1. Can phytochemical agents manage prostate cancer morbidity and mortality?

A systematic review, published in the British Journal of Urology International (BJUI) evaluated the evidence from randomised trials of phytotherapeutic interventions in the management of prostate cancer recurrence and disease progression. Phytochemicals are compounds that are produced by plants and the researchers of this review assessed 23 articles, with only five meeting the criteria for inclusion. The interventions investigated looked at phytochemical agents including lycopene, soy protein, pomegranate extract, green tea and broccoli sprouts.

The results from the review indicated there is limited evidence that the phytochemicals such as sulphoraphane, lycopene, soy isoflavones, and pomegranate extracts (e.g. POMx, and Pomi-T) can affect PSA dynamics, although the data indicates they are safe and well-tolerated. In conclusion the authors stated no recommendation can be made for the use of these agents in managing prostate cancer morbidity and mortality until high-quality, fully powered, placebo-controlled studies are available.

2. Systematic review of MRI/US-fusion biopsy in prostate cancer detection

The current ‘gold standard’ for the diagnosis of prostate cancer is ultrasonography (US) guided systematic biopsies. This technique has several limitations. Recent research has been focussing on targeted prostate biopsies using magnetic resonance imaging (MRI) and ultrasonography (MRI/US)-fusion platforms. The aim of this systematic review published in the BJUI was to assess the cancer detection rates of different MRI/Ultrasound (US)-fusion platforms for taking prostate targeted biopsies from the published literature.

The researchers identified over 2000 records during the literature search and in total 11 studies met the inclusion criteria for analysis. The results of the systematic review indicated no clear advantage of MRI/US-fusion guided targeted biopsies was seen for cancer detection rates of all prostate cancers. However, the technique tended to give higher detection rates for clinically significant prostate cancers. In their conclusion the authors also highlighted general limitations in assessing the value of MRI/US-fusion targeted biopsies, which included the quality of taking biopsies and experience of the radiologist and physician performing the biopsy which may determine the quality of the biopsy cores and ultimately determines the detection rates. The authors also highlighted the need for more prospective studies on the effectiveness of MRI/US-fusion TB for prostate cancer diagnosis. 

3. Can pelvic floor training before post-prostatectomy help incontinence?

Urinary incontinence is one of the most common side effects of radical prostatectomy (RP) and can substantially affect a man's quality of life. Reported rates of urinary incontinence after radical prostatectomy have been as high as 87% at one-month postoperatively, but generally improving after a year. A meta-analysis and systematic review, conducted by Chang and colleagues at the University of Sydney assessed almost 20 articles, and included 11 in their systematic review and 7 in their meta-analysis. Their meta-analysis demonstrated a significant 36% reduced risk of postoperative incontinence at 3 months after radical prostatectomy if pelvic floor muscle exercise was taken. Although no significant difference was seen at 1- or 6 months.

In conclusion the authors stated, based on their systematic review and meta-analysis, preoperative pelvic floor muscle exercise might aid early urinary incontinence recovery and increase the QoL of patients after RP. This systematic review and meta-analysis did not investigate how pelvic floor muscle exercise improves incontinence. The researchers also acknowledged their study was limited by the small number of studies and patients that were available for analysis, as well as the difference in pelvic floor exercise regimens and definitions of continence and quality of life tools across the available studies.

4. Cancer control outcomes following robotic-assisted laparoscopic radical prostatectomy

This multi-institutional study, involving researchers from the USA, Germany and Italy, investigated cancer control outcomes in over 5,500 prostate cancer patients following robot-assisted radical prostatectomy between 2001 and 2010. The study examined recurrence-free survival (BCRFS), clinical recurrence-free survival (CRFS), and cancer-specific survival (CSS) at least 5-years following RARP. At 5-year follow up BCRFS, CRFS and CSS were 3.3, 98.6, and 99.5 %, respectively. Less than 2% of patients received any adjuvant treatment. Independent clinical predictors of BCRFS, CRFS and CSS included preoperative PSA and biopsy gleason score.

The authors concluded data from their study suggests despite low overall rate of adjuvant treatment, cancer control outcomes of RARP are comparable to those reported for open and laparoscopic RP in previous literature.

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