Modified three-layer vesicourethral reconstruction in robot-assisted radical prostatectomy can change cystography pattern and improve early recovery of continence.

BACKGROUND AND OBJECTIVES: To determine early continence outcomes after three-layer vesicourethral reconstruction during robot-assisted radical prostatectomy (RARP) and the role of postoperative cystography pattern. METHODS: Between May 2015 and January 2019, a total of 170 consecutive patients with localized prostate cancer who underwent RARP, were divided into one- and three-layer groups based on the method of vesicourethral reconstruction. Continent status, preoperative, intraoperative, postoperative, clinicopathological variables, and cystography parameters were analyzed. The patients were followed up for at least 12 months. RESULTS: Of the 170 consecutive patients, 85 with one-layer vesicourethral anastomosis, and 85 with three-layer reconstruction. The continence rates immediately after catheter removal, 4, 12, and 24 weeks after RARP were 47.1%, 75.3%, 92.9%, and 98.8% in the three-layer group; compared to 15.3%, 60%, 78.8%, and 90.6% in the one-layer group, respectively. In the multivariate analysis, three-layer reconstruction was the only independent variable with a 42% risk reduction of postprostatectomy incontinence (hazard ratio (HR): 0.58, 95% confidence interval (CI) = 0.42-0.80, p = 0.001). Cystography in the three-layer group revealed less anastomotic leakage, less sharp bladder neck angle, and higher bladder neck level category. CONCLUSIONS: Three-layer anatomical reconstruction demonstrated promising early continence outcomes, and postoperative cystography revealed a specific pattern more associated with continence.

Development and assessment of a self-management intervention for urinary incontinence among patients with prostate cancer: protocol for a randomized feasibility study.

BACKGROUND: Urinary incontinence is a common complication among patients with prostate cancer who have undergone radical prostatectomy. Guided by social cognitive theory and a framework for the recovery of health and well-being, we propose to develop and test a self-management intervention for patients with prostate cancer who experience urinary incontinence after undergoing radical prostatectomy. METHODS: In this study, a self-management intervention for urinary incontinence (SMI-UI) is developed, comprising a mobile self-management application, a self-management handbook, and professional support. The feasibility, acceptability, and effectiveness of this intervention will be assessed. Patient data from the urology departments of two hospitals will be collected through convenience sampling by adopting an experimental, parallel, and random assignment research design. Patients experiencing urinary incontinence after undergoing radical prostatectomy will be invited to participate. After completing the pretest questionnaire, patients will be randomly divided into the experimental and attention control groups. The experimental group will undergo a 12-week SMI-UI, whereas the attention control group will receive an intervention consisting of a single dietetic education information package. The two groups will be tested 12 and 16 weeks after the pretest. In this study, we recorded the sociodemographic and clinical variables; recruitment rate; retention rate; satisfaction with the intervention; cancer-related self-efficacy; urination symptoms and disturbance; social participation and satisfaction; resilience; and demoralization. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT05335967 [date of registration 04-04-2022].

Androgen deprivation therapy for prostate cancer and the risk of thyroid diseases.

BACKGROUND: Androgen deprivation therapy (ADT) is the major treatment for metastatic prostate cancer (PCa), but few studies have investigated the effects of ADT on thyroid diseases. METHODS: This population-based, nationwide cohort study utilized the Taiwan National Health Insurance Research Database (NHIRD) with 17,192 PCa patients between 1997 and 2013. We used the Cox proportional hazards models and propensity score-matched analysis to analyze the association between ADT and the development of thyroid diseases. RESULTS: A total of 17,192 newly diagnosed men with PCa were selected from the NHIRD. There were 6200 ADT users and 6200 non-ADT users after 1:1 propensity score matching. There was a significantly decreased risk of thyroid diseases among ADT users compared with non-ADT users (adjusted hazard ratio (aHR): 0.79, 95% confidence interval (CI): 0.65-0.95, p < 0.001). Further analysis showed a significantly decreased risk of thyroid diseases with increasing ADT duration (p < 0.001). CONCLUSIONS: The result showed that ADT use in men with PCa was associated with a decreased risk of thyroid disease development.

Emotional state and cancer-related self-efficacy as affecting resilience and quality of life in kidney cancer patients: a cross-sectional study.

OBJECTIVE: To assess the relationship between resilience and quality of life (QOL) of kidney cancer patients, including influencing factors. METHODS: Based on a cross-sectional study design, participants (N = 103) were recruited from patients who were admitted to the urology clinic of a medical center in Taiwan between April 2020 and January 2021. Data collection was accomplished via a questionnaire. The study variables included demographic information, disease attributes, happiness level, depression, cancer-related self-efficacy, resilience, and QOL. One-way analysis of variance, Pearson correlation coefficients, independent-sample t-tests, hierarchical regression, and process analysis were the statistical methods used to analyze the data. RESULTS: Kidney cancer patients who were less depressed exhibited better cancer-related self-efficacy and have better resilience. In non-depressed individuals, higher levels of happiness and better resilience resulted in better QOL. Resilience is a mediator that affects the relationship between depression and QOL. CONCLUSIONS: Patients with better emotional state experience better resilience and QOL. Patients' better cancer-related self-efficacy is related to better resilience while better resilience is associated with better QOL. Clinical care providers need to evaluate and improve cancer-related self-efficacy, emotional state, and resilience of kidney cancer patients, which will improve their resilience and QOL.

Exploring psychological resilience and demoralisation in prostate cancer survivors.

OBJECTIVE: This study aimed to investigate psychological resilience and demoralisation and their predictors and mediators in prostate cancer survivors (PCSs). METHODS: A cross-sectional research design was used. PCSs (N = 122; mean time since diagnosis = 54.79 months, range in 13 years and 2 months) were recruited using convenience sampling at the outpatient department of a hospital in Taiwan. Data collection was conducted using self-report structured questionnaires, including one for demographic and disease characteristics, the Expanded Prostate Cancer Index Composite, Cancer Survivors' Self-Efficacy Scale, Connor-Davidson Resilience Scale and the Demoralisation Scale. RESULTS: In PCSs, a lower most-recent level of prostate-specific antigen and higher cancer-specific self-efficacy were associated with better psychological resilience. Further, fewer hormonal, bowel and urinary symptoms and bother; higher cancer-specific self-efficacy; and better psychological resilience were associated with less demoralisation. Cancer-specific self-efficacy was a mediator for the relationship between urinary symptoms and bother and demoralisation, while psychological resilience mediated the relationship between cancer-specific self-efficacy and demoralisation. CONCLUSIONS: The results reveal that cancer-specific self-efficacy is a protective factor against demoralisation and increases psychological resilience in PCSs. Better psychological resilience and fewer physical symptoms and bother are associated with less demoralisation in PCSs.

Risk of major adverse cardiovascular events among second-line hormonal therapy for metastatic castration-resistant prostate cancer: A real-world evidence study.

BACKGROUND: To evaluate the possible major adverse cardiovascular events (MACE) associated with second-line hormonal therapy in patients with metastatic castration-resistant prostate cancer (mCRPC). METHODS: We performed a population-based real-world cohort study of 4962 prostate cancer patients between 2014 and 2017 utilizing the Chang Gung Research Database of Taiwan. The second-line hormonal therapies included enzalutamide and abiraterone acetate. The outcomes of interest were MACE, including acute coronary syndrome (ACS), ischemic stroke (IS), and heart failure (HF) events that resulted in hospitalization. Cox proportional-hazards models with inverse probability of treatment weighting (IPTW) with propensity scores were used. RESULTS: After IPTW, 288 patients were prescribed second-line hormonal therapy and 1575 received first-line androgen-deprivation therapy (ADT). Of all patients diagnosed with MACE, the event rates were 2.92% in the second-line hormonal group and 2.22% in the first-line ADT group. The mean follow-up period was 9.52 months for the second-line hormonal group. Patients who received second-line hormonal therapy exhibited a significantly increased risk for MACE (hazard ratio [HR]: 3.15; 95% confidence interval [CI]: 2.03-4.89), ACS (HR: 4.94; 95% CI: 2.36-10.33), and HF (HR: 2.83; 95% CI: 1.53-5.25), compared with the first-line ADT group, but a similar risk for IS was observed in both groups (HR: 1.70; 95% CI: 0.95-3.04). CONCLUSIONS: The real-world evidence study revealed increased risks for MACE in mCRPC patients receiving second-line hormonal therapy.

Management of intractable post-adrenalectomy chylous ascites with microsurgical intra-abdominal lymphaticovenous anastomosis: A case report and literature review.

Postoperative chylous ascites is a rare but highly morbid complication following thoracic or abdominal surgeries. Treatment options vary according to different clinical scenarios and facility equipment, but there is no standard guideline. We report a case of 46-year-old patient with chylous ascites after left laparoscopic adrenalectomy for metastatic lung cancer. The conservative treatments failed, included diet control, somatostatin provided and intranodal lymphangiography with lipiodol injection. Laparotomy was performed to explore the lymphatic vessel in the retroperitoneal area where a major and several small leaking holes were identified along the thoracic duct. The left gonadal vein was explored and transposed toward the lymphatic vessel. The lymphaticovenous anastomosis (LVA) was done using side (major leaking hole) to end (gonadal vein) fashion. The chylous leakage dropped from 2000 to 200 mL per day gradually within 10 days after LVA, and the patient was discharged uneventfully 30 days after the LVA surgery. He was followed at our clinic during the first postoperative 10 months without recurrent chylous ascites. This case demonstrates that microsurgical intervention with LVA to physiologically drain the chyle can be an optimal treatment for chylous ascites. A literature review was also conducted, and strategic management is proposed.

Effectiveness of a couple-based psychosocial intervention on patients with prostate cancer and their partners: A quasi-experimental study.

AIMS: To understand the effectiveness of a couple-based psychosocial information package (PIP) and multimedia psychosocial intervention (MPI) on patients with prostate cancer and their partners. DESIGN: A random assignment and quasi-experimental design were used. METHODS: From August 2015-March 2018, 103 newly diagnosed patients with prostate cancer and their partners were divided into a control group (CG) (N = 50), PIP group (N = 25) and MPI group (N = 28). The CG received usual care, the PIP group received information manuals and telephone counselling for 6-week and the MPI group received multimedia films and manuals and professional support for 6 weeks. The three groups were posttested 6, 10, 18 and 24 weeks after the pre-test. The outcome measurements included disease appraisals, emotion status, relationship satisfaction, health-related quality of life (HRQOL) and satisfaction with MPI. RESULTS/FINDINGS: Partners in the MPI and PIP groups experienced significant improvements in positive and negative affect or mental HRQOL as compared with the CG. The effectiveness of MPI and PIP on negative affect, mental HRQOL, however, were not statistically significant in patients with prostate cancer. Nevertheless, patients were satisfied with the MPI. CONCLUSION: Nurses can provide different types of interventions for partners, depending on personal preferences and available resources. IMPACT: There is a lack of studies that focus on the effectiveness of couple-based psychosocial intervention on both the patients with prostate cancer and their partners in Asia. Partners in the multimedia psychosocial intervention group and psychosocial information package group experienced improvements in positive affect, negative affect or health-related quality of life as compared with the control group. Patients in both intervention groups experienced similar negative affect and health-related quality of life as compared with the control group. The couple-based psychosocial interventions can be provided by nurses based on partners' preferences and available resources.

Prostate cancer-specific anxiety and the resulting health-related quality of life in couples.

AIMS: To explore health-related quality of life (HRQOL) and its individual or mutual influences in people with prostate cancer and their spouses. BACKGROUND: Few studies have explored the influence of prostate cancer-specific anxiety of these people and their spouses on their individual or mutual HRQOL. DESIGN: Repeated-measures design. METHODS: Data on 48 dyadic of people and their spouses were collected from August 2015 - December 2016. Before the people' treatment for prostate cancer, the first data collection occurred for the people and their spouses. The second to fifth data collections were conducted 6, 10, 18, and 24 weeks after the initial measurement. The variables concerned health status, marital satisfaction, positive affect, negative affect, prostate cancer-specific anxiety, and HRQOL. The Actor-Partner-Interdependence Model was adopted for data analysis. RESULTS: The people who had better physical HRQOL were those with good self-reported health status, higher positive affect and lower prostate cancer-specific anxiety. Better physical HRQOL was observed in the spouses who had good self-reported health status and had lower prostate cancer-specific anxiety. The people with localized cancer stages and lower negative affect had a better mental HRQOL. Better mental HRQOL was detected in spouses who had higher marital satisfaction, higher positive affect and lower negative affect. CONCLUSION: Nurses can improve the HRQOL of people and their spouses by implementing activities that promote health and energy and reduce stress and by administering a mindfulness intervention.

MCP-1/MCPIP-1 Signaling Modulates the Effects of IL-1ß in Renal Cell Carcinoma through ER Stress-Mediated Apoptosis.

In renal cell carcinoma (RCC), interleukin (IL)-1ß may be a pro-metastatic cytokine. However, we have not yet noted the clinical association between tumoral expression or serum level of IL-1ß and RCC in our patient cohort. Herein, we investigate molecular mechanisms elicited by IL-1ß in RCC. We found that IL-1ß stimulates substantial monocyte chemoattractant protein (MCP)-1 production in RCC cells by activating NF-kB and AP-1. In our xenograft RCC model, intra-tumoral MCP-1 injection down-regulated Ki67 expression and reduced tumor size. Microarray analysis revealed that MCP-1 treatment altered protein-folding processes in RCC cells. MCP-1-treated RCC cells and xenograft tumors expressed MCP-1-induced protein (MCPIP) and molecules involved in endoplasmic reticulum (ER) stress-mediated apoptosis, namely C/EBP Homologous Protein (CHOP), protein kinase-like ER kinase (PERK), and calnexin (CNX). ER stress-mediated apoptosis in MCP-1-treated RCC cells was confirmed using Terminal deoxynucleotidyl transferase dUTP Nick-End Labeling (TUNEL) assay. Moreover, ectopic MCPIP expression increased PERK expression in Human embryonic kidney (HEK)293 cells. Our meta-analysis revealed that low MCP-1 levels reduce 1-year post-nephrectomy survival in patients with RCC. Immunohistochemistry indicated that in some RCC biopsy samples, the correlation between MCP-1 or MCPIP expression and tumor stages was inverse. Thus, MCP-1 and MCPIP potentially reduce the IL-1ß-mediated oncogenic effect in RCC; our findings suggest that ER stress is a potential RCC treatment target.

Predictive Value of CD44 in Muscle-Invasive Bladder Cancer and Its Relationship with IL-6 Signaling.

BACKGROUND: CD44, a cancer stem cell surface marker, is associated with treatment resistance and prognosis in some cancers. In the present study, we examined the predictive value of CD44 in muscle-invasive bladder cancer (MIBC). METHODS: We retrospectively analyzed the clinical outcomes of 105 MIBC patients and correlated these outcomes with the expression of CD44. Furthermore, the bladder cancer cell lines HT1197 and MB49 were selected for cellular and animal experiments to investigate the correlation between CD44 and tumor aggressiveness. RESULTS: Analysis of clinical specimens indicated that CD44 staining was significantly associated with a higher clinical stage, higher locoregional failure rate, and lower disease-specific survival rate for MIBC patients. Using cellular experiments and orthotopic tumor models, we showed that CD44+ bladder cancer cells had a higher invasion ability and augmented epithelial-mesenchymal transition (EMT) compared with CD44 cells. There was a significant correlation between interleukin (IL)-6 and CD44 levels noted by in vitro testing, and clinical samples. Blockade of IL-6 attenuated the expression of CD44, cancer stem-cell-like properties, and aggressive tumor behavior in vitro and in vivo. The related changes included the attenuated STAT3 activation and EMT, and decreased programmed death ligand 1-mediated T-cell suppression. CONCLUSION: Our findings suggest that CD44 expression is positively associated with tumor aggressiveness in bladder cancer, and activated IL-6 signaling provides a suitable microenvironment for the induction of CD44 expression.

Individual and mutual predictors of marital satisfaction among prostate cancer patients and their spouses.

AIMS AND OBJECTIVES: To determine the individual and mutual predictors of the marital satisfaction of couples in which the husband experienced prostate cancer. BACKGROUND: Marital satisfaction of patients with prostate cancer has been insufficiently studied in Asian countries as compared with Western countries. DESIGN: This study used a prospective and repeated-measures design. METHODS: Seventy Taiwanese couples in which the husband had prostate cancer completed measures at 6 and 12 months post-treatment. Assessments of physical symptoms, marital satisfaction, coping behaviour and psychological distress were made. Multiple linear regression was used to analyse the data. RESULTS: The marital satisfaction of patients with prostate cancer and that of their spouses were significantly correlated. At 6 months, spouses' marital satisfaction, patients' appraisal of prostate cancer as a threat and patients' serum prostate-specific antigen levels were found to be the predictors of patients' marital satisfaction. Furthermore, patients' marital satisfaction and their spouses' psychological distress were predictors of spouses' marital satisfaction. At 12 months, spouses' marital satisfaction and patients' appraisal of prostate cancer as harm were predictors of patients' marital satisfaction. Finally, spouses' marital satisfaction (at 6 months) and appraisal of prostate cancer as a threat were predictors of spouses' marital satisfaction. CONCLUSIONS: At 6 months post-treatment, patients' and spouses' marital satisfaction will influence each other. However, at 12 months, patients' marital satisfaction exerts an insignificant effect on spouses' marital satisfaction. Moreover, patients' serum prostate-specific antigen level or the negative appraisal of prostate cancer affects their marital satisfaction. Spouses' marital satisfaction is affected by psychological distress and their negative appraisal of prostate cancer. RELEVANCE TO CLINICAL PRACTICE: The results can be used to develop interventions for prostate cancer couples. Such an intervention can be used to modify couples' appraisal of prostate cancer by changing incorrect thinking or to ease the psychological distress to improve marital satisfaction.

TGF Beta1 Expression Correlates with Survival and Tumor Aggressiveness of Prostate Cancer.

BACKGROUND: Although biopsy Gleason score and clinical stage can be used to inform treatment decisions for prostate cancer, identifying molecular markers of tumor aggressiveness could lead to a more tailored approaches to therapy. In the present study, we investigated the association of transforming growth factor (TGF)-ß1 levels and various markers of tumor aggressiveness and explore some potential mechanisms underlying the associations. METHODS: We used human and murine prostate cancer cell lines and their respective hormone resistance sub-lines, in vitro and in vivo to examine the changes in tumor aggressiveness, as well as the pathway responsible for these changes. Furthermore, 105 prostate cancer biopsy specimens were analyzed to correlate the level of TGF-ß1 with the clinical characteristics of patients. RESULTS: Our data revealed that activated TGF-ß1 signaling resulted in more aggressive tumor growth and augmented the epithelial-mesenchymal transition. Activated IL-6 signaling was associated with TGF-ß1 levels and the aggressive tumor features noted in TGF-ß1-positive prostate cancers in vitro and in vivo. Furthermore, the TGF-ß1 levels significantly correlated with Tregs accumulation in vivo. The clinical data indicated that TGF-ß1 immunoreactivity had a moderate positive correlation with IL-6 staining, advanced clinical stage, higher Gleason score, and pretreatment PSA in patients with prostate cancer. CONCLUSIONS: TGF-ß1 levels are significantly associated with aggressive prostate features. In vitro and in vivo alternations of TGF-ß1 expression impacts tumor invasiveness, tumor growth rate and recruitment of immunosuppressive Treg cells in the tumor microenvironment. TGF-ß1 expression may represent a clinical useful biomarker to guide prostate cancer treatment decisions.