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Case series
Patient: Male, 78 • Male, 65
Final Diagnosis: Bone metastasis from prostate cancer recurrence
Symptoms: Joint pain
Medication: —
Clinical Procedure: —
Specialty: Uro-Oncology
Objective
Rare presentation
Background
Prostate cancer is a common cancer in men. Radical prostatectomy, i.e., the surgical removal of the entire prostate, is a...
Context in source publication
Citations
... These can be detected immunohistochemically in biopsy specimens or by measuring their levels in peripheral blood to assess NED and have been reported to be useful in predicting prostate cancer prognosis [7]. Mahdy et al. also reported a case of bone metastasis without a significant increase in PSA several years after treatment for localized prostate cancer [8]. Therefore, the possibility of bone metastasis from NED prostate cancer should be considered when new bone lesions appear without an elevated PSA. ...
... Our results showed that biochemical progression after RP was more typically presented with distant metastatic involvement, especially bone metastatic lesions in males with lower PSA values, even less than 0.04 ng/mL. The clinical use of BCR as a substitute end point for intervention to alter the subsequent PC management has been questionable in this context, which is fully concordant with observations in other studies (29,30). ...
ABSTRACT
INTRODUCTION: Currently 68Ga-PSMA PET/CT is making a significant shift in the diagnosis, staging and restaging of prostate cancer (PC) patients. Мany questions have been raised concerning the indications and the sensitivity of the method. Most of them are related to the PSA values in biochemical progression, specifically in the low
PSA values of up to 2.00 ng/mL.
AIM: The aim of this study was to analyze the influence of PSA values in biochemical progression on 68Ga-PSMA
PET/CT sensitivity, detection rate and the association with regional or metastatic lesions incidence in patients after
radical prostatectomy (RP) with a focus on the impact of the lower ranges of the PSA values.
MATERIAL AND METHODS: We performed a retrospective analysis in 144 consecutive patients with radical
prostatectomy (RP) who underwent 68Ga-PSMA PET/CT from July 2019 to February 2020. The patients were divided
into six groups according to the PSA value: 1) ≤0.040 ng/mL; 2) 0.041–0.160 ng/mL; 3) 0.161–0.500 ng/mL; 4) 0.501–
1.0 ng/mL; 5) 1.001–2.00 ng/mL; 6) >2.00 ng/mL.
RESULTS AND DISCUSSION: The mean age of the patients was 67.3 (7) years and the mean PSA level was 11.0
(52.28) ng/mL. A total of 62 patients (43.1%) showed at least one positive lesion. 68Ga-PSMA PET/CT detection rate
varied into the different groups between 12.0% and 94.0%. There was a significant relationship between the PSA level and the ability of 68Ga-PSMA PET/CT to detect the lesions. Local recurrence was determined in patients with higher PSA values. Regional metastatic lymph nodes incidence in the 6 groups was between 17.0% and 50.0%. Bone metastases were most commonly diagnosed in patients with low PSA levels. Distant lymph nodes involvement in the
studied groups ranged between 0.0% and 75.0%. Distant metastases were detected most commonly in patients with
low levels of PSA. The PSA-based assessment of the overall sensitivity and specificity of 68Ga-PSMA PET/CT was
58.0% and 87.0%, respectively. Sensitivity of 15.0% was
found in the group with the lowest mean PSA levels.
CONCLUSION: Tumor detection rate is positively associated with PSA levels. Biochemical progression after RP is more commonly related to distant metastases,
specifically bone metastases in patients with lower levels of PSA.
Keywords: 68Ga-PSMA PET/CT, prostate cancer,
PSA levels, biochemical progression
... Most skull bone metastases are purely intraosseous lesions limited to the calvarium or base of the skull [6]. A review of previous reports and literature revealed that metastatic prostate cancer of the temporal bone is rare, especially in the frontotemporal bone [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]. ...
... Cranial neurological deficits or nerve palsies caused by prostatic cancer metastasis are uncommon in advanced disease but constitute important clinical characteristics. Skull metastasis can cause symptoms of nervous system debilitation, such as cranial nerve palsy, preferentially causing urological symptoms, facial nerve palsy, multiple cranial nerve palsies, otological symptoms, and ophthalmoplegia [2][3][4]14,17]. ...
Introduction
and important: Prostatic cancer is often prone to metastasis and bone invasion. Skull metastasis in prostate cancer is uncommon, accounting for less than 2% of all metastases. However, frontotemporal bone metastasis without dural or brain metastasis is rare.
Case presentation
Herein, we report the case of a 91-year-old male patient who presented with a sudden-onset dizziness, a fall to the ground, and gradual loss of consciousness. Computed tomography (CT) of the brain revealed an aggressive bony lesion secondary to locally advanced metastatic malignancy and subdural hematoma. Subsequently, he underwent decompressive craniectomy. Histopathological and immunohistochemical (IHC) examinations demonstrated metastatic prostatic adenocarcinoma (PCa). Although after treatment by a multidisciplinary team, unfortunately, the patient expired two months after the surgery and could no longer be traced.
Clinical discussion
In the majority of reported cases, CT scans of the brain are often mistaken for subdural hematoma or meningioma. The present case suggests is a preliminary incidental case of a single frontotemporal bony lesion. This is the first case described in the literature of incidental finding of metastatic PCa presenting with asymptomatic characteristics.
Conclusion
Awareness of the possibility of metastatic PCa involving the skull bones, as well as histopathological and IHC examinations, are important to arrive at a correct initial diagnosis.
The role of noncoding RNA has made remarkable progress in understanding progression, metastasis, and metastatic castration-resistant prostate cancer (mCRPC). A better understanding of the miRNAs has enhanced our knowledge of their targeting mainly at the therapy level in solid tumors, such as prostate cancer (PCa). microRNAs (miRNAs) belong to a class of endogenous RNA that deficit encoded proteins. Therefore, the role of miRNAs has been well-coined in the progression and development of PCa. miR-21 has a dual nature in its work both as a tumor suppressor and oncogenic role, but most of the recent studies showed that miR-21 is a tumor promoter and also is involved in castration-resistant prostate cancer (CRPC). Upregulation of miR-21 suppresses programmed cell death and inducing metastasis and castration resistant in PCa. miR-21 is involved in the different stages, such as proliferation, angiogenesis, migration, and invasion, and plays an important role in the progression, metastasis, and advanced stages of PCa. Recently, various studies directly linked the role of high levels of miR-21 with a poor therapeutic response in the patient of PCa. In the present review, we have explained the molecular mechanisms/pathways of miR-21 in PCa progression, metastasis, and castration resistant and summarized the role of miR-21 in diagnosis and therapeutic levels in PCa. In addition, we have spotlighted the recent therapeutic strategies for targeting different stages of PCa.
Background
Radical prostatectomy, radiotherapy, chemotherapy, and androgen‐deprivation therapy are among the most common treatment options for different forms of prostate cancer (PCa). However, making therapeutic decisions is difficult due to the lack of reliable prediction markers indicating therapy outcomes in clinical practice. The involvement of miRNAs in all mechanisms of the PCa development and their easy detection characterize them as attractive PCa biomarkers. Although there are extensive data on the role of miRNAs in PCa therapy resistance and sensitivity development, the issues of whether they could be used as a guide for therapy choice and, if so, how we can progress toward this goal, remain unclear. Thus, generalizable reviews and studies which summarize, compare, and analyze data on miRNA involvement in responses to different types of PCa therapies are required.
Objectives
Data on the involvement of miRNAs in therapy responses, on the role of cross‐miRNA expression in different therapies, and on miRNA targets were analyzed in order to determine the miRNA‐related factors which can lend perspective to the future development of personalized predictors of PCa sensitivity/resistance to therapies.
Materials and methods
The data available on the miRNAs associated with different PCa therapies (resistance and sensitivity therapies) are summarized and analyzed in this study, including analyses using bioinformatics resources. Special attention was dedicated to the mechanisms of the development of therapy resistance.
Results and discussion
A comprehensive combined analysis of the current data revealed a panel of miRNAs that were shown to be most closely associated with the PCa therapy response and were found to regulate the genes involved in PCa development via cell proliferation regulation, epithelial‐mesenchymal transition (EMT), apoptosis, cell‐cycle progression, angiogenesis, metastasis and invasion regulation, androgen‐independent development, and colony formation.
Conclusion
The selected miRNA‐based panel has the potential to be a guide for therapeutic decision making in the effective treatment of PCa.
Elevated levels of miR-21 expression are associated with many cancers, suggesting it may be a promising clinical biomarker. In prostate cancer (PCa), however, there is still no consensus about the usefulness of miR-21 as an indicator of disease progression. This systematic review and meta-analysis was conducted to investigate the value of miR-21 expression as a prognostic measurement in PCa patients. Medline (Ovid), EMBASE, Web of Science, Scopus and Cochrane Library databases were systematically searched for relevant publications between 2010 to 2021. Studies exploring the relationship between miR-21 expression, PCa prognosis and clinicopathological factors were selected for review. Those reporting hazard ratio (HR) and 95% confidence intervals (CIs) were subject to meta-analyses. Fixed-effect models were employed to calculated pooled HRs and 95% CIs. Risk of bias in each study was assessed using QUIPS tool. Certainty of evidence in each meta-analysis was assessed using GRADE guidelines. A total of 64 studies were included in the systematic review. Of these, 11 were eligible for inclusion in meta-analysis. Meta-analyses revealed that high miR-21 expression was associated with poor prognosis: HR=1.58 (95% CI=1.19-2.09) for biochemical recurrence, MODERATE certainty; HR=1.46 (95% CI=1.06-2.01) for death, VERY LOW certainty; and HR=1.26 (95% CI=0.70-2.27) for disease progression, VERY LOW certainty. Qualitative summary revealed elevated miR-21 expression was significantly positively associated with PCa stage, Gleason score and risk groups. This systematic review and meta-analysis suggests that elevated levels of miR-21 are associated with poor prognosis in PCa patients. miR-21 expression may therefore be a useful prognostic biomarker in this disease.
Background:
Studies of microRNAs (miRNAs) and genes have particular interest for cancer biology and medicine due to the discovery of new therapeutic targets and markers. These studies are extensively influenced by anticancer therapy, as miRNAs interfere with the therapy's efficacy in prostate cancer (PCa).
Objectives:
In this article, we summarise the available data on the influence of radical prostatectomy (RP) and biochemical recurrence on miRNA expression.
Materials and methods:
Molecular targets of these miRNAs, as well as the reciprocal relations between different miRNAs and their targets, were studied using the DIANA, STRING, and TransmiR databases. Special attention was dedicated to the mechanisms of PCa development, miRNA, and associated genes as tumour development mediators.
Results and discussion:
Combined analysis of the databases and available literature indicates that expression of four miRNAs that are associated with prostate cancer relapse and alter their expression after RP, combined with genes that closely interact with selected miRNAs, have high potential for the prediction of PCa relapse after RP. PCa tissues and biofluids, both immediately after RP for diagnostics/prognostics and in long-term (relapse) monitoring, may be used as sources of these miRNAs.
Conclusion:
An overview of the usefulness of published data and bioinformatics resources looking for diagnostic markers and molecular targets is presented in this article. The selected miRNA and gene panels have good potential as prognostic and PCa relapse markers after RP and likely could also serve as markers for therapeutic efficiency on a broader scale.
