Role of leptin as a biomarker for early detection of renal cell carcinoma? No evidence from a systematic review and meta-analysis

Renal cell carcinoma (RCC) is the commonest from of renal neoplasm. Although surgery is a successful curative treatment for localized RCC, most patients are diagnosed with advanced or metastatic RCC, which has poor prognosis. RCC is classified by stage and grade using tissue samples. Whilst these provide good prognostic information, they are not very useful for early detection. Proteins that are dysregulated in patient's serum can be a valuable alternative and less invasive biomarker for early detection of the disease. For this reason, a hypothesis was formed that leptin is a possible biomarker for early detection and prognostication of RCC. The literature has disparate results on the usefulness of leptin as a biomarker for the early detection of RCC. Hence, a systematic review and a meta-analysis was carried out to investigate whether serum leptin could be a reliable diagnostic and prognostic factor in RCC patients. Literature on the available cohort and case-control studies on serum leptin in RCC was searched in electronic databases and included to evaluate this adipokine in the progression of RCC. The relevant studies were evaluated for the diagnostic and prognostic value of leptin in RCC patients. Overall, only 6 original research studies matched selection criteria and were included for meta-analysis. This study was hypothesised that; leptin might be a useful biomarker for early detection and prognostication of RCC. However, the data were presented in this study did not support our hypothesis. Serum leptin levels in RCC patients do not strongly associate with the development or progression of RCC, thus cannot act as a biomarker for early detection in RCC in patients. Extending our hypothesis further to include levels of obesity and RCC development may be worthwhile, but studies are currently limited

Expression of Selected Inflammatory Cytokine Genes in Bladder Biopsies

Besides the deregulation of oncogene and tumour suppressor gene, bladder carcinoma can also be caused by inflammation. To date, the association of inflammatory cytokines with carcinoma of the bladder (especially the transitional cell carcinomas) is not fully understood. In this study, we report an attempt to examine expression patterns of pro- and anti- inflammatory cytokine genes from normal and tumour tissue biopsies of the human bladder. Our molecular assays involved the use of the GeneXP™ Human Cyto-3 kit and the Reverse Transcription – Polymerase Chain Reaction test. Due to limitation in our experimental process, mainly attributed by inconsistencies in the results obtained between the two assay systems, we cannot reach a conclusion regarding the association of the six selected inflammatory cytokine genes (IL-8, IL-12A, IL-18, TGF-β1, TGF- β2, and TGF-β3) with bladder carcinoma. However, our data provided early novel evidence of expression of four inflammatory cytokine genes, namely IL-12A, TGF-β1, TGF-β2, and TGF-β3 in tissues derived from the human bladder

Doctors' approaches to decision support in counseling patients with localized prostate cancer: an Asian perspective

There are many treatment options for localized prostate cancer, and there is clinical equipoise in relation to the treatment outcomes. This study aimed to explore doctors’ approaches to decision support in counselling patients with localized prostate cancer in a country with a less established system of support and care delivery for cancer treatment. Four in-depth interviews and three focus group discussions were conducted with seven government policy makers/consultant urologists, three oncologists, four private urologists and six urology trainees in Malaysia between 2012 and 2013. Doctors facilitated the treatment decision by explaining about the disease and the treatment options, which included monitoring, side effects and complications of each treatment option. Paper-based (charts and diagram drawings) or electronic (ipad apps and websites) illustrations and physical models were used as patient education aids. Further reading materials and websites links were often provided to patients. Patients were given time till subsequent follow up to decide on the treatment and family involvement was encouraged. Referral to other healthcare professionals (oncologist, radiotherapist or other urologist) for second opinion was offered to the patients. The doctors would recommend patients to speak to prostate cancer survivors for peer support but official support groups were not easily accessible. This study highlighted a multi-faceted approach to support patients with localized prostate cancer in making a treatment decision. It not only involved the doctors (urologist or oncologist) themselves, but also empowered the patients and their social network to support the decision making process

Who makes the decision? Malaysian healthcare professionals' views on prostate cancer treatment

Purpose: This study aimed to explore the views of Malaysian healthcare professionals (HCPs) on the roles of various stakeholders who were involved in making decisions about prostate cancer treatment. Method: Four in-depth interviews and three focus group discussions were conducted with HCPs from government and private hospitals in Malaysia between December 2012 and March 2013. HCPs consisted of private urologists (n=4), government urologists (n=6), urology trainees (n=5), government policy maker (n=1) and oncologists (n=3). There were 16 male and three female participants. Trained researchers used a topic guide to guide the interviews which were audio-recorded, transcribed verbatim, checked and managed with Nvivo 10 software. Thematic approach was used to analyse the data. Result: Three parties were involved in the decision making process: HCPs, patients and family. Patients who did not understand prostate cancer and its treatment had difficulty in making decisions. These patients tended to leave the decision to the HCPs. Some patients made their own treatment decision. Some patients avoid asking too many questions to avoid the possibility of being influenced towards one option by their HCP. HCPs would leave the final say to the patient because of three reasons: to avoid patients’ regret (“patient will not be happy at the end of the day”); wanting the patient to “balance what they wanted and what was the reality of each option”; and knowing there was no single best treatment option. The family members, especially children, made the decision for some patients. This may be due to Malaysia’s close-knit family culture where patients were concerned about their children’s emotions. While some patients were able to make their own decisions for non-invasive treatment (e.g. hormonal treatment), they would like to involve their family if they were considering surgery. HCPs observed that patients rarely involved their wives in decision making. Conclusion: Decision making during prostate cancer treatment involves three parties; HCP, patient and family. The decisional roles depend on the patients personal preferences, understanding of the illness, and the family dynamics

Report of the third Asian Prostate Cancer study meeting.

The Asian Prostate Cancer (A-CaP) study is an Asia-wide initiative that was launched in December 2015 in Tokyo, Japan, with the objective of surveying information about patients who have received a histopathological diagnosis of prostate cancer (PCa) and are undergoing treatment and clarifying distribution of staging, the actual status of treatment choices, and treatment outcomes. The study aims to clarify the clinical situation for PCa in Asia and use the outcomes for the purposes of international comparison. Following the first meeting in Tokyo in December 2015, the second A-CaP meeting was held in Seoul, Korea, in September 2016. This, the third A-CaP meeting, was held on October 14, 2017, in Chiang Mai, Thailand, with the participation of members and collaborators from 12 countries and regions. In the meeting, participating countries and regions presented the current status of data collection, and the A-CaP office presented a preliminary analysis of the registered cases received from each country and region. Participants discussed ongoing challenges relating to data input and collection, institutional, and legislative issues that may present barriers to data sharing, and the outlook for further patient registrations through to the end of the registration period in December 2018. In addition to A-CaP-specific discussions, a series of special lectures were also delivered on the situation for health insurance in the United States, the correlation between insurance coverage and PCa outcomes, and the outlook for robotic surgery in the Asia-Pacific region. Members also confirmed the principles of authorship in collaborative studies, with a view to publishing original articles based on A-CaP data in the future

miR-137-mediated loss of KDM5B expression leads to suppression of the malignant phenotype of bladder cancer cells

The oncogenic role of KDM5B is implicated in the pathogenesis of many cancers including bladder cancer (BC). KDM5B is a histone demethylase enzyme that modifies the chromatin structure to specify cellular transcriptional states. Overexpression of KDM5B in cancer cells is correlated with an increased proliferative capacity. Intriguingly, KDM5B is a cancer/testis antigen; while its expression in tumours is ectopically amplified, KDM5B expression in normal conditions is limited to embryonic stem cells (ESCs) and the testis in adults. These unique characteristics make KDM5B a potential pan-cancer therapeutic target. Thus, this study was aimed at identifying potential regulators of KDM5B. Since KDM5B expression in ESCs is orchestrated by microRNAs (miRNAs) and the expression of many miRNAs are altered in BC, we hypothesized that miRNAs may be the switch that can abate KDM5B expression to mitigate the BC malignant phenotype. Based on IHC- and RT-QPCR analysis, we found that KDM5B protein and transcript levels were differentially expressed in cancer tissues and cell lines, respectively. Amongst several in silico-predicted putative KDM5B-targeting miRNAs, the in vitro basal expression of miR-137 was inversely correlated with KDM5B expression. We demonstrated that the overexpression of miR-137 significantly attenuated KDM5B expression, induced G1 cell-cycle arrest, suppressed cell growth and blocked invasion and migration of BC cells. In contrast, downregulation of miR-137 expression led to the reverse effect. By integrating in silico screens of miR-137 putative target genes and microarray data using the Ingenuity Pathway Analysis (IPA), we revealed that miR-137 possibly exerts control over the cell-cycle through Rb and adenylyl cyclic signalling pathways by targeting key regulators of cyclin A. We also showed that miR-137 gain-of-function increased the expression of tumor suppressor, JDP2. While our results suggest that miR-137 can mitigate the KDM5B-associated BC phenotype, further studies on understanding the effect on aberrant histone methylation patterns are warranted

Overexpression of CTAG1B is a potential biomarker in bladder cancer

Urothelial cell carcinoma (UCC) is the most common form of bladder cancer and is associated with the need for life-long surveillance once a patient is diagnosed with a non-invasive disease. Due to the long-term risk of recurrence and the need for life-long routine monitoring and therapy, the cost per UCC patient from diagnosis to death is the highest of all cancers. The development of non-invasive biomarkers of recurrence and progression can increase survival, decrease treatment costs and improve patient quality of life. However, to date, no biomarker(s) have been endorsed for the use in the clinical management of UCC, especially in predicting risk of progression and recurrence. CTAG1B was previously found to be highly expressed in high-stage and grade bladder cancer, albeit in Caucasian cohorts. However, despite its potential as a target for cancer immunotherapy, the effect of expression modulation on cellular phenotypes has never been reported. In this study, we overexpressed CTAG1B in an invasive bladder cancer cell line, EJ28 after we confirmed that this cell line minimally expressed CTAG1B. The cells were transfected with CTAG1B-pcDNA3.1(-) and the level of expression was confirmed by qRT-PCR. Once the expression was confirmed to persist up to 72h post-transfection, the transfected cells were subjected to various phenotypic assays. In addition, the pattern of CTAG1B expression in a cohort of Malaysian bladder cancer paraffin-embedded tissues was also determined using immunohistochemistry. The effect of CTAG1B overexpression on the cell cycle, migratory and proliferative potential was observed. The changes in phenotype were compared with that of untransfected and mock controls. CTAG1B was overexpressed 20 times as compared to the untransfected and mock controls in the transfected cells. CTAG1B overexpression resulted in cells to migrate slower at 24h post-transfection but proliferate significantly faster after 72-96h post-transfection. In addition, CTAG1B was more frequently expressed in advanced bladder cancer stages and grades. The findings from this study contribute to the current knowledge of CTAG1B‟s role in tumourigenesis. Further functional studies will contribute towards realising the potential of CTAG1B as a biomarker for predicting the risk of progression and recurrence of bladder cancer

Adverse events following immunization and psychological distress among cancer patients/survivors following vaccination against SARS-CoV-2 infection

PurposeThis study aims to describe the adverse events following immunization (AEFIs) of SARS-CoV-2 vaccination in cancer patients/survivors associated with their psychological distress.MethodsA cross-sectional study was conducted to assess AEFIs after the receipt of SARS-CoV-2 vaccines in cancer patients/survivors attending a university hospital in Malaysia. Psychological distress was measured using the Hospital Anxiety and Depression Scale (HADS) before and after the first and second doses of COVID-19 vaccine.ResultsA total of 217 complete responses were received. Compared with before vaccination, both HADS Anxiety (HADS-A) and HADS Depression (HADS-D) scores were significantly reduced after the first and second dose of the SARS-CoV-2 vaccine. Most of the participants had mild-or-moderate systemic and local AEFIs, with the most common being pain at the injection site, tiredness, and headache for both the first and second doses of the vaccine. Positive correlations between the total AEFI score and HADS-A (r = 0.309, p < 0.001) and HADS-D (r = 0.214, p = 0.001) scores were observed after the first dose of the SARS-CoV-2 vaccine. Similarly, positive associations were observed between the total AEFI score and HADS-A (r = 0.305, p < 0.001) and HADS-D (r = 0.235, p < 0.001) scores after the second dose of the SARS-CoV-2 vaccine.ConclusionMild-to-moderate AEFIs found in this study help address vaccine hesitancy in cancer patients/survivors. Receiving the SARS-CoV-2 vaccine had a positive effect on decreasing psychological distress in cancer patients/survivors. High severity of an AEFI was associated with higher anxiety and depressive symptoms

Controversy and Consensus on Indications for Sperm DNA Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations

Purpose: Sperm DNA fragmentation (SDF) testing was recently added to the sixth edition of the World Health Organization laboratory manual for the examination and processing of human semen. Many conditions and risk factors have been associated with elevated SDF; therefore, it is important to identify the population of infertile men who might benefit from this test. The purpose of this study was to investigate global practices related to indications for SDF testing, compare the relevant professional society guideline recommendations, and provide expert recommendations. Materials and Methods: Clinicians managing male infertility were invited to take part in a global online survey on SDF clinical practices. This was conducted following the CHERRIES checklist criteria. The responses were compared to professional society guideline recommendations related to SDF and the appropriate available evidence. Expert recommendations on indications for SDF testing were then formulated, and the Delphi method was used to reach consensus. Results: The survey was completed by 436 experts from 55 countries. Almost 75% of respondents test for SDF in all or some men with unexplained or idiopathic infertility, 39% order it routinely in the work-up of recurrent pregnancy loss (RPL), and 62.2% investigate SDF in smokers. While 47% of reproductive urologists test SDF to support the decision for varicocele repair surgery when conventional semen parameters are normal, significantly fewer general urologists (23%; p=0.008) do the same. Nearly 70% would assess SDF before assisted reproductive technologies (ART), either always or for certain conditions. Recurrent ART failure is a common indication for SDF testing. Very few society recommendations were found regarding SDF testing. Conclusions: This article presents the largest global survey on the indications for SDF testing in infertile men, and demonstrates diverse practices. Furthermore, it highlights the paucity of professional society guideline recommendations. Expert recommendations are proposed to help guide clinicians

Controversy and consensus on the management of elevated sperm DNA fragmentation in male infertility: A global survey, current guidelines, and expert recommendations

Purpose Sperm DNA fragmentation (SDF) has been associated with male infertility and poor outcomes of assisted reproductive technology (ART). The purpose of this study was to investigate global practices related to the management of elevated SDF in infertile men, summarize the relevant professional society recommendations, and provide expert recommendations for managing this condition. Materials and Methods An online global survey on clinical practices related to SDF was disseminated to reproductive clinicians, according to the CHERRIES checklist criteria. Management protocols for various conditions associated with SDF were captured and compared to the relevant recommendations in professional society guidelines and the appropriate available evidence. Expert recommendations and consensus on the management of infertile men with elevated SDF were then formulated and adapted using the Delphi method. Results A total of 436 experts from 55 different countries submitted responses. As an initial approach, 79.1% of reproductive experts recommend lifestyle modifications for infertile men with elevated SDF, and 76.9% prescribe empiric antioxidants. Regarding antioxidant duration, 39.3% recommend 4–6 months and 38.1% recommend 3 months. For men with unexplained or idiopathic infertility, and couples experiencing recurrent miscarriages associated with elevated SDF, most respondents refer to ART 6 months after failure of conservative and empiric medical management. Infertile men with clinical varicocele, normal conventional semen parameters, and elevated SDF are offered varicocele repair immediately after diagnosis by 31.4%, and after failure of antioxidants and conservative measures by 40.9%. Sperm selection techniques and testicular sperm extraction are also management options for couples undergoing ART. For most questions, heterogenous practices were demonstrated. Conclusions This paper presents the results of a large global survey on the management of infertile men with elevated SDF and reveals a lack of consensus among clinicians. Furthermore, it demonstrates the scarcity of professional society guidelines in this regard and attempts to highlight the relevant evidence. Expert recommendations are proposed to help guide clinicians