Treatment Of Early Prostate Cancer Research Articles

Selection of prostate cancer therapy strategy under early androgen suppression treatment

Intermittent androgen suppression therapy is increasingly employed as an alternative method of advanced prostate cancer. However, it remains controversial whether intermittent therapy is superior to continuous therapy in controlling cancer progression. In this paper, we study the mathematical model for early treatment of prostate cancer that incorporates the individual differences and the pharmacodynamics of drugs. The mathematical criteria for selection of better treatment are established on the basis of stability of periodic solution induced by treatment. Numerical results further explore the optimal design of intermittent treatment. The results provide valuable insights for clinical practice.

Comparison of Volumetric Modulated Arc Therapy and Fixed Field Intensity Modulated Radiotherapy for Radical Treatment of Early Prostate Cancer using Hypofractionated Radiotherapy

Objective: To investigate the dosimetric advantages of volumetric modulated arc therapy over intensity-modulated radiation therapy for radical treatment of early-stage prostate cancer.
 Study Design: Retrospective longitudinal study.
 Place and Duration of Study: Department of Radiation Oncology, Combined Military Hospital, Rawalpindi Pakistan, from Jan to Jun 2019.
 Methodology: Two treatment plans; one volumetric modulated arc therapy and other intensity-modulated radiation therapy, were made for 13 patients undergoing radical radiotherapy for early prostate cancer. Conformity index, Homogeneity index, the volume of rectum and bladder receiving a dose of 50 Gy or more, monitor units employed and treatment delivery time were compared between both techniques.
 Results: Volumetric modulated arc therapy plans showed statistically better conformity index and Homogeneity index with significantly lower doses to the rectum and bladder than intensity-modulated radiation therapy plans. The number of monitor units (MUs) employed and treatment delivery time were also reduced significantly with volumetric modulated arc therapy.
 Conclusion: Volumetric modulated arc therapy generates dose-metrically better radiotherapy plans than intensity-modulated radiation therapy and can deliver the required dose faster.Keywords: Hypofractionated radiotherapy, Intensity-modulated radiation therapy, Prostate cancer, Volumetric modulated arc therapy.

Efficacy of early screening for prostate cancer in an elderly patient with absence of urinary symptoms but a manifestation of a rare symptom: a case report

This is a case report of an unusual symptom of prostate cancer, constipation seen in an elderly 81-year-old patient. The patient was initially referred for physiotherapy for concerns involving his lumbosacral spines. Following which, he attended the clinic again with the same symptoms of back pain and constipation and was immediately referred for prostate cancer screening. The patient did not have urinary symptoms. Despite a number of factors that point towards aggressive prostate cancer, the patient was screened early and further investigation led to identifying his cancer. This allowed for the patient to undergo early prostate cancer treatment and is presently cancer free. This is a report to underline the importance of early prostate cancer screening in elderly men who present without the key concern of urinary symptoms.

Disposal Immunosensor for Sensitive Electrochemical Detection of Prostate-Specific Antigen Based on Amino-Rich Nanochannels Array-Modified Patterned Indium Tin Oxide Electrode.

Sensitive detection of prostate-specific antigens (PSA) in serum is essential for the prevention and early treatment of prostate cancer. Simple and disposable electrochemical immunosensors are highly desirable for screening and mobile detection of PSAs in high-risk populations. Here, an electrochemical immunosensor was constructed based on amino-rich nanochannels array-modified patterned, inexpensive, and disposable indium tin oxide (ITO) electrodes, which can be employed for the sensitive detection of PSA. Using an amino-group-containing precursor, a vertically ordered mesoporous silica nanochannel film (VMSF) containing amino groups (NH2-VMSF) was rapidly grown on ITO. When NH2-VMSF contained template surfactant micelle (SM), the outer surface of NH2-VMSF was directionally modified by aldehyde groups, which enabled further covalent immobilization of the recognitive antibody to prepare the immuno-recognitive interface. Owing to the charge-based selective permeability, NH2-VMSF can electrostatically adsorb negatively charged redox probes in solution (Fe(CN)63-/4-). The electrochemical detection of PSA is realized based on the mechanism that the antigen-antibody complex can reduce the diffusion of redox probes in solution to the underlying electrode, leading to the decrease in electrochemical signal. The constructed immunosensor can achieve sensitive detection of PSA in the range from 10 pg/mL to 1 μg/mL with a limit of detection (LOD) of 8.1 pg/mL. Sensitive detection of PSA in human serum was also achieved. The proposed disposable immunosensor based on cheap electrode and nanochannel array is expected to provide a new idea for developing a universal immunosensing platform for sensitive detection of tumor markers.

The Economic Burden of Localized Prostate Cancer and Insights Derived from Cost-Effectiveness Studies of the Different Treatments.

Simple SummaryProstate cancer is one of the most frequent and impacting malignant neoplasms for men. In particular, localized prostate cancer has a notably high incidence and prevalence, despite which a solid consensus on treatment and procedure of care has not yet been reached. This article aims to shed light on this challenge by characterizing the economic burden and cost-effectiveness of different treatment strategies for localized prostate cancer after analyzing published comparable data from studies conducted in OECD countries.Prostate cancer has huge health and societal impacts, and there is no clear consensus on the most effective and efficient treatment strategy for this disease, particularly for localized prostate cancer. We have reviewed the scientific literature describing the economic burden and cost-effectiveness of different treatment strategies for localized prostate cancer in OECD countries. We initially identified 315 articles, studying 13 of them in depth (those that met the inclusion criteria), comparing the social perspectives of cost, time period, geographical area, and severity. The economic burden arising from prostate cancer due to losses in productivity and increased caregiver load is noticeable, but clinical decision-making is carried out with more subjective variability than would be advisable. The direct cost of the intervention was the main driver for the treatment of less severe cases of prostate cancer, whereas for more severe cases, the most important determinant was the loss in productivity. Newer, more affordable radiotherapy strategies may play a crucial role in the future treatment of early prostate cancer. The interpretation of our results depends on conducting thorough sensitivity analyses. This approach may help better understand parameter uncertainty and the methodological choices discussed in health economics studies. Future results of ongoing clinical trials that are considering genetic characteristics in assessing treatment response of patients with localized prostate cancer may shed new light on important clinical and pharmacoeconomic decisions.

Irreversible Electroporation of Carcinoma of the Prostate Gland with a Focus on Localized Carcinoma of the Prostate Gland: A Review and Update

Irreversible Electroporation of Carcinoma of the Prostate Gland with a Focus on Localized Carcinoma of the Prostate Gland: A Review and Update

Comparison of the medical costs between active surveillance and other treatment for early prostate cancer in Japan: From the data of PRIAS JAPAN study.

280 Background: As the number of prostate cancer patients increases, the cost of treatment is becoming an urgent issue. To compare the costs between active surveillance, robot-assisted laparoscopic prostatectomy (RALP), Brachytherapy (BT), Intensity Modulated Radiation Therapy (IMRT), and Androgen deprivation therapy(ADT). Methods: The costs of protocol biopsies in the first year of AS performed between January 2010 and June 2020, and the treatment costs of RALP, BT, and IMRT performed between May 2019 and June 2020 at Kagawa university hospital were analyzed. The cost of ADT was assumed to be the cost of the LH-RH analog over 5 years. The inpatient treatment cost for each treatment was calculated from our DPC data, and for IMRT, the treatment cost was calculated by the outpatient cost at the time of irradiation. AS-eligible patients were defined as less than 74 years old, less than T2, less than GS6, and less than two positive cores. We estimated the total number of AS-eligible patients in Japan based on the data of the J-CAP study and the data of cancer statistics in 2017 and estimated the total treatment cost of AS-eligible patients based on the data of treatment breakdown of T1/T2 patients in the J-CAP study. In addition, we used the data from PRIAS-JAPAN to calculate the AS continuation rate, protocol biopsy acceptance rate, and the breakdown of secondary treatments. We simulated the 5-year treatment cost for AS patients using the system. Results: The median treatment costs for AS (n = 45), RALP (n = 68), BT (n = 27), and IMRT (n = 44), and ADT were US$1.24 thousand, US$ 14.6 thousand, US$14.8 thousand, US$ 12.9 thousand, and US$8.16, respectively. The number of AS-eligible patients in Japan was estimated to be 5414, and the total cost of AS, RALP, BT, IMRT, HT, and ADT over 5 years was estimated to be US$3.07 million, US$34.8 million, US$8.46 million, US$11.09 million, and US$14.05 million, respectively. If 50% and 100% of the patients in each treatment group chose AS as their first treatment, the total cost of treatment would be reduced by US$18.6 million and US$38.5 million, respectively. Conclusions: The prevalence of AS will contribute to reducing the cost of prostate cancer treatment.

Mapping the prevalence and use of questionnaires to detect the neglected sexual side effects after prostate cancer treatment: a scoping review

BackgroundEarly prostate cancer (PCa) treatment interventions may leave men with debilitating sexual side effects, especially when not diagnosed or present at initial follow-up treatment. Men are often embarrassed to disclose their sexual dysfunction. This may lead to sexual side effects related to PCa treatment remaining untreated, adding to their burden of disability. This study was conducted to map the evidence on the prevalence of neglected sexual side effects (NSSE) after radical prostatectomy (RP) surgery or radiation treatment (RT) for PCa treatment and the reported use of questionnaires to identify such side effects.MethodsThis systematic scoping review’s search strategy involved searching MEDLINE/PubMed, Science Direct and Google Scholar databases. Guided by eligibility criteria, two independent reviewers conducted title, abstract and full-text screening. Data from the included studies were extracted. The review team explored the implications of the findings in relation to the research question and aims of the study. The Mixed Method Appraisal Tool was used to appraise the quality of the included studies. This review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.ResultsSearches of the databases identified 1369 articles, with 23 eventually included for review. The prevalence of NSSE ranged between 0 and 78% in studies reporting on early PCa treatment of RP and RT patients. Orgasmic dysfunction (5–78%), penile curvature changes (10–15.9%) and penile length shortening (0–55%) similarly showed a low to moderate prevalence. Climacturia had low prevalence (4–5.2%) after RT and moderate prevalence (21–38%) after RP, whilst anejaculation had low to high prevalence (11–72%) after RT. No validated questionnaire was used to detect any NSSE after early PCa treatment. Studies mainly modified other questionnaires, and two studies used non-validated questionnaires to identify some NSSE. Participants in the included studies reported being inadequately informed about the possible sexual side effects of their treatment.ConclusionThis study showed a low to a high prevalence of NSSE in men after RP and RT for early PCa treatment. Questionnaires helped detect individual NSSEs after PCa treatment but there is currently no evidence of a valid, reliable and comprehensive questionnaire to detect the NSSE collectively.Scoping review registrationN/A

Mapping the prevalence of the neglected sexual side effects after prostate cancer treatment and the questionnaires used in their screening: a scoping review protocol

BackgroundInterventions to treat early prostate cancer (PCa) can leave men with debilitating sexual side effects. The cluster of side effects referred to as the neglected sexual side effects (NSSE) may remain permanent, undiagnosed and untreated because men are hesitant to disclose them. Questionnaires offer a discreet way into the discussion, subsequent diagnosis and possible treatment of the NSSE. This study will be conducted to map the evidence about the prevalence of the neglected sexual side effects (NSSE) after PCa treatment, and use of questionnaires in its diagnosis and screening.MethodsThis systematic scoping review will involve searching the following electronic databases: PubMed, Science Direct and Google Scholar. Following title searching, two-independent reviewers will conduct screening of abstracts and full articles. Eligibility criteria will guide the screenings. Data will be extracted from the included studies, and the emerging themes will be analysed. The review team will analyse the implications of the findings concerning the research question and aim of the study. The mixed method appraisal tool (MMAT) will be employed for quality appraisal of included studies.DiscussionWe anticipate finding a number of studies that describe the prevalence of NSSE after early PCa treatment and that report on using questionnaires to screen for the presence of symptoms including orgasm-associated incontinence, urinary incontinence during sexual stimulation, altered perceptions of orgasm, orgasm associated pain, penile shortening and penile deformity. The study findings will be disseminated through publication in a peer-reviewed journal, peer presentations and presentations at relevant conferences.

Comparison of bicalutamide 150 mg coupled with the standard therapy and only standard methods of treatment in early prostate cancer

Comparison of bicalutamide 150 mg coupled with the standard therapy and only standard methods of treatment in early prostate cancer

Complications of curative radiation treatment for early prostate cancer.

To report the incidence of urological complications following curative radiation treatment for early prostate cancer, including minimally invasive urological procedures (MUIP), hospital admissions and open surgical procedures. Second malignancies following radiation are also reported and compared with patients undergoing a prostatectomy. Included were patients receiving curative intent external beam radiation treatment for early prostate cancer between January 1, 2002, and December 31, 2009. Medical records were reviewed for baseline characteristics, treatment details and outcomes. Kaplan-Meier methods were used to derive the 5-year cumulative incidence of the urological outcomes and second malignancy. There were 439 patients identified. The median follow-up was 6.96 years. The median age was 69. A total of 56 patients developed a radiation related urological complication, 25 requiring hospital admission. The 5-year cumulative incidence for an MIUP and admission was 3.95% (95% confidence interval (CI), 2.47-6.28) and 2.24% (95% CI, 1.17-4.27), respectively. There were no open surgical procedures. Further malignancy developed in 27 patients during the 5- to 9-year posttreatment period with a cumulative incidence of 10.7% (95% CI, 7.31-15.51). Of the comparator prostatectomy group, of the 265 eligible patients analyzed, 19 patients developed a second malignancy with a cumulative incidence of 9.92% (95% CI, 6.28-15.48). On log-rank testing, there was no difference in the cumulative incidence rates of second malignancy between 5 and 9 years, following respective treatments (P=0.8554). The incidence of MUIP, hospital admissions and open surgical procedures following radiation is reassuringly low. The second malignancy rates are also low and similar to the rates in patients treated with a prostatectomy.

SU‐F‐T‐41: 3D MTP‐TRUS for Prostate Implant

Purpose:Prostate brachytherapy is an effective treatment for early prostate cancer. The current prostate implant is limited to using 2D transrectal ultrassound (TRUS) or machenical motor driven 2D array either in the end or on the side. Real‐time 3D images can improve the accuracy of the guidance of prostate implant. The concept of our system is to allow realtime full visualization of the entire prostate with the multiple transverse scan.Methods:The prototype of 3D Multiple‐Transverse‐Plane Transrectal Ultrasound probe (MTP‐TRUS) has been designed by us and manufactured by Blatek inc. It has 7 convex linear arrays and each array has 96 elements. It is connected to cQuest Fire bird research system (Cephasonics inc.) which is a flexible and configurable ultrasound‐development platform. The size of cQuest Firebird system is compact and supports the real‐time wireless image transferring. A relay based mux board is designed for the cQuest Firebird system to be able to connect 672 elements.Results:The center frequency of probe is 6MHz±10%. The diameter of probe is 3cm and the length is 20cm. The element pitch is 0.205 mm. Array focus is 30mm and spacing 1.6cm. The beam data for each array was measured and met our expectation. The interface board of MTP‐TURS is made and able to connect to cQuest Firebird system. The image display interface is still under the development. Our real‐time needle tracking algorithm will be implemented too.Conclusion:Our MTP‐TRUS system for prostate implant will be able to acquire real‐time 3D images of prostate and do the real‐time needle segmentation and tracking. The system is compact and have wireless function.

Quality of Prostate Cancer Treatment Information on Cancer Center Websites.

IntroductionCancer center websites are trusted sources of internet information about treatment options for prostate cancer. The quality of information on these websites is unknown. The objective of this study was to evaluate the quality of information on cancer center websites addressing prostate cancer treatment options, outcomes, and toxicity.Materials and methodsWe evaluated the websites of all National Cancer Institute-designated cancer centers to determine if sufficient information was provided to address eleven decision-specific knowledge questions from the validated Early Prostate Cancer Treatment Decision Quality Instrument. We recorded the number of questions addressed, the number of clicks to reach the prostate cancer-specific webpage, evaluation time, and Spanish and mobile accessibility. Correlation between evaluation time and questions addressed were calculated using the Pearson coefficient.ResultsSixty-three websites were reviewed. Eighty percent had a prostate cancer-specific webpage reached in a median of three clicks. The average evaluation time was 6.5 minutes. Information was available in Spanish on 24% of sites and 59% were mobile friendly. Websites provided sufficient information to address, on average, 19% of questions. No website addressed all questions. Evaluation time correlated with the number of questions addressed (R2 = 0.42, p < 0.001).ConclusionsCancer center websites provide insufficient information for men with localized prostate cancer due to a lack of information about and direct comparison of specific treatment outcomes and toxicities. Information is also less accessible in Spanish and on mobile devices. These data can be used to improve the quality and accessibility of prostate cancer treatment information on cancer center websites.

This Month in Adult Urology

No AccessJournal of UrologyThis Month in Adult Urology1 May 2016This Month in Adult Urology Joseph A. Smith Joseph A. SmithJoseph A. Smith More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2960AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail References 1 : Diagnostic accuracy and risks of biopsy in the diagnosis of a renal mass suspicious for localized renal cell carcinoma: systematic review of the literature. J Urol2016; 195: 1340. Link, Google Scholar 2 : Metastatic prostate cancer in men initially treated with active surveillance. J Urol2016; 195: 1409. Link, Google Scholar 3 : Castration-resistant prostate cancer: AUA guideline amendment 2015. J Urol2016; 195: 1444. Link, Google Scholar 4 : Artificial urinary sphincter mechanical failures—is it better to replace the entire device or just the malfunctioning component?. J Urol2016; 195: 1523. Link, Google Scholar 5 : Trade-off between treatment of early prostate cancer and incidence of advanced prostate cancer in the prostate screening era. J Urol2016; 195: 1397. Link, Google Scholar 6 : Factors influencing readmission after elective ureteroscopy. J Urol2016; 195: 1487. Link, Google Scholar 7 : Reoperations following robot-assisted radical cystectomy: a decade of experience. J Urol2016; 195: 1368. Link, Google Scholar 8 : Endoscopic treatment of vesicourethral stenosis after radical prostatectomy: outcomes and predictors of success. J Urol2016; 195: 1495. Link, Google Scholar 9 : Risks and benefits of pharmacological prophylaxis for venous thromboembolism prevention in patients undergoing robotic partial nephrectomy. J Urol2016; 195: 1348. Link, Google Scholar 10 : Serial magnetic resonance imaging in active surveillance of prostate cancer: incremental value. J Urol2016; 195: 1421. Link, Google Scholar 11 : The effect of start and stop age at screening on the risk of being diagnosed with prostate cancer. J Urol2016; 195: 1390. Google Scholar © 2016 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 195Issue 5May 2016Page: 1319-1321 Advertisement Copyright & Permissions© 2016 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph A. Smith More articles by this author Expand All Advertisement PDF downloadLoading ...

Trade-Off between Treatment of Early Prostate Cancer and Incidence of Advanced Prostate Cancer in the Prostate Screening Era

Prostate specific antigen screening has led to the early detection of prostate cancer. However, there has also been concern about the over diagnosis and overtreatment of patients with indolent cancers. We performed a population based analysis to evaluate the trade-off between excess treatment and prevention. We used the CDC (Centers for Disease Control and Prevention) Behavioral Risk Factor Surveillance System survey from 2001 to 2010 to determine rates of prostate specific antigen screening. We used the SEERdatabase to identify all patients diagnosed with prostate cancer from 1988(pre-prostate specific antigen screening) to 2010. Demographic, staging andtreatment data were collected. Cases were classified as early (low/intermediate risk), high risk, node positive or metastatic disease. Prostate specific antigen screening rates in the last 2 years were 54% for men older than 40 years, including 71% for those older than 60, and did not varyduring 2001 to 2010. Comparing 1988 and 2000 to 2010, per 100,000 men the incidence of early prostate cancer increased (61.7 to 113.7), while high risk cancer increased (20.7 to 28.2), node positive cancer decreased (3.7 to 1.8) andmetastatic cancer decreased (13.6 to 6.2). The rate of definitive primary treatment (radical prostatectomy or radiation therapy) for men with early cancer increased from 47% to 67% (p <0.001). Prostate specific antigen screening has led to an additional diagnosis of 5.8 cases of early stage cancer and 3.9 cases receiving treatment for earlycancer for every 1 less case of stage IV disease at initial diagnosis. This ratio represents the worst-case scenario for overtreatment and provides a quantitative basis for studying the effect of prostate specific antigen screening.

B55 - Complications rate after early prostate cancer treatment with I-125 seeds

B55 - Complications rate after early prostate cancer treatment with I-125 seeds

Focal radiotherapy as focal therapy of prostate cancer

Focal radiotherapy treatment procedures play an increasingly important role in function-preservation and organ-preservation treatment techniques. As an alternative to traditional whole-gland radiotherapy regimes, focal prostate radiotherapy may be of benefit for both primary tumor as well as locally recurrent disease. This is a review of the current literature on the topic, including patient selection, preliminary toxicity, and outcome data as well as a technical overview on treatment delivery techniques. Partial organ treatment in early prostate cancer (PCa) is now technically feasible with both newer external-beam and brachytherapy technology. To date, only small and generally monoinstitutional series have been published in the literature. Early feasibility and toxicity data are encouraging, and demonstrate potential advantages for the role of focal brachytherapy in early PCa. Although some advanced external-beam techniques can also be used to deliver focal therapy within the prostate, there is no relevant publication in the literature. Radiotherapy, especially interventional radiotherapy (brachytherapy), is a technically feasible treatment technique to deliver focal radiotherapy for PCa. To date, only preliminary results are available for all forms of interventional radiotherapy (high dose rate, low dose rate, and pulsed dose rate) for focal PCa treatment and no large cohort comparative results are published. As interventional radiotherapy (brachytherapy) as yet lacks any such long-term studies, comparative outcome data are not available to suggest differences in efficacy for one form of brachytherapy or another.

Does increasing life expectancy affect competing mortality after radical prostatectomy?

ObjectivesIn Germany, between 1991 to 1993 and 2004 to 2006, the life expectancy in men increased by 4.2 years with greater gains in the eastern part of the country. In this study, we investigated to which degree this life-expectancy increase was translated into lower competing mortality rates after radical prostatectomy. Methods and materialsThe study sample comprised 6,831 consecutive patients who underwent radical prostatectomy at the Department of Urology of the Dresden University of Technology and the Department of Urology of the University of Hamburg/Martini Clinic in the years 1992 to 2005. The median age was 63.0 years and the median follow-up was 8.6 years. Three time periods (1992–1995, 1996–2001, and 2002–2005) were compared. Competing mortality was the study end point. Rates after 8 years were used for comparison. Comparisons of mortality rates were made with the 2-sided Wald test. ResultsThe 8-year competing mortality rates decreased from 7.6% (1992–1995) via 5.6% (1996–2001) to 4.7% (2002–2005 vs. 1992–1995; P = 0.0127). When deaths due to unknown causes (92 of 969 deaths) were considered as non–prostate cancer competing deaths, the corresponding figures were 9.0 % (1992–1995), 6.5% (1996–2001), and 5.6% (2002–2005) vs. 1992 to 1995; P = 0.0107. The effect was greater in men who are 65 years of age or older and those of East German origin. ConclusionsParallel to the increasing life expectancy in Germany, the competing mortality after radical prostatectomy decreased in both centers mainly in men who are 65 years of age or older. This information may be important for elderly men considering alternatives to immediate curative treatment for early prostate cancer.

Treatment of early‐stage prostate cancer among rural and urban patients

Geographic barriers and limited availability of cancer specialists may influence early prostate cancer treatment options for rural men. This study compares receipt of different early prostate cancer treatments between rural and urban patients. Using 2004-2006 SEER Limited-Use Data, 51,982 early prostate cancer patients were identified (T1c, T2a, T2b, T2c, T2NOS; no metastases) who were most likely to benefit from definitive treatment (< 75 years old, Gleason score < 8, PSA ≤ 20). Definitive treatment included radical prostatectomy, daily external beam radiation for 5 to 8 weeks, brachytherapy, or combination external beam radiation/brachytherapy. Adjusted definitive treatment rates were calculated by rural-urban residence overall, and for different sociodemographic and cancer characteristics, and different states based on logistic regression analyses, using general estimating equation methods to account for clustering by county. Adjusted definitive treatment rates were lower for rural (83.7%) than urban (87.1%) patients with early-stage prostate cancer (P ≤ .01). Rural men were more likely than urban men to receive non-definitive surgical treatment and no initial treatment. The lowest definitive treatment rates were among rural subgroups: 70 to 74 years (73.9%), African Americans (75.6%), American Indians/Alaska Natives (77.8%), single/separated/divorced (76.8%), living in New Mexico (69.3%), and living in counties with persistent poverty (79.6%). Between 2004 and 2006, this adjusted analysis found that men who were living in rural areas were less likely to receive definitive treatment for their early-stage prostate cancer than those living in urban areas. Certain rural patient groups with prostate cancer need particular attention to ensure their access to appropriate treatment. Rural providers, rural health care systems, and cancer advocacy and support organizations should ensure resources are in place so that the most vulnerable rural groups (men between 60 and 74 years of age; African American men; men who are single, separated, or divorced; and men living in rural New Mexico) can make informed prostate cancer treatment choices based on their preferences.

Tumor Suppressor microRNAs, miR-100 and -125b, Are Regulated by 1,25-dihydroxyvitamin D in Primary Prostate Cells and in Patient Tissue

MiR-100 and miR-125b are lost in many cancers and have potential function as tumor suppressors. Using both primary prostatic epithelial cultures and laser capture-microdissected prostate epithelium from 45 patients enrolled in a vitamin D3 randomized trial, we identified miR-100 and -125b as targets of 1,25-dihydroxyvitamin D3 (1,25D). In patients, miR-100 and -125b levels were significantly lower in tumor tissue than in benign prostate. Similarly, miR-100 and -125b were lower in primary prostate cancer cells than in cells derived from benign prostate. Prostatic concentrations of 1,25D positively correlated with these miRNA levels in both prostate cancer and benign epithelium, showing that patients with prostate cancer may still benefit from vitamin D3. In cell assays, upregulation of these miRNAs by 1,25D was vitamin D receptor dependent. Transfection of pre-miR-100 and pre-miR-125b in the presence or absence of 1,25D decreased invasiveness of cancer cell, RWPE-2. Pre-miR-100 and pre-miR-125b decreased proliferation in primary cells and cancer cells respectively. Pre-miR-125b transfection suppressed migration and clonal growth of prostate cancer cells, whereas knockdown of miR-125b in normal cells increased migration indicates a tumor suppressor function. 1,25D suppressed expression of previously bona fide mRNA targets of these miRNAs, E2F3 and Plk1, in a miRNA-dependent manner. Together, these findings show that vitamin D3 supplementation augments tumor suppressive miRNAs in patient prostate tissue, providing evidence that miRNAs could be key physiologic mediators of vitamin D3 activity in prevention and early treatment of prostate cancer.