Tesis: "Androgen deprivation"

1

Lorch, Robert A. "MicroRNA regulation of prostate cancer desensitization to androgen receptor antagonist drugs during androgen deprivation therapy". Honors in the Major Thesis, University of Central Florida, 2011. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/462.

Texto completo

Resumen

The current standard treatment of prostate cancer by androgen deprivation therapy involves using drugs such as bicalutamide (Casodex) to antagonistically block androgen receptors that are normally present within prostate cells. Usually, the therapy is successful in the short run at limiting the growth of prostate cancer. However, in virtually all cases tumors begin to grow aggressively again after several months of treatment and new therapies must be started. The mechanism by which these prostate cells transform from androgen sensitive to androgen independent and anti-androgen resistant is unclear. In this study, we investigated the role of microRNAs, small 15 to 18 nucleotide regulatory RNAs, in regulating the desensitization of prostate cancer cells to the androgen receptor antagonist drug bicalutamide. In order to identify significant microRNAs, quantitative PCR was used to obtain genome-wide microRNA expression levels of 885 human microRNAs at different timepoints for androgen sensitive LNCaP cancer cells treated with bicalutamide and for untreated control cells in tissue culture. Analysis of microRNA expression by clustering analysis and by statistical comparisons of treatment groups resulted in identification of 28 microRNAs that have altered expression in the progression process. In silico target prediction analysis was performed with the microRNAs shown to have altered expression, and a group of genes predicted to be under microRNA regulatory control during cancer progression to resistance was identified. A microRNA expression profile can be useful in developing more effective prognostic and therapeutic tools for prostate cancer.
B.S.
Bachelors
Medicine
Molecular Biology and Microbiology

Los estilos APA, Harvard, Vancouver, ISO, etc.

2

Galvão, Daniel Abido. "Resistance exercise in men receiving androgen deprivation therapy for prostate cancer". Connect to thesis, 2006. http://portal.ecu.edu.au/adt-public/adt-ECU2006.0046.html.

Texto completo

Los estilos APA, Harvard, Vancouver, ISO, etc.

3

Gilbert, Stephen E. "Cardiovascular health in men on androgen deprivation therapy for prostate cancer". Thesis, Sheffield Hallam University, 2013. http://shura.shu.ac.uk/20685/.

Texto completo

Resumen

Androgen deprivation therapy (ADT) is a cornerstone treatment option for men with metastatic or locally advanced prostate cancer, however, treatment with ADT has been associated with increased incidence of adverse cardiovascular events. Strategies to investigate and monitor cardiovascular risk, as well as to reduce such treatment-related morbidity are urgently required in this population. Study 1 of this thesis investigated the differences in endothelial function between men with advanced prostate cancer treated with ADT and matched controls using a case-control design. Flow-mediated dilatation (FMD) and glyceryl-trinitrate (GTN)-mediated dilatation of the brachial artery were assessed in 20 men (69 +/- 7 years) with prostate cancer treated with ADT for a median of 22 months (range 6-133 months) and compared against 20 controls (69 +/- 5 years) matched for age, history of cardiovascular disease and physical activity levels. FMD was reduced in men on ADT compared to controls (P 0.05). These findings provide novel data to suggest endothelial function is impaired in men with prostate cancer treated with ADT, which is in agreement with evidence of increased cardiovascular risk in this population. Study 2 investigated the effects of a 12-week lifestyle intervention including supervised exercise training and dietary advice on markers of cardiovascular health and general well-being in men treated with ADT for prostate cancer. Fifty men treated with ADT for ≥6 months were randomly allocated to receive the intervention or usual care. Assessments of vascular function, blood pressure, body composition, exercise tolerance and psychological well-being were undertaken prior to randomisation (baseline) and after completion of the intervention (end-point), with a follow-up assessment completed a further 12 weeks after end-point assessments. Statistically significant differences between groups were observed for changes in skeletal muscle mass, body fat percentage, exercise tolerance, quality of life and fatigue (P < 0.05). In addition, clinically meaningful effect sizes were observed for the difference between groups for the change between baseline and end-point in FMD and diastolic blood pressure (d >0.51), with post-hoc analysis demonstrating a statistically significant change in FMD in men in the intervention group (P = 0.038). These findings support evidence that diet and exercise can improve general well-being of patients treated with ADT, and provide novel data on the effects of such an intervention on cardiovascular health.

Los estilos APA, Harvard, Vancouver, ISO, etc.

4

Giannantoni-Ibelli, Gina. "Association Between Androgen Deprivation Therapy for Prostate Cancer and Alzheimer's Disease". ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/6206.

Texto completo

Resumen

Alzheimer's disease (AD) is the most common progressive, neurodegenerative disease and form of dementia. The hallmarks of AD are extracellular accumulation of amyloid beta protein, resulting in neuritic, senile plaques and intracellular accumulation of tau protein. AD mainly arises from imbalance of amyloid beta protein production and its clearance in the brain. Testosterone modulates production of amyloid beta protein by decreasing its accumulation. Prostate cancer remains a substantial public health challenge in the United States. While androgen deprivation therapy (ADT) is an effective treatment for prostate cancer, it may be associated with cognitive impairment due to decreased levels of testosterone. The purpose of this study was to explore the association between ADT and the development of AD. This study was a retrospective, quantitative cohort study of subjects diagnosed with prostate cancer from a large population database, SEER Medicare-linked database. Data were analyzed using descriptive statistics along with correlation and multiple logistic regression analysis to evaluate the association between ADT use for prostate cancer and AD risk. The sample consisted of 27,913 men with a mean age of 72 years, majority being Caucasian with multiple comorbidities. Subjects who had received ADT were 20% more likely to develop AD than subjects who had not received ADT (OR, 1.20; 95% CI, 1.09, 1.32; p < .001) after controlling for race, ethnicity, prostate cancer stage, prostate cancer risk groups, and comorbidities. This association did not appear to vary by race or PCa risk group. Given an aging population and increased incidence and prevalence of prostate cancer and AD, these results may lead to positive social change by furthering AD prevention.

Los estilos APA, Harvard, Vancouver, ISO, etc.

5

Galvao, Daniel A. "Resistance exercise in men receiving androgen deprivation therapy for prostate cancer". Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2006. https://ro.ecu.edu.au/theses/64.

Texto completo

Resumen

This thesis encompasses two literature reviews (chapter 2 & 3) and two experimental chapters (4 and 5) examining the available literature on exercise and cancer, resistance training and its anabolic responses in older men and women, the side effects of Androgen Deprivation Therapy (ADT) for prostate cancer and finally, the role of resistance exercise as a clinical intervention to counteract such changes as an adjuvant therapy.

Los estilos APA, Harvard, Vancouver, ISO, etc.

6

Joshee, Paras. "Cognition in prostate cancer patients before undergoing androgen deprivation therapy and elderly males". Thesis, University of Birmingham, 2018. http://etheses.bham.ac.uk//id/eprint/8853/.

Texto completo

Resumen

Deleterious cognitive effects of testosterone deprivation in prostate cancer (PC) patients undergoing androgen deprivation therapy have been reported. However, due to methodological limitations of past research, there is mixed consensus of the cognitive domains affected. The current study therefore aimed to assess cognition before ADT through a comprehensive battery of cognitive and neuroimaging investigations which previous undertakings have lacked. A cross sectional study of 30 ageing PC patients before ADT and 29 age and intelligence matched healthy controls underwent neuropsychological and neuroimaging investigations. While there were generally no differences, some significant differences were revealed where patients had higher testosterone levels and better spatial reasoning accuracy compared to controls suggesting some compensatory effect of testosterone in patients. A second study was conducted to assess the reliability of cognition in controls in a longitudinal six month study. Controls were confirmed to have reliable and stable cognition with intact underlying neural correlates confirming their appropriateness for future longitudinal assessments in PC patients. In conclusion, this research facilitated development and management of cognition in PC patients before therapy. If side-effects can be resolved before therapy, then they may be prevented during ADT. Moreover, it provides a basis for a longitudinal future research.

Los estilos APA, Harvard, Vancouver, ISO, etc.

7

Sarkar, Phoebe Lorraine. "Characterizing the role of insulin signalling in advanced prostate cancer". Thesis, Queensland University of Technology, 2017. https://eprints.qut.edu.au/110524/2/Phoebe_Lorraine_Sarkar_Thesis.pdf.

Texto completo

Resumen

The majority of prostate cancer patients receiving hormone therapy become insulin resistant and studies show this metabolic dysfunction is associated with more rapid treatment failure, yet the effect of insulin on prostate cancer is not fully known. This thesis discovered the mechanisms by which insulin increases the propensity of prostate cancer cells to migrate which is required for cancer cells to disseminate and metastasise, giving a possible explanation for the more aggressive disease in prostate cancer patients with insulin resistance. The results provide a strong rationale for specifically monitoring and treating insulin resistance in prostate cancer patients, which is not current clinical practice. The results suggest that anti-diabetes drugs may be useful as adjuvant therapy in prostate cancer.

Los estilos APA, Harvard, Vancouver, ISO, etc.

8

Mennen-Winchell, Lori J. "Self-reported exercise and risk of osteoporosis in prostate cancer patients receiving androgen deprivation therapy". Thesis, Loma Linda University, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=3721215.

Texto completo

Resumen

Prostate cancer is stimulated to grow in response to testosterone. Androgen deprivation therapy (ADT) leads to chemical castration and suppression of prostate cancer cell production. Testosterone levels less then 300ng/ml decreases bone mineral density and could result in osteoporosis. Studies have shown that during the first year of ADT, fracture risk, mainly in hips and spine increases about 50%. In men, 40% of hip fractures result in death. Exercise may reduce the risk of osteoporosis and thus contribute to the prevention of hip and other fractures. There is limited data regarding whether exercise is associated with a reduced risk of osteoporosis in men treated with ADT.

Purpose of this study was to evaluate the relationship between self-reported exercise and bone mineral density measured by dual-energy x-ray absorptiometry (DEXA) and 25 hydroxy vitamin D levels in prostate cancer patients receiving ADT.

A convenience sample of 96 men with prostate cancer treated with ADT for a minimum of nine months or longer and up to the time of inclusion in the study completed the Canadian Fitness Survey questionnaire to assess the amount and types of exercise performed. In addition, questions from a section of the NHANES survey about cigarette and alcohol use, history of non traumatic fracture, diseases causing fracture, and use of medication including calcium supplementation were asked. A serum vitamin D level and DEXA scan were completed within a specified time period based on length of time receiving ADT. Subjects were recruited from eight urology practices and one cancer center in Clark County, Nevada.

The relationships between total duration of exercise, intensity, frequency, bone density T-scores, and serum vitamin D were examined using correlation analysis, as was the relationship between specific types of exercise, measured the same way and bone density T-scores. Furthermore, regression analysis was used to examine for potential confounders. Confounders identified for this study include age, body mass index, cigarette smoking, alcohol use, history of non-traumatic fracture or disease causing fracture, and use of medication, including calcium supplementation. Regression analysis was conducted to determine if there was an independent association between exercise and bone mineral density and serum vitamin D. This study provides evidence associating exercise with reduced risk of osteoporosis in patients receiving ADT.

The second study looked at determinants of 25 OH vitamin D. We found that the only independent modifiable determinant was vitamin D supplementation of ≥800 IU/day. Avoiding osteoporosis by increasing exercise in this group of patients is a practical measure that preventive care specialists could institute.

Los estilos APA, Harvard, Vancouver, ISO, etc.

9

Shah, Syed Imran Ali. "Assessment of systemic effects of sex hormone alterations in androgen deprivation therapy for prostate cancer". Thesis, Imperial College London, 2015. http://hdl.handle.net/10044/1/42883.

Texto completo

Resumen

Sex hormonal variations cause bodily changes reflecting their systemic functions. This project was designed to define the influence of sex hormones on systemic function in men with prostate cancer (PC) receiving contemporary androgen deprivation therapy (ADT) with luteinising hormone-releasing hormone agonists (LHRHa). LHRHa induced suppression of sex hormones results in multiple serious toxicities of which the cognitive, skeletal and psychosocial aspects were addressed in this project. Acute castration appears to cause cognitive problems in some men with PC. In order to identify the neuropathology of such cognitive decline, positron emission tomography (PET) was used along with a battery of validated neuropsychological tests, documenting for the first time an increased global and regional cortical neuroinflammatory response in patients with PC experiencing cognitive deterioration since being on LHRHa. Bone mineral density, a commonly employed measure of bone mass, lacks accuracy in predicting bone strength and fracture risk. The present work showed bone volume fraction (a newer non-invasive metric of bone mass derived using computed tomography imaging) to be highly correlated with bone strength measured ex-vivo, thereby demonstrating its potential for use in clinical assessments. Levels of serum bone-specific alkaline phosphatase, a marker of skeletal metabolism, were also measured to assess bone changes in the early stages of LHRHa therapy but no change was observed. Metabolic derivatives of sex hormones have been suggested to influence psycho-socio-sexual behaviour via odour signalling. The current work, investigating effects of castration on odour, showed no change in the olfactory perception of odour samples provided by men on LHRHa treatment. These pilot data and observations will help shape future work that may not only improve quality of life outcomes in men with PC undergoing ADT but also benefit patients suffering from other clinical conditions involving physiological, pathological or therapeutic changes in sex hormone levels.

Los estilos APA, Harvard, Vancouver, ISO, etc.

10

Wiens, Kristin Patricia. "Dietary risk factors for bone loss among men undergoing androgen deprivation therapy for the treatment of prostate cancer". Thesis, University of British Columbia, 2009. http://hdl.handle.net/2429/21737.

Texto completo

Resumen

Androgen deprivation therapy (ADT) is the preferred mode of treatment for patients with recurrence of prostate cancer (PC) following definitive treatment and locally advanced disease. With more men commencing ADT earlier in the treatment trajectory and for longer duration, the side effects of ADT are becoming more prevalent and of greater concern to clinicians. ADT can have serious adverse effects on bone mineral density (BMD) and metabolism, leading to the development of osteopenia or osteoporosis. This study was a cross-sectional investigation of dietary risk factors for bone loss, particularly calcium and vitamin D intakes, among men undergoing ADT for the treatment of non-metastatic PC (n = 12), hormone-naïve men with PC (n = 21) and healthy controls (n = 20). Outcome measures were dietary intake of calcium and vitamin D assessed by diet history questionnaire, as well as vitamin D status as assessed by serum 25-hydroxyvitamin D and parathyroid hormone levels. There were no between-group differences in calcium or vitamin D intake from food, supplements or both. When compared with the current Adequate Intake and treatment-specific guidelines, the majority of men did not meet current recommendations. Adherence to current dietary guidelines for the prevention of osteoporosis among men undergoing ADT was poor, with 91.7% falling short of the recommended 1500 mg of calcium per day, and no men meeting the treatment-specific recommendation of 20 mcg of daily vitamin D. In addition to inadequate calcium and vitamin D intakes, several additional dietary risk factors present among study participants further increase risk of bone loss and osteoporosis in this group of men. Vitamin D status was also not different among groups; however, serum values quantitated by the assays were well outside expected values, and it was concluded that the assays were likely not valid. The results of this study demonstrate the need for provision of nutrition information to these men at time of therapy commencement and on an ongoing basis throughout treatment, as a means of preventing or reducing the negative effects of ADT on nutritional status and quality of life.

Los estilos APA, Harvard, Vancouver, ISO, etc.

11

Chaplow, Zachary Lewis. "Effects of a Lifestyle Intervention on Change in Body Composition in Prostate Cancer Patients Undergoing Androgen Deprivation Therapy". The Ohio State University, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=osu1523462399213986.

Texto completo

Los estilos APA, Harvard, Vancouver, ISO, etc.

12

Ovtcharov, Slav. "Impact of TMPRSS2-ERG fusion gene on prostate cancer cell response to chemotherapy, radiotherapy and androgen deprivation therapy". Thesis, University of Oxford, 2015. http://ora.ox.ac.uk/objects/uuid:f30bf48d-fff5-49e7-8258-107a500c8752.

Texto completo

Resumen

Many aspects of the mechanisms by which prostate cancer (PCa) progresses from being a confined tumour to advanced metastatic and castration-resistant disease remain unclear. The aim of this study is to evaluate in vitro the potential role of the fusion gene TMPRSS2-ERG in the response of PCa cells to ionising radiation (IR) and androgen deprivation therapy (ADT). This research focused on assessing the presence of the TMPRSS2-ERG transcript across various PCa cell lines and identifying any correlation between the TMPRSS2-ERG transcript and other genes, particularly genes related to DNA damage repair pathways. Several genes involved in cell metabolism and development were found to correlate with TMPRSS2-ERG but not genes involved in DNA repair. In accordance with previous reports, this research confirmed a proliferative advantage for cells expressing ERG. However this project also tested the role of ERG-status in response to chemotherapy, radiation and ADT. The data showed that VCaP and DuCaP cells exposed to low-dose radiation demonstrated decreased viability irrespective of their ERG-status. Similarly ADT decreased the viability of VCaP cells and seemed to neutralise the proliferative advantage of TMPRSS2-ERG positive cells. Stimulation with dihydrotestosterone caused increased radioresistance of TMPRSS2-ERG positive cells. Treatment with taxanes showed stronger effect on cells with lower ERG expression. This work suggests that the proliferative advantage conferred by ERG overexpression in in vitro models can be neutralised by castration and IR.

Los estilos APA, Harvard, Vancouver, ISO, etc.

13

Chiu, Helen Hoi-Lun. "Induction of neuronal apoptosis inhibitory protein expression in response to androgen deprivation by NF-κB in prostate cancer cells". Thesis, University of British Columbia, 2007. http://hdl.handle.net/2429/31584.

Texto completo

Resumen

Androgen deprivation therapy is an efficacious treatment for advanced prostate cancer (CaP) by inducing apoptosis of prostate cells. Despite the initial effectiveness of this systemic therapy, the cancer will inevitably recur and progress to an androgen-independent stage. The molecular mechanism by which some CaP cells may bypass the cell death induced by androgen deprivation is unclear. Emerging studies have highlighted the role of the inhibitor of apoptosis protein (lAP) family members in conferring an enhanced ability of malignant cells to survive in conditions normally resulting in cell death. Therefore, we explored levels of expression of these anti-apoptotic proteins in CaP cells in response to androgen deprivation. Levels of neuronal apoptosis inhibitory protein (NAIP) mRNA were significantly increased in response to castration of hosts. The increase in NAIP mRNA levels in response to androgen deprivation was further confirmed in an in vitro system. Nuclear factor (NF)-κB, for which constitutive activity has been implicated in CaP, is suspected to play a role in the expression of lAPs. Using a NF-κB luciferase reporter construct, we demonstrated that the transcriptional activity of NF-κB was inhibited by androgen. In vitro, nuclear localization of NF-κB correlated with the DNA-binding activity of NF-κB as determined by electrophoretic mobility shift assay in human CaP cell lines with different androgen requirement and androgen receptor status. However, in vivo, the DNA-binding activity of NF-κB was independent from its protein levels in the nucleus. Importantly, elevated expression of NAIP correlated to the increased DNA-binding activity of NF-κB in vivo in response to castration of the hosts. To determine if the transcription of NAIP was directly regulated by NF-κB, subsequent characterization of three κB-like sites in the regulatory regions of the NAIP locus led us to confirm the physiological relevance of the κB-like site within the second intron of the gene locus using chromatin immunoprecipitation assay. Our observations suggest that transcription of NAIP may be regulated by NF-κB via regulatory element(s) in the NAIP locus in response to androgen deprivation. Thus, this study underlines a plausible mechanism by which some CaP cells may acquire the ability to resist apoptosis in androgen-deprived conditions.
Medicine, Faculty of
Pathology and Laboratory Medicine, Department of
Graduate

Los estilos APA, Harvard, Vancouver, ISO, etc.

14

Rhee, Handoo V. "Androgen deprivation therapy (ADT), metabolic syndrome and metastatic prostate cancer: In vivo and in vitro assessments of effects of metformin". Thesis, Queensland University of Technology, 2018. https://eprints.qut.edu.au/118290/2/Handoo%20Rhee%20Thesis.pdf.

Texto completo

Resumen

This thesis describes a translational research approach to identifying a cancer mechanism driven by metabolic syndrome. It examines the impact of androgen deprivation therapy, its association with metabolic syndrome and prostate cancer progression, and the therapeutic and metabolic benefits of adjuvant metformin. The study investigates with a randomized placebo controlled clinical trial, with characterization of the molecular mechanism of metformin in vitro using conditions to mimic physiological hormonal milieu.

Los estilos APA, Harvard, Vancouver, ISO, etc.

15

Winters, Erin. "Hot flashes in men with prostate cancer : prevalence, severity, and psychosocial correlates". [Tampa, Fla] : University of South Florida, 2006. http://purl.fcla.edu/usf/dc/et/SFE0001632.

Texto completo

Los estilos APA, Harvard, Vancouver, ISO, etc.

16

Blood, Paul. "A population-based analysis of the risk of hip fracture in men with prostate cancer exposed to radiation and androgen deprivation therapy". Thesis, University of British Columbia, 2008. http://hdl.handle.net/2429/2390.

Texto completo

Resumen

Prostate cancer is frequently diagnosed in elderly men and, despite the largely unproven survival benefits of treatment, the majority receive treatment. Treatment options include surgery, radiation, and/or androgen deprivation therapy (ADT). Risks associated with treatment include hip fracture. Current understanding suggests that hip fracture is a frequent cause of morbidity and mortality in the elderly, and both radiation treatment and ADT can increase the risk of hip fracture. It is important to understand these risks so they can be minimized and the morbidity of treatment reduced. The objectives of this study were to estimate the risk of hip fracture as a major adverse outcome of treatment for prostate cancer among elderly men. The specific objectives include estimating: 1) the risk of hip fracture and the dose-risk relationship among patients receiving curative radiation treatment, and 2) the risk of hip fracture associated with palliative ADT and relapsed ADT compared to curative ADT. The cancer diagnosis and treatment records of 32,673 men were linked to their hospital discharge abstracts. The risk of hip fracture was estimated using Cox regression and the estimates were adjusted for age, comorbidity, income, and year of diagnosis. The risk of hip fracture was 59% higher among men who received curative radiation when compared to men who received curative surgery. The risk of hip fracture fell by 6% with each one Gy increase in radiation dose between 55 and 81 Gy Biological Equivalent Dose to the hip-bone. The risk of hip fracture for subjects in the palliative ADT and relapsed ADT categories was 5.98 and 5.77 times the risk in comparison to men who received curative ADT treatment. Curative radiation treatment is associated with an increased risk of hip fracture when compared to curative surgery. The risk of hip fracture is greater with ADT for palliation and relapsed cancer than with curative treatment. Current treatments for prostate cancer contain significant risk of hip fracture for elderly men and these risks should be considered as part of the treatment decision.

Los estilos APA, Harvard, Vancouver, ISO, etc.

17

Edmunds, Kim. "Cost-effectiveness of exercise medicine for prostate cancer". Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2021. https://ro.ecu.edu.au/theses/2405.

Texto completo

Resumen

Background Androgen deprivation therapy (ADT) is associated with numerous adverse effects that impact on quality of life and contribute further to the cost burden of prostate cancer (PCa) via treatment and supportive care. Exercise medicine is effective in slowing PCa progression, reversing treatment adverse effects and improving quality of life and survival of patients, however, no economic analyses have been conducted to determine whether exercise is cost-effective in this population. Objectives Firstly, to examine the adverse effects of ADT for PCa and the evidence supporting the use of exercise medicine in their management. Secondly, to conduct the first economic evaluations of exercise medicine in the management of the adverse effects of ADT for PCa to strengthen the evidence base for the development of effective health policy around exercise and PCa survivorship. Methods A systematic review was conducted to determine the incidence of the adverse effects of ADT for PCa. A rapid review examined the role of exercise in managing these adverse effects. Three economic evaluations were then conducted to determine the cost-effectiveness of supervised exercise for men with PCa receiving ADT. Two trial-based cost-effectiveness analyses (CEAs) compared exercise training and usual care (a suggestion to exercise). The first involved a preliminary randomised controlled trial (RCT) of exercise for 20 men with metastatic PCa. A value of information (VOI) analysis was also conducted to examine the need for and value of a larger trial. The second CEA involved a RCT of exercise for men previously treated with radiation therapy and ADT. For the third economic evaluation, a decision analytic Markov model was constructed to evaluate the cost-effectiveness of an exercise intervention in preventing falls and fractures for men with localised or locally advanced PCa receiving ADT. All economic analyses were conducted from a healthcare payer perspective and the primary outcome measure was quality adjusted life years (QALYs) gained. Uncertainty in the results was explored using deterministic univariate and probabilistic sensitivity analysis where appropriate. Results The systematic review generated incidence evidence for nine adverse effect groups and 19 sub-groups, with statistically significant increased risks in 17 sub-groups. The rapid review revealed that exercise was effective in improving body composition, physical function and fatigue, as well as mitigating the bone loss, sexual dysfunction and psychosocial effects associated with ADT. The first within-trial CEA of exercise for men with metastatic PCa resulted in an incremental cost-effectiveness ratio (ICER) of $133,509 and a 30% probability of being cost-effective after three months at a willingness-to-pay of AU$50,000. VOI analysis suggested further research is likely to be cost-effective to conduct. The second within-trial CEA of exercise for men who received radiation therapy and adjuvant ADT for localised PCa resulted in an ICER of $64,235 and a 41 per cent probability of cost-effectiveness after six months at a willingness-to-pay of AU$50,000. For the modelled cost-utility analysis, the exercise intervention dominated usual care (a suggestion to exercise), as it was less costly and more effective. Net monetary benefit (NMB) was $102,112 and probabilistic sensitivity analysis showed a 58% probability of cost-effectiveness at a willingness-to-pay of AU$50,000. Conclusion This research is the first to examine the cost-effectiveness of exercise for men with PCa receiving ADT. Supervised exercise is effective in managing many adverse effects of PCa treatment and cost saving in preventing falls and fractures. Future efforts need to focus on strengthening the evidence base in exercise for ADT adverse effect management. Uncertainty in economic evaluation can be reduced with more comprehensive cost and outcome data, longer follow up and larger sample sizes. This research has the potential to translate into changes in clinical practice, better informed policy decisions, cost savings for healthcare payers, and ultimately, better health and quality of life for PCa patients, survivors and their families.

Los estilos APA, Harvard, Vancouver, ISO, etc.

18

Dinh, Kathryn Tindell. "An Exploration of Risk Stratification for Active Surveillance and Androgen Deprivation Therapy Side Effects for Prostate Cancer Utilizing Data From the Surveillance, Epidemiology, and End Results Database". Thesis, Harvard University, 2016. http://nrs.harvard.edu/urn-3:HUL.InstRepos:27007753.

Texto completo

Resumen

Part 1: Occult high-risk disease in clinically low-risk prostate cancer patients: Incidence and clinical predictors from SEER data Objective: First, to determine the incidence of pathologic upgrading and upstaging for contemporary, clinically low-risk patients and identify predictors of having occult, advanced disease to inform selection of patients for active surveillance. We will further consider the differing risk of upgrading at prostatectomy between clinically low-risk patients with ≥50% biopsy cores positive and other prostate cancer patients. Methods: For the first portion of the study, we identified 10,273 patients in the Surveillance, Epidemiology, and End Results (SEER) database diagnosed with clinically low-risk disease (cT1c/T2a, Prostate specific antigen (PSA)<10ng/mL, Gleason 3+3=6) in 2010-2011 who received a prostatectomy. The primary outcome was the incidence of upgrading to pathologic Gleason score 7-10 or upstaging to pathologic T3-T4/N1 disease. Multivariable logistic regression (MVA) of men with complete biopsy data (n=5,581) identified significant predictors of upgrading or upstaging. As a second analysis, we identified 14,902 patients with prostate cancer of any risk-group diagnosed 2010-2011 with prostatectomy who also had percent positive biopsy cores (PBC) available. Patients were categorized by NCCN clinical risk-groups, separating low-risk patients by percent PBC. We measured incidence of pathologic high-risk disease, defined as pT3a-T4 or Gleason 8-10, and used MVA to consider differing risk of advanced disease in patients with clinical low-risk disease and ≥50% PBC. Results: Of the first cohort, 44% of patients were upgraded and 9.7% were upstaged at prostatectomy. MVA showed age, PSA, and percent positive cores (all p<0.001), but not race, were associated with occult, more aggressive disease. With these variables dichotomized at the median, age >60 (Adjusted Odds Ratio [AOR] 1.39), PSA>5.0 (AOR 1.28), and >25% positive cores (AOR 1.76) were significantly associated with upgrading (all p<0.001). Similarly, age>60 (AOR 1.42), PSA>5.0 (AOR 1.44), and >25% positive cores (AOR 2.26) were associated with upstaging (all p<0.001). In the second cohort, 9.2% of clinically low-risk and <50%PBC, 18.6% of clinically low-risk and ≥50%PBC, and 27.6% of clinically intermediate-risk patients had occult, high-risk disease at prostatectomy (p<0.001). On MVA, low-risk with ≥50%PBC were more likely than low-risk with <50%PBC to have pathologic high-risk disease (AOR 2.28, 95%CI 1.90-2.73, p<0.001), had similar risk to favorable-intermediate disease overall (AOR 1.09, 0.91-1.31, p=0.33), and had higher risk than favorable-intermediate among men over 60 (AOR 1.28, 1.00-1.64, p=0.04). Conclusion: Nearly half of clinically low-risk patients harbor Gleason ≥7 or ≥pT3 disease. Percent PBC demonstrates utility for identifying a subset of NCCN low-risk patients who should have further testing before deciding on active surveillance as nearly one in five clinically low-risk prostate cancer patients with ≥50% positive biopsy cores harbored occult pT3a-T4 or Gleason 8-10. This suggests that such patients should not be classified by national guidelines as “low-risk” and these patients should be made aware of this excess risk if considering active surveillance. Part 2: Association of Androgen Deprivation Therapy with Depression in Localized Prostate Cancer Using SEER-Medicare Objective: Androgen deprivation therapy (ADT) may contribute to depression, yet several studies have not demonstrated a link. We aimed to determine if receipt of any ADT or longer duration of ADT for prostate cancer is associated with increasing risk of depression. Methods: We identified 78,552 men over 65 with stage I-III prostate cancer using the Surveillance, Epidemiology, and End Results-Medicare linked database from 1992-2006, excluding patients with psychiatric diagnoses within the prior year. Our primary analysis was the association of pharmacologic ADT with the diagnosis of depression, or receipt of inpatient- or outpatient-psychiatric treatment, using Cox-proportional hazard regression. Drug-data for treatment of depression was not available. Our secondary analysis was association of duration of ADT with each endpoint. Results: Overall, 43% (33,882) of patients received ADT and had higher 3-year cumulative incidence of depression (7.1% vs. 5.2%), inpatient- (2.8% vs. 1.9%), and outpatient-psychiatric treatment (3.4% vs. 2.5%) than patients without ADT (all p<0.001). Adjusted cox-analyses demonstrated patients with ADT had a 23% increased risk of depression (adjusted hazard ratio [AHR]=1.23,95%CI=[1.15-1.31]), 29% increased risk of inpatient-psychiatric treatment (AHR=1.29,95%CI=[1.17-1.41]), and a non-significant 7% increased risk of outpatient-psychiatric treatment (AHR=1.07,95%CI=[0.97-1.17]) compared to patients without ADT. The risk of depression increased with duration of ADT, from 12% with ≤6, 26% with 7-11, to 37% with ≥12 months (p-trend<0.0001). Similar duration-effect was seen for inpatient- (p-trend<0.0001) and outpatient-psychiatric treatment (p-trend<0.0001). Conclusion: Pharmacologic ADT increased the risk of depression and inpatient-psychiatric treatment in this large study of elderly men with localized prostate cancer. This risk increased with longer duration of ADT. The possible psychiatric effects of ADT should be recognized by physicians and discussed with patients prior to initiating treatment.

Los estilos APA, Harvard, Vancouver, ISO, etc.

19

Hammerer, Peter G. y Manfred P. Wirth. "Health-Related Quality of Life in 536 Long-Term Prostate Cancer Survivors after Treatment with Leuprorelin Acetate: A Combined Retrospective and Prospective Analysis". Karger, 2018. https://tud.qucosa.de/id/qucosa%3A70627.

Texto completo

Resumen

Introduction: We investigated the health-related quality of life (HRQoL) of long-term prostate cancer patients who received leuprorelin acetate in microcapsules (LAM) for androgen-deprivation therapy (ADT). Methods: The observational study was carried out by 30 office-based German urologists in 536 prostate cancer (PCa) patients treated for ≥5 years with LAM and in 116 patients of an age-matched control group (CG). Data on HRQoL and health status was collected prospectively using validated questionnaires QLQ-C30, QLQ-PR25 and Karnofsky Index. Data on effectiveness (clinical response, prostate specific antigen [PSA], testosterone) and safety was collected retrospectively from patients’ health records. We used descriptive statistics to analyze the data. Results: The mean treatment duration was 8.6 years (range 4.5–19.8 years). General health status (QLQ-C30) was comparable for both groups. Differences were observed regarding physical – and role functioning. ADT patients rated single items slightly worse than CG. Karnofsky-Index showed comparable high values (median of 90%). QLQ-PR25 revealed more PCa-related symptoms for ADT patients. Within 6 months, median PSA level declined >90% and median testosterone levels declined below castration level from 4.0 to 0.2 ng/mL. Clinical response (European Organisation for Research and Treatment of Cancer criteria) was observed in at least 90% of ADT patients. Conclusions: Long-term ADT with LAM is a well-accepted, tolerated, effective, and low-burden treatment option for patients with advanced, hormone-sensitive PCa.

Los estilos APA, Harvard, Vancouver, ISO, etc.

20

Bousset, Laura. "Cancer de la prostate et mécanismes de résistance à la castration : étude du rôle des récepteurs nucléaires LXR". Thesis, Université Clermont Auvergne‎ (2017-2020), 2019. http://www.theses.fr/2019CLFAS016.

Texto completo

Resumen

Les formes avancées du cancer de la prostate sont classiquement traitées par hormonothérapie. Malheureusement, la plupart des patients, répondant initialement à la privation androgénique, font l’expérience d’une reprise de la croissance tumorale sous traitement qui progresse inévitablement vers un stade létal de la pathologie, le cancer de la prostate résistant à la castration (CRPC). Les altérations du métabolisme lipidique représentent une caractéristique clé des cellules tumorales prostatiques. Parmi ces anomalies, les tumeurs prostatiques accumulent de manière excessive du cholestérol. De façon cohérente, les études épidémiologiques associent de forts taux de cholestérol avec un risque plus élevé de survenue d’un cancer de la prostate et des formes agressives de la pathologie. Les récepteurs nucléaires LXR jouent un rôle important dans le maintien de l’homéostasie intracellulaire du cholestérol. Par ailleurs, ils jouent également un rôle clé dans la physiologie immunitaire en régulant notamment les processus inflammatoires. Enfin, des travaux précédemment menés notamment dans l’équipe ont démontré les effets anti-prolifératifs et pro-apoptotiques des LXR dans le cancer de la prostate.Dans ce contexte, l’objectif de mes travaux de thèse a été d’étudier le rôle des récepteurs nucléaires LXR dans le cancer de la prostate et plus particulièrement dans sa réponse à la castration. Les résultats montrent que les souris invalidées pour les LXR présentent en réponse à la castration une inflammation chronique de la prostate qui conduit plus tardivement à l’émergence de lésions néoplasiques. En modèle murin de tumorigenèse induite par la perte du suppresseur de tumeurs Pten, l’invalidation des LXR ne modifie pas l’agressivité des tumeurs. Cependant, en réponse à la castration, les souris mutantes pour Pten et pour les LXR présentent une exacerbation de l’inflammation qui est associée à une prolifération accrue de la prostate, sans modification de l’agressivité des tumeurs. Pour s’affranchir du rôle des LXR dans le microenvironnement tumoral, et plus particulièrement dans le contrôle de la réponse immunitaire à la castration, nous avons développé et étudié le phénotype des souris invalidées de façon conditionnelle pour les LXR au niveau de l’épithélium prostatique. Des données préliminaires ont montré que l’invalidation épithéliale des LXR ne semble pas induire de phénotype épithélial prostatique.Au final, ces résultats montrent que les récepteurs nucléaires LXR, en régulant l’inflammation en réponse à la castration, peuvent favoriser l’initiation et augmenter la prolifération de lésions tumorales de la prostate
Androgen deprivation therapy remains the gold standard treatment for advanced prostate cancer. Unfortunately, most of the patients who initially respond to androgen deprivation therapy, later experience tumor relapse, which inevitably progresses to a lethal pathology, named castration-resistant prostate cancer (CRPC).Lipid metabolism anomalies are a key feature of prostate tumor cells. Among these, prostate tumors present excessive cholesterol accumulation. Consistently, epidemiologic studies associate high level of cholesterol with an increased risk of prostate cancer and advanced pathology. LXR nuclear receptors are key regulators of intracellular cholesterol homeostasis that are also implicated in immune physiology through regulation of inflammatory processes. Previous studies conducted in our lab also demonstrated the anti-proliferative and pro-apoptotic effects of LXR in prostate cancer, suggesting a potential central role of these nuclear receptors in this disease.In this context, the goal of my work was to study the role of nuclear receptors LXR in prostate cancer and especially in response to castration. My results show that in response to castration, LXR knockout mice present chronic inflammation of the prostate that eventually induces development of neoplasia. In a Pten-null tumor mouse model, LXR deletion exacerbates inflammation and results in a concomitant increase in proliferation of the prostate. However, this has no significant impact on tumor aggressiveness. To bypass the role of LXR in tumor microenvironment, and especially in the control of immune response to castration, we developed and studied the phenotype mice with conditional ablation of LXR restricted to prostate epithelium. Preliminary analyses did not show a significant phenotype in the prostate of these mice, suggesting that most of the effects of LXR ablation in the prostate result from its activity in the microenvironment.Altogether, these results demonstrate that LXR nuclear receptors, by regulating inflammation in response to castration, can favor epithelial tumor initiation and increase proliferation of the prostate

Los estilos APA, Harvard, Vancouver, ISO, etc.

21

McKenzie, Ian Robert. "The role of insulin in advanced prostate cancer". Thesis, Queensland University of Technology, 2011. https://eprints.qut.edu.au/50662/1/Ian_McKenzie_Thesis.pdf.

Texto completo

Resumen

Advanced prostate cancer is a common and generally incurable disease. Androgen deprivation therapy is used to treat advanced prostate cancer with good benefits to quality of life and regression of disease. Prostate cancer invariably progresses however despite ongoing treatment, to a castrate resistant state. Androgen deprivation is associated with a form of metabolic syndrome, which includes insulin resistance and hyperinsulinaemia. The mitogenic and anti-apoptotic properties of insulin acting through the insulin and hybrid insulin/IGF-1 receptors seem to have positive effects on prostate tumour growth. This pilot study was designed to assess any correlation between elevated insulin levels and progression to castrate resistant prostate cancer. Methods: 36 men receiving ADT for advanced prostate cancer were recruited, at various stages of their treatment, along with 47 controls, men with localised prostate cancer pre-treatment. Serum measurements of C-peptide (used as a surrogate marker for insulin production) were performed and compared between groups. Correlation between serum C-peptide level and time to progression to castrate resistant disease was assessed. Results: There was a significant elevation of C-peptide levels in the ADT group (mean = 1639pmol/L)) compared to the control group (mean = 1169pmol/L), with a p-value of 0.025. In 17 men with good initial response to androgen deprivation, a small negative trend towards earlier progression to castrate resistance with increasing C-peptide level was seen in the ADT group (r = -0.050), however this did not reach statistical significance (p>0.1). Conclusions: This pilot study confirms an increase in serum C-peptide levels in men receiving ADT for advance prostate cancer. A non-significant, but negative trend towards earlier progression to castrate resistance with increasing C-peptide suggests the need for a formal prospective study assessing this hypothesis.

Los estilos APA, Harvard, Vancouver, ISO, etc.

22

Maldonado, Pijoan Javier. "Escalada de dosis de radioterapia en combinación con deprivación androgénica en el tractamiento del cáncer de próstata de riesgo intermedio y alto". Doctoral thesis, Universitat Autònoma de Barcelona, 2018. http://hdl.handle.net/10803/665829.

Texto completo

Resumen

En la última década, han surgido dos conceptos para mejorar el control local y los resultados para pacientes con cáncer de próstata localizado, a saber, la escalda de la dosis con nuevas tecnologías de radioterapia y el tratamiento combinado con la deprivación androgénica. Los estudios institucionales y multiinstitucionales de intensificación de la dosis de radioterapia en cáncer de próstata, han demostrado consistentemente una mejora en la supervivencia libre de enfermedad bioquímica y control local a medida que se administra una dosis creciente de radiación (≥75.6 Gy vs. 70.0 Gy). Esta mejora en los resultados se ha evidenciado principalmente en pacientes con cáncer de próstata de riesgo intermedio y alto. En la actualidad, existe una cantidad considerable de datos para respaldar el uso de la escalada de dosis con RT en pacientes seleccionados con cáncer de próstata, particularmente en aquellos con enfermedad de riesgo desfavorable. Debido a que los ensayos aleatorizados que muestran un mejor resultado con la deprivación androgénica (DA) han utilizado niveles de dosis exclusivamente convencionales de 65 a 70 Gy, la pregunta sobre si la DA conduciría a un beneficio similar en pacientes que reciben RT conformada de dosis alta permanece sin respuesta. GICOR-DART 01/05 inció con el apoyo de una beca FIS (04/2506). Es un ensayo aleatorizado y multicéntrico de fase III que evalúa el potencial de dos años de deprivación de andrógenos adyuvante cuando se combina con neoadyuvancia (4 meses) y dosis altas (78 Gy) de radioterapia conformada (3DCRT e IMRT). Se aleatorizaron 355 pacientes con carcinoma de próstata cT1c-T3bN0, (National Comprehensive Cancer Network) de riesgo intermedio y alto. Solo el 14% recibió irradiación ganglionar pélvica. El objetivo principal del estudio era demostrar una mejora en la supervivencia libre de recidiva bioquímica con una supresión androgénica de largo plazo en el contexto de una escalada de dosis de radioterapia. Este objetivo ha sido alcanzado. La probabilidad a los 5 años de la supervivencia libre de enfermedad bioquímica (BDFS) fue estadísticamente significativa mayor, 90%, en el grupo de deprivación de andrógenos de larga duración (LTAD) (IC 95%: 87% -92%) en comparación, 81% en el de corta duración (STAD) (IC del 95%: 78% -85%), p = 0,019. Con una mediana de seguimiento de tan solo 5 años, el uso de DA a largo plazo parece mejorar significativamente la supervivencia global (95% vs 86%, HR 2,48 [IC 95% 1,31-4,68], p = 0,009), así como la supervivencia libre de metástasis y la supervivencia libre de recidiva bioquímica. Con respecto a la toxicidad tardía, DART 01/05 ha demostrado que la LTAD no se asocia con ningún aumento en la toxicidad vesical o intestinal tardía ≥ 2, pero sí a un aumento significativo en los eventos cardiovasculares en el brazo de LTAD (HR ajustado 2,09 [IC del 95%: 1,17 a 3,72], p = 0,012). La tesis contribuye fundamentalmente en dos puntos. El primero es que, demuestra que para tratar un paciente con cáncer de próstata de alto riesgo, se debe hacer un tratamiento combinado con DA de largo plazo en combinación con la radiación con escalada de dosis. Esta combinación tiene un impacto muy importante en el control bioquímico de la enfermedad y en la supervivencia en pacientes con tumores más agresivos. La escalada de dosis no suple el uso de la DA. En segundo lugar, la combinación de tratamientos no aumenta la toxicidad tardía, pero hay evidencia de un aumento en el desarrollo de eventos cardiovasculares, y no de la muerte cardiovascular.
Over the last decade two concepts have emerged to improve local control and outcome for patients with localized prostate cancer, namely, dose escalation with new radiation technologies and combined modality treatment with hormonal therapy. Institutional and multi-institutional studies of dose escalation in prostate cancer, have consistently demonstrated an improvement in biochemical disease free survival and local control as an increasing dose of radiation is delivered (≥75.6 Gy vs. 70.0 Gy). This improvement in outcome has been mainly proved for intermediate and high-risk patients. Other of the recent step-up advances for the treatment of prostate cancer is combined modality treatment using androgen deprivation (AD) and RT. At the present time, there is a considerable amount of data to support the use of AD with RT in selected prostate cancer patients, particularly those with locally advanced, unfavourable-risk disease. Because the randomized trials showing improved outcome with AD have used exclusively conventional dose levels of 65 to 70 Gy, the question as to whether AD would lead to similar benefit in patients receiving high-dose conformal RT remains unanswered. GICOR-DART 01/05 was launched with a FIS (04/2506) grant support. It is a phase III randomized and multicentre trial evaluating the potential additional impact effect of two years adjuvant androgen deprivation when combined with neoadjuvant (4 months) and high-dose (78 Gy) conformal radiotherapy (3DCRT and IMRT). It randomized 355 patients with cT1c-T3bN0, National Comprehensive Cancer Network intermediate and high-risk disease. Only 14% received pelvic nodal radiation. The main objective of the study was to demonstrate an improvement in biochemical recurrence-free survival with long-term androgenic suppression in the context of escalating radiotherapy dose. It has been reached. The 5 year probabilista of biochemical disease free survival (BDFS) was statistically significant higher, 90%, in the long term androgen deprivation group (LTAD) (IC 95%: 87% -92%) in comparison with 81% in the short term group (STAD) (IC 95%: 78 % -85%), p=0.019. With a median follow-up of only 5 years we found that the use of long-term ADT seemed to significantly improve overall survival (95% vs. 86%, HR 2.48 [95% CI 1.31-4.68], p=0.009), as well as metastasis free survival and biochemical recurrence-free survival. On subgroup analysis, the overall survival benefit seemed to be demonstrable for the high-risk patients (HR 3.43, p=0.015) but not intermediate-risk (HR 1.67, P=0.381). Regarding late toxicity, DART 01/05 showed that LTAD was not associated with any increase in late grade ≥ 2 bladder or bowel toxicity, but there was a significant increase in cardiovascular events in the LTAD arm (adjusted HR 2.09 [95% CI 1.17-3.72], p=0.012). The thesis contributes fundamentally in two points. The first, it shows that in order to treat a patient with high-risk prostate cancer, a combination therapy with long-term AD should be done in combination with radiation with dose escalation. This combination has a very important impact on the biochemical control of the disease and on survival in patients with more aggressive tumors. Dose escalation does not replace the use of AD. Second, the combination of treatments does not increase late toxicity, but there is evidence of an increase in the development of cardiovascular events, not cardiovascular death.

Los estilos APA, Harvard, Vancouver, ISO, etc.

23

Scailteux, Lucie-Marie. "Evaluation de la sécurité d’emploi des médicaments modulant les androgènes dans les maladies prostatiques, une approche pharmaco-épidémiologique". Thesis, Rennes 1, 2017. http://www.theses.fr/2017REN1B006.

Texto completo

Resumen

Contexte : En France, le cancer de la prostate est une maladie fréquente de l’homme âgé et la première cause de cancer. Il est associé à une survie de 70 % à 10 ans. Différentes options thérapeutiques sont recommandées dans la prise en charge de ce cancer, parmi lesquelles l’hormonothérapie (ou thérapie par déprivation d’androgène, ADT). Le profil de sécurité de l’hormonothérapie et des différentes modalités qui la composent est remis en question depuis le milieu des années 2000 avec plusieurs auteurs ayant évoqué un sur-risque cardiovasculaire comparativement aux patients non traités. Les résultats de ces études étant discordants, l’hypothèse d’une hétérogénéité entre les différentes modalités d’ADT a été évoquée mais n’a pas été directement investiguée. Objectif : L’objet de ce travail a été d’évaluer l’hypothèse d’une hétérogénéité qualitative entre les différentes modalités d’ADT indiquées dans le cancer de la prostate. Méthodes : De façon originale par rapport aux études précédemment publiées, une méta-analyse des essais cliniques randomisés et des études observationnelles, « METADTCR », a été réalisée comparant la morbidité et mortalité cardiovasculaire ischémique ainsi que la mortalité toutes causes au sein des différentes modalités d’ADT. Dans un second temps, une étude observationnelle, « ADTCR », utilisant la base de données de l’Assurance Maladie couplée aux données de remboursement hospitalières, a été réalisée afin de suivre spécifiquement, sur une cohorte nationale de patients avec un cancer de la prostate initiant une hormonothérapie, l’apparition d’évènements ischémiques (accidents vasculaires cérébraux ischémiques et infarctus du myocarde). Résultats - Conclusion : Concernant METADTCR, les essais cliniques se sont révélés extrêmement peu contributifs quant au risque de morbidité et mortalité cardiovasculaire ; la méta-analyse des études observationnelles souffrant d’une hétérogénéité substantielle au niveau des différentes comparaisons étudiées, la question du risque de morbidité et mortalité cardiovasculaire subsistait. Concernant ADTCR, une hétérogénéité du risque d’évènements ischémiques a été constatée entre les différentes modalités d’ADT : comparativement aux agonistes GnRH, un sur-risque d’évènements ischémiques a été identifié avec le blocage androgénique complet et une diminution du risque observée avec les anti-androgènes. La comparaison d’intérêt pour les cliniciens concernait celle avec l’antagoniste GnRH : aucune différence statistiquement significative n’a été observée. La plausibilité pharmacologique expliquant un potentiel sur-risque d’évènements ischémiques entre ces deux modalités n’a par ailleurs pas emporté la conviction et nous conforte dans l’hypothèse de l’absence de différence de risque. Ces résultats viennent compléter les recommandations françaises et européennes de prise en charge du cancer de la prostate quant à la différence de profil de sécurité de certaines modalités d’ADT en matière d’évènements ischémiques à court terme (< 2 ans)
Context: In France, prostate cancer is a frequent disease in elderly men, and the first cause of cancer. It is associated with a 70 % survival at 10 years. Different therapeutics options are recommended in prostate cancer management, including hormonotherapy (or androgen deprivation therapy, ADT). Safety of ADT modalities is challenged since mid of 2000’s when some authors evoked an increased cardiovascular risk in ADT-treated patients compared to non-treated patients. Results of these studies appeared conflicting, and heterogeneity of cardiovascular risk across ADT modalities was evoked but not directly investigated. Objective: Our aim was to assess the hypothesis of qualitative heterogeneity across the different ADT modalities used for prostate cancer. Methods: Through a new approach compared to previously published studies, we firstly conducted a direct and network meta-analysis of both randomized controlled trials and observational studies, “METADTCR”, comparing ischemic cardiovascular morbidity, mortality and overall death across the different ADT modalities. Secondly, we set up a population-based cohort study, “ADTCR”, using French Health Insurance database (SNIIRAM/DCIR) linked to hospital reimbursement data (PMSI), including men with prostate cancer who initiated an ADT, and measuring the occurrence of ischemic diseases (myocardial infarction or ischemic stroke). Results – Conclusion: As regards METADTCR, randomized controlled trials gave too few data related to cardiovascular morbidity and mortality; observational studies meta-analysis suffered from substantial inconsistency and eventually the question of cardiovascular risk morbidity and mortality remained. In ADTCR, a heterogeneous risk of ischemic events was observed across ADT modalities: compared to GnRH agonists, an increased risk of ischemic events was identified with combined androgen blockade, and a decrease risk with anti-androgen alone. The most interesting comparison concerned GnRH antagonist: no statistically significant difference was observed. Pharmacological plausibility for a potential increased risk of ischemic events between GnRH agonists and antagonist is not convincing to date and the hypothesis of no risk difference might be true. These results add valuable information to the French and European guidelines for prostate cancer management as regards the safety profile of the different ADT modalities in term of short term ischemic events onset (< 2 years)

Los estilos APA, Harvard, Vancouver, ISO, etc.

24

Johansson, Eva. "Quality of Life and Functional Outcomes in Men with Localized Prostate Cancer". Doctoral thesis, Uppsala universitet, Medicinska fakulteten, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-158094.

Texto completo

Resumen

Quality-of-life and functional outcomes are important in the choice of treatment for men with localized prostate cancer. These issues were investigated in the present thesis. All living 400 men randomized to radical prostatectomy or watchful waiting from 1989 to 1999 in the Scandinavian Prostate Cancer Group Number 4 (SPCG-4) were included. An additional 281 men compromised an age-matched control group. Physical symptoms, symptom-induced stress, sense of well-being and self-assessed quality of life were evaluated by a study-specific questionnaire. Results showed that prostate cancer men, regardless if they were allocated to radical prostatectomy or watchful waiting were suffering of long term adverse effects, mainly erectile dysfunction, urinary leakage and voiding symptoms. In the prostatectomy group, erectile dysfunction and urinary leakage were often consequences of surgery; in the watchful waiting group the side-effects could be caused by tumor progression. The quality of life deteriorated over time. High self-assessed quality of life was reported by 35 % in the radical, 34 % in watchful-waiting, and 43 % in the control groups after a median follow-up time of 12.2 years. The SPCG-4 men significantly more often reported anxiety than did controls. Erectile dysfunction was associated with the most negative influence on quality of life in both SPCG-4 groups. Men in the prostatectomy group were more distressed by erectile dysfunction than watchful waiting. Androgen deprivation therapy had negative effects on all psychological parameters, including quality of life, for the watchful waiting but not for the prostatectomy group. Information about the prostate-cancer disease was significantly higher in the radical-prostatectomy group than in watchful waiting. Check-ups were associated with worry, especially for those on androgen deprivation therapy. Open radical prostatectomy led to an increased rate of inguinal hernia compared with robot-assisted technique. In conclusion, the data of this thesis emphasize that it takes more than a decade to understand the patterns of adverse effects and time dimension of their occurrence for each treatment. Consideration of quality of life has a high priority to aid the ageing man through the shifting scenarios of localized prostate cancer.

Los estilos APA, Harvard, Vancouver, ISO, etc.

25

Klaff, Rami. "Disease-Specific Survival in Prostate Cancer Patients : Results from the Scandinavian Prostate Cancer Group (SPCG) Trial No. 5 and Regional Cancer Register Data". Doctoral thesis, Linköpings universitet, Institutionen för klinisk och experimentell medicin, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-132385.

Texto completo

Resumen

Introduction Prostate cancer (PCa) is the most common cancer among men in Sweden. The clinical course varies considerably, which makes it difficult to predict the prognosis in the individual case. In order to explore the early as well as the late course of the disease, large study groups and population-based cohorts are necessary. Aims To explore factors that influence the long-term outcome of men with low-risk tumours in a population-based register, to predict the long-term course, and to assess the mortality rate for men with prostate cancer (Paper I) To analyse long-term outcome and to investigate factors associated with long-term survival in patients with metastases to the skeleton (Paper II) To analyse early androgen deprivation treatment (ADT) failure and to define clinical predictors associated with short survival due to early ADT failure in prostate cancer patients with bone metastases (Paper III) To analyse the prognostic significance of the extent of bone metastases in relation to other pretreatment variables in prostate cancer patients, and to explore the impact of bone metastases on quality-of-life (Paper IV) Material and methods The study groups were assembled from The South East Region Prostate Cancer Register (SERPCR), and The Scandinavian Prostate Cancer Group (SPCG) Trial No. 5. In the first study, prognostic factors and long-term disease-specific mortality rates of low-risk prostate cancer patients from the early PSA era were analysed. In the second study, patient-related factors, quality-of-life (QoL) and long-term survival in 915 PCa patients with bone metastases (M1b) under ADT, were analysed. In Study III factors predicting primary failure to respond to ADT were identified. Study IV explored the impact of the extent of bone metastases on survival and QoL for these men. Result and conclusions The long-term disease-specific mortality of low-risk localised PCa is low, but the annual mortality rate gradually increases. This indicates that some tumours slowly develop into lethal cancer, particularly in men 70 years or older and with a PSA level ≥ 4 μg/L. From the SPCG Trial No. 5, a subgroup of patients with M1b disease and favourable set of predictive factors survived more than 10 years under ADT with an acceptable QoL. Independent predictors of long-term survival were identified as performance status (PS) < 2, limited extent of bone metastases, and a PSA level < 231 μg/L at the time of enrolment in the trial. However, four independent clinical predictors of early ADT failure could be defined. Men exhibiting these features should be considered for an alternative treatment. Patient grouping based on three categories of extent of bone metastases related to PS, haemoglobin, and QoL at presentation, as independent predictors of mortality, may provide improved accuracy of prognosis.

Los estilos APA, Harvard, Vancouver, ISO, etc.

26

Regis, Plácido Lucas. "Valor de la testosterona libre en el diagnóstico y seguimiento del cáncer de próstata". Doctoral thesis, Universitat Autònoma de Barcelona, 2016. http://hdl.handle.net/10803/386533.

Texto completo

Resumen

Desde que Huggins y Hodges en 1941 describieran la hormono dependencia del cáncer de próstata, la elevación de los niveles de testosterona en suero ha sido relacionada con la carcinogénesis prostática. Sin embargo, el papel de la testosterona en la neoplasia de la próstata es controvertida. La testosterona en suero se encuentra unida mayoritariamente a la hormona transportadora de esteroides sexuales y a la albúmina, y solamente, entre un 1 y 2% circula en forma de testosterona libre, isoforma biológicamente activa. Los pacientes con cáncer de próstata avanzado sometidos a terapia de deprivación androgénica presentan mayor intervalo libre de progresión y supervivencia si mantienen bajos niveles de testosterona. La castración ha sido definida históricamente como testosterona total inferior a 50 ng/dL, aunque los niveles óptimos de supresión están por definir. Actualmente las guías de práctica clínica recomiendan la determinación de la testosterona total sérica para evaluar la eficacia de la terapia de deprivación androgénica y, además, para diagnosticar la resistencia a la castración. Dado que la testosterona libre es la isoforma biológicamente activa de la hormona, creemos que se correlaciona mejor con los niveles intraprostáticos que la testosterona total. El objetivo global de nuestro proyecto de tesis fue comparar la testosterona total y libre en el I. diagnóstico del cáncer de próstata; II. predicción de la agresividad tumoral; y III. control de los pacientes sometidos a terapia de deprivación androgénica, como predictor de supervivencia libre de resistencia a la castración. Se trata de un estudio realizado en dos grupos de pacientes que representan momentos distintos de la historia natural de la enfermedad: la base de datos 1 formada por 3364 pacientes con sospecha clínica de cáncer de próstata por elevación del PSA y/o tacto rectal anormal, con recogida prospectiva de los datos clínicodemográficos (edad, índice de masa corporal, PSA total y libre, tacto rectal, volumen prostático, resultado de la biopsia, suma Gleason, estadiaje patológico [TNM 2002]) y perfil hormonal (testosterona total y testosterona libre). La base de datos 2 compuesta por 126 pacientes con diagnóstico histológico de cáncer de próstata avanzado sometidos a terapia de deprivación androgénica con agonista de la LHRH, con recogida retrospectiva de los datos clínico-demográficos y perfil hormonal. La intervención realizada en nuestro estudio fue la determinación sérica de la testosterona total mediante método enzimático competitivo de quimioluminiscencia con límite inferior de detección de 10,0 ng/dL (Immulite 2500 automated analyzer, DPC Inc., Los Angeles, CA, USA) y de testosterona libre mediante método de radioinmunoanálisis con límite inferior de detección de 0,05 pg/mL (DPC Inc., Los Angeles, CA, USA). Los objetivos principales fueron establecer la relación de la testosterona total y libre con la detección de cáncer de próstata y la predicción de su agresividad (base de datos 1); y analizar el valor predictivo de los niveles de testosterona total y testosterona libre en la supervivencia libre de resistencia a castración en pacientes sometidos a deprivación androgénica, así como establecer el menor nivel con impacto clínico (base de datos 2). Se concluye que I. niveles bajos de testosterona sérica total y de testosterona libre incrementan el riesgo de detección de cáncer de próstata; II. Ninguno de los niveles de testosterona total o testosterona libre se asociaron con la agresividad tumoral; III. la testosterona sérica libre determinada a los 6 meses de deprivación androgénica fue un predictor independiente de supervivencia libre de resistencia a la castración en pacientes no diseminados, mientras que la testosterona total no lo fue. El menor nivel de testosterona libre con significado clínico fue 1,7 pg/dL.
Since Huggins and Hodges published the prostate cancer hormone dependence theory in 1941, high levels of serum testosterone have been associated with the prostatic carcinogenesis. However, there is a lack of knowledge about the real role of testosterone in the prostatic neoplasm. Serum testosterone is mainly bounded with sex hormone binding globulin and albumin and only 1-2% is found as free testosterone, the biologically active hormone isoform. Advanced prostate cancer patients under androgen deprivation therapy have long overall survival and survival free of progression rates when testosterone is kept in low levels. Historically, castration has been defined as total testosterone lower than 50 ng/dL, although optimal degree of testosterone suppression following castration remains in question. Current guidelines recommend serum testosterone determinations to evaluate the androgen deprivation therapy efficacy and, furthermore, to diagnose castration resistance status. Because free testosterone is the active isoform of serum testosterone, we believe that it correlates better with intraprostatic environment than total testosterone. The main objective of our thesis project was to compare total and free testosterone in the I. prostate cancer diagnose; II. tumor aggressiveness prediction; and III. control of patients under androgen deprivation therapy as a survival free of castration resistance predictor. Our study was performed in two groups of patients that represent different moments of the natural history of the disease. 3364 men under prostate cancer suspicious due to rising PSA and/or abnormal digital rectal examination (DRE) integrated the prospective collected database 1. 126 patients under androgen deprivation therapy with LHRH agonist due to advanced prostate cancer histologically diagnosed integrated the retrospective collected database 2. Both databases included clinical-demographic data (age, BMI, total and free PSA, DRE, prostatic volume, biopsy result, Gleason score, pathologic stage [TNM 2002]) and hormone profile (total and free testosterone). The intervention performed was serum total testosterone measurement by competitive enzymatic chemiluministent assay with lower level of detection of 10.0 ng/dL (Immulite 2500 automated analyzer, DPC Inc., Los Angeles, CA, USA) and serum free testosterone measurement by radioinmunoanalysis assay with lower limit of detection of 0.05 pg/mL (DPC Inc., Los Angeles, CA, USA). Main endpoints were determine the relation between total and free testosterone and prostate cancer detection and its aggressiveness (database 1); and analyze total and free testosterone predictive values in survival free of castration resistance in order to establish the lower threshold with clinical impact in patients under androgen deprivation therapy (database 2). We conclude that I. low levels of total and free testosterone increment the risk of prostate cancer detection, II. no free or total testosterone levels showed any association with tumor aggressiveness; III. serum free testosterone determined at 6 months of androgen deprivation therapy was an independent predictor of survival free of castration resistance in no metastatic patients, while total testosterone wasn’t. The lower free testosterone threshold with clinical impact was 1.7 pg/mL.

Los estilos APA, Harvard, Vancouver, ISO, etc.

27

Servián, Vives Pol. "Clinical significance of prostatic proliferative inflammatory atrohpy". Doctoral thesis, Universitat Autònoma de Barcelona, 2016. http://hdl.handle.net/10803/386532.

Texto completo

Resumen

La atrofia proliferativa inflamatoria (PIA) se ha relacionado con la carcinogénesis prostática. El epitelio proliferativo en la lesión PIA podría progresar a neoplasia intraepitelial prostática de alto grado (HGPIN), adenocarcinoma o ambos. Sin embargo, se conoce poco acerca del significado clínico de detectar PIA en biopsias prostáticas (BPs) negativas. Se realizó una revisión de la literatura actual(1rartículo). Objetivos: 1)Determinar la incidencia de PIA en BPs con y sin cáncer de próstata (CaP) y en prostatectomías radicales (PRs), su asociación con HGPIN y agresividad tumoral(2ºartículo). 2)Determinar el valor pronóstico del hallazgo de PIA en BPs negativas, riego de CaP y agresividad(3r artículo). Métodos: Estudio retrospectivo y observacional de la lesión PIA en 528 BPs extendidas y 200 PRs. Variables de medida: PIA, HGPIN, incidencia CaP, suma Gleason, estadío clínico y patológico y ratio de tumor insignificante(2º artículo). Estudio retrospectivo y observacional de 474 hombres sometidos a BPs de repetición. Evaluación de PIA y su extensión en la biopsia previa. Detección de CaP y agresividad tumoral. Edad, PSA total, PSA libre, porcentaje PSA libre(%PSAL), tacto rectal(TR), volumen prostático(VP), densidad PSA(DPSA), cinética PSA(VPSA y TDPSA), hallazgos de PIA y HGPIN y nº cilindros afectados en BPs previas se incluyeron en el análisis univariante y multivariante. Se consideró como tumor agresivo cuando se detectó algún patrón Gleason 4(3r artículo). Resultados: La incidencia global de PIA y HGPIN fue 30.3% y 54% en BPs. En PRs, la inicidencia fue 30.5% y 72% respectivamente. No se encontró asociación estadística entre PIA y HGPIN. La detección global de CaP en BPs fue 38.1%. Se encontró CaP en 27.5% BPs con PIA y en 42.7% de éstas sin PIA, p>0.001. Por el contrario, se detectó CaP en 50.9% BPs con HGPIN y 23% sin HGPIN,p=0.001. El análisis multivariante mostró que PIA disminuía el riesgo de CaP, OR:0.59 (95%CI:0.37–0.95),p=0.029, mientras que HGPIN lo aumentaba OR:3.16 (95%CI:2.04–4.90),p=0.001. La PIA no se relacionó con el grado de Gleason y el estadío clínico, aunque sí con el aumento de tumores insignificantes OR:3.08 (95%CI:1.09–8.7),p=0.033. La información derivada de PRs sugiere que PIA está asociada con tumores menos agresivos y mayor probabilidad de tumores insignificantes(2º artículo). En el análisis de 474 hombres sometidos a BPs repetidas, se detectó CaP en 133 hombres(28.1%). La edad, PSA total, %PSAL, VP, DPSA, VPSA, TDPSA y hallazgo de PIA se relacionaron con la detección de CaP. Sin embargo, solo la edad, OR:1.061 (95%CI:1.025-1.098),p=0.001; TR, OR:1.755 (95%CI:1.054-2.923),p=0.031; %PSAL, OR:0.963 (95%CI: 0.933-0.996),p=0.028; VP, OR:0.983 (95%CI:0.972-0.994),p=0.002 y hallazgo de PIA, OR:0.491 (95%CI:0.291-0.828),p=0.008, fueron factores predictores independientes de detección de CaP. Se encontró CaP en 18% de los 159 hombres con PIA previa y en 33% de los 315 hombres sin PIA previa(p=0.001). Ninguno de los parámetros estudiados incluido el hallazgo de PIA en la BP previa se relacionó con la agresividad del CaP(3r artículo). Conclusiones: 1)PIA se encontró en el 30% de las BPs extendidas, sólo el 27% de las BPs con PIA tenían CaP. La incidencia de PIA en PRs fue 32%. 2)El hallazgo de PIA en BPs no se relacionó con la detección de HGPIN en BPs ni en PRs. El hallazgo de PIA se relaciona con un menor riesgo de CaP. En caso de deteción de CaP, el hallazgo de PIA se asoció con tumores menos agresivos e insignificantes en BPs y en PRs. 3)La lesión PIA se detectó en el 30% de los pacientes con BP negativa. El hallazgo de PIA en BPs negativas representa una disminución en el riesgo de detección de CaP en futuras BPs de repetición. No hay relación entre PIA en BPs negativas y agresividad tumoral en biopsias sucesivas.
Background: Proliferative inflammatory atrophy (PIA) has been involved in prostatic carcinogenesis. Proliferative epithelium in PIA may progress to high-grade prostatic intraepithelial neoplasia (HGPIN) or adenocarcinoma or both. However, little is known about the clinical significance of a PIA finding in negative prostate biopsies (PBs). A preliminary review of the current literature has been done.(1st article) Objectives: 1)Determine the incidence of PIA in PBs with and without prostate cancer (PCa) and RPs, its association to HGPIN and tumor aggressiveness.(2nd article) 2)Determine the prognostic value of PIA finding in a negative PB regarding PCa risk and agressiveness.(3rd article) Methods: Retrospective and observational study of PIA lesion in 528 extended PBs and 200 RPs. Outcome measurements: PIA, HGPIN, PCa incidence, Gleason score, clinical and pathologic tumor stage and insignificant tumor rate.(2nd article) Retrospective and observational study of 474 men scheduled to repeated PBs. Assessment of PIA and its extension in the previous biopsy. PCa detection rate and tumor aggressiveness. Age, serum total PSA, free PSA, percent free PSA (%fPSA), digital rectal exam (DRE), prostate volume (PV), PSA density (PSAD), PSA kinetics (PSAV and PSADT) findings of PIA and HGPIN and number of affected cores in previous PBs were included in the univariate and multivariate analysis. Aggressive tumors were considered when any Gleason pattern 4 was found.(3rd article) Results: Overall incidence of PIA and HGPIN was 30.3% and 54% in extended PBs. In RPS, the incidence was 30.5% and 72%, respectively. No significant association was found between PIA and HGPIN. Overall PCa detection rate in PBs was 38.1%. PCa was found in 27.5% PBs with PIA and 42.7% of those without PIA, p<0.001. In contrast, PCa was detected in 50.9% of PBs with HGPIN and 23% of those without HGPIN, p=0.001. Multivariate analysis revealed that PIA decreased the risk of PCa, OR: 0.59 (95%CI:0.37–0.95), p=0.029, while HGPIN increased OR: 3.16 (95%CI:2.04–4.90), p=0.001. PIA was not related to Gleason grade and clinical stage, however it was associated to an insignificant tumors increase, OR:3.08 (95%CI:1.09–8.7), p=0.033. The information in RPs suggests that PIA is associated with less aggressive tumors and a higher probability of insignificant tumors.(2nd article) In the analysis of 474 men that underwent repeated PBs, PCa was detected in 133 men (28.1%). Age, serum total PSA, %fPSA, PV, PSAD, PSAV, PSADT and PIA finding were significantly associated to PCa detection. However, only age, OR:1.061 (95%CI:1.025-1.098), p=0.001; DRE, OR:1.755 (95%CI:1.054-2.923), p=0.031; %fPSA, OR:0.963 (95%CI: 0.933-0.996), p=0.028; PV, OR:0.983 (95%CI:0.972-0.994), p=0.002 and PIA finding, OR:0.491 (95%CI:0.291-0.828), p=0.008, were independent predictors of PCa detection. PCa was found in 18% of 159 men with previous PIA finding while in 33% of 315 men without previous PIA (p=0.001). None of the studied parameters including PIA in the previous biopsy were related with subsequent PCa aggressiveness. (3rd article) Conclusions: 1)PIA lesion is found in 30% of extended prostate biopsies, only 27% of PBs with PIA had PCa. PIA incidence in RPs was 32%. 2)The finding of PIA in prostate biopsies is not related with HGPIN finding in PBs nor in RPs. PIA finding is related to a lower risk of associated PCa. If PCa is present in prostate biopsies, the finding of PIA is associated to less aggressive and insignificant tumors. The presence of PIA in RPs was associated to less aggressive and insignificant tumors. 3)PIA lesion can be identified in 30% of patients with a negative PB. PIA finding in negative prostatic biopsies represents a decreased risk of PCa detection in future repeated PBs due to persistent PCa suspicion. There is no relation between PIA lesion in negative prostate biopsies and PCa aggressiveness in further biopsies.

Los estilos APA, Harvard, Vancouver, ISO, etc.

28

Wang, Wei-Na y 王維那. "A cost-outcome analysis of androgen deprivation therapy and androgen deprivation therapy combine radiotherapy for locally advanced prostate cancer". Thesis, 2011. http://ndltd.ncl.edu.tw/handle/28097547706589051855.

Texto completo

Resumen

碩士
高雄醫學大學
醫務管理學研究所碩士在職專班
99
Purpose 1. Comparison of androgen deprivation therapy to androgen deprivation therapy with radiation therapy at the patient characteristics and hospital characteristics of the different medical treatment. 2. Comparison of androgen deprivation therapy to androgen deprivation therapy with radiation therapy at the cost difference. 3. Comparison of combined androgen deprivation therapy and differences in the effect of radiation therapy. 4. Androgen deprivation therapy to androgen deprivation therapy with radiation therapy Comparison of cost-effectiveness analysis Methods This study was retrospective secondary data analysis, form January 1997 to December 2008 between the diagnosis of primary prostate cancer patient and outpatient basis, Select the " androgen deprivation therapy "and" androgen deprivation therapy "for the study sample. The sources of this study, Mainly from the National Institutes of Health released the National Health Insurance Research Database, Of January 1997 to December 2008 detailed file of outpatient prescription treatment (CD) and hospital expenses detailed file list (DD) and the basic data file medical institutions, The statistical software package SPSS for Windows 14.0 Chinese, For data processing and analysis, Based on the framework and assumptions descriptive and inferential statistics, Using two-tailed test (two-tailed) of its P value to 0.05. Using chi-square test, independent sample t test, one factor ANOVA and survival analysis for data analysis and verification of hypotheses. Results The results showed, Prostate cancer patients in Taiwan to perform a single androgen deprivation therapy and androgen deprivation therapy and radiation therapy at a total of 124, Infer the end of the age of prostate cancer patients are mainly distributed in more than75 years of age. Currently patients androgen deprivation therapy and radiation therapy to the main medical center, And androgen deprivation therapy with radiation therapy 50% of the Taipei branch of androgen deprivation therapy significantly higher than that of a single branch in Taipei do not, The androgen deprivation therapy is 30.1% higher than the area south of androgen deprivation therapy with radiation therapy, Furthermore, Part of cost analysis, Direct costs of two treatments for two years and five years in significant differences, And total direct costs are also significant differences. The other effect analysis, Impact indicators referred to the number of complications, Survival time, outpatient visits and hospital days did not differ. Finally, cost-effectiveness analysis, both treatments may, the cost of outpatient treatment results are significantly different. Conclusions and suggestions Overall, for patient characteristics, hospital characteristics, and not in terms of branches found, androgen deprivation therapy with radiation therapy at the Medical Center, Taipei Branch and the main, Estimate shows north-south area treatment patients choose physicians of their choice or the way patients are very different, This study compared the androgen deprivation therapy and radiation therapy and androgen deprivation therapy cost , effectiveness and cost effectiveness of different, Found that both the total cost of treatment difference of about 23 million, However, no difference in treatment, nd cost-effectiveness analysis found that the average level of outpatient visits, androgen deprivation therapy with radiation therapy more than androgen deprivation therapy, Statistics show no difference between treatment. Its better than androgen deprivation therapy and radiation treatment of drug, addition cost analysis also showed that treatment costs less than a androgen deprivation therapy and radiation therapy. Select the end of the basic treatment for prostate cancer patients based on their conditions and will, Coupled with the clinical diagnosis of clinical specialist, However, this study found that treatment with different patients may cause the number of out-patient treatment costs and cost-effectiveness of different, This conclusion provides medical services, prostate cancer patients and their families to discuss their behavior decision-making principles, and propose that the unit can use the data of this study as a reference for the future allocation of medical resources to provide for appropriate and realistic Demand for payment standards.

Los estilos APA, Harvard, Vancouver, ISO, etc.

29

Wilke, Derek R. "Preferences for short- versus long term androgen deprivation in prostate cancer survivors". 2005. http://link.library.utoronto.ca/eir/EIRdetail.cfm?Resources__ID=362404&T=F.

Texto completo

Los estilos APA, Harvard, Vancouver, ISO, etc.

30

Hwang, Olivia Rachel y 黃珞薇. "Risk of Comorbidities in Advanced Prostate Cancer Patients Receiving Androgen Deprivation Therapy". Thesis, 2018. http://ndltd.ncl.edu.tw/handle/cw8k6w.

Texto completo

Los estilos APA, Harvard, Vancouver, ISO, etc.

31

Maturi, M. Brigida. "Cost-effectiveness of Intermittent versus Continuous Androgen Deprivation Therapy in Advanced Prostate Cancer". Thesis, 2012. http://hdl.handle.net/1807/33443.

Texto completo

Resumen

Background: Androgen deprivation therapy (ADT) has known adverse effects (AEs). Intermittent (INT) ADT may reduce AEs, improve quality of life, and lower costs compared to continuous (CONT) treatment. Objective: To evaluate the cost-effectiveness of INT vs CONT ADT in men with advanced prostate cancer. Methods: A lifetime Markov individual simulation model was developed to evaluate the incremental cost per quality adjusted life month (QALM) of INT vs CONT ADT. Results: INT dominated CONT ADT (mean total costs $94,460 vs $109,431; mean total QALMs 47.0 vs 46.4). INT ADT resulted in less time on therapy (22.4 vs 56.8 months), fewer hip fractures (0.080 vs 0.093 per patient), and fewer total cases of sexual dysfunction (72.5% vs 87.0% of patients) and cardiovascular disease (38.7% vs 44.6% of patients). Conclusions: These results suggest INT ADT is cost-effective compared to CONT ADT however, differences were small. Additional research is required to confirm these findings.

Los estilos APA, Harvard, Vancouver, ISO, etc.

32

Chiang, Szu-Yu y 姜思羽. "Assessing Effectiveness and Safety of Androgen Deprivation Therapy in Patients with Prostate Cancer in Taiwan". Thesis, 2017. http://ndltd.ncl.edu.tw/handle/77091402812039115846.

Texto completo

Resumen

碩士
高雄醫學大學
藥學系臨床藥學碩士班
105
Background and objective: Hormone therapy, known as androgen deprivation therapy (ADT), is one of the treatment options for prostate cancer patients. ADT includes surgical bilateral orchiectomy and medical therapy. In several studies, ADT was found to increase the risk of diabetes and cardiovascular disease, including myocardial infarction and stroke. Furthermore, there are few studies evaluating the effectiveness and safety of ADT in Taiwanese population. Our study aimed to evaluate the effectiveness and safety of medical androgen deprivation therapy in patients with prostate cancer in Taiwan. Methods: We conducted a population-based retrospective cohort study from Longitudinal Health Insurance Database 2005 (LHID2005) for the analysis. We enrolled newly diagnosed prostate cancer patients from 1998 to 2012, and divided patients into ADT users and non-user group. Primary outcome was all-cause mortality. Secondary outcomes were stroke, and acute myocardial infarction (AMI). Follow-up was complete through December 2013. Hazard ratio, with 95% confidence intervals, were estimated with the use of a Cox proportional-hazards model. Results: In total 1,057 prostate cancer patients who met our study criteria were enrolled in our study. After 1 to 1 propensity score matching, there were 389 patients in ADT user group and non-user group, respectively. No significant increased risk of stroke (adjusted HR=1.267, 95% CI=0.774-2.076), and AMI (adjusted HR=1.005, 95% CI=0.570-1.772) were found between user and non-user group. In contrast, we found an increasing risk of all-cause mortality (adjusted HR=2.461, 95%CI=1.834-3.303) in ADT-user group. Conclusion: In conclusion, medical ADT for patients with prostate cancer was at a higher risk of all-cause mortality with a statistical difference compared to non-user group. No significantly increased risk of stroke and acute myocardial infarction were found in patients receiving ADT. Further research is needed to confirm our findings from National Health Insurance Administration database of larger population.

Los estilos APA, Harvard, Vancouver, ISO, etc.

33

Geng, Jiun-Hung y 耿俊閎. "Association analysis of Wnt pathway gene on clinical outcomes in prostate cancer patients receiving androgen-deprivation therapy". Thesis, 2015. http://ndltd.ncl.edu.tw/handle/80712294420825500230.

Texto completo

Resumen

碩士
高雄醫學大學
醫學研究所碩士班
103
Approximately 10% to 20% of newly diagnosed prostate cancer patients presented with advanced disease and androgen deprivation therapy (ADT) is the most common first-line treatment for advanced prostate cancer. However, many patients on ADT progress to castration-resistant prostate cancer (CRPC) within 2–3 years. Once CRPC develops, patient’s life expectancy is approximately 16–18 months. A few parameters, including prostate specific antigen (PSA) doubling time, PSA nadir, PSA level at ADT initiation, clinical stage and Gleason score, have been reported as useful prognostic predictors for disease progression or survival in patients receiving ADT. However, these parameters are still limited. The Wnt signaling pathway is an evolutionarily conserved signal transduction pathway that governs embryonic growth, cell proliferation, polarity, migration, apoptosis and the self renewal of stem cell populations. Although aberrant Wnt signaling has been observed in many kinds of disease, including human prostate cancer, there is currently no information on the role of Wnt signaling gene polymorphisms in the population receiving ADT. The aim of the present study was tried to find a link between the genetic variants of the Wnt pathway and clinical outcomes in prostate cancer patients receiving ADT. We comprehensively studied the contribution of genetic variations in CTNNB1, adenomatous polyposis coli (APC) and WNT1 to the clinical outcomes in prostate cancer patients receiving ADT using a cohort study. We selected and genotyped 17 tagged single-nucleotide polymorphisms (tSNP) based on the HapMap population data to predict common variants across entire CTNNB1, APC and WNT1 genes in 465 patients with clinically advanced prostate cancer patients who received ADT. We found that after adjusting for known risk factors in multivariate Cox regression models, APC rs2707765 and rs497844 remained significantly associated with disease progression and all-cause mortality (ACM) after ADT (P<0.01). Furthermore, protective alleles refer to C alleles in rs2707765 and T alleles in rs497844, which also present with cumulative effects on disease progression and ACM. Individuals carrying 3-4 protective genotypes at these loci present a 44% reduction in disease progression and 64% reduction in all-cause mortality (ACM) compared with individuals carrying zero (P<0.01). Our results identify two candidate molecular markers in key genes of Wnt pathway associated with disease progression and ACM after ADT, establishing the role of pharmacogenomics in this therapy.

Los estilos APA, Harvard, Vancouver, ISO, etc.

34

Murphy, Robyn Marie. "THE PHYSIOLOGICAL AND PSYCHOSOCIAL EFFECTS OF A 16-WEEK COMBINED AEROBIC AND RESISTANCE EXERCISE PROGRAM IN MEN RECEIVING ANDROGEN DEPRIVATION THERAPY FOR PROSTATE CANCER". 2011. http://hdl.handle.net/10222/13338.

Texto completo

Resumen

Objectives: Men who receive androgen deprivation therapy (ADT) for prostate cancer (PCa) are at risk of several adverse effects that can be detrimental to both their physical and mental health. Common adverse effects include weight gain, muscle wasting, cardiovascular morbidity, fatigue and impaired quality of life (QOL). This study tested whether a combined aerobic and resistance exercise program can alleviate some of these symptoms in men receiving ADT. Design: Men with PCa, aged 50-80 years, receiving ADT were recruited to participate in this prospective randomized controlled trial. Subjects were assigned to a usual care group (UCG) or an exercise intervention group (EIG). The EIG completed a 16 week combined aerobic and resistance exercise program. Outcomes measures were assessed at baseline, 16 weeks, and 24 weeks and included: cardio-respiratory fitness; muscle strength and endurance; body composition; and reports of QOL, fatigue, mood, partner relations, and exercise behaviour. Results: Fifteen men were recruited to this study, but two participants in the EIG did not finish the study leaving the EIG with an n = 6 and the UCG with an n = 7. The exercise program did not lead to changes in weight, BMI or body fat. There was a small, close to significant, increase in muscle mass in the EIG over the intervention period (p = 0.052). This is encouraging as it demonstrates that exercise can counteract the catabolic effects of ADT. Interestingly, cardio-respiratory fitness improved over the course of the study for both groups. Muscular fitness, however, improved only for the EIG. There was a significant difference in chest press strength (p = 0.041) and leg press strength was bordering significance (p = 0.058). Unexpectedly, QOL declined for both groups during the intervention (p = 0.029). Participants in both groups also reported increased levels of fatigue from baseline to 24 weeks, although these changes were not significant (p = 0.586). Mood worsened over the study period for both groups from baseline to 16 weeks, but this increase in anxiety and depression was reduced at the follow-up period. These changes, too, were not significant (p = 0.364). Reports of partner relationships trended towards lower scores from baseline to 16 weeks. The men’s report in both groups and the women’s report in the EIG improved at the 24 week mark, but women in the UCG experienced further decline. Surprisingly, participants in both groups reported increases in exercise behaviour from baseline to 24 weeks. This could account for the lack of difference found in many of the measures. The power of this study was 0.22. Conclusion: Although this was a small study, it showed that a combined aerobic and resistance exercise program can have some positive benefits for men with PCa who are receiving ADT. Larger trials are needed to further examine the role of exercise in ameliorating the side effects of ADT, particularly in the areas of mood and partner relationships.

Los estilos APA, Harvard, Vancouver, ISO, etc.

35

Cordia, Igor [Verfasser]. "Docetaxel in the management of PSA progression following primary androgen deprivation for prostate cancer / vorgelegt von Igor Cordia". 2009. http://d-nb.info/996274405/34.

Texto completo

Los estilos APA, Harvard, Vancouver, ISO, etc.

36

Wu, Fang-Jen y 吳芳仁. "Investigation of Fall Risk and a Herpes Zoster Attack in Patients Receiving Androgen Deprivation Therapy for Prostate Cancer". Thesis, 2018. http://ndltd.ncl.edu.tw/handle/8p9gy3.

Texto completo

Los estilos APA, Harvard, Vancouver, ISO, etc.

37

Huang, Yu-Ting y 黃郁庭. "Evaluation of Health-related Quality of Life of Androgen Deprivation Therapy in Patients with Prostate Cancer in Taiwan". Thesis, 2018. http://ndltd.ncl.edu.tw/handle/2cyuw3.

Texto completo

Resumen

碩士
高雄醫學大學
藥學系臨床藥學碩士班
106
Background and study aim: Prostate cancer (PC) is one of the common cancer among Taiwanese male. Current treatments, such as radical prostatectomy (RP), radiation therapy (RT), androgen deprivation therapy (ADT), and chemotherapy, for PC can provide quite long-term survival to patients. However, long-term therapies might induce several adverse effects, and might affect health-related quality of life (HRQoL). The aim of the study was to assess the HRQoL between ADT users and non-user in PC. Besides, PC patients’ quality of life evaluation was few in Asia. Methods: A cross-sectional study was performed to assess HRQoL of life among PC patients with different therapies. The quality of life was evaluated with Taiwan Chinese version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and the QLQ-PR25. The study was conducted at the urology outpatient department in Kaohsiung Medical University Hospital and Kaohsiung Municipal Ta-Tung Hospital. Results: In total, 182 subjects participated in the study. Besides, 116 (63.74%) subjects were in ADT user group with a mean age (±SD, standard deviation) of 75.94 years (±8.31), and 66 (36.26%) subjects were in non-ADT user group with a mean age of 70.65 years (±7.12). The most commonly used ADT was followed by Leuprolide combined with Bicalutamide (65.12%), Leuprolide alone (11.63%), Goserelin combined with Bicalutamide (6.98%), Bicalutamide alone (4.65%), and others (11.63%). Moreover, the mean Global quality of life (QoL) of ADT users was 72.15 (±19.39), while the mean QoL of non-ADT users was 77.82 (±16.62); furthermore, the QoL of non-ADT users were significantly higher than ADT users (p=0.0493). Furthermore, the symptoms are the key determinants of the quality of life in PC patients. Conclusion: In conclusion, the QoL in PC patients with all stages between ADT user group and non-ADT user group are significantly different. The quality of life for ADT users is worse than the non-ADT users. Additionally, the symptoms are the key determinants of the quality of life. The patients and health care providers might need to know and prepare for them

Los estilos APA, Harvard, Vancouver, ISO, etc.

38

Post, Hunter. "Left Ventricular Strain and Strain Rate Responses to Submaximal Exercise in Prostate Cancer Patients Treated with Androgen Deprivation Therapy". Thesis, 2018. http://hdl.handle.net/2097/39102.

Texto completo

Resumen

Master of Science
Department of Kinesiology
Carl Ade
Background: Androgen Deprivation Therapy (ADT) is a commonly used treatment for prostate cancer with controversy currently surrounding its association with long-term cardiovascular disease risk. Therefore, the aim of the current investigation was to non-invasively measure left ventricular mechanics at rest and during submaximal exercise in human prostate cancer survivors with and without a history of ADT. Methods: Eighteen prostate cancer survivors, 9 with a history of ADT and 9 matched (1:1) non-ADT controls, completed the protocol. Standard and tissue Doppler echocardiography were used to evaluate left ventricular systolic and diastolic function at rest and during submaximal cycling exercise. Results: At rest, there were no differences between groups. Ejection fraction was not different between groups at rest or during exercise (rest p=0.7; exercise p=0.8). During exercise, systolic left ventricular longitudinal strain and strain rate failed to increase in the ADT group (p=0.4; p=0.07), but significantly increased in the non-ADT group (p=0.03; p=0.02). During exercise, systolic strain was significantly different between groups (p=0.02). Diastolic longitudinal strain increased with exercise in both groups (p=0.003; p=0.003). In the ADT group during exercise, mitral valve deceleration time was not significantly different from rest (p=0.8) and was slower compared to non-ADT (p=0.03). Conclusion: In prostate cancer survivors with a history of ADT, there are significant abnormalities of left ventricular systolic function that become apparent with exercise. These findings may hold significant value beyond the standard resting characterization of ventricular function, in particular as part of a risk-stratification strategy.

Los estilos APA, Harvard, Vancouver, ISO, etc.

39

Lam, Teresa. "Androgen deprivation therapy for prostate cancer : novel mechanisms of testosterone action and the benefits of home-based progressive resistance training". Thesis, 2021. http://hdl.handle.net/1959.7/uws:59637.

Texto completo

Resumen

Testosterone is a key anabolic hormone which has a major role in the regulation of muscle mass and function, glucose and fat metabolism, mental well-being and general health. Androgen deprivation therapy (ADT) is a common treatment modality in men with prostate cancer. In reducing testosterone to castrate levels, it offers a unique model to study the physiological effects of testosterone. Testosterone is known to act on multiple pathways which regulates muscle mass, fibre hypertrophy and protein turnover. Protein is hydrolysed into amino acids which are then available for synthesis of new protein, or alternatively can be eliminated as urea by the hepatic urea cycle; a rate limiting step in the irreversible loss of protein nitrogen. Although testosterone deficiency is well-known to be associated with loss of muscle mass and other protein depots, the effect of testosterone on the hepatic urea cycle has not been studied in humans. ADT also leads to a substantial increase in fat mass, worsening glucose tolerance, impairment in muscle function, and deterioration in mental health. In fact, cardiovascular disease accounts for approximately a quarter of deaths amongst men with prostate cancer. Exercise has been used to improve ADT-induced adverse effects, but existing studies focus on reversing established changes with supervised programs which have limitations in terms of access and cost. Home-based progressive resistance training (PRT), if found effective, may provide a viable alternative to supervised training programs. The work described in this thesis aimed to determine a hepatic site of testosterone action via the urea cycle- firstly in a cohort of hypogonadal men, followed by a population of men with prostate cancer starting ADT. A home-based PRT program was 16 also evaluated in this population regarding its efficacy in preventing the adverse effects of ADT when initiated at the start of treatment. In summary, the work described in this thesis demonstrates, for the first time, a hepatic site of testosterone action via the urea cycle in humans. Additionally, it shows the benefits of a home-based PRT program in preventing ADT-induced adverse effects. These findings may contribute to the discovery of a potential, novel treatment method for sarcopenia, and a viable alternative to supervised exercise programs during prostate cancer treatment.

Los estilos APA, Harvard, Vancouver, ISO, etc.

40

"Drug Modeling Dynamics in the Treatment of Prostate Cancer". Master's thesis, 2020. http://hdl.handle.net/2286/R.I.63019.

Texto completo

Resumen

abstract: Efforts to treat prostate cancer have seen an uptick, as the world’s most commoncancer in men continues to have increasing global incidence. Clinically, metastatic prostate cancer is most commonly treated with hormonal therapy. The idea behind hormonal therapy is to reduce androgen production, which prostate cancer cells require for growth. Recently, the exploration of the synergistic effects of the drugs used in hormonal therapy has begun. The aim was to build off of these recent advancements and further refine the synergistic drug model. The advancements I implement come by addressing biological shortcomings and improving the model’s internal mechanistic structure. The drug families being modeled, anti-androgens, and gonadotropin-releasing hormone analogs, interact with androgen production in a way that is not completely understood in the scientific community. Thus the models representing the drugs show progress through their ability to capture their effect on serum androgen. Prostate-specific antigen is the primary biomarker for prostate cancer and is generally how population models on the subject are validated. Fitting the model to clinical data and comparing it to other clinical models through the ability to fit and forecast prostate-specific antigen and serum androgen is how this improved model achieves validation. The improved model results further suggest that the drugs’ dynamics should be considered in adaptive therapy for prostate cancer.
Dissertation/Thesis
Masters Thesis Mathematics 2020

Los estilos APA, Harvard, Vancouver, ISO, etc.

41

Wibowo, Erik. "MODULATION OF SEXUAL AND SLEEP FUNCTIONS BY ESTROGEN IN CASTRATED MALE RATS AS A MODEL FOR PROSTATE CANCER PATIENTS ON ANDROGEN DEPRIVATION THERAPY". 2013. http://hdl.handle.net/10222/36281.

Texto completo

Resumen

Advanced prostate cancer (PCa) patients are offered androgen deprivation therapy (ADT) to control their cancer’s growth. ADT impairs sexual function and the sleep patterns of ADT patients. Since ADT deprives patients of estrogen, and supplemental estrogen reduces such problems in menopausal women, I studied whether administering estrogen reduces these problems for castrated male rats as a model for PCa patients on ADT. First, I tested how early versus late estradiol treatment after castration influenced rats’ sexual behaviour. Estradiol increases mounting behaviour to comparable levels regardless of when the treatment was started after castration, suggesting that estrogen’s ability to restore male sexual interest is insensitive to a delay since castration. Secondly, to understand the biological basis of these behavioural effects, I examined brain and muscle tissues from the same animals. Specifically, I compared changes in 1) estrogen receptors (ERs) and c-Fos protein (a neuronal activation marker) levels in brain areas controlling sex behavior; 2) ERs levels in pelvic floor muscles, important for erection; and 3) ERs levels in the hippocampus and prefrontal cortex. Prolonged castration increases ER? levels in the preoptic area (POA), a key brain area that regulates mating behaviour, and estradiol treatment reduced these effects. In the POA, mating-induced c-Fos expression was not affected by estradiol regardless of when the treatment began post-castration. Estrogen may upregulate ERs in pelvic floor muscles, and downregulate ERs in the hippocampus and prefrontal cortex, depending on administration time after castration. These findings suggest that mating activates POA neurons, and this activation induces mounting only in the presence of estrogen. Additionally, the duration after castration influences ER autoregulation in the pelvic floor muscles, hippocampus, and prefrontal cortex in response to estradiol. Lastly, I studied how estrogen modulates the sleep-wake behaviour of orchiectomized rats. Estradiol promotes baseline wakefulness during the dark period and prevents castration-induced impairment in sleep recovery after sleep deprivation. These findings suggest that estradiol may positively influence the sleep-wake behaviour of castrated males. Collectively, I demonstrate that estrogen administered to castrated rats improves sexual and sleep functions. It may similarly improve the quality of life of PCa patients on ADT.

Los estilos APA, Harvard, Vancouver, ISO, etc.

42

"Comparative effectiveness of primary androgen deprivation therapy versus conservative management and radical prostatectomy among clinically localized prostate cancer patients in SEER-MEDICARE data 1998-2007". Tulane University, 2012.

Buscar texto completo

Los estilos APA, Harvard, Vancouver, ISO, etc.

43

Tsai, Yi-Hsun y 蔡易訓. "The association between androgen-deprivation therapy in prostate cancer and cardiovascular risk, and explore the impact of chronic pulmonary disease in advanced prostate cancer in Taiwan". Thesis, 2012. http://ndltd.ncl.edu.tw/handle/61815476067278155224.

Texto completo

Resumen

碩士
高雄醫學大學
臨床藥學研究所
100
BACKGROUND: The study aims to analyze the association between androgen deprivation therapy (ADT) and cardiovascular risk and investigate whether chronic pulmonary disease will affect the prognosis of prostate cancer in Taiwan. METHODS: The study can be divied into two parts. The first part is to investigate the association between ADT and cardiovascular risk, and the second part is to investigate the impact of chronic pulmonary disease in prostate cancer. The observational cohort study used data sourced from Longitudinal health Insurance Database (LHID 2000). T-test and chi-squared were used to examine differences between exposure and unexposure group, in terms of age, location, socioeconomic status, year of diagnosis, type of procedure, co-morbidity and drug. The survival analysis was using Kaplan-Meier method, and used the log-rank test to compare differences in exposure and unexposure group. In addition, we used cox proportional hazards regression to adjust confounding factor. RESULTS: The cohort included 693 patients with prostate cancer during during 1 January 1998 to 31 December 2007 to analyze the association between ADT and risk of cardiovascular disease or diabetes. Treatment with ADT, GnRH agonist, oral antandrogen monotherapy and combination of two was not associated with diabetes, coronary heart disease (CHD), stroke and heart failure after adjused confounding factors. However, GnRH agonist will increase risk of CHD in medication possession ratio (MPR) greater than 80% group (aHR＝3.26, 95%CI＝1.359 – 7.839) and increase risk of stroke in MPR between 30% to 80% group (aHR＝4.16, 95%CI＝1.373 – 12.597). In stratified analysis, ADT use was associated with an increased risk of heart failure (aHR＝4.25, 95%CI＝1.765 – 10.219) when patients with past medical history of dyslipidemia. In GnRH agonist group, GnRH agonist use was associated with an increased risk of stroke (aHR＝2.32, 95%CI＝1.010 – 5.324) (aHR＝4.47, 95%CI＝1.283 – 15.560) or CHD (aHR＝4.03, 95%CI＝1.055 – 15.369) when patients did not receive prostatectomy or with past medical history of dyslipidemia or asthma. In oral antiandrogen monotherapy group, oral antiandrogen use was associated with an increased risk of diabetes (aHR＝5.25, 95%CI＝1.621 – 16.973) and heart failure (aHR＝4.61, 95%CI＝1.273 – 16.680) when patients with past medical history of asthma or chornic obsyructive pulmonary disease. In combined therapy group, combined therapy used was associated with an increased risk of heart failure when patients with past medical history of CHD (aHR＝2.71, 95%CI＝1.078 – 6.807), dyslipidemia (aHR＝4.12, 95%CI＝1.241 – 13.658) or chornic obsyructive pulmonary disease (aHR＝5.71, 95%CI＝1.158 – 28.131). In the associated between chronic pulmonary disease and prognosis of prostate caner, study included 412 patients with prostate cancer during 1 January 2000 to 31 December 2007. Patients with chronic pulmonary disease was not associated with increased risk of death (aHR＝1.25, 95%CI＝0.848 – 1.829) and chemotherapy rate (aHR＝0.55, 95%CI＝0.235 – 1.263). CONCLUSIONS: Androgen deprivation therapy with GnRH agonist, oral antiandrogen monotherapy and combination of two was not associated with an increased risk of diabetes and cardiovascular disease in Taiwan. However, when patients with certain past medical history, used ADT should be wariness. In addition, we found chronic pulmonary disease was not associated with decrease prognosis of prostate cancer.

Los estilos APA, Harvard, Vancouver, ISO, etc.

44

"Applications of the Droop Cell Quota Model to Data Based Cancer Growth and Treatment Models". Doctoral diss., 2015. http://hdl.handle.net/2286/R.I.29732.

Texto completo

Resumen

abstract: The phycologist, M. R. Droop, studied vitamin B12 limitation in the flagellate Monochrysis lutheri and concluded that its specific growth rate depended on the concentration of the vitamin within the cell; i.e. the cell quota of the vitamin B12. The Droop model provides a mathematical expression to link growth rate to the intracellular concentration of a limiting nutrient. Although the Droop model has been an important modeling tool in ecology, it has only recently been applied to study cancer biology. Cancer cells live in an ecological setting, interacting and competing with normal and other cancerous cells for nutrients and space, and evolving and adapting to their environment. Here, the Droop equation is used to model three cancers. First, prostate cancer is modeled, where androgen is considered the limiting nutrient since most tumors depend on androgen for proliferation and survival. The model's accuracy for predicting the biomarker for patients on intermittent androgen deprivation therapy is tested by comparing the simulation results to clinical data as well as to an existing simpler model. The results suggest that a simpler model may be more beneficial for a predictive use, although further research is needed in this field prior to implementing mathematical models as a predictive method in a clinical setting. Next, two chronic myeloid leukemia models are compared that consider Imatinib treatment, a drug that inhibits the constitutively active tyrosine kinase BCR-ABL. Both models describe the competition of leukemic and normal cells, however the first model also describes intracellular dynamics by considering BCR-ABL as the limiting nutrient. Using clinical data, the differences in estimated parameters between the models and the capacity for each model to predict drug resistance are analyzed. Last, a simple model is presented that considers ovarian tumor growth and tumor induced angiogenesis, subject to on and off anti-angiogenesis treatment. In this environment, the cell quota represents the intracellular concentration of necessary nutrients provided through blood supply. Mathematical analysis of the model is presented and model simulation results are compared to pre-clinical data. This simple model is able to fit both on- and off-treatment data using the same biologically relevant parameters.
Dissertation/Thesis
Doctoral Dissertation Applied Mathematics 2015

Los estilos APA, Harvard, Vancouver, ISO, etc.

Tesis sobre el tema "Androgen deprivation"

Crea una cita precisa en los estilos APA, MLA, Chicago, Harvard y otros