control probability values decreased as a function of joint volume. The normal tissue complication probability value increased as a function of joint volume. The 9 and 7 fields IMRT techniques had not any significant differences (P=0.06) in all of the joint volume ranges. In patients with the joint volumes higher than 30%, the 9 and 7 fields techniques showed significantly better radiobiological values in comparison with 5 fields and automatic techniques (P=0.009).
Conclusion: In the patients with lower percentage of joint volume, all the mentioned prostate IMRT techniques showed same radiobiological effects; however, in the patients with higher joint volume percentages (> 30%), the 9 and 7 fields techniques have better results. It is proposed to use the 7 fields technique instead of the 9 fields technique, especially in prostate cancer cases with high uncertainty in patients’ setup.
Volume 77, Issue 12 (3-2020)
Methods: This is a systematic review study. Databases including Scopus, Medline, PubMed, Google Scholar, Cochrane, Embase were searched. The terms used include prostate cancer, adenocarcinoma, neoadjuvant, chemotherapy, chemotherapy alone, systemic therapy. Of the various types of articles, only oiginal research studies that specifically focused on neoadjuvant chemotherapy (not chemotherapy with target therapy, immunotherapy, or hormone therapy) were identified. Inclusion criteria included study type (original research studies) and sample type (high-risk localized prostate cancer patients) and outcome type (patient survival).
Results: A total of 17 original research studies were identified. All of these studies were phase one or phase two. Docetaxel was the most commonly used chemotherapy drug. Also, the most common regimen used was the use of docetaxel alone. The rate of decrease in prostate-specific antigen (PSA) (>50%) after neoadjuvant chemotherapy was reported in 24 to 58% of patients. PSA declines of less than 50% after neoadjuvant chemotherapy occurred in 40 to 100% of patients. No studies reported a complete pathologic response following neoadjuvant chemotherapy. However, the relative pathologic response and reduced tumor volume were seen in the majority of patients. All of these studies showed that neoadjuvant chemotherapy alone, in high-risk prostate cancer patients, was almost well tolerated and that the complications were mostly mild (grade 1 and 2). Grade 3 and 4 complications were negligible. A 2-year recurrence-free survival of up to 68.5% and a 5-year recurrence-free survival of up to 49% were reported. The overall 5-year survival also ranged from 35 to 48%.
Conclusion: The use of neoadjuvant chemotherapy alone has not clearly increased the survival of patients with high-risk localized prostate cancer, and there is controversy in studies.
Volume 79, Issue 12 (3-2022)
| Prostate cancer is the most common and second leading cause of death among men in the world. Nowadays, radiotherapy has been known as one of the most affecting methods for prostate cancer treatment. Nevertheless, radiotherapy is accompanied by the concern of developing secondary cancers by the scattered radiation to the neighbor organs at risk. Several studies have shown that secondary cancers after the radiotherapy of prostate cancer treatment, occur in tissues such as the bladder and rectum which have been exposed to direct or indirect radiations. Therefore, this review study aimed to evaluate the influencing factors for developing secondary cancers after the radiotherapy of prostate cancer. To access the previously validated published studies, Persian and English keywords such as prostate cancer, secondary cancers, radiotherapy and organs at risk have been searched in ISID, Google Scholar, Science Direct, PubMed, and World Health Organization, between 1997 and 2021. Totally 246 pieces of literature have been selected which finally, by ignoring the similar and overlapping studies, only 40 studies were reviewed. In the present study, the most affecting factors for developing secondary malignancies including the anatomical status changes, dose variations, smoking and the impact of the various treatment techniques, have been studied. The results of the reviewed studies showed a reduction of secondary cancer risks with performing the modern modalities such as proton therapy to treat prostate cancer. Moreover, organ movements and anatomical status changes which vary from one patient to others, have been reported to make a significant difference in the relative risk of secondary cancers. It has been shown that smoking may increase the risk of secondary cancers after the radiotherapy of prostate cancer, so radiotherapy and smoking may cause genetic mutations. Despite the advantages of radiotherapy for prostate cancer treatment, developing secondary cancers after the radiotherapy should not be ignored. Assessments of the affecting factors for secondary cancers after the radiotherapy of prostate cancer require social and comprehensive studies which can result in an accurate modality with fewer side effects. |
Volume 80, Issue 6 (9-2022)
Methods: In this study, with a systematic review of studies conducted during February 2015 to October 2021, the role and potential of integrating the results of morphological and functional imaging in a multi-parameter approach were evaluated and the optimal combination was introduced. This article collected studies that have employed mp-MRI in prostate cancer including: peer-reviews, research articles, academic reports and conferences. This review has been studied from September 2016 to January 2022.
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Results: According to the reported results, the optimum combination of T2-w, DWI and DCE in the mp-MRI approach provides the highest sensitivity and specificity in the diagnosis, localization and staging of prostate cancer. Applying the field strength of 3T versus 1.5T improves detection accuracy including improving sensitivity and specificity as well, and also the application of endorectal coils does not provide much advantage compared to pelvic phased-array coil in term of prostate cancer detection accuracy.
Conclusion: MP-MRI as a precision instrument plays a valuable role in the diagnosis of prostate cancer. The most suitable combination of the pulse sequences to achieve the goals of this approach is T2-w, DWI and DCE. This review is comprehensive overview covered previous articles of mp-MRI in prostate cancer for all the researchers in this field and expresses the positive and negative points of each modality. Moreover, this article reports the sensitivity and the Specificity of the recent researches. |
Volume 80, Issue 12 (3-2023)
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Volume 81, Issue 3 (6-2023)
Background: In prostate cancer radiotherapy, due to the proximity of the prostate to the rectum, it can be affected by high radiation doses. It has been reported that about 70% of secondary cancers after prostate cancer radiotherapy occur in the bladder and rectum, which are exposed to direct radiation. Since prostate cancer radiotherapy may be accompanied by side effects, the aim of this study is to investigate the risk of secondary cancers after the radiotherapy of prostate cancer inside the outfield organs.
Methods: The dose volume histogram data relevant to 39 patients with prostate cancer (who were treated with 3-dimensional conformal radiotherapy technique in 2022 in Tehran) were extracted, and the uniform absorbed dose inside the sensitive tissues was calculated according to the gEUD concept. Then, the risks of secondary malignancies following prostate cancer radiotherapy were calculated using the model introduced by the BEIR report. Accordingly, the lifetime attributable risk values (LAR) were estimated based on the desired organs and patient age at exposure time through the calculation of Excess relative risk (ERR) and Excess absolute risk (EAR) values.
| Results: From the obtained results, the gEUD values for the rectum ranged from 51.04 Gy to 74.69 Gy and for the bladder from 27.22 Gy to 75.51 Gy. The maximum calculated risk values for the rectum and bladder were calculated to be 49.85% and 74.91%, respectively. Besides, a significant level of secondary cancer risk within the rectum and bladder was obtained for most of the studied patients. Furthermore, small values of secondary cancer risks were estimated for patients who were irradiated at older ages, and higher ones were obtained for patients who were irradiated at younger ages. Conclusion: The results showed that there is a higher probability of developing secondary malignancies in the bladder than the rectum. The information obtained in this research can improve the performance of the treatment process, so that information about secondary cancers following radiation therapy for prostate cancer will ultimately help doctors design more effective and optimal treatment designs. |
Volume 81, Issue 9 (12-2023)
Methods: The study conducted is a systematic review article in which a review of the treatment of prostate cancer with brachytherapy has been done. The information used is taken from articles published in Persian and English in Google scholar, SID and PubMed databases from 2000 to 2022. The selected keywords in this article included Brachy therapy, Prostate cancer, Radio therapy, Prostate neoplasms, High dose rate, Low dose rate and External beam radio therapy. Selection of studies was done according to PRISMA guidelines.
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Results: Brachytherapy can be classified into 2 types of permanent implantation and temporary implantation based on the length of the treatment period. In permanent brachytherapy implants for prostate cancer, iodine (125I) or palladium (103Pd) are used as radioactive sources for low dose rate cases and for high dose rate brachytherapy. Iridium (192Ir) is used. Brachytherapy is usually used in two ways, either as a monotherapy in which LDR and HDR are used to treat some low-risk patients, or as a booster treatment after other treatments such as EBRT, which here may be part of the treatment process before, after, or during treatment. In contrast to brachytherapy alone, brachytherapy plus EBRT is an appropriate approach in patients with intermediate-risk and high-risk disease. In high-risk patients, the combined use of EBRT and HDR-BT can lead to better results than EBRT alone. Brachytherapy treatment is not suitable for every disease.
Conclusion: One of the main advantages of this treatment method is the ability to administer a high dose of radiation while minimizing radiation exposure to adjacent healthy organs. Since optimal dose distribution occurs in the treatment, quality treatment can be ensured. The results obtained from both forms of brachytherapy are generally suitable and comparable to other treatment methods with fewer side effects. |
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