Risk of prostate cancer in men with spinal cord injury: A systematic review and meta-analysis

Abstract

A lower risk of prostate cancer has been reported in men with spinal cord injury (SCI) as compared to that observed in able-bodied subjects. As injury-related consequences can have opposite effects on prostate pathophysiology, this meta-analysis aimed to (1) establish the existence/quantify the extent of decreased prostate cancer risk following SCI and (2) find out if there is any statistically significant difference in prostate-specific antigen (PSA) levels between SCI and able-bodied subjects. MEDLINE, Cochrane Library, Scopus, CINAHL, and ScienceDirect databases were used. Only studies reporting a prostate cancer diagnosis and/or PSA levels following SCI and in able-bodied controls were included. Five studies provided information about prostate cancer on 35 293 subjects with SCI and 158 140 controls. Six studies were included in PSA analysis which reported information on 391 men with SCI and 1921 controls. Pooled estimates indicated that SCI reduced the prostate cancer risk by approximately 50% as compared to controls, whereas differences in PSA levels were not statistically significant. Funnel plots suggested the presence of publication bias only in PSA analysis. Between-study heterogeneity was established and when, according to meta-regression models, analysis was restricted to studies including men with mean age over 55 years, prostate cancer risk in SCI decreased up to 65.0% than that in controls with no heterogeneity (P = 0.33, I2 = 9%). In conclusion, in men over 55 years old, SCI decreases the prostate cancer risk up to 65.0% than that in controls. The large between-study heterogeneity on PSA confirms its poor reliability as a screening tool for prostate cancer in SCI.

Investigation of Neural Microenvironment in Prostate Cancer in Context of Neural Density, Perineural Invasion, and Neuroendocrine Profile of Tumors

“…Complex interactions between nerves and PCa cells were first described by Ayala et al who showed that the co-culture of PCa cell line with dorsal root ganglion stimulated the outgrowth of neurites and the migration of tumor cells toward the neural structures (6). PCa represents a tumor with a specific microenvironment, where reciprocal interactions between nerves and other cellular and extracellular components were observed molecularly and clinically in vitro and in vivo (5,7,36,37). Neurotransmitters released within the tumor microenvironment modulate the expression of genes by targeting tumor receptors affecting the biological potential of cancer.…”

Sensory nerves: A driver of the vicious cycle in bone metastasis?

“…In turn, excited SNs secrete neurotransmitters and neurotrophins that may modulate cancer aggressiveness. In support of this notion, it has been demonstrated that metastasis of prostate cancer is decreased following spinal cord injury, suggesting an important role of nerves in prostate cancer progression [11] , [12] . Further, the association between stress-related psychosocial factors and higher lung cancer incidence in healthy populations or poorer survival in cancer patients implicates autonomic nerves (ANs) in cancer development and progression [13] .…”

Onkologische Relevanz neurourologischer Erkrankungen

“…Im Gegensatz zum Harnblasenkarzinom ist das Prostatakarzinom bei männlichen QSL-Patienten seltener als in der Normalbevölkerung. Eine aktuelle systematische Review und Metaanalyse [57] errechnete an 35.293 QSL-Patienten (aus 5 Studien) in Vergleich zu 158.140 Kontrollpersonen eine OR von 0,47 (95%-KI 0,27-0,83), d. h. eine Risikoreduktion von etwa 50%. Für Männer im Alter über 55 Jahre betrug die Risikoreduktion sogar 65% (OR 0,35; 95%-KI 0,22-0,56).…”