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Natalicchio A, Marrano N, Montagnani M, Gallo M, Faggiano A, Zatelli MC, Argentiero A, Del Re M, D'Oronzo S, Fogli S, Franchina T, Giuffrida D, Gori S, Ragni A, Marino G, Mazzilli R, Monami M, Morviducci L, Renzelli V, Russo A, Sciacca L, Tuveri E, Cortellini A, Di Maio M, Candido R, Perrone F, Aimaretti G, Avogaro A, Silvestris N, Giorgino F. Glycemic control and cancer outcomes in oncologic patients with diabetes: an Italian Association of Medical Oncology (AIOM), Italian Association of Medical Diabetologists (AMD), Italian Society of Diabetology (SID), Italian Society of Endocrinology (SIE), Italian Society of Pharmacology (SIF) multidisciplinary critical view. J Endocrinol Invest 2024:10.1007/s40618-024-02417-z. [PMID: 38935200 DOI: 10.1007/s40618-024-02417-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 06/16/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Increasing evidence suggests that diabetes increases the risk of developing different types of cancer. Hyperinsulinemia, hyperglycemia and chronic inflammation, characteristic of diabetes, could represent possible mechanisms involved in cancer development in diabetic patients. At the same time, cancer increases the risk of developing new-onset diabetes, mainly caused by the use of specific anticancer therapies. Of note, diabetes has been associated with a ∼10% increase in mortality for all cancers in comparison with subjects who did not have diabetes. Diabetes is associated with a worse prognosis in patients with cancer, and more recent findings suggest a key role for poor glycemic control in this regard. Nevertheless, the association between glycemic control and cancer outcomes in oncologic patients with diabetes remains unsettled and poorly debated. PURPOSE The current review seeks to summarize the available evidence on the effect of glycemic control on cancer outcomes, as well as on the possibility that timely treatment of hyperglycemia and improved glycemic control in patients with cancer and diabetes may favorably affect cancer outcomes.
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Affiliation(s)
- A Natalicchio
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Piazza Giulio Cesare, 11, I-70124, Bari, Italy
| | - N Marrano
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Piazza Giulio Cesare, 11, I-70124, Bari, Italy
| | - M Montagnani
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Pharmacology, University of Bari Aldo Moro, Bari, Italy
| | - M Gallo
- Endocrinology and Metabolic Diseases Unit, Azienda Ospedaliero-Universitaria SS Antonio e Biagio e Cesare Arrigo of Alessandria, Alessandria, Italy
| | - A Faggiano
- Endocrinology Unit, Department of Clinical & Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - M C Zatelli
- Section of Endocrinology, Geriatrics and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - A Argentiero
- Medical Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - M Del Re
- Department of Clinical and Experimental Medicine, University of Pisa, 55, Via Roma, 56126, Pisa, Italy
| | - S D'Oronzo
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - S Fogli
- Clinical Pharmacology and Pharmacogenetics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - T Franchina
- Medical Oncology Unit, Department of Human Pathology "G. Barresi", University of Messina, Messina, Italy
| | - D Giuffrida
- Department of Oncology, Istituto Oncologico del Mediterraneo, Viagrande, Catania, Italy
| | - S Gori
- Oncologia Medica, IRCCS Don Calabria-Sacro Cuore Hospital, Negrar, Verona, Italy
| | - A Ragni
- Endocrinology and Metabolic Diseases Unit, Azienda Ospedaliero-Universitaria SS Antonio e Biagio e Cesare Arrigo of Alessandria, Alessandria, Italy
| | - G Marino
- Internal Medicine Department, Ospedale dei Castelli, Asl Roma 6, Ariccia, Rome, Italy
| | - R Mazzilli
- Endocrinology Unit, Department of Clinical & Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - M Monami
- Diabetology, Careggi Hospital and University of Florence, Florence, Italy
| | - L Morviducci
- Diabetology and Nutrition Unit, Department of Medical Specialties, ASL Roma 1 - S. Spirito Hospital, Rome, Italy
| | - V Renzelli
- Diabetologist and Endocrinologist, Italian Association of Clinical Diabetologists, Rome, Italy
| | - A Russo
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - L Sciacca
- Department of Clinical and Experimental Medicine, Endocrinology Section, University of Catania, Catania, Italy
| | - E Tuveri
- Diabetology, Endocrinology and Metabolic Diseases Service, ASL-Sulcis, Carbonia, Italy
| | - A Cortellini
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
- Department of Medicine and Surgery, Universitá Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
- Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, UK
| | - M Di Maio
- Department of Oncology, University of Turin, AOU Città Della Salute e della Scienza di Torino, Turin, Italy
| | - R Candido
- Department of Medical Surgical and Health Sciences, University of Trieste, 34149, Trieste, Italy
| | - F Perrone
- Clinical Trials Unit, National Cancer Institute, Naples, Italy
| | - G Aimaretti
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - A Avogaro
- Department of Medicine, Section of Diabetes and Metabolic Diseases, University of Padova, Padua, Italy
| | - N Silvestris
- Medical Oncology Unit, Department of Human Pathology "G. Barresi", University of Messina, Messina, Italy
| | - F Giorgino
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Piazza Giulio Cesare, 11, I-70124, Bari, Italy.
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2
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Wright JL, Schenk JM, Gulati R, Beatty SJ, VanDoren M, Lin DW, Porter MP, Morrissey C, Dash A, Gore JL, Etzioni R, Plymate SR, Neuhouser ML. The Prostate Cancer Active Lifestyle Study (PALS): A randomized controlled trial of diet and exercise in overweight and obese men on active surveillance. Cancer 2024; 130:2108-2119. [PMID: 38353455 DOI: 10.1002/cncr.35241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 01/11/2024] [Accepted: 01/16/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Active surveillance (AS) is increasingly used to monitor patients with lower risk prostate cancer (PCa). The Prostate Cancer Active Lifestyle Study (PALS) was a randomized controlled trial to determine whether weight loss improves obesity biomarkers on the causal pathway to progression in patients with PCa on AS. METHODS Overweight/obese men (body mass index >25 kg/m2) diagnosed with PCa who elected AS were recruited. The intervention was a 6-month, individually delivered, structured diet and exercise program adapted from the Diabetes Prevention Program with a 7% weight loss goal from baseline. Control participants attended one session reviewing the US Dietary and Physical Activity Guidelines. The primary outcome was change in glucose regulation from baseline to the end of the 6-month intervention, which was measured by fasting plasma glucose, C-peptide, insulin, insulin-like growth factor 1, insulin-like growth factor binding protein-3, adiponectin, and homeostatic model assessment for insulin resistance. RESULTS Among 117 men who were randomized, 100 completed the trial. The mean percentage weight loss was 7.1% and 1.8% in the intervention and control arms, respectively (adjusted between-group mean difference, -6.0 kg; 95% confidence interval, -8.0, -4.0). Mean percentage changes from baseline for insulin, C-peptide, and homeostatic model assessment for insulin resistance in the intervention arm were -23%, -16%, and -25%, respectively, compared with +6.9%, +7.5%, and +6.4%, respectively, in the control arm (all p for intervention effects ≤ .003). No significant between-arm differences were detected for the other biomarkers. CONCLUSIONS Overweight/obese men with PCa undergoing AS who participated in a lifestyle-based weight loss intervention successfully met weight loss goals with this reproducible lifestyle intervention and experienced improvements in glucose-regulation biomarkers associated with PCa progression.
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Affiliation(s)
- Jonathan L Wright
- Department of Urology, University of Washington School of Medicine, Seattle, Washington, USA
- Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
| | | | - Roman Gulati
- Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | | | | | - Daniel W Lin
- Department of Urology, University of Washington School of Medicine, Seattle, Washington, USA
- Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Michael P Porter
- Department of Urology, University of Washington School of Medicine, Seattle, Washington, USA
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
| | - Colm Morrissey
- Department of Urology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Atreya Dash
- Department of Urology, University of Washington School of Medicine, Seattle, Washington, USA
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
| | - John L Gore
- Department of Urology, University of Washington School of Medicine, Seattle, Washington, USA
- Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Ruth Etzioni
- Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Stephen R Plymate
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
- Geriatric Research Education, and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
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3
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Ma C, Cui D, Han B, Ding M, Zhang J, Liu S, Gao Y, Xia S. Poorly Controlled Diabetes Mellitus Increases the Risk of Deaths and Castration-Resistance in Locally Advanced Prostate Cancer Patients. Cancer Invest 2023; 41:345-353. [PMID: 36715444 DOI: 10.1080/07357907.2023.2171050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The association between DM and prostate cancer progression remains controversial. Previous studies mainly focused on early stage prostate cancer patients. We aimed to study the association between DM and prostate cancer progression in locally advanced prostate cancer patients. 598 locally advanced prostate cancer patients in a top tertiary hospital in China between 2012 and 2021 were divided into three groups based on the postoperative average HbA1c level. The follow-up time is 46.96 ± 27.07 months. Three hundred and forty-eight (58.2%) were normal glucose, 175 (29.3%) were moderate glucose, and 75 (12.5%) were high glucose. Higher postoperative-average HbA1c was associated with poorer OS, PCSM, and PSA-RFS. We concluded that poorly controlled DM was correlated with poorer OS, PCSM, and PSA-RFS in locally advanced prostate cancer patients.
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Affiliation(s)
- Cheng Ma
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Di Cui
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bangmin Han
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mao Ding
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jiahao Zhang
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shiyun Liu
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingli Gao
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shujie Xia
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Lutz SZ, Hennenlotter J, Franko A, Dannecker C, Fritsche L, Kantartzis K, Wagner R, Peter A, Stefan N, Fritsche A, Todenhöfer T, Stenzl A, Häring HU, Heni M. Diabetes and the Prostate: Elevated Fasting Glucose, Insulin Resistance and Higher Levels of Adrenal Steroids in Prostate Cancer. J Clin Med 2022; 11:jcm11226762. [PMID: 36431238 PMCID: PMC9693518 DOI: 10.3390/jcm11226762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 11/17/2022] Open
Abstract
Although epidemiological studies suggest a lower prostate cancer incidence rate in patients with type 2 diabetes, cancer survival is markedly reduced. Underlying mechanisms that connect the two diseases are still unclear. Potential links between type 2 diabetes and prostate cancer are hallmarks of the metabolic syndrome, such as hyperglycemia and dyslipidemia. Therefore, we explored the systemic metabolism of 103 prostate cancer patients with newly diagnosed and yet untreated prostate cancer compared to 107 healthy controls, who were carefully matched for age and BMI. Here, we report that patients with prostate cancer display higher fasting blood glucose levels and insulin resistance, without changes in insulin secretion. With respect to lipid metabolism, serum triglyceride levels were lower in patients with prostate cancer. In addition, we report increased adrenal steroid biosynthesis in these patients. Our results indicate that higher fasting glucose levels in patients with prostate cancer may be explained at least in part by insulin resistance, due to the enhanced synthesis of adrenal steroids.
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Affiliation(s)
- Stefan Zoltán Lutz
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich, University of Tübingen, 72074 Tübingen, Germany
- German Center for Diabetes Research (DZD), 85764 Munich, Germany
- Clinic for Geriatric and Orthopedic Rehabilitation Bad Sebastiansweiler, 72116 Mössingen, Germany
| | - Jörg Hennenlotter
- Department of Urology, University of Tübingen, 72076 Tübingen, Germany
| | - Andras Franko
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich, University of Tübingen, 72074 Tübingen, Germany
- German Center for Diabetes Research (DZD), 85764 Munich, Germany
- Department of Internal Medicine, Division of Endocrinology, Diabetology and Nephrology, University of Tübingen, 72074 Tübingen, Germany
| | - Corinna Dannecker
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich, University of Tübingen, 72074 Tübingen, Germany
- German Center for Diabetes Research (DZD), 85764 Munich, Germany
| | - Louise Fritsche
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich, University of Tübingen, 72074 Tübingen, Germany
- German Center for Diabetes Research (DZD), 85764 Munich, Germany
| | - Konstantinos Kantartzis
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich, University of Tübingen, 72074 Tübingen, Germany
- German Center for Diabetes Research (DZD), 85764 Munich, Germany
- Department of Internal Medicine, Division of Endocrinology, Diabetology and Nephrology, University of Tübingen, 72074 Tübingen, Germany
| | - Róbert Wagner
- German Center for Diabetes Research (DZD), 85764 Munich, Germany
- Clinic for Geriatric and Orthopedic Rehabilitation Bad Sebastiansweiler, 72116 Mössingen, Germany
- Department of Internal Medicine, Division of Endocrinology, Diabetology and Nephrology, University of Tübingen, 72074 Tübingen, Germany
| | - Andreas Peter
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich, University of Tübingen, 72074 Tübingen, Germany
- German Center for Diabetes Research (DZD), 85764 Munich, Germany
- Department for Diagnostic Laboratory Medicine, Institute for Clinical Chemistry and Pathobiochemistry, University Hospital of Tübingen, 72076 Tübingen, Germany
| | - Norbert Stefan
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich, University of Tübingen, 72074 Tübingen, Germany
- German Center for Diabetes Research (DZD), 85764 Munich, Germany
- Department of Internal Medicine, Division of Endocrinology, Diabetology and Nephrology, University of Tübingen, 72074 Tübingen, Germany
| | - Andreas Fritsche
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich, University of Tübingen, 72074 Tübingen, Germany
- German Center for Diabetes Research (DZD), 85764 Munich, Germany
- Department of Internal Medicine, Division of Endocrinology, Diabetology and Nephrology, University of Tübingen, 72074 Tübingen, Germany
| | - Tilman Todenhöfer
- Department of Urology, University of Tübingen, 72076 Tübingen, Germany
| | - Arnulf Stenzl
- Department of Urology, University of Tübingen, 72076 Tübingen, Germany
| | - Hans-Ulrich Häring
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich, University of Tübingen, 72074 Tübingen, Germany
- German Center for Diabetes Research (DZD), 85764 Munich, Germany
- Department of Internal Medicine, Division of Endocrinology, Diabetology and Nephrology, University of Tübingen, 72074 Tübingen, Germany
| | - Martin Heni
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich, University of Tübingen, 72074 Tübingen, Germany
- German Center for Diabetes Research (DZD), 85764 Munich, Germany
- Department for Diagnostic Laboratory Medicine, Institute for Clinical Chemistry and Pathobiochemistry, University Hospital of Tübingen, 72076 Tübingen, Germany
- Department of Internal Medicine 1, Division of Endocrinology and Diabetology, University Hospital Ulm, 89081 Ulm, Germany
- Correspondence:
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Bell DSH, Jerkins T. Testosterone Deficiency is Not Protective Against the Development of Adenocarcinoma of the Prostate in a Type 1 Diabetic Patient. Diabetes Ther 2022; 13:1115-1119. [PMID: 35391594 PMCID: PMC9076779 DOI: 10.1007/s13300-022-01256-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/17/2022] [Indexed: 11/26/2022] Open
Abstract
We present a case of prostate cancer (PC) developing in a hypogonadal patient with well-controlled type 1 diabetes. The purpose of reporting this case is to emphasize that regular prostate examinations and prostate-specific antigen (PSA) measurements should be preformed in the diabetic male, even though the incidence of PC is lower in this group of patients. In addition, these examinations and tests need to be preformed even in the hypogonadal patient with diabetes since the presence of a low serum testosterone (T) level does not preclude the development of PC. This is because the development of PC is not related to serum androgen levels but to the androgen levels within the prostate, and dihydrotestosterone (DHT) levels and not T levels within the prostate gland are responsible for the development of PC. In the hypogonadal male, intraprostatic DHT may be high since DHT can be formed from adrenal androgens, particularly androstenedione, through activation of 5α-reductase 2, which is the minority enzyme in the normal prostate but becomes the major enzyme in the formation and growth of PC.
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Affiliation(s)
- David S. H. Bell
- Southside Endocrinology, 1900 Crestwood Blvd, Suite 201, Irondale, AL 35210 USA
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6
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Broggi G, Lo Giudice A, Di Mauro M, Pricoco E, Piombino E, Ferro M, Caltabiano R, Morgia G, Russo GI. Insulin signaling, androgen receptor and PSMA immunohistochemical analysis by semi-automated tissue microarray in prostate cancer with diabetes (DIAMOND study). Transl Res 2021; 238:25-35. [PMID: 34314871 DOI: 10.1016/j.trsl.2021.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/03/2021] [Accepted: 07/15/2021] [Indexed: 12/16/2022]
Abstract
In the last years, many studies have highlighted the hypothesis that diabetes and hyperglycemia could be relevant for prostate cancer (PC) development and progression. We aimed to identify the prognostic value of tissue expression of androgen receptor (AR), Prostate-Specific Membrane Antigen (PSMA), Ki-67, insulin receptors (IR) α and β, insulin growth factor-1 (IGF-1) receptor, in patients with PC and to evaluate their association with diabetes. We retrospectively collected data from 360 patients who underwent radical prostatectomy for PC or surgery for benign prostatic hyperplasia (BPH), between 2010 and 2020. We constructed tissue microarray for immunohistochemistry (IHC) analysis. In the final cohort (76 BPH and 284 PC), 57 (15.8%) patients had diabetes, 17 (22.37%) in BPH and 40 (14.08%) in PC (P = 0.08). IR-α was more expressed in patients with PC compared to the BPH Group (95.96% vs 4.04%; P <0.01). We found that AR was associated with increased risk of International Society of Urological Pathology (ISUP) score ≥4 (OR: 2.2; P <0.05), higher association with Ki-67 (OR: 2.2; P <0.05) and IR-α (OR: 5.7; P <0.05); IGF-1 receptor was associated with PSMA (OR: 2.8; P <0.05), Ki-67 (OR: 3.5; P <0.05) and IR-β (OR: 5.1; P <0.05). Finally, IGF-1 receptor was predictive of ISUP ≥ 4 (OR: 16.5; P =0.017) in patients with PC and diabetes. In the present study we highlighted how prostate cancer patients have a different protein expression in the tissue. This expression, and in particular that relating to IGF-1R, is associated with greater tumor aggressiveness in those patients with diabetes. We suppose that these results are attributable to an alteration of the insulin signal which therefore determines a greater mitogenic activity that can influence tumor progression.
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Affiliation(s)
- Giuseppe Broggi
- Department of Medical and Surgical Sciences and Advanced Technologies "G. F. Ingrassia", Anatomic Pathology, University of Catania, 95123, Catania, Italy
| | - Arturo Lo Giudice
- Department of Surgery, Urology Section, University of Catania, Catania, Italy; Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Marina Di Mauro
- Department of Surgery, Urology Section, University of Catania, Catania, Italy
| | - Elisabetta Pricoco
- Department of Surgery, Urology Section, University of Catania, Catania, Italy
| | - Eliana Piombino
- Department of Experimental Oncology, Mediterranean Institute of Oncology (IOM), 95029, Catania, Italy
| | - Matteo Ferro
- Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Rosario Caltabiano
- Department of Medical and Surgical Sciences and Advanced Technologies "G. F. Ingrassia", Anatomic Pathology, University of Catania, 95123, Catania, Italy
| | - Giuseppe Morgia
- Department of Surgery, Urology Section, University of Catania, Catania, Italy; Department of Experimental Oncology, Mediterranean Institute of Oncology (IOM), 95029, Catania, Italy
| | - Giorgio Ivan Russo
- Department of Surgery, Urology Section, University of Catania, Catania, Italy.
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7
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Lee H, Byun SS, Lee SE, Hong SK. Impact of poor glycemic control upon clinical outcomes after radical prostatectomy in localized prostate cancer. Sci Rep 2021; 11:12002. [PMID: 34099748 PMCID: PMC8184888 DOI: 10.1038/s41598-021-91310-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/20/2021] [Indexed: 12/29/2022] Open
Abstract
To evaluate the clinical impact of preoperative glycemic status upon oncological and functional outcomes after radical prostatectomy in patients with localized prostate cancer, we analyzed the data of 2664 subjects who underwent radical prostatectomy with preoperative measurement of hemoglobin A1c within 6 months before surgery. The possible association between high hemoglobin A1c (≥ 6.5 ng/dL) and oncological/functional outcomes was evaluated. Among all subjects, 449 (16.9%) were categorized as the high hemoglobin A1c group and 2215 (83.1%) as the low hemoglobin A1c group. High hemoglobin A1c was associated with worse pathological outcomes including extra-capsular extension (HR 1.277, 95% CI 1.000–1.630, p = 0.050) and positive surgical margin (HR 1.302, 95% CI 1.012–1.674, p = 0.040) in multi-variate regression tests. Kaplan–Meier analysis showed statistically shorter biochemical recurrence-free survival in the high hemoglobin A1c group (p < 0.001), and subsequent multivariate Cox proportional analyses revealed that high hemoglobin A1c is an independent predictor for shorter BCR-free survival (HR 1.135, 95% CI 1.016–1.267, p = 0.024). Moreover, the high hemoglobin A1c group showed a significantly longer incontinence-free survival than the low hemoglobin A1c group (p = 0.001), and high preoperative hemoglobin A1c was also an independent predictor for longer incontinence-free survival in multivariate Cox analyses (HR 0.929, 95% CI 0.879–0.981, p = 0.008). The high preoperative hemoglobin A1c level was independently associated with worse oncological outcomes and also with inferior recovery of urinary continence after radical prostatectomy.
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Affiliation(s)
- Hakmin Lee
- Department of Urology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, 463-707, Gyeonggi-do, Korea.,Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, 463-707, Gyeonggi-do, Korea.,Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Eun Lee
- Department of Urology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, 463-707, Gyeonggi-do, Korea.,Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Kyu Hong
- Department of Urology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, 463-707, Gyeonggi-do, Korea. .,Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
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8
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Increased Expressions of Matrix Metalloproteinases (MMPs) in Prostate Cancer Tissues of Men with Type 2 Diabetes. Biomedicines 2020; 8:biomedicines8110507. [PMID: 33207809 PMCID: PMC7696165 DOI: 10.3390/biomedicines8110507] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 11/07/2020] [Accepted: 11/12/2020] [Indexed: 12/12/2022] Open
Abstract
Type 2 diabetes (T2D) is associated with worse prognosis of prostate cancer (PCa). The molecular mechanisms behind this association are still not fully understood. The aim of this study was to identify key factors, which contribute to the more aggressive PCa phenotype in patients with concurrent T2D. Therefore, we investigated benign and PCa tissue of PCa patients with and without diabetes using real time qPCR. Compared to patients without diabetes, patients with T2D showed a decreased E-cadherin/N-cadherin (CDH1/CDH2) ratio in prostate tissue, indicating a switch of epithelial-mesenchymal transition (EMT), which is a pivotal process in carcinogenesis. In addition, the gene expression levels of matrix metalloproteinases (MMPs) and CC chemokine ligands (CCLs) were higher in prostate samples of T2D patients. Next, prostate adenocarcinoma PC3 cells were treated with increasing glucose concentrations to replicate hyperglycemia in vitro. In these cells, high glucose induced expressions of MMPs and CCLs, which showed significant positive associations with the proliferation marker proliferating cell nuclear antigen (PCNA). These results indicate that in prostate tissue of men with T2D, hyperglycemia may induce EMT, increase MMP and CCL gene expressions, which in turn activate invasion and inflammatory processes accelerating the progression of PCa.
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Franko A, Berti L, Guirguis A, Hennenlotter J, Wagner R, Scharpf MO, de Angelis MH, Wißmiller K, Lickert H, Stenzl A, Birkenfeld AL, Peter A, Häring HU, Lutz SZ, Heni M. Characterization of Hormone-Dependent Pathways in Six Human Prostate-Cancer Cell Lines: A Gene-Expression Study. Genes (Basel) 2020; 11:E1174. [PMID: 33036464 PMCID: PMC7599530 DOI: 10.3390/genes11101174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/26/2020] [Accepted: 09/30/2020] [Indexed: 12/13/2022] Open
Abstract
Prostate cancer (PCa), the most incident cancer in men, is tightly regulated by endocrine signals. A number of different PCa cell lines are commonly used for in vitro experiments, but these are of diverse origin, and have very different cell-proliferation rates and hormone-response capacities. By analyzing the gene-expression pattern of main hormone pathways, we systematically compared six PCa cell lines and parental primary cells. We compared these cell lines (i) with each other and (ii) with PCa tissue samples from 11 patients. We found major differences in the gene-expression levels of androgen, insulin, estrogen, and oxysterol signaling between PCa tissue and cell lines, and between different cell lines. Our systematic characterization gives researchers a solid basis to choose the appropriate PCa cell model for the hormone pathway of interest.
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Affiliation(s)
- Andras Franko
- Department of Internal Medicine IV, Division of Diabetology, Endocrinology, and Nephrology, University Hospital Tübingen, 72076 Tübingen, Germany; (A.F.); (R.W.); (A.L.B.); (H.-U.H.); (S.Z.L.); (M.H.)
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen, 72076 Tübingen, Germany;
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany; (M.H.d.A.); (H.L.)
| | - Lucia Berti
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen, 72076 Tübingen, Germany;
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany; (M.H.d.A.); (H.L.)
| | - Alke Guirguis
- Department for Diagnostic Laboratory Medicine, Institute for Clinical Chemistry and Pathobiochemistry, University Hospital Tübingen, 72076 Tübingen, Germany;
| | - Jörg Hennenlotter
- Department of Urology, University Hospital Tübingen, 72076 Tübingen, Germany; (J.H.); (A.S.)
| | - Robert Wagner
- Department of Internal Medicine IV, Division of Diabetology, Endocrinology, and Nephrology, University Hospital Tübingen, 72076 Tübingen, Germany; (A.F.); (R.W.); (A.L.B.); (H.-U.H.); (S.Z.L.); (M.H.)
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen, 72076 Tübingen, Germany;
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany; (M.H.d.A.); (H.L.)
| | - Marcus O. Scharpf
- Institute of Pathology, University Hospital Tübingen, 72076 Tübingen, Germany;
| | - Martin Hrabĕ de Angelis
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany; (M.H.d.A.); (H.L.)
- Institute of Experimental Genetics, Helmholtz Zentrum München, 85764 Neuherberg, Germany
| | - Katharina Wißmiller
- Institute of Diabetes and Regeneration Research, Helmholtz Zentrum München, 85764 Neuherberg, Germany;
- Institute of Stem Cell Research, Helmholtz Zentrum München, 85764 Neuherberg, Germany
- Department of Medicine, Technical University of Munich, 81675 München, Germany
| | - Heiko Lickert
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany; (M.H.d.A.); (H.L.)
- Institute of Diabetes and Regeneration Research, Helmholtz Zentrum München, 85764 Neuherberg, Germany;
- Institute of Stem Cell Research, Helmholtz Zentrum München, 85764 Neuherberg, Germany
- Department of Medicine, Technical University of Munich, 81675 München, Germany
| | - Arnulf Stenzl
- Department of Urology, University Hospital Tübingen, 72076 Tübingen, Germany; (J.H.); (A.S.)
| | - Andreas L. Birkenfeld
- Department of Internal Medicine IV, Division of Diabetology, Endocrinology, and Nephrology, University Hospital Tübingen, 72076 Tübingen, Germany; (A.F.); (R.W.); (A.L.B.); (H.-U.H.); (S.Z.L.); (M.H.)
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen, 72076 Tübingen, Germany;
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany; (M.H.d.A.); (H.L.)
| | - Andreas Peter
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen, 72076 Tübingen, Germany;
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany; (M.H.d.A.); (H.L.)
- Department for Diagnostic Laboratory Medicine, Institute for Clinical Chemistry and Pathobiochemistry, University Hospital Tübingen, 72076 Tübingen, Germany;
| | - Hans-Ulrich Häring
- Department of Internal Medicine IV, Division of Diabetology, Endocrinology, and Nephrology, University Hospital Tübingen, 72076 Tübingen, Germany; (A.F.); (R.W.); (A.L.B.); (H.-U.H.); (S.Z.L.); (M.H.)
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen, 72076 Tübingen, Germany;
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany; (M.H.d.A.); (H.L.)
| | - Stefan Z. Lutz
- Department of Internal Medicine IV, Division of Diabetology, Endocrinology, and Nephrology, University Hospital Tübingen, 72076 Tübingen, Germany; (A.F.); (R.W.); (A.L.B.); (H.-U.H.); (S.Z.L.); (M.H.)
- Clinic for Geriatric and Orthopedic Rehabilitation Bad Sebastiansweiler, 72116 Mössingen, Germany
| | - Martin Heni
- Department of Internal Medicine IV, Division of Diabetology, Endocrinology, and Nephrology, University Hospital Tübingen, 72076 Tübingen, Germany; (A.F.); (R.W.); (A.L.B.); (H.-U.H.); (S.Z.L.); (M.H.)
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen, 72076 Tübingen, Germany;
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany; (M.H.d.A.); (H.L.)
- Department for Diagnostic Laboratory Medicine, Institute for Clinical Chemistry and Pathobiochemistry, University Hospital Tübingen, 72076 Tübingen, Germany;
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10
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Determining the Impact of a Cancer Diagnosis on Diabetes Management: A Systematic Literature Review. Am J Clin Oncol 2020; 42:870-883. [PMID: 31592804 DOI: 10.1097/coc.0000000000000612] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Cancer patients with comorbid diabetes have a 50% increased risk of all-cause mortality compared with cancer patients without diabetes. Less attention to diabetes management (glucose control, medication adherence, and diabetes self-management behaviors) during active cancer treatment is hypothesized as an explanation for worse outcomes among diabetic cancer patients. The objective of this systematic review is to determine and quantify how a cancer diagnosis impacts diabetes management. METHODS Quantitative and qualitative studies evaluating diabetes management among patients were identified by searching 4 databases: MEDLINE, EMBASE, The Cochrane Library, and Web of Science. Two independent reviewers extracted data and summarized results from eligible studies. Study quality was formally assessed. RESULTS Thirty-six studies met all inclusion criteria. We observed heterogeneity across studies in terms of study design, sample size, cancer site, type of diabetes management evaluated, and quality. Numerous articles discussed that overall, glucose control, medication adherence, and diabetes self-management behaviors declined following a cancer diagnosis. However, findings were inconsistent across studies. CONCLUSIONS Although the effects of a cancer diagnosis on diabetes management are mixed, when results across studies were synthesized together, diabetes management appeared to generally decline after a cancer diagnosis. Declines in diabetes management seem to be primarily due to shifts in the priority of care from diabetes management to cancer. A next critical step in this line of work is to identify patient and provider level predictors of better or worse diabetes management to design and test interventions aimed at improving effective diabetes management for cancer patients.
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11
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Schenk JM, Neuhouser ML, Beatty SJ, VanDoren M, Lin DW, Porter M, Gore JL, Gulati R, Plymate SR, Wright JL. Randomized trial evaluating the role of weight loss in overweight and obese men with early stage prostate Cancer on active surveillance: Rationale and design of the Prostate Cancer Active Lifestyle Study (PALS). Contemp Clin Trials 2019; 81:34-39. [PMID: 31002955 PMCID: PMC6527481 DOI: 10.1016/j.cct.2019.04.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/26/2019] [Accepted: 04/04/2019] [Indexed: 12/01/2022]
Abstract
Active surveillance (AS) is increasingly used to monitor patients with low-risk prostate cancer; however, approximately 50% of AS patients experience disease reclassification requiring definitive treatment and little is known about patient characteristics that modify the risk of reclassification. Obesity may be one of the major contributing factors. The Prostate Cancer Active Lifestyle Study (PALS) is a clinical trial evaluating the impact of weight loss among overweight/obese (Body Mass Index (BMI) ≥ 25 kg/m2) men with clinically localized prostate cancer on AS. Two hundred participants will be randomized to either the PALS intervention, a 6-month structured diet and exercise program adapted from the Diabetes Prevention Program followed by 6 months of maintenance, or control (general diet and physical activity guidelines delivered in a single session). The PALS intervention involves one-on-one instruction with a registered dietitian and exercise physiologist to achieve the study goal of loss of 7% of baseline weight. Participation is coordinated so that the 6-month time point coincides with the participants' standard-of-care AS prostate biopsy. Primary outcomes will evaluate the intervention effects on circulating and tissue markers of glucose and insulin regulation, health-related quality of life and pathologic upgrading on follow-up prostate biopsies. Additional analyses will determine whether changes in weight and glucose regulation can be sustained for 6 months after the end of instruction. Findings from this trial may have wide reaching implications for men diagnosed with clinically-localized prostate cancer by providing an active lifestyle-based approach to improve prostate cancer patient outcomes.
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Affiliation(s)
| | | | | | | | - Daniel W Lin
- Fred Hutchinson Cancer Research Center, United States; University of Washington, United States
| | - Michael Porter
- Veterans Affairs Puget Sound Health Care System, United States; University of Washington, United States
| | | | - Roman Gulati
- Fred Hutchinson Cancer Research Center, United States
| | | | - Jonathan L Wright
- Fred Hutchinson Cancer Research Center, United States; Veterans Affairs Puget Sound Health Care System, United States; University of Washington, United States
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12
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Nik-Ahd F, Howard LE, Eisenberg AT, Aronson WJ, Terris MK, Cooperberg MR, Amling CL, Kane CJ, Freedland SJ. Poorly controlled diabetes increases the risk of metastases and castration-resistant prostate cancer in men undergoing radical prostatectomy: Results from the SEARCH database. Cancer 2019; 125:2861-2867. [PMID: 31034601 DOI: 10.1002/cncr.32141] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 01/31/2019] [Accepted: 03/14/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Although diabetes is inversely related to prostate cancer (PC) risk, to the authors' knowledge the impact of glycemic control on PC progression is unknown. In the current study, the authors tested the association between hemoglobin A1c (HbA1c) and long-term PC outcomes among diabetic men undergoing radical prostatectomy (RP). METHODS The authors retrospectively reviewed data regarding men undergoing RP from 2000 to 2017 at 8 Veterans Affairs hospitals. Diabetic patients were identified using International Classification of Diseases, Ninth Revision (ICD-9) codes (250.x) or by an HbA1c value >6.5% at any time before RP. Cox models tested the association between HbA1c and biochemical disease recurrence (BCR), castration-resistant PC (CRPC), metastases, PC-specific mortality, and all-cause mortality. The model for BCR was adjusted for multiple variables. Due to limited events, models for long-term outcomes were adjusted for biopsy grade and prostate-specific antigen only. RESULTS A total of 1409 men comprised the study population. Of these, 699 patients (50%) had an HbA1c value <6.5%, 631 (45%) had an HbA1c value of 6.5% to 7.9%, and 79 (6%) had an HbA1c value ≥8.0%. Men with an HbA1c value ≥8.0% were younger (P < .001) and more likely to be black (P = .013). The median follow-up after RP was 6.8 years (interquartile range, 3.7-10.6 years). On multivariable analysis, HbA1c was not found to be associated with BCR. However, a higher HbA1c value was associated with metastasis (hazard ratio [HR], 1.21; 95% CI, 1.02-1.44 [P = .031]) and CRPC (HR, 1.27; 95% CI, 1.03-1.56 [P = .023]). Although not statistically significant, there were trends between higher HbA1c and risk of PC-specific mortality (HR, 1.24; 95% CI, 0.99-1.56 [P = .067]) and all-cause mortality (HR, 1.09; 95% CI, 0.99-1.19 [P = .058]). CONCLUSIONS Among diabetic men undergoing RP, a higher HbA1c value was associated with metastases and CRPC. If validated in larger studies with longer follow-up, future research should test whether better glycemic control improves long-term PC outcomes.
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Affiliation(s)
- Farnoosh Nik-Ahd
- David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Lauren E Howard
- Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina.,Division of Urology, Veterans Affairs Medical Center, Durham, North Carolina
| | - Adva T Eisenberg
- Department of Endocrinology, Duke University School of Medicine, Durham, North Carolina
| | - William J Aronson
- Department of Urology, University of California at Los Angeles School of Medicine, Los Angeles, California.,Urology Section, Department of Surgery, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Martha K Terris
- Section of Urology, Veterans Affairs Medical Center, Augusta, Georgia.,Section of Urology, Medical College of Georgia, Augusta, Georgia
| | - Matthew R Cooperberg
- Department of Urology, University of California at San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Christopher L Amling
- Division of Urology, Department of Surgery, Oregon Health and Science University, Portland, Oregon
| | - Christopher J Kane
- Department of Urology, University of California at San Diego Health System, San Diego, California
| | - Stephen J Freedland
- Division of Urology, Department of Surgery, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
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13
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Lutz SZ, Todenhöfer T, Wagner R, Hennenlotter J, Ferchl JM, Scharpf MO, Martus P, Staiger H, Fritsche A, Stenzl A, Häring HU, Heni M. Higher prevalence of lymph node metastasis in prostate cancer in patients with diabetes. Endocr Relat Cancer 2018; 25:L19-L22. [PMID: 29330196 DOI: 10.1530/erc-17-0465] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/04/2018] [Indexed: 01/01/2023]
Affiliation(s)
- Stefan Zoltán Lutz
- Department of Internal MedicineDivision of Endocrinology, Diabetology, Vascular Disease, Nephrology and Clinical Chemistry, University of Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center MunichUniversity of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD)Munich-Neuherberg, Germany
| | | | - Robert Wagner
- Department of Internal MedicineDivision of Endocrinology, Diabetology, Vascular Disease, Nephrology and Clinical Chemistry, University of Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center MunichUniversity of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD)Munich-Neuherberg, Germany
| | | | - Jana Marlene Ferchl
- Department of Internal MedicineDivision of Endocrinology, Diabetology, Vascular Disease, Nephrology and Clinical Chemistry, University of Tübingen, Tübingen, Germany
| | | | - Peter Martus
- Institute of Clinical Epidemiology and applied BiostatisticsUniversity of Tübingen, Tübingen, Germany
| | - Harald Staiger
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center MunichUniversity of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD)Munich-Neuherberg, Germany
- Institute of Pharmaceutical SciencesDepartment of Pharmacy and Biochemistry, University of Tübingen, Tübingen, Germany
| | - Andreas Fritsche
- Department of Internal MedicineDivision of Endocrinology, Diabetology, Vascular Disease, Nephrology and Clinical Chemistry, University of Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center MunichUniversity of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD)Munich-Neuherberg, Germany
| | - Arnulf Stenzl
- Department of UrologyUniversity of Tübingen, Tübingen, Germany
| | - Hans-Ulrich Häring
- Department of Internal MedicineDivision of Endocrinology, Diabetology, Vascular Disease, Nephrology and Clinical Chemistry, University of Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center MunichUniversity of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD)Munich-Neuherberg, Germany
| | - Martin Heni
- Department of Internal MedicineDivision of Endocrinology, Diabetology, Vascular Disease, Nephrology and Clinical Chemistry, University of Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center MunichUniversity of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD)Munich-Neuherberg, Germany
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14
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Meta-analysis of metabolic syndrome and prostate cancer. Prostate Cancer Prostatic Dis 2017; 20:146-155. [DOI: 10.1038/pcan.2017.1] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 10/31/2016] [Accepted: 11/29/2016] [Indexed: 12/20/2022]
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15
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Joentausta RM, Kujala PM, Visakorpi T, Tammela TLJ, Murtola TJ. Tumor features and survival after radical prostatectomy among antidiabetic drug users. Prostate Cancer Prostatic Dis 2016; 19:367-373. [DOI: 10.1038/pcan.2016.32] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 05/28/2016] [Accepted: 06/25/2016] [Indexed: 12/13/2022]
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16
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Dankner R, Boffetta P, Keinan-Boker L, Balicer RD, Berlin A, Olmer L, Murad H, Silverman B, Hoshen M, Freedman LS. Diabetes, prostate cancer screening and risk of low- and high-grade prostate cancer: an 11 year historical population follow-up study of more than 1 million men. Diabetologia 2016; 59:1683-91. [PMID: 27189066 PMCID: PMC4930460 DOI: 10.1007/s00125-016-3972-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 04/06/2016] [Indexed: 12/12/2022]
Abstract
AIMS/HYPOTHESIS An inverse association has consistently been shown between diabetes and prostate cancer incidence. We investigated whether lower prostate cancer incidence among men with diabetes is attributable to lower detection due to prostate cancer screening patterns. METHODS We studied a population-based historical cohort of 1,034,074 Israeli men aged 21-90 years, without a previous history of cancer. The cohort was followed-up from 2002 to 2012, according to diabetes morbidity, for frequency of prostate-specific antigen (PSA) testing, mean PSA values and detection of prostate cancer, after adjustment for age, ethnic origin, socioeconomic status and PSA testing. RESULTS In January 2002, 74,756 men had prevalent diabetes. During the 11 year follow-up, 765,483 (74%) remained diabetes-free and 193,835 developed diabetes. Approximately 10% more PSA screening was performed in men with than without diabetes, but the rate of PSA positivity (>4 μg/l) was 20% lower in men with diabetes. PSA values were already significantly lower in men who developed diabetes than in those who did not, 3 years before diabetes diagnosis. Reduced prostate cancer risk was observed among men with incident diabetes only for low-moderate grade tumours (Gleason score 2-6: adjusted HR 0.83; 95% CI 0.77, 0.89). No association was observed for high-grade tumours (Gleason score 7-10: HR 0.99; 95% CI 0.88, 1.11). CONCLUSIONS/INTERPRETATION Our findings suggest that diabetes comorbidity is a factor to be considered in prostate cancer screening strategies, and specifically in the interpretation of PSA levels. Furthermore, our demonstration of reduced incidence of low-moderate grade but not high-grade prostate cancer tumours among men with diabetes supports the possibility that low PSA levels, rather than lower tumour risk, explains the observed reduced incidence of prostate cancer in men with diabetes. TRIAL REGISTRATION ClinicalTrials.gov NCT02072902.
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Affiliation(s)
- Rachel Dankner
- Unit for Cardiovascular Epidemiology, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, 52621, Israel.
- Sackler Faculty of Medicine, School of Public Health, Department of Epidemiology and Preventive Medicine, Tel Aviv University, Tel Aviv, Israel.
- Patient Oriented Research, The Feinstein Institute for Medical Research, Manhasset, NY, USA.
| | - Paolo Boffetta
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lital Keinan-Boker
- Israel Center for Disease Control (ICDC), Israel Ministry of Health, Tel Hashomer, Israel
- School of Public Health, Faculty of Social Welfare and Health Sciences, Haifa University, Haifa, Israel
| | - Ran D Balicer
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel
- Public Health Department, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Alla Berlin
- Unit for Cardiovascular Epidemiology, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, 52621, Israel
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel
| | - Liraz Olmer
- Biostatistics Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Havi Murad
- Biostatistics Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Barbara Silverman
- Sackler Faculty of Medicine, School of Public Health, Department of Epidemiology and Preventive Medicine, Tel Aviv University, Tel Aviv, Israel
- Israel Center for Disease Control (ICDC), Israel Ministry of Health, Tel Hashomer, Israel
| | - Moshe Hoshen
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel
| | - Laurence S Freedman
- Sackler Faculty of Medicine, School of Public Health, Department of Epidemiology and Preventive Medicine, Tel Aviv University, Tel Aviv, Israel
- Biostatistics Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
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17
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Lee H, Kuk H, Byun SS, Lee SE, Hong SK. Preoperative glycemic control status as a significant predictor of biochemical recurrence in prostate cancer patients after radical prostatectomy. PLoS One 2015; 10:e0124761. [PMID: 25897669 PMCID: PMC4405577 DOI: 10.1371/journal.pone.0124761] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 03/07/2015] [Indexed: 11/18/2022] Open
Abstract
Background The effect of diabetes mellitus (DM) on prostate cancer (PCa) outcome remains controversial. Thus, we investigated the association of DM history, glycemic control, and metformin use with oncologic outcomes after radical prostatectomy (RP). Methods We reviewed the records of 746 contemporary patients who had hemoglobin A1c (HbA1c) measured within the 6 months preceding RP. The associations between clinical variables and risk of adverse pathological features and biochemical recurrence (BCR) were tested using a multivariate logistic regression and multiple Cox-proportional hazards model, respectively. BCR was defined as prostatic specific antigen (PSA) > 0.2 ng/mL in 2 consecutive tests. Results There were no significant differences in the rates of adverse pathologic features and BCR-free survival between patients with (n = 209) and without (n = 537) a history of DM diagnosis (all p > 0.05). In multivariate analyses, high HbA1c level (≥ 6.5%) was significantly related with high pathologic Gleason score (≥ 4+3; odds ratio [OR] 1.704, p = 0.019) and BCR-free survival (OR 1.853, p = 0.007). Metformin use was not associated with BCR-free survival (OR 0.662, p = 0.125). Conclusions Poor glycemic control was significantly associated with BCR after RP. Meanwhile, metformin use was not associated with biochemical outcome after RP. Further investigation would be needed to identify exact mechanism underlying the impact of glycemic control on PCa treatment outcome.
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Affiliation(s)
- Hakmin Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Harim Kuk
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang Eun Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung Kyu Hong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
- * E-mail:
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18
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Park J, Cho SY, Lee YJ, Lee SB, Son H, Jeong H. Poor glycemic control of diabetes mellitus is associated with higher risk of prostate cancer detection in a biopsy population. PLoS One 2014; 9:e104789. [PMID: 25198675 PMCID: PMC4157745 DOI: 10.1371/journal.pone.0104789] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 07/13/2014] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES To evaluate the impact of glycemic control of diabetes mellitus (DM) on prostate cancer detection in a biopsy population. PATIENTS AND METHODS We retrospectively reviewed the records of 1,368 men who underwent prostate biopsy at our institution. We divided our biopsy population into three groups according to their history of DM, and their Hemoglobin A1c (HbA1c) level: a no-DM (DM-) group; a good glycemic control (DM+GC) group (HbA1c <6.5%); and a poor glycemic control (DM+PC) group (HbA1c ≥6.5%). For sub-analyses, the DM+PC group was divided into a moderately poor glycemic control (DM+mPC) group (6.5≤ HbA1c <7.5%) and a severely poor glycemic control (DM+sPC) group (HbA1c ≥7.5%). RESULTS Among 1,368 men, 338 (24.7%) had a history of DM, and 393 (28.7%) had a positive biopsy. There was a significant difference in prostatic specific antigen density (PSAD) (P = 0.037) and the frequency of abnormal DRE findings (P = 0.031) among three groups. The occurrence rate of overall prostate cancer (P<0.001) and high-grade prostate cancer (P = 0.016) also presented with a significantly difference. In the multivariate analysis, the DM+PC group was significantly associated with a higher rate of overall prostate cancer detection in biopsy subjects compared to the DM- group (OR = 2.313, P = 0.001) but the DM+PC group was not associated with a higher rate of high-grade (Gleason score ≥7) diseases detected during the biopsy (OR = 1.297, P = 0.376). However, in subgroup analysis, DM+sPC group was significantly related to a higher risk of high-grade diseases compared to the DM- group (OR = 2.446, P = 0.048). CONCLUSIONS Poor glycemic control of DM was associated with a higher risk of prostate cancer detection, including high-grade disease, in the biopsy population.
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Affiliation(s)
- Juhyun Park
- Department of Urology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Dongjak-gu, Seoul, Korea
| | - Sung Yong Cho
- Department of Urology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Dongjak-gu, Seoul, Korea
| | - Young Ju Lee
- Department of Urology, Seoul National University Hospital 101, Daehak-Ro Jongno-gu, Seoul, Korea
| | - Seung Bae Lee
- Department of Urology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Dongjak-gu, Seoul, Korea
| | - Hwancheol Son
- Department of Urology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Dongjak-gu, Seoul, Korea
| | - Hyeon Jeong
- Department of Urology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Dongjak-gu, Seoul, Korea
- * E-mail:
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19
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Ozbek E, Otunctemur A, Dursun M, Sahin S, Besiroglu H, Koklu I, Erkoc M, Danis E, Bozkurt M. Diabetes Mellitus and HbA1c Levels Associated with High Grade Prostate Cancer. Asian Pac J Cancer Prev 2014; 15:2555-8. [DOI: 10.7314/apjcp.2014.15.6.2555] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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20
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de Beer JC, Liebenberg L. Does cancer risk increase with HbA1c, independent of diabetes? Br J Cancer 2014; 110:2361-8. [PMID: 24675382 PMCID: PMC4007234 DOI: 10.1038/bjc.2014.150] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 02/24/2014] [Accepted: 02/26/2014] [Indexed: 12/31/2022] Open
Abstract
Background: The risks for several cancer types are increased in people with diabetes. Hyperglycaemia, hyperinsulinaemia, inflammation and altered hormonal concentrations are common characteristics between the two diseases and can all be linked to hyperglycaemia. Methods: Here, we use glycated haemoglobin (HbA1c) as a biomarker for chronic hyperglycaemia. We explore whether cancer risk increases with HbA1c, independent of diabetes, and, therefore, if risk is already increased below the diabetic HbA1c range, by analysing data from current studies linking HbA1c to risk of several cancer types. Results: The data reveal that chronic hyperglycaemia correlates with increased cancer risk for a number of cancers, except prostate cancer. Evidence is also provided that risk is already increased in the pre-diabetic and normal ranges for several cancers. Conclusions: These results merit urgent investigation into the risks and advantages of updating recommendations for stricter glycaemic control in diabetic and non-diabetic subjects, as this could help reduce the risk of cancer incidence and mortality.
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Affiliation(s)
- J C de Beer
- Center for Research and Continued Engineering Development, North-West University (Pretoria Campus), Suite No. 91, Private Bag X30, Lynnwood Ridge, Pretoria 0040, South Africa
| | - L Liebenberg
- 1] Center for Research and Continued Engineering Development, North-West University (Pretoria Campus), Suite No. 91, Private Bag X30, Lynnwood Ridge, Pretoria 0040, South Africa [2] TEMM International (Pty) Ltd, Pretoria, South Africa
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21
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Abstract
The age-related epithelial cancers of the breast, colorectum and prostate are the most prevalent and are increasing in our aging populations. Epithelial cells turnover rapidly and mutations naturally accumulate throughout life. Most epithelial cancers arise from this normal mutation rate. All elderly individuals will harbour many cells with the requisite mutations and most will develop occult neoplastic lesions. Although essential for initiation, these mutations are not sufficient for the progression of cancer to a life-threatening disease. This progression appears to be dependent on context: the tissue ecosystem within individuals and lifestyle exposures across populations of individuals. Together, this implies that the seeds may be plentiful but they only germinate in the right soil. The incidence of these cancers is much lower in Eastern countries but is increasing with Westernisation and increases more acutely in migrants to the West. A Western lifestyle is strongly associated with perturbed metabolism, as evidenced by the epidemics of obesity and diabetes: this may also provide the setting enabling the progression of epithelial cancers. Epidemiology has indicated that metabolic biomarkers are prospectively associated with cancer incidence and prognosis. Furthermore, within cancer research, there has been a rediscovery that a switch in cell metabolism is critical for cancer progression but this is set within the metabolic status of the host. The seed may only germinate if the soil is fertile. This perspective brings together the different avenues of investigation implicating the role that metabolism may play within the context of post-genomic concepts of cancer.
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Affiliation(s)
- Jeff M P Holly
- School of Clinical Science, Faculty of Medicine, University of Bristol, Learning and Research Building, Southmead Hospital, Bristol, BS10 5NB, UK,
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22
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Allott EH, Abern MR, Gerber L, Keto CJ, Aronson WJ, Terris MK, Kane CJ, Amling CL, Cooperberg MR, Moorman PG, Freedland SJ. Metformin does not affect risk of biochemical recurrence following radical prostatectomy: results from the SEARCH database. Prostate Cancer Prostatic Dis 2013; 16:391-7. [PMID: 24100644 PMCID: PMC3830588 DOI: 10.1038/pcan.2013.48] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 09/05/2013] [Accepted: 09/09/2013] [Indexed: 02/08/2023]
Abstract
Background While epidemiologic studies suggest that metformin use among diabetics may decrease prostate cancer (PC) incidence, the effect of metformin use on PC outcome is unclear. We investigated the association between pre-operative metformin use, dose and duration of use and biochemical recurrence (BCR) in PC patients with diabetes who underwent radical prostatectomy (RP). Methods We conducted a retrospective cohort analysis within the Shared Equal Access Regional Cancer Hospital (SEARCH) database of 371 PC patients with diabetes who underwent RP. Time to BCR between metformin users and non-users, and by metformin dose and duration of use was assessed using multivariable Cox proportional analysis adjusted for demographic, clinical and/or pathologic features. Time to castrate-resistant PC (CPRC), metastases and PC-specific mortality were explored as secondary outcomes using unadjusted analyses. Results Of 371 diabetic men, 156 (42%) were using metformin prior to RP. Metformin use was associated with more recent year of surgery (p<0.0001) but no clinical or pathologic characteristics. After adjustment for year of surgery, clinical and pathologic features, there were no associations between metformin use (HR 0.93; 95%CI 0.61–1.41), high metformin dose (HR 0.96; 95%CI 0.57–1.61) or duration of use (HR 1.00; 95%CI 0.99–1.02) and time to BCR. A total of 14 patients (3.8%) developed CRPC, 10 (2.7%) distant metastases and 8 (2.2%) died from PC. Unadjusted analysis suggested high metformin dose versus non-use was associated with increased risk of CRPC (HR 5.1; 95%CI 1.6–16.5), metastases (HR 4.8; 95%CI 1.2–18.5) and PC-specific mortality (HR 5.0; 95%CI 1.1–22.5). Conclusions Metformin use, dose or duration of use was not associated with BCR in this cohort of diabetic PC patients treated with RP. The suggestion that higher metformin dose was associated with increased risk of CPRC, metastases and PC-specific mortality merits testing in large prospective studies with longer follow-up.
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Affiliation(s)
- E H Allott
- 1] Division of Urology, Department of Surgery, Duke University School of Medicine, Durham, NC, USA [2] Cancer Prevention, Detection and Control Program, Duke Cancer Institute, Durham, NC, USA [3] Section of Urology, Veterans Affairs Medical Center, Durham, NC, USA
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23
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Goncalves SC, de Moraes Siqueira R, Nogueira MVF, Pereira-Correia JA, Vaz FP, Peres WAF. The Relationship Between Prostate Cancer Aggressiveness and Glycemic Levels in Patients Submitted to Radical Prostatectomy. World J Oncol 2013; 4:87-94. [PMID: 29147337 PMCID: PMC5649674 DOI: 10.4021/wjon664e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2013] [Indexed: 11/03/2022] Open
Abstract
Background The relationship between hyperglycemia and prostate cancer remains controversial. According to current hypotheses, elevated serum glucose levels may lead to disease development or disease prevention. Our study examined the potential correlation between pre-operative glycemic levels of patients with prostate cancer and the grade of tumor aggressiveness. Method We studied the case files of patients with a diagnosis of prostate cancer who had received putatively curative cancer surgery at the Urology Department of the Servidores do Estado Federal Hospital (RJ/Brazil). We transcribed information related to glycemia - collected up to 3 months before the surgery - and the histopathological grade of tumor aggressiveness (Gleason score) of the surgically removed prostates. Results We analyzed 42 people who met the inclusion criteria. Based on Gleason scores, among the normoglycemic patients, we detected low, moderate, and highly aggressive neoplasias in 13%, 53%, and 36% of the cases, respectively. For the hyperglycemic group, these rates were 30%, 60%, and 10%, respectively. Normoglycemic patients had primary Gleason grade 3 in 40% of the cases and grade 4 in 60% of the cases. For the hyperglycemic patients, these rates were 90% and 10%, respectively (P < 0.05 vs. grade 3 group). Conclusion Both Gleason score and primary Gleason grade were lower in hyperglycemic patients with prostate cancer than in normoglycemic patients, suggesting a "protective action" of hyperglycemic states.
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Affiliation(s)
- Suzana Cristina Goncalves
- Department of Nutritional Biochemistry, Faculty of Nutrition, Federal University of Rio de Janeiro, Avenida Carlos Chagas Filho 373, Ilha do Fundao, Rio de Janeiro, RJ, Brazil
| | - Rafael de Moraes Siqueira
- Department of Urology, Servidores do Estado Federal Hospital, Rua Sacadura Cabral 120, Saude, Rio de Janeiro, RJ, Brazil
| | - Marcus Vinicius F Nogueira
- Department of Urology, Servidores do Estado Federal Hospital, Rua Sacadura Cabral 120, Saude, Rio de Janeiro, RJ, Brazil
| | - Joao Antonio Pereira-Correia
- Department of Urology, Servidores do Estado Federal Hospital, Rua Sacadura Cabral 120, Saude, Rio de Janeiro, RJ, Brazil
| | - Fernando Pires Vaz
- Department of Urology, Servidores do Estado Federal Hospital, Rua Sacadura Cabral 120, Saude, Rio de Janeiro, RJ, Brazil
| | - Wilza Arantes Ferreira Peres
- Department of Nutritional Biochemistry, Faculty of Nutrition, Federal University of Rio de Janeiro, Avenida Carlos Chagas Filho 373, Ilha do Fundao, Rio de Janeiro, RJ, Brazil
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Wright JL, Plymate SR, Porter MP, Gore JL, Lin DW, Hu E, Zeliadt SB. Hyperglycemia and prostate cancer recurrence in men treated for localized prostate cancer. Prostate Cancer Prostatic Dis 2013; 16:204-8. [PMID: 23459096 DOI: 10.1038/pcan.2013.5] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Obesity is consistently linked with prostate cancer (PCa) recurrence and mortality, though the mechanism is unknown. Impaired glucose regulation, which is common among obese individuals, has been hypothesized as a potential mechanism for PCa tumor growth. In this study, we explore the relationship between serum glucose at time of treatment and risk of PCa recurrence following initial therapy. METHODS The study group comprised 1734 men treated with radical prostatectomy (RP) or radiation therapy (RT) for localized PCa between 2001-2010. Serum glucose levels closest to date of diagnosis were determined. PCa recurrence was determined based on PSA progression (nadir PSA+2 for RT; PSA≥0.2 for RP) or secondary therapy. Multivariate Cox regression was performed to determine whether glucose level was associated with biochemical recurrence after adjusting for age, race, body mass index, comorbidity, diagnosis of diabetes, Gleason Sum, PSA, treatment and treatment year. RESULTS Recurrence was identified in 16% of men over a mean follow-up period of 41 months (range 1-121 months). Those with elevated glucose (≥100 mg/dl) had a 50% increased risk of recurrence (HR 1.5, 95% CI: 1.1-2.0) compared with those with a normal glucose level (<100 mg/dl). This effect was seen in both those undergoing RP (HR 1.9, 95% CI: 1.0-3.6) and those treated with RT (HR 1.4, 95% CI: 1.0-2.0). CONCLUSIONS Glucose levels at the time of PCa diagnosis are an independent predictor of PCa recurrence for men undergoing treatment for localized disease.
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Affiliation(s)
- J L Wright
- Department of Urology, University of Washington School of Medicine, Seattle, WA 98195, USA.
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25
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Sutcliffe S, Colditz GA. Prostate cancer: is it time to expand the research focus to early-life exposures? Nat Rev Cancer 2013; 13:208-518. [PMID: 23363989 PMCID: PMC3962783 DOI: 10.1038/nrc3434] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Although the contribution of lifestyle and environment (non-genetic factors) to prostate carcinogenesis is indicated by international variation in prostate cancer occurrence and migration studies, no conclusive modifiable risk factors have yet been identified. One possible reason for this may be the dearth of epidemiological research on exposures experienced early in life, when the immature prostate may be more susceptible to carcinogenic exposures. In this Opinion article, we summarize the rationale for studying early-life exposures, describe the small body of early-life research and its associated challenges, and point to solutions for future research.
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Affiliation(s)
- Siobhan Sutcliffe
- The Division of Public Health Sciences and Alvin J. Siteman Cancer Center, Department of Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, St. Louis, Missouri 63110, USA.
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Wu C, Aronson WJ, Terris MK, Presti JC, Kane CJ, Amling CL, Freedland SJ. Diabetes predicts metastasis after radical prostatectomy in obese men: results from the SEARCH database. BJU Int 2013; 111:E310-8. [PMID: 23305170 DOI: 10.1111/j.1464-410x.2012.11687.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To examine the association between diabetes and metastasis risk after radical prostatectomy (RP) and to determine if race or obesity modifies this relationship. PATIENTS AND METHODS Patients comprised 2058 US veterans with prostate cancer (PCa) enrolled in the Shared Equal-Access Regional Cancer Hospital (SEARCH) database and treated with RP between 1988 and 2010. The association of diabetes with metastasis risk or secondary treatment rates was examined using Cox proportional hazards, adjusting for preoperative and, separately, clinical and postoperative findings. The effect modification by race (black vs white) and obesity (body mass index [BMI] ≥30 vs <30 kg/m(2) ) was tested via interaction terms. RESULTS Men with diabetes had higher BMIs and were more likely to be non-white (all P ≤ 0.001). On multivariable analysis, diabetes was not associated with metastasis risk (P ≥ 0.45), but, among men with diabetes, longer diabetes duration was associated with higher metastasis risk (P ≤ 0.035). When stratified by obesity, diabetes was linked with higher metastasis risk in obese but not in non-obese men (P-interaction ≤ 0.037), but there was no significant interaction with race (P-interaction ≥ 0.56). Diabetes also predicted more aggressive secondary treatment among obese men but less aggressive treatment among non-obese men (hazard ratio 1.39 vs 0.63, P-interaction = 0.006). Where applicable, results were similar for both pre- and postoperative models. CONCLUSIONS Diabetes was not associated with metastasis risk overall. Stratification by obesity yielded significant differences, with diabetes linked to a fourfold higher metastasis risk in obese men, despite predicting more aggressive secondary treatment. Longer diabetes duration was also associated with increased metastasis risk.
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Affiliation(s)
- Chenwei Wu
- Duke University School of Medicine, Durham, NC, USA
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27
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Vitamin d levels in subjects with prostate cancer compared to age-matched controls. Prostate Cancer 2012; 2012:524206. [PMID: 23304521 PMCID: PMC3530178 DOI: 10.1155/2012/524206] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 11/25/2012] [Accepted: 11/27/2012] [Indexed: 12/31/2022] Open
Abstract
Prostate cancer (PCa) is the second most common cancer in men worldwide and the second leading cause of cancer deaths in men in the United States. Vitamin D is considered to have anticancer properties, currently thought to work mainly through its nuclear receptor or vitamin D receptor. In this retrospective study, we compared vitamin D levels in subjects with PCa with those of age-matched men without PCa. Study subjects included 479 in each group with a mean age of 73 and a mean creatinine of 1.05 and 1.15. Levels of 25 (OH) vitamin D were 28.4 ± 0.54 and 28.05 ± 0.62 in subjects with and without PCa. Levels of 1,25 (OH) vitamin D were 47.2 ± 6.8 and 47.1 ± 7.11 in subjects with and without PCa. In contrast to other studies, we did not find a significant difference in vitamin D levels. Among prostate cancer patients, vitamin D levels correlated positively with age (r = 0.12, P < 0.02), and were negatively associated with BMI (r = -0.13, P = 0.003), glucose (r = -0.12, P < 0.007), HbA1C (r = -0.16, P = 0.001), and PTH (r = -0.21; P < 0.0001). The data do not show the causal effect of vitamin D levels on PCa.
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Pelttari LM, Nurminen R, Gylfe A, Aaltonen LA, Schleutker J, Nevanlinna H. Screening of Finnish RAD51C founder mutations in prostate and colorectal cancer patients. BMC Cancer 2012; 12:552. [PMID: 23176254 PMCID: PMC3522023 DOI: 10.1186/1471-2407-12-552] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 11/13/2012] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Rare, heterozygous germline mutations in the RAD51C gene have been found in breast and ovarian cancer families. In the Finnish population, we have identified two founder mutations in RAD51C that increase the risk of ovarian cancer but not breast cancer in the absence of ovarian cancer. Risk for other cancers has not been studied. METHODS To study the role of RAD51C mutations in other common cancer types, we genotyped the Finnish RAD51C founder mutations c.837 + 1G > A and c.93delG in 1083 prostate cancer patients and 802 colorectal cancer patients using TaqMan Real-Time PCR. RESULTS No RAD51C mutations c.837 + 1G > A or c.93delG were detected among the prostate or colorectal cancer patients. CONCLUSIONS The results suggest that the RAD51C mutations do not predispose to prostate or colorectal cancer.
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Affiliation(s)
- Liisa M Pelttari
- Departments of Obstetrics and Gynecology, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
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29
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Sanz AB, Sanchez-Niño MD, Carrasco S, Manzarbeitia F, Ruiz-Andres O, Selgas R, Ruiz-Ortega M, Gonzalez-Enguita C, Egido J, Ortiz A. Inflammatory cytokines and survival factors from serum modulate tweak-induced apoptosis in PC-3 prostate cancer cells. PLoS One 2012; 7:e47440. [PMID: 23077618 PMCID: PMC3471822 DOI: 10.1371/journal.pone.0047440] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 09/17/2012] [Indexed: 12/24/2022] Open
Abstract
Tumor necrosis factor-like weak inducer of apoptosis (TWEAK, TNFSF12) is a member of the tumor necrosis factor superfamily. TWEAK activates the Fn14 receptor, and may regulate cell death, survival and proliferation in tumor cells. However, there is little information on the function and regulation of this system in prostate cancer. Fn14 expression and TWEAK actions were studied in two human prostate cancer cell lines, the androgen-independent PC-3 cell line and androgen-sensitive LNCaP cells. Additionally, the expression of Fn14 was analyzed in human biopsies of prostate cancer. Fn14 expression is increased in histological sections of human prostate adenocarcinoma. Both prostate cancer cell lines express constitutively Fn14, but, the androgen-independent cell line PC-3 showed higher levels of Fn14 that the LNCaP cells. Fn14 expression was up-regulated in PC-3 human prostate cancer cells in presence of inflammatory cytokines (TNFα/IFNγ) as well as in presence of bovine fetal serum. TWEAK induced apoptotic cell death in PC-3 cells, but not in LNCaP cells. Moreover, in PC-3 cells, co-stimulation with TNFα/IFNγ/TWEAK induced a higher rate of apoptosis. However, TWEAK or TWEAK/TNFα/IFNγ did not induce apoptosis in presence of bovine fetal serum. TWEAK induced cell death through activation of the Fn14 receptor. Apoptosis was associated with activation of caspase-3, release of mitochondrial cytochrome C and an increased Bax/BclxL ratio. TWEAK/Fn14 pathway activation promotes apoptosis in androgen-independent PC-3 cells under certain culture conditions. Further characterization of the therapeutic target potential of TWEAK/Fn14 for human prostate cancer is warranted.
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Affiliation(s)
| | | | - Susana Carrasco
- Nefrologia, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid and Fundación Renal Iñigo Alvarez de Toledo, Madrid, Spain
| | - Felix Manzarbeitia
- Anatomia Patologica, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Olga Ruiz-Andres
- Nefrologia, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid and Fundación Renal Iñigo Alvarez de Toledo, Madrid, Spain
| | | | - Marta Ruiz-Ortega
- Nefrologia, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid and Fundación Renal Iñigo Alvarez de Toledo, Madrid, Spain
| | | | - Jesus Egido
- Nefrologia, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid and Fundación Renal Iñigo Alvarez de Toledo, Madrid, Spain
| | - Alberto Ortiz
- Nefrologia, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid and Fundación Renal Iñigo Alvarez de Toledo, Madrid, Spain
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Diabetes mellitus is associated with short prostate-specific antigen doubling time after radical prostatectomy. Int Urol Nephrol 2012; 45:121-7. [PMID: 23054323 DOI: 10.1007/s11255-012-0306-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Accepted: 09/20/2012] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To investigate whether diabetes mellitus (DM) was associated with postoperative outcomes, including prostate-specific antigen doubling time, among men who underwent radical prostatectomy (RP) for clinically localized prostate cancer (PCa). METHODS Data of 661 patients who underwent radical prostatectomy for node-negative prostate cancer and were followed up for ≥3 years postoperatively at our institution were analyzed. Associations between diabetes mellitus at surgery and outcomes following radical prostatectomy, such as biochemical recurrence-free survival and prostate-specific antigen doubling time, were examined. Aggressive recurrence was defined as biochemical recurrence with prostate-specific antigen doubling time <9 months. RESULTS Of the 661 total subjects, DM (n = 67, 10.1 %) and non-DM group (n = 594, 89.9 %) showed no significant differences in various clinicopathologic parameters including age and PSA. DM group had lower postoperative biochemical recurrence-free survival than non-DM group, with observed difference approaching statistical significance (log-rank, p = 0.077). On multivariate analysis, DM at surgery was significantly associated with aggressive recurrence following RP (p = 0.048). Pathologic Gleason score (p = 0.008) and seminal vesicle invasion (p = 0.010) were also significantly associated with aggressive recurrence on multivariate analysis. CONCLUSION Our results show that pre-existing DM in men with PCa is associated with more aggressive recurrence, suggesting that DM may affect disease progression following RP. Further investigation would be needed to elucidate exact biologic interaction between DM and PCa and also assess causal relationships that potentially could be modified to improve long-term outcome in patients with the two diseases.
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Ewing CM, Ray AM, Lange EM, Zuhlke KA, Robbins CM, Tembe WD, Wiley KE, Isaacs SD, Johng D, Wang Y, Bizon C, Yan G, Gielzak M, Partin AW, Shanmugam V, Izatt T, Sinari S, Craig DW, Zheng SL, Walsh PC, Montie JE, Xu J, Carpten JD, Isaacs WB, Cooney KA. Germline mutations in HOXB13 and prostate-cancer risk. N Engl J Med 2012; 366:141-9. [PMID: 22236224 PMCID: PMC3779870 DOI: 10.1056/nejmoa1110000] [Citation(s) in RCA: 474] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Family history is a significant risk factor for prostate cancer, although the molecular basis for this association is poorly understood. Linkage studies have implicated chromosome 17q21-22 as a possible location of a prostate-cancer susceptibility gene. METHODS We screened more than 200 genes in the 17q21-22 region by sequencing germline DNA from 94 unrelated patients with prostate cancer from families selected for linkage to the candidate region. We tested family members, additional case subjects, and control subjects to characterize the frequency of the identified mutations. RESULTS Probands from four families were discovered to have a rare but recurrent mutation (G84E) in HOXB13 (rs138213197), a homeobox transcription factor gene that is important in prostate development. All 18 men with prostate cancer and available DNA in these four families carried the mutation. The carrier rate of the G84E mutation was increased by a factor of approximately 20 in 5083 unrelated subjects of European descent who had prostate cancer, with the mutation found in 72 subjects (1.4%), as compared with 1 in 1401 control subjects (0.1%) (P=8.5x10(-7)). The mutation was significantly more common in men with early-onset, familial prostate cancer (3.1%) than in those with late-onset, nonfamilial prostate cancer (0.6%) (P=2.0x10(-6)). CONCLUSIONS The novel HOXB13 G84E variant is associated with a significantly increased risk of hereditary prostate cancer. Although the variant accounts for a small fraction of all prostate cancers, this finding has implications for prostate-cancer risk assessment and may provide new mechanistic insights into this common cancer. (Funded by the National Institutes of Health and others.).
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Affiliation(s)
- Charles M Ewing
- Johns Hopkins University and the James Buchanan Brady Urological Institute, Baltimore, USA
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Hong SK, Oh JJ, Byun SS, Hwang SI, Lee HJ, Choe G, Lee SE. Impact of diabetes mellitus on the detection of prostate cancer via contemporary multi (≥ 12)-core prostate biopsy. Prostate 2012; 72:51-7. [PMID: 21520162 DOI: 10.1002/pros.21405] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 03/28/2011] [Indexed: 12/31/2022]
Abstract
BACKGROUND Currently, controversy continues regarding the association between diabetes mellitus (DM) and prostate cancer (PCa). We investigated the impact of DM in PCa detection among men who underwent contemporary multi-core prostate biopsy. METHODS In this retrospective study, we reviewed records of 3,925 men who underwent multi (≥ 12)-core prostate biopsy at our institution. Biopsy outcomes were analyzed with respect to various variables, including DM, patient age, body mass index (BMI), prostate-specific antigen (PSA), digital rectal exam (DRE) finding, ultrasound finding, and prostate volume. RESULTS Among 3,925 subjects, 607 (15.5%) reported having DM at biopsy. Overall PCa was detected from biopsy in 1,387 (35.3%) patients, and high grade (biopsy Gleason score ≥ 7) PCa in 781 (19.9%). In multivariate analysis incorporating variables of patient age, BMI, PSA, DRE finding, ultrasound finding, and prostate volume, DM was observed to be significantly associated with higher odds of overall PCa detection via contemporary prostate biopsy (OR = 1.46, P = 0.019). When analyzed by tumor grade, DM was significantly associated with higher rate of high grade PCa detection from biopsy in multivariate analysis (OR = 1.54, P = 0.036) whereas DM and detection of low grade (biopsy Gleason score ≤ 6) PCa demonstrated no significant association (OR = 1.11, P = 0.558). CONCLUSIONS Our results showed DM was independently associated with the detection of high grade PCa via contemporary multi-core prostate biopsy. Further investigations would be needed to elucidate exact biologic basis of relationship between the two diseases.
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Affiliation(s)
- Sung Kyu Hong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
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Hwang EC, Kim YJ, Hwang IS, Hwang JE, Jung SI, Kwon DD, Park K, Ryu SB. Impact of diabetes mellitus on recurrence and progression in patients with non-muscle invasive bladder carcinoma: a retrospective cohort study. Int J Urol 2011; 18:769-76. [PMID: 21914000 DOI: 10.1111/j.1442-2042.2011.02845.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim of the present study was to investigate the relationship between diabetes mellitus (DM) and tumor features in patients with non-muscle invasive bladder cancer (NMIBC). METHODS Data from 251 patients who underwent transurethral resection (TUR) for NMIBC from January 2000 to June 2010 were analyzed retrospectively. Patients were divided into two groups: Group I, 159 patients (63%) who did not have DM at the time of surgery; and (ii) Group II, 92 patients (37%) who had DM at the time of surgery. Recurrence- and progression-free survival was assessed in both groups. Preoperative HbA1c levels, as parameter of glycemic control, were determined in Group II patients, with patients divided into two subgroups: (i) HbA1c ≥ 7.0%; and (ii) HbA1c <7.0%. The clinical features of the bladder tumor were compared in these two subgroups. RESULTS Compared with Group I, Group II patients were older and had a higher rate of hypertension, recurrence, and progression (P < 0.05). Univariate survival analysis showed that gender, DM, smoking, and serum creatinine were associated with recurrence-free survival (P < 0.05), whereas DM, stage, grade, intravesical instillation, and serum creatinine were associated with progression-free survival. In multivariate survival analysis, DM was found to be an independent factor for recurrence- (hazard ratio [HR] 2.11; 95% confidence interval [CI] 1.4-3.2; P = 0.001) and progression-free survival (HR 9.35; 95% CI 3.1-28.6; P = 0.001). Furthermore, patients with HbA1c ≥ 7.0% exhibited a significantly higher rate of multiplicity (P = 0.001), tumor grade (P = 0.03), and intravesical treatment (P = 0.04). CONCLUSIONS In conclusion, DM seems to be an independent predictor of recurrence- and progression-free survival in NMIBC patients. Further prospective studies are needed to establish the prognostic significance of postoperative glycemic control in this patient population.
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Affiliation(s)
- Eu Chang Hwang
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
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