Brian Birch

Depression and anxiety in prostate cancer: a systematic review and meta-analysis of prevalence rates

Objectives To systematically review the literature pertaining to the prevalence of depression and anxiety in patients with prostate cancer as a function of treatment stage. Design Systematic review and meta-analysis. Participants 4494 patients with prostate cancer from primary research investigations. Primary outcome measure The prevalence of clinical depression and anxiety in patients with prostate cancer as a function of treatment stage. Results We identified 27 full journal articles that met the inclusion criteria for entry into the meta-analysis resulting in a pooled sample size of 4494 patients. The meta-analysis of prevalence rates identified pretreatment, on-treatment and post-treatment depression prevalences of 17.27% (95% CI 15.06% to 19.72%), 14.70% (95% CI 11.92% to 17.99%) and 18.44% (95% CI 15.18% to 22.22%), respectively. Pretreatment, on-treatment and post-treatment anxiety prevalences were 27.04% (95% CI 24.26% to 30.01%), 15.09% (95% CI 12.15% to 18.60%) and 18.49% (95% CI 13.81% to 24.31%), respectively. Conclusions Our findings suggest that the prevalence of depression and anxiety in men with prostate cancer, across the treatment spectrum, is relatively high. In light of the growing emphasis placed on cancer survivorship, we consider that further research within this area is warranted to ensure that psychological distress in patients with prostate cancer is not underdiagnosed and undertreated.

A prospective trial of flexible cystodiathermy for recurrent transitional cell carcinoma of the bladder.

PURPOSE The flexible cystoscope has a proved role in the followup of patients with transitional cell carcinoma of the bladder but the full extent of its therapeutic role has yet to be defined. We analyzed 171 flexible cystodiathermies to assess patient tolerance and treatment success. Potential cost savings were also analyzed. MATERIALS AND METHODS All patients with single or multiple small papillary (Ta) recurrences at followup flexible cystoscopy were treated with flexible cystodiathermy. Plain lubricating gel was used and no other analgesia was prescribed. A visual analog pain scale was completed by the patient after the procedure and an observer rating of discomfort was recorded. Followup for efficacy of treatment was performed. RESULTS A total of 103 patients were treated with cystodiathermy during the last 3 years. Median followup was 21 months (range 12 to 42). Of the patients 52 (50.5%) had no recurrence of transitional cell carcinoma after treatment and 51 (49.5%) required treatment for recurrence. Only 13 patients (12.6%) had recurrences at or close to the original tumor site. Pain scales indicated that the procedure was well tolerated and all patients agreed to undergo it in the future if required. Estimated cost savings were approximately

Evolution of the Southampton Enhanced Recovery Programme for radical cystectomy and the aggregation of marginal gains

66,500 per 100 patients. CONCLUSIONS Flexible cystodiathermy is a well tolerated and efficacious treatment for recurrent small papillary (Ta) transitional cell carcinoma of the bladder. Since transitional cell carcinoma of the bladder frequently occurs in an elderly and often unfit population treatment that avoids general anesthetic offers considerable advantages.

The effects of dietary lycopene supplementation on human seminal plasma

To describe and assess the evolution of an enhanced recovery programme (ERP) for open radical cystectomy.

Male sex hormones and systemic inflammation in Alzheimer disease.

To investigate whether lycopene levels in blood and seminal plasma increase after dietary supplementation with a natural source of the compound, and whether any potential increase of lycopene levels in semen translates into increased free‐radical trapping capacity in the seminal plasma.

Current Drug Therapy for Prostate Cancer: An Overview

Several studies have shown that the levels of sex hormones in men with Alzheimer disease (AD) differ from men without AD. Therefore, male sex hormones have been postulated as risk modifiers in AD, possibly through immunomodulatory effects on known inflammatory AD risk factors, such as tumor necrosis factor &agr; (TNF-&agr;). We conducted a cross-sectional study of sex hormones and TNF-&agr; levels in 94 community-dwelling men with AD. Comparisons were made with normal values derived from the literature. Men with AD had lower free testosterone levels than non-AD men (1-sample t test: age <80, P=0.0002; age ≥80, P<0.0001), and higher luteinizing hormone (LH) levels (Wilcoxon signed rank test: age <80, P=0.001; age ≥80, P<0.0001). Within the cohort of men with AD, there was a positive correlation between LH and TNF-&agr; (Spearman r=0.25, P=0.019), and this remained significant after correcting for age (partial r=0.21, P=0.05). These data support the hypothesis that sex hormones and the immune system influence each other in AD. Furthermore, modulatory effects between LH and TNF-&agr; may provide a mechanism for an effect of male sex hormones on AD risk.

Epirubicin and meglumine ?-linolenic acid: a logical choice of combination therapy for patients with superficial bladder carcinoma

Prostate cancer is the most common cancer amongst men in the USA and the second most common malignant cause of male death worldwide after lung cancer. The life time risk of having microscopic evidence of prostate cancer for a 50 year old man is 42%. Prostate cancer is thus becoming an increasingly significant global health problem in terms of mortality, morbidity, as well as economically. This review, discusses current medical therapeutic options for prostate cancer including traditional treatments using luteinising hormone releasing analogues (LHRH), anti-androgens and estrogen treatments, and the use of novel drugs directed against molecular targets considered important in oncogenesis and metastasis. Prostate cancer chemoprevention using 5alpha-reductase inhibitors and the role of gene therapy are also considered.

Absorption Characteristics of Lignocaine Following Intravesical Instillation

BACKGROUND Anthracyclines have been established as first-line drugs for intravesical use in the treatment of patients with superficial bladder carcinoma, although they result only in a modest reduction in tumor recurrence rates. The essential fatty acid γ-linolenic acid (GLA) also is an effective cytotoxic agent against superficial bladder carcinoma when it is applied topically. The objective of this study was to assess the efficacy of combined epirubicin and GLA with the purpose of developing a suitable model for modification of existing intravesical regimens. METHODS The human urothelial carcinoma cell lines MGH-U1 and RT112 were used in standard cytotoxicity assays and were exposed to meglumine GLA (MeGLA) and epirubicin in two-dimensional concentration matrices. A thiozolyl blue (methyl-thiazoldiphenyl tetrazolium) assay was used to determine residual cell biomass. Drug interaction was quantified by median-effect analysis software (CalcuSyn®), and the evaluation of drug uptake utilized fluorescence confocal microscopy (FCM) and flow cytometry. RESULTS MeGLA caused a significant enhancement of anthracycline uptake, viewed by FCM, from 92 fluorescence units to 222 fluorescence units (P < 0.001). Flow cytometry confirmed the increased drug uptake and showed that the mean epirubicin content per cell increased from 23 to 57 units and from 8 to 24 units for MGH-U1 and RT112 cells, respectively (99% confidence interval < 0.3). This resulted in improved cytotoxicity, and it was shown that the drugs acted synergistically with all but the highest MeGLA concentrations. CONCLUSIONS The efficacy of epirubicin was enhanced significantly when it was used in combination with most concentrations of MeGLA (< 300 μg/mL), and the two agents acted synergistically. There was a corresponding increase in epirubicin uptake by cells under these conditions. At high MeGLA concentrations, however, anthracycline solubility was compromised, and drug synergy was lost. Cancer 2003;97:71–8.

A quantitative analysis of the prevalence of clinical depression and anxiety in patients with prostate cancer undergoing active surveillance

The systemic absorption of topical lignocaine applied intravesically was studied in 11 patients with indwelling catheters. Group A patients (n = 9) had lignocaine 400 mg (as 40 ml of a 1% solution) instilled into the bladder for 1 hour whilst in Group B patients (n = 2) the application was for 2 hours. The mean maximum lignocaine concentration measured in Group A patients was 121 ng ml-1 with a time to maximum concentration of 60-90 minutes. The two patients in Group B had corresponding values of 410 and 1580 ng ml-1 respectively at 120 minutes. Transitional cell epithelium, like intact skin, constitutes a significant barrier to the uptake of topically applied lignocaine which, from the bladder, is both slow and limited. Intravesical application is safe (maximum levels in Group A patients being x 30 less than the minimal toxic level of lignocaine) but its clinical efficacy remains to be determined.

IS GAMMA-LINOLENIC ACID AN EFFECTIVE INTRAVESICAL AGENT FOR SUPERFICIAL BLADDER CANCER ? IN VITRO CYTOTOXICITY AND IN VIVO TOLERANCE STUDIES

Objective To quantitatively determine the prevalence of anxiety and depression in men on active surveillance (AS). Design Cross-sectional questionnaire survey. Setting Secondary care prostate cancer (PCa) clinics across South, Central and Western England. Participants 313 men from a total sample of 426 with a histological diagnosis of PCa currently managed with AS were identified from seven UK urology departments. The mean age of respondents was 70 (51–86) years with the majority (76%) being married or in civil partnerships. 94% of responders were of white British ethnicity. Primary outcome measures The prevalence of clinically meaningful depression and anxiety as assessed by the Hospital Anxiety and Depression Scale (HADS; score ≥8/21). Secondary outcome measures Patient demographic data (age, employment, relationship, ethnic and educational status). Each demographic variable was cross-tabulated against patients identified as depressed or anxious to allow for the identification of variables that were significantly associated with depression and anxiety. In order to determine predictors for depression and anxiety among the demographic variables, logistic regression analyses were conducted, with p<0.05 considered as indicating statistical significance. Results The prevalence of clinical anxiety and depression as determined via the HADS (HADS ≥8) was 23% (n=73) and 12.5% (n=39), respectively. Published data from men in the general population of similar age has shown prevalence rates of 8% and 6%, respectively, indicating a twofold increase in depression and a threefold increase in anxiety among AS patients. Our findings also suggest that AS patients experience substantially greater levels of anxiety than patients with PCa treated radically. The only demographic predictor for anxiety or depression was divorce. Conclusions Patients with PCa managed with AS experienced substantially higher rates of anxiety and depression than that expected in the general population. Strategies to address this are needed to improve the management of this population and their quality of life.