Radionuclides can be labeled on biomolecules with specific binding ability. By binding with specific targets of tumors, particles such as α or β emitted by the radionuclides will specifically irradiate tumors and produce ionizing radiation effects, resulting in cell senescence and death within the irradiation range, achieving tumor treatment results, and this way has little impact on surrounding normal tissues. Lutetium-177 (177Lu) can emit γ rays for CT imaging, and can also emit β rays for tumor treatment, so 177Lu is now one of the radionuclides that can be used for integrated diagnosis and treatment. This review summarizes the clinical application of 177Lu in several solid tumors, in conjunction with currently published research.
Objective To investigate the application of the dynamic contrast enhanced MRI (DCE-MRI ) combined with magnetic resonance spectroscopy (MRS) in the diagnosis of prostate cancer. Method A total of 60 patients with prostate cancer and 60 patients with benign prostatic hyperplasia diagnoses in Sichuan Cancer Hospital from January 2011 to January 2014 were included as prostate cancer group and proliferative group respectively. Sixty healthy individuals during the same period were included as the control group. We used Siemens Avanto 1.5 T high field superconducting MRI for DCE-MRI scan and MRS scan. After the MRS scan was finished, we used the workstation spectroscopy tab spectral analysis. Eventually we got the crest lines of prostate metabolites choline (Cho), creatine (Cr) and citrate (Cit). Then we calculated Cho/Cit, (Cho+Cr)/Cit and their average. Results Comparing the signal value in 21 seconds, 1 minute, 2 minutes of DCE-MRI, the differences among the three groups were statistically significant (P<0.05). Comparing the results of spectral analysis, the differences among the three groups were statistically significant (P<0.05). The sensitivity was 89.67%, the specificity was 95.45% and the accuracy was 94.34% when using DCE-MRI combined with MRS. Conclusion DCE-MRI combined with MRS greatly improves the sensitivity, specificity and accuracy of the diagnosis of prostate cancer; it has a great application value in the diagnosis of prostate cancer.
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.
【摘要】 目的 观察低频超声（20 kHz）辐照联合静脉注射微泡造影剂SonoVue对裸鼠前列腺癌（Du145）移植瘤的抑瘤效应，并探讨其可能的抑瘤机制。 方法 通过细胞移植和瘤块移植方法建立24只裸鼠前列腺癌Du145移植瘤模型，随机分为超声微泡组、单纯超声组、单纯微泡组和对照组，每组各6只。超声微泡组：尾静脉注射0.2 mL SonoVue的同时对瘤体行20 kHz超声辐照，辐照强度200 mW/cm2；单纯超声组：尾静脉注射生理盐水0.2 mL，同时超声辐照2 min；单纯微泡组：尾静脉注射SonoVue 0.2 mL同时行假照，各组均隔天1次，共3次，对照组不做任何处理。治疗后测量瘤体大小，绘制瘤体生长曲线，计算抑瘤率。首次治疗后14 d剥离瘤体，通过光学显微镜、电子显微镜观察肿瘤组织病理改变。免疫组织化学方法观察CD34阳性染色血管，计算肿瘤微血管密度（micro vessel density，MVD），比较各组间MVD的差异。 结果 24只裸鼠均成功植瘤。治疗后超声微泡组瘤体体积均数明显小于其他3组（Plt;0.05），抑瘤率为62.7%。光学显微镜下超声微泡组瘤体组织大部分损伤坏死，电子显微镜下超声微泡组肿瘤内微血管的内皮细胞损伤，线粒体肿大，基底膜断裂。超声微泡组瘤体内CD34阳性染色微血管数减少，其MVD值显著低于其他各组。 结论 20 kHz低频超声辐照联合微泡造影剂SonoVue可有效抑制裸鼠人前列腺癌移植瘤的生长，其抑瘤机制可能是通过超声空化效应破坏肿瘤的微血管实现的。【Abstract】 Objective To investigate the anti-tumor effect induced by low-frequency ultrasound (20 kHz) radiation combined with intravenous injection of microbubbles on human prostate carcinoma xenograft in nude mice, and to discuss its probable mechanism. Methods Human prostate carcinoma xenograft model in 24 nude mice were established with human prostate carcinoma Du145 cells inoculation and sub-graft through mice, which were randomly divided into ultrasound+microbubble, ultrasound, microbubble, and control group, with 6 mice in each group. In the ultrasound+microbubble group, 0.2 mL SonoVue was injected intravenously, followed by 20 kHz ultrasound exposure of 200 mW/cm2 at every other day for 3 times totally. Mice in the ultrasound group and the microbubbles group were only treated with ultrasound radiation and microbubbles injection, respectively. The volume of gross tumors was measured, and tumor growth curve was drawn. The ratio of anti-tumor growth was calculated. The mice were sacrificed 14 days after the last ultrasound exposure. Specimens of the exposed tumor tissues were obtained and observed pathologically under light microscope and transmission electron microscope. CD34 positive vessels were counted in all the tumor slices by immunohistochemistry, and the micro-vessels density（MVD）of the tumor was also calculated. Results Du145 prostate tumor model was successfully established in all the mice. The average gross tumor volume of the ultrasound+microbubble group was significant lower compared with the other two groups after treatment (Plt;0.05), and the ratio of anti-tumor growth was 62.7%. Histological examination showed signs cell injury in the ultrasound+microbubble group. Electron microscopic examination revealed that the endothelium of vessels in the tumor was injured. The amount of CD34 positive vessels and MVD of the ultrasound+microbubble group was less than that of the other two groups. Conclusion The low-frequency ultrasound of 20 kHz exposure combined with microbubbles can be used to ablate human prostate carcinoma xenograft in nude mice, which is probably realized through micro-vessels destroyed by cavitation effect of ultrasound.
Prostate cancer ranks second among the causes of death of malignant tumors in middle-aged and elderly men. A considerable number of patients are not easily detected in early-stage prostate cancer. Although traditional imaging examinations are of high value in the diagnosis and staging of prostate cancer, they also have certain limitations. With the development of nuclear medicine instruments and molecular probes, molecular imaging is playing an increasingly important role in the diagnosis and treatment of prostate cancer. Positron emission tomography and computed tomography (PET/CT) using prostate-specific membrane antigen (PSMA) as a probe has gained increasing recognition. This article will review the latest progress in the application of PET/CT using probes for targeting PSMA to imaging and treatment of prostate cancer, in order to provide a theoretical basis for the application of probes for targeting PSMA in the diagnosis and treatment of prostate cancer.
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.
Objective To systematically review the efficacy and safety of abiraterone acetate in the treatment of castration-resistant prostate cancer. Methods CNKI, WanFang Data, VIP, Web of Science, PubMed, EMbase and The Cochrane Library databases were electronically searched to collect randomized controlled trials on abiraterone in the treatment of castration-resistant prostate cancer from inception to December 31st, 2020. Two reviewers independently screened literature, extracted data and evaluated the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.3 software. Results A total of 25 randomized controlled trials involving 8 654 patients were included. Meta-analysis results showed that the median radiographic progression-free survival (MD=5.81, 95%CI 3.58 to 8.03, P<0.01), PSA response rate (RR=2.77, 95%CI 1.65 to 4.65, P<0.01), median overall survival (MD=6.44, 95%CI 4.54 to 8.33, P<0.01), median time to PSA progression (MD=2.57, 95%CI 1.30 to 3.84, P<0.01), median PSA progressionfree survival (MD=6.74, 95%CI 5.08 to 8.39, P<0.01), testosterone level control (MD=−0.41, 95%CI −0.68 to −0.14, P<0.01), PSA level control (MD=−8.06, 95%CI −13.82 to −2.31, P<0.01), effective rate (RR=2.94, 95%CI 1.89 to 4.58, P<0.01), complete remission (RR=1.66, 95%CI 1.02 to 2.72, P<0.05), granulocytopenia (RR=0.18, 95%CI 0.07 to 0.45, P<0.01) and KPS score (MD=4.29, 95%CI 4.06 to 4.52, P<0.01) were significantly superior to non-abiraterone treatment group. The incidence of hypertension (RR=2.04, 95%CI 1.62 to 2.57, P<0.01), heart disease (RR=2.27, 95%CI 1.80 to 2.86, P<0.01) and hypokalemia (RR=2.89, 95%CI 1.59 to 5.26, P<0.01) adverse reactions were significantly higher than those in non-abiraterone group. The number of drug withdrawals caused by adverse reactions (RR=1.26, 95%CI 0.98 to 1.61, P>0.05), fluid retention or edema (RR=1.23, 95%CI 0.73 to 2.09, P>0.05), liver function damage (RR=1.66, 95%CI 0.93 to 2.97, P>0.05), fatigue and weakness (RR=0.97, 95%CI 0.73 to 1.29, P>0.05), anemia (RR=0.86, 95%CI 0.64 to 1.16, P>0.05) and elevated blood glucose (RR=1.51, 95%CI 0.96 to 2.36, P>0.05), were not significantly different between the two groups. Conclusion Abiraterone acetate can effectively delay the progression of castration-resistant prostate cancer, prolong the survival period, and improve the quality of life. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
Prostate cancer is the most common malignant tumor in male urinary system, and the morbidity and mortality rate are increasing year by year. Traditional imaging examinations have some limitations in the diagnosis of prostate cancer, and the advent of molecular imaging probes and imaging technology have provided new ideas for the integration of diagnosis and treatment of prostate cancer. In recent years, prostate-specific membrane antigen (PSMA) has attracted much attention as a target for imaging and treatment of prostate cancer. PSMA ligand positron emission tomography (PET) has important reference value in the diagnosis, initial staging, detection of biochemical recurrence and metastasis, clinical decision-making guidance and efficacy evaluation of prostate cancer. This article briefly reviews the clinical research and application progress on PSMA ligand PET imaging in prostate cancer in recent years, so as to raise the efficiency of clinical applications.
ObjectivesTo systematically review the association between the variants of HNF1B gene and the risk of prostate cancer.MethodsPubMed, EMbase, The Cochrane Library, CNKI, CBM and WanFang Data databases were electronically searched to collect case-control studies on the association between the variants of HNF1B gene and risk of prostate cancer from inception to December, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using Stata 14.0 software.ResultsA total of 15 case-control studies involving 30 532 patients and 38 832 controls were included. The results of meta-analysis showed that: there was a strong significant association between rs4430796 variants (Gvs.A: OR=0.802, 95%CI 0.784 to 0.821, P<0.001; GGvs.AA: OR=0.659, 95%CI 0.606 to 0.717, P<0.001; AGvs.AA: OR=0.762, 95%CI 0.714 to 0.814, P<0.001), rs11649743 variants (Avs.G: OR=0.875, 95%CI 0.820 to 0.941, P<0.001; AAvs.GG: OR=0.669, 95%CI 0.564 to 0.792, P<0.001; AGvs.GG: OR=0.855, 95%CI 0.798 to 0.916, P<0.001), rs7501939 variants (Avs.G: OR=0.833, 95%CI 0.807 to 0.859, P<0.001), rs3760511 variants (Avs.C: OR=0.834, 95%CI 0.803 to 0.868, P<0.001) and risk of prostate cancer.ConclusionsCurrent evidence shows that HNF1B gene variants are associated with risk of prostate cancer. Due to limited quantity and quality of the included studies, more high quality studies are required to verify the above conclusion.
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.