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Fang Y, Chen C, Chen X, Song J, Feng S, Li Z, Li Z, Xiong Y, Zhang Q, Su H, Liu H, Zhu G, Hu B, Wang W, Liu Z, Jiao K, Zhang C, Zhang F, Jiang K, He J, Sun Z, Yuan D, Chen W, Zhu J. Exposure to heavy metal elements may significantly increase serum prostate-specific antigen levels with overdosed dietary zinc. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 272:116080. [PMID: 38350215 DOI: 10.1016/j.ecoenv.2024.116080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/24/2024] [Accepted: 02/04/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Serum prostate-specific antigen (PSA) is a primary metric for diagnosis and prognosis of prostate cancer (PCa). Exposure to heavy metals, such as lead, cadmium, mercury, and zinc can impact PSA levels in PCa patients. However, it is unclear whether this effect also occurs in men without PCa, which may lead to the overdiagnosis of PCa. METHOD Data on a total of 5089 American men who had never been diagnosed with PCa were obtained from the National Health and Nutrition Examination Survey performed from 2003-2010. The relationship between serum PSA levels (dependent variable) and concentrations of lead (μmol/L), cadmium (nmol/L), and mercury (μmol/L) were investigated with dietary zinc intake being used as a potential modifier or covariate in a weighted linear regression model and a generalized additive model. A series of bootstrapping analyses were performed to evaluate sensitivity and specificity using these models. RESULTS Regression analyses suggested that, in general, lead, cadmium, or mercury did not show an association with PSA levels, which was consistent with the results of the bootstrapping analyses. However, in a subgroup of participants with a high level of dietary zinc intake (≥14.12 mg/day), a significant positive association between cadmium and serum PSA was identified (1.06, 95% CI, P = 0.0268, P for interaction=0.0249). CONCLUSIONS With high-level zinc intake, serum PSA levels may rise in PCa-free men as the exposure to cadmium increases, leading to a potential risk of an overdiagnosis of PCa and unnecessary treatment. Therefore, environmental variables should be factored in the current diagnostic model for PCa that is solely based on PSA measurements. Different criteria for PSA screening are necessary based on geographical variables. Further investigations are needed to uncover the biological and biochemical relationship between zinc, cadmium, and serum PSA levels to more precisely diagnose PCa.
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Affiliation(s)
- Yinyi Fang
- Guizhou University Medical College, Guiyang city, Guizhou Province 550025, China; People's Hospital Affiliated to Guizhou University, Guiyang city, Guizhou Province, China
| | - Chi Chen
- Department of Immunology and Microbiology, Guiyang College of Traditional Chinese Medicine, Guiyang, Guizhou Province 550001, China
| | - Xiaoyue Chen
- Guizhou University Medical College, Guiyang city, Guizhou Province 550025, China
| | - Jukun Song
- Guizhou University Medical College, Guiyang city, Guizhou Province 550025, China; People's Hospital Affiliated to Guizhou University, Guiyang city, Guizhou Province, China
| | - Shuangshuang Feng
- Guizhou University Medical College, Guiyang city, Guizhou Province 550025, China
| | - Zhuang Li
- Urology Department, Guizhou Provincial People's Hospital, Guiyang city, Guizhou Province 550002, China; Guizhou Medical University, Guiyang city, Guizhou Province, China
| | - Zhengnan Li
- Urology Department, Guizhou Provincial People's Hospital, Guiyang city, Guizhou Province 550002, China; Zunyi Medcical University, Zunyi City, Guizhou Province, China
| | - Yuliang Xiong
- Urology Department, Guizhou Provincial People's Hospital, Guiyang city, Guizhou Province 550002, China; Guizhou Medical University, Guiyang city, Guizhou Province, China
| | - Qinyi Zhang
- Urology Department, Guizhou Provincial People's Hospital, Guiyang city, Guizhou Province 550002, China; Zunyi Medcical University, Zunyi City, Guizhou Province, China
| | - Hao Su
- Urology Department, Guizhou Provincial People's Hospital, Guiyang city, Guizhou Province 550002, China; Zunyi Medcical University, Zunyi City, Guizhou Province, China
| | - Heng Liu
- Urology Department, Guizhou Provincial People's Hospital, Guiyang city, Guizhou Province 550002, China; Zunyi Medcical University, Zunyi City, Guizhou Province, China
| | - Guohua Zhu
- Urology Department, Guizhou Provincial People's Hospital, Guiyang city, Guizhou Province 550002, China; Guizhou Medical University, Guiyang city, Guizhou Province, China
| | - Bin Hu
- Zunyi Medcical University, Zunyi City, Guizhou Province, China
| | - Wei Wang
- Urology Department, Guizhou Provincial People's Hospital, Guiyang city, Guizhou Province 550002, China; Guizhou Medical University, Guiyang city, Guizhou Province, China
| | - Zhangcheng Liu
- Urology Department, Guizhou Provincial People's Hospital, Guiyang city, Guizhou Province 550002, China; Zunyi Medcical University, Zunyi City, Guizhou Province, China
| | - Ke Jiao
- Urology Department, Guizhou Provincial People's Hospital, Guiyang city, Guizhou Province 550002, China; Guizhou Medical University, Guiyang city, Guizhou Province, China
| | - Chang Zhang
- Urology Department, Guizhou Provincial People's Hospital, Guiyang city, Guizhou Province 550002, China
| | - Fan Zhang
- Urology Department, Guizhou Provincial People's Hospital, Guiyang city, Guizhou Province 550002, China; Guizhou Medical University, Guiyang city, Guizhou Province, China
| | - Kehua Jiang
- Urology Department, Guizhou Provincial People's Hospital, Guiyang city, Guizhou Province 550002, China
| | - Jun He
- Department of Reproductive Medicine, Guizhou Provincial People's Hospital, Guiyang city, Guizhou Province 550002, China
| | - Zhaolin Sun
- Guizhou University Medical College, Guiyang city, Guizhou Province 550025, China; Urology Department, Guizhou Provincial People's Hospital, Guiyang city, Guizhou Province 550002, China; People's Hospital Affiliated to Guizhou University, Guiyang city, Guizhou Province, China
| | - Dongbo Yuan
- Guizhou University Medical College, Guiyang city, Guizhou Province 550025, China; Urology Department, Guizhou Provincial People's Hospital, Guiyang city, Guizhou Province 550002, China; People's Hospital Affiliated to Guizhou University, Guiyang city, Guizhou Province, China.
| | - Weiming Chen
- Guizhou University Medical College, Guiyang city, Guizhou Province 550025, China; People's Hospital Affiliated to Guizhou University, Guiyang city, Guizhou Province, China; Department of Reproductive Medicine, Guizhou Provincial People's Hospital, Guiyang city, Guizhou Province 550002, China.
| | - Jianguo Zhu
- Guizhou University Medical College, Guiyang city, Guizhou Province 550025, China; Urology Department, Guizhou Provincial People's Hospital, Guiyang city, Guizhou Province 550002, China; People's Hospital Affiliated to Guizhou University, Guiyang city, Guizhou Province, China.
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Hurwitz LM, Dogbe N, Barry KH, Koutros S, Berndt SI. Obesity and prostate cancer screening, incidence, and mortality in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. J Natl Cancer Inst 2023; 115:1506-1514. [PMID: 37382561 PMCID: PMC10699801 DOI: 10.1093/jnci/djad113] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/02/2023] [Accepted: 06/07/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Though obesity, measured by body mass index (BMI), is an established risk factor for several cancer sites, there is conflicting evidence on whether obesity increases prostate cancer risk or mortality and, if it does, whether it increases risk directly or indirectly by affecting prostate cancer screening efficacy. METHODS We examined associations between BMI and prostate cancer screening outcomes, incidence, and mortality in men randomly assigned to the intervention arm of the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (n = 36 756) between 1993 and 2001. Participants received annual screening with the prostate-specific antigen test and digital rectal exam. Associations between baseline BMI and screening outcomes were assessed via multinomial logistic regression, and associations with prostate cancer incidence and mortality were assessed via Cox proportional hazards regression. RESULTS Individuals with higher BMI were less likely to screen positive via the prostate-specific antigen test and/or digital rectal exam and more likely to have an inadequate screen (all Ptrend < .01). Higher BMI was inversely associated with prostate cancer incidence (per 5 kg/m2 BMI increase: hazard ratio [HR] = 0.94, 95% confidence interval [CI] = 0.91 to 0.97), including incidence of early stage (HR = 0.94, 95% CI = 0.90 to 0.97) and advanced-stage (HR = 0.91, 95% CI = 0.82 to 1.02) disease, but positively associated with prostate cancer mortality (HR = 1.21, 95% CI = 1.06 to 1.37). The association with mortality was not modified by screening outcome (Pinteraction = .13). CONCLUSIONS Within this screened population, individuals with higher BMI had lower risk of prostate cancer diagnosis but higher risk of prostate cancer mortality. As higher BMI was not positively associated with advanced-stage prostate cancer risk, the increased mortality is unlikely to be due to delayed prostate cancer detection.
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Affiliation(s)
- Lauren M Hurwitz
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Rockville, MD, USA
| | - Nadine Dogbe
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Rockville, MD, USA
| | - Kathryn Hughes Barry
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
- Program in Oncology, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
| | - Stella Koutros
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Rockville, MD, USA
| | - Sonja I Berndt
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Rockville, MD, USA
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3
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Daniels JP, Freedland SJ, Gresham G. The growing implications of obesity for prostate cancer risk and mortality: where do we go from here? J Natl Cancer Inst 2023; 115:1448-1450. [PMID: 37587090 PMCID: PMC10699795 DOI: 10.1093/jnci/djad140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/13/2023] [Indexed: 08/18/2023] Open
Affiliation(s)
| | - Stephen J Freedland
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Durham VA Medical Center, Durham, NC, USA
| | - Gillian Gresham
- Division of Population Sciences, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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4
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Darand M, Salimi Z, Ghorbani M, Sadeghi N, Babaie S, Hosseinzadeh M. Obesity is associated with quality of sperm parameters in men with infertility: a cross-sectional study. Reprod Health 2023; 20:134. [PMID: 37700299 PMCID: PMC10496307 DOI: 10.1186/s12978-023-01664-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/08/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Previous studies examined the effects of obesity on sperm parameters and reported inconsistent results. Thus, the present study aimed to evaluate the association between obesity and the quality of sperm parameters in infertile men. MATERIAL AND METHODS The present cross-sectional study evaluated 218 infertile men aged 20-50. To this end, the 168-item food frequency questionnaire (FFQ) was utilized to evaluate dietary intake. The anthropometric and biochemical variables were examined using standard methods. Further, the association between obesity and the quality of sperm parameters was evaluated using the controlled linear regression for potential confounders. RESULTS The normal sperm morphology had a significant inverse association with BMI [adjusted β - 0.074, CI (- 0.141 to - 0.008), P = 0.029] and WC [adjusted β - 0.026, CI (- 0.051 to - 0.001), P = 0.038]. Additionally, visceral fat had a marginal inverse association with normal sperm morphology [adjusted β - 0.065, CI (- 0.138 to 0.008), P = 0.079] and non-progressive sperm motility [adjusted β - 0.241, CI (- 0.495 to 0.014), P = 0.063]. CONCLUSION Even though the present results indicated that obesity, abdominal obesity, and visceral fat had inverse associations with normal sperm morphology, more mechanism-based studies should be conducted to confirm these findings.
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Affiliation(s)
- Mina Darand
- Nutrition and Food Security Research Center and Department of Clinical Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Salimi
- Nutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Moloud Ghorbani
- Department of Community Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Narges Sadeghi
- Nutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Syavash Babaie
- Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mahdieh Hosseinzadeh
- Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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Vickers AJ, Assel M, Dunn RL, Zabor EC, Kattan MW, van Smeden M, Dahly D. Guidelines for Reporting Observational Research in Urology: The Importance of Clear Reference to Causality. Eur Urol 2023; 84:147-151. [PMID: 37286459 DOI: 10.1016/j.eururo.2023.04.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 04/19/2023] [Indexed: 06/09/2023]
Abstract
Observational studies often dance around the issue of causality. We propose guidelines to ensure that papers refer to whether or not the study aim is to investigate causality, and suggest language to use and language to avoid.
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Affiliation(s)
| | - Melissa Assel
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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6
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Vickers AJ, Assel M, Dunn RL, Zabor EC, Kattan MW, van Smeden M, Dahly D. Guidelines for Reporting Observational Research in Urology: The Importance of Clear Reference to Causality. Urology 2023; 177:1-5. [PMID: 37085050 PMCID: PMC10524387 DOI: 10.1016/j.urology.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 04/05/2023] [Indexed: 04/23/2023]
Affiliation(s)
- Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Melissa Assel
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rodney L Dunn
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Emily C Zabor
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Mike W Kattan
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Maarten van Smeden
- Julius Center for Health Sciences and Primary Care, Utrecht University Medical Center, Utrecht, Netherlands
| | - Darren Dahly
- School of Public Health, University College Cork, Cork, Ireland
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7
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Rabbani S, Santoni G, Lagergren J, Xie SH. Use of anti-androgenic 5α-reductase inhibitors and risk of oesophageal and gastric cancer by histological type and anatomical sub-site. Br J Cancer 2022; 127:892-897. [PMID: 35715630 PMCID: PMC9427733 DOI: 10.1038/s41416-022-01872-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/14/2022] [Accepted: 05/26/2022] [Indexed: 12/24/2022] Open
Abstract
Background To investigate if anti-androgenic medications 5α-reductase inhibitors (5-ARIs) decrease the risk of developing oesophageal and gastric tumours, analysed by histological type and anatomical sub-site. Methods A Swedish population-based cohort study between 2005 and 2018 where men using 5-ARIs were considered exposed. For each exposed participant, ten male age-matched non-users of 5-ARIs (non-exposed) were included. Multivariable Cox regression provided hazard ratios (HR) with 95% confidence intervals (CI) adjusted for age, calendar year, smoking, non-steroidal anti-inflammatory drugs/aspirin use, and statins use. Further adjustments were made depending on the tumour analysed. Results The cohort included 191,156 users of 5-ARIs and 1,911,560 non-users. Overall, the use of 5-ARIs was not associated with any statistically significantly reduced risk of oesophageal or cardia adenocarcinoma (adjusted HR 0.92, 95% CI 0.82–1.02) or gastric non-cardia adenocarcinoma (adjusted HR 0.90, 95% CI 0.80–1.02). However, the use of 5-ARIs indicated a decreased risk of oesophageal or cardia adenocarcinoma among obese or diabetic participants (adjusted HR 0.55, 95% CI 0.39–0.80) and a reduced risk of oesophageal squamous cell carcinoma (adjusted HR 0.49, 95% CI 0.37–0.65). Conclusion Users of 5-ARIs may have a decreased risk of developing oesophageal or cardia adenocarcinoma among those obese or diabetic, and a decreased risk of oesophageal squamous cell carcinoma.
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Affiliation(s)
- Sirus Rabbani
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Giola Santoni
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Jesper Lagergren
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Shao-Hua Xie
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. .,School of Public Health and Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.
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Alcantara-Zapata DE, Llanos AJ, Nazzal C. High altitude exposure affects male reproductive parameters: Could it also affect the prostate?†. Biol Reprod 2021; 106:385-396. [PMID: 34725677 DOI: 10.1093/biolre/ioab205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/26/2021] [Indexed: 11/14/2022] Open
Abstract
Living at high altitudes and living with prostatic illness are two different conditions closely related to a hypoxic environment. People at high altitudes exposed to acute, chronic, or intermittent hypobaric hypoxia turn on several mechanisms at the system, cellular and molecular level to cope with oxygen atmosphere scarcity maintaining the oxygen homeostasis. This exposure affects the whole organism and function of many systems, such as cardiovascular, respiratory, and reproductive. On the other hand, malignant prostate is related to the scarcity of oxygen in the tissue microenvironment due to its low availability and high consumption due to the swift cell proliferation rates. Based on the literature, this similarity in the oxygen scarcity suggests that hypobaric hypoxia, and other common factors between these two conditions, could be involved in the aggravation of the pathological prostatic status. However, there is still a lack of evidence in the association of this disease in males at high altitudes. This review aims to examine the possible mechanisms that hypobaric hypoxia might negatively add to the pathological prostate function in males who live and work at high altitudes. More profound investigations of hypobaric hypoxia's direct action on the prostate could help understand this exposure's effect and prevent worse prostate illness impact in males at high altitudes.
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Affiliation(s)
| | - Aníbal J Llanos
- Laboratorio de Fisiología y Fisiopatología del Desarrollo, Programa de Fisiopatología, ICBM, Facultad de Medicina, Universidad de Chile, Santiago, Chile.,Centro Internacional de Estudios Andinos (INCAS), Universidad de Chile, Santiago, Chile
| | - Carolina Nazzal
- Department of Epidemiology. School of Public Health. Faculty of Medicine. University of Chile
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Wang S, Sun J, Wang J, Ping Z, Liu L. Does obesity based on body mass index affect semen quality?-A meta-analysis and systematic review from the general population rather than the infertile population. Andrologia 2021; 53:e14099. [PMID: 34028074 DOI: 10.1111/and.14099] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/08/2021] [Accepted: 04/11/2021] [Indexed: 02/06/2023] Open
Abstract
Whether obesity affects the quality of semen has become the focus of research. However, there are some deficiencies in the past research, because the vast majority of known infertile patients were included in the study samples. Taking infertile men as the research object to analyse the impact of obesity on semen quality, which cannot accurately prove that the impact on semen quality is caused by obesity, because the impact on semen quality may also be caused by other factors. Therefore, we selected ordinary obese men rather than infertile patients to conduct a systematic review and meta-analysis of the effects of obesity on semen parameters. The results showed that obesity had no effect on sperm concentration (SMD: -0.15, 95% CI: -0.32 ~ 0.02, p = .088) and percentage of normal sperm morphology (SMD: -0.17, 95% CI: -0.66 ~ 0.32, p = .487), but decreased semen volume (SMD: -0.32, 95% CI: -0.52 ~ -0.12, p = .002), total sperm number (SMD: -0.77, 95% CI: -1.31 ~ -0.23, p = .005), percentage of forward progression (SMD: -0.95, 95% CI: -1.7 ~ -0.19, p = .014) and percentage of viability (SMD: -0.812, 95% CI: -1.532 ~ -0.093, p = .027). Therefore, obesity affects semen quality to a certain extent, and maintaining normal weight may be one of the effective ways to improve male fertility.
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Affiliation(s)
- SuiYan Wang
- School of basic medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Jun Sun
- School of basic medical Sciences, Zhengzhou University, Zhengzhou, China
| | - JunYi Wang
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - ZhiGuang Ping
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Li Liu
- School of basic medical Sciences, Zhengzhou University, Zhengzhou, China
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10
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PSA and obesity among men with localized prostate cancer: results of the ANDROCAN study. World J Urol 2021; 39:2945-2951. [PMID: 33521883 DOI: 10.1007/s00345-020-03557-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE PSA is known to be lowered in obese patients. There is a lack of data regarding patients with prostate cancer. Our objective was to prospectively assess the relationship PSA concentration, PSA mass and BMI in a cohort of patients with localized prostate cancer. METHODS A prospective, multicenter cohort study was conducted including patients undergoing radical prostatectomy. Clinical and biological data were collected for each patient before surgery. RESULTS A total of 1343 patients were analyzed. Mean age was 64.0 years. Mean weight was 82.2 kg and mean BMI was 26.8 kg/m2. Mean PSA concentration was 8.7 ng/mL and mean PSA mass 29.3 ng. On univariate analysis, an association was found between PSA mass and either BMI, weight and waist circumference. No association was found between PSA concentration and each weight parameters. On multivariate analysis, obesity was not an independent predictor of PSA concentration (p = 0.73). Independent predictors of PSA concentration were cardiovascular disease (negative association, p = 0.034), predominant Gleason 4 (positive association, p < 0.001) and pT3a (positive association, p < 0.001). BMI was an independent predictor of PSA mass (positive association, p = 0.009). PSA mass was negatively associated with TT (p = 0.015) and cardiovascular disease (p = 0.003), and positively associated with BT (p = 0.032), Gleason grade ≥ 4 + 3 (p < 0.001) and pT3a (p < 0.001). CONCLUSION In this prospective study of patients with localized prostate cancer, higher BMI was associated with higher PSA mass but not with higher PSA concentration. Screening obese patients with a specific PSA method does not appear to be critical.
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Zhao Y, Zhang Y, Wang X, Lin D, Chen Z. Relationship between body mass index and concentrations of prostate specific antigen: a cross-sectional study. Scandinavian Journal of Clinical and Laboratory Investigation 2019; 80:162-167. [PMID: 31855065 DOI: 10.1080/00365513.2019.1703217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The possible relationship between body mass index (BMI) and prostate-specific antigen (PSA) concentrations is controversial. The objective of this study was to assess the relationship between BMI and PSA concentrations in Chinese men. A total of 81,122 men who had undergone annual medical examinations at the First Affiliated Hospital of Army Medical University between 1 January 2011 and 31 December 2018 were included. Univariate and multivariate linear regression models were used to assess the relationship between BMI and PSA concentrations. The nonlinear relationship was analyzed using a generalized additive model with a spline smoothing function. Subsequently, a stratified linear regression model was used for subgroup analysis. The mean age and BMI of the participants were 45.91 ± 12.21 years and 24.79 ± 3.11 kg/m2, respectively. After adjustment for age, waist circumference-hip circumference ratio, systolic blood pressure, diastolic blood pressure, fasting blood glucose, total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, alanine aminotransferase and aspartate aminotransferase, BMI was negatively related to PSA level (p < .001). A nonlinear relationship was detected, and different relationships between BMI and PSA concentrations were observed on each side of the inflection point (BMI = 23.11 kg/m2). Our study revealed an inverse, nonlinear relationship between BMI and PSA concentrations. Thus, this relationship may be a concern when establishing reference intervals or decision limits for PSA concentrations.
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Affiliation(s)
- Ying Zhao
- Health Management Centre, The First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Yuting Zhang
- Health Management Centre, The First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Xin Wang
- Epidemiology Centre, The First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Dandan Lin
- Health Management Centre, The First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Zongtao Chen
- Health Management Centre, The First Affiliated Hospital of Army Medical University, Chongqing, China
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Association of Long-Term Dynamics in Circulating Testosterone with Serum PSA in Prostate Cancer-Free Men with Initial-PSA < 4 ng/mL. Discov Oncol 2019; 10:168-176. [PMID: 31621000 DOI: 10.1007/s12672-019-00369-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 09/30/2019] [Indexed: 12/31/2022] Open
Abstract
We previously reported that an accelerated decline in circulating testosterone level is associated with a higher risk of prostate cancer (PCa). This study is to examine whether testosterone change rate is related to serum prostate-specific antigen (PSA) concentration among PCa-free men. Longitudinal data were derived from electronic medical records at a tertiary hospital in the Southeastern USA. PCa-free men with initial-PSA < 4 ng/mL and ≥ 2 testosterone measurements were included (n = 632). Three PSA measures (peak, the most recent, and average PSA) during the study period (from first testosterone measurement to the most recent hospital visit) were examined using multivariable-adjusted geometric means and were compared across quintiles of testosterone change rate (ng/dL/month) and current testosterone level (cross-sectional). Mean (standard deviation, SD) age at baseline was 59.3 (10.5) years; mean study period was 93.0 (55.3) months. After adjusting for covariates including baseline testosterone, the three PSA measures all significantly increased across quintile of testosterone change rate from increase to decline (peak PSA: quint 1 = 1.09, quint 5 = 1.41; the most recent PSA: quint 1 = 0.85, quint 5 = 1.00; average PSA: quint 1 = 0.89, quint 5 = 1.02; all Ptrend < 0.001). But current testosterone level was not associated with PSA levels. Stratified analyses indicated men with higher adiposity (body mass index > 24.1 kg/m2) or lower baseline testosterone (≤ 296 ng/dL) were more sensitive to testosterone change in regard to PSA. Among PCa-free men, accelerated testosterone decline might correlate with higher serum PSA concentration. It will help to elucidate the mechanisms relating aging-accompanying testosterone dynamics to prostate carcinogenesis.
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Kobayashi M, Mizuno T, Yuki H, Kambara T, Betsunoh H, Nukui A, Abe H, Fukabori Y, Yashi M, Kamai T. Association between serum prostate-specific antigen level and diabetes, obesity, hypertension, and the laboratory parameters related to glucose tolerance, hepatic function, and lipid profile: implications for modification of prostate-specific antigen threshold. Int J Clin Oncol 2019; 25:472-478. [PMID: 31440861 DOI: 10.1007/s10147-019-01527-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/06/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Previous studies indicated inverse relationships between body mass index (BMI), diabetes and prostate-specific antigen (PSA) concentration besides an established positive relationship between age and PSA. Other causal relationships between clinical parameters including hypertension, hepatic function, tests, lipid profile and PSA were also suggested. Thus, we incorporated these parameters all together into the analysis to identify possible determinants of PSA concentration to improve the accuracy of PSA tests. METHODS Associations between PSA and the above-mentioned clinical parameters were examined among 14,486 men who visited our hospital for a routine health checkup, using linear regression analyses. RESULTS Total of 1403 (9.7%) and 784 (5.4%) men were classified as diabetes and obesity, respectively. After adjusting age, significant PSA reductions were found in diabetic men, especially for men taking antidiabetics. Such association was seen when the diabetic status was represented by hemoglobin A1c (HbA1c) and fasting blood sugar (FBS) levels. That is, PSA levels were significantly reduced in men with higher HbA1c and FBS levels. Obesity was also associated with a reduction in PSA levels. Moreover, PSA levels were significantly decreased with increased ALT levels. CONCLUSIONS PSA test results should be carefully interpreted especially for men with diabetes and obesity, in whom a substantial reduction in PSA concentration is likely to occur.
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Affiliation(s)
- Minoru Kobayashi
- Department of Urology, Utsunomiya Memorial Hospital, 1-3-16, Ohdori, Utsunomiya City, Tochigi, 320-0811, Japan.
| | - Tomoya Mizuno
- Department of Urology, Nasu Red Cross Hospital, Tochigi, Japan
| | - Hideo Yuki
- Department of Urology, Dokkyo Medical University, Tochigi, Japan
| | | | | | - Akinori Nukui
- Department of Urology, Dokkyo Medical University, Tochigi, Japan
| | - Hideyuki Abe
- Department of Urology, Dokkyo Medical University, Tochigi, Japan
| | | | - Masahiro Yashi
- Department of Urology, Dokkyo Medical University, Tochigi, Japan
| | - Takao Kamai
- Department of Urology, Dokkyo Medical University, Tochigi, Japan
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Aref AT, Vincent AD, O'Callaghan ME, Martin SA, Sutherland PD, Hoy AJ, Butler LM, Wittert GA. The inverse relationship between prostate specific antigen (PSA) and obesity. Endocr Relat Cancer 2018; 25:933-941. [PMID: 29941675 DOI: 10.1530/erc-17-0438] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 06/25/2018] [Indexed: 12/17/2022]
Abstract
Obese men have lower serum prostate-specific antigen (PSA) than comparably aged lean men, but the underlying mechanism remains unclear. The aim of this study was to determine the effect of obesity on PSA and the potential contributing mechanisms. A cohort of 1195 men aged 35 years and over at recruitment, with demographic, anthropometric (BMI, waist circumference (WC)) and serum hormone (serum testosterone, estradiol (E2)) PSA and hematology assessments obtained over two waves was assessed. Men with a history of prostate cancer or missing PSA were excluded, leaving 970 men for the final analysis. Mixed-effects regressions and mediation analyses adjusting for hormonal and volumetric factors explore the potential mechanisms relating obesity to PSA. After adjusting for age, PSA levels were lower in men with greater WC (P = 0.001). In a multivariable model including WC, age, E2/testosterone and PlasV as predictors, no statistically significant associations were observed between with PSA and either WC (P = 0.36) or PlasV (P = 0.49), while strong associations were observed with both E2/testosterone (P < 0.001) and age (P < 0.001). In the mediation analyses with PlasV as the mediator, the average causal mediation effect (ACME) explained roughly 20% of the total effect of WC on PSA (P = 0.31), while when E2/testosterone is a mediator, the ACME explained roughly 50% of the effect (P < 0.001). Our findings indicate that lower PSA levels in obese men, as compared to normal weight men, can be explained both by hormonal changes (elevated E2/testosterone ratio) and hemodilution. Hormonal factors therefore represent a substantial but underappreciated mediating pathway.
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Affiliation(s)
- Adel T Aref
- University of Adelaide Medical School and Freemasons Foundation Centre for Men's HealthAdelaide, South Australia, Australia
- South Australian Health and Medical Research InstituteAdelaide, South Australia, Australia
| | - Andrew D Vincent
- University of Adelaide Medical School and Freemasons Foundation Centre for Men's HealthAdelaide, South Australia, Australia
- South Australian Health and Medical Research InstituteAdelaide, South Australia, Australia
| | - Michael E O'Callaghan
- University of Adelaide Medical School and Freemasons Foundation Centre for Men's HealthAdelaide, South Australia, Australia
- Urology UnitSA Health, Repatriation General Hospital, Adelaide, South Australia, Australia
- South Australian Prostate Cancer Clinical Outcomes Collaborative (SA-PCCOC)Adelaide, South Australia, Australia
- Flinders Centre for Innovation in CancerFlinders University, Adelaide, South Australia, Australia
| | - Sean A Martin
- University of Adelaide Medical School and Freemasons Foundation Centre for Men's HealthAdelaide, South Australia, Australia
- South Australian Health and Medical Research InstituteAdelaide, South Australia, Australia
| | - Peter D Sutherland
- Department of UrologyRoyal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Andrew J Hoy
- Discipline of PhysiologySchool of Medical Sciences and Bosch Institute, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Lisa M Butler
- University of Adelaide Medical School and Freemasons Foundation Centre for Men's HealthAdelaide, South Australia, Australia
- South Australian Health and Medical Research InstituteAdelaide, South Australia, Australia
| | - Gary A Wittert
- University of Adelaide Medical School and Freemasons Foundation Centre for Men's HealthAdelaide, South Australia, Australia
- South Australian Health and Medical Research InstituteAdelaide, South Australia, Australia
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15
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Preventing Lethal Prostate Cancer with Diet, Supplements, and Rx: Heart Healthy Continues to Be Prostate Healthy and "First Do No Harm" Part I. Curr Urol Rep 2018; 19:104. [PMID: 30368693 DOI: 10.1007/s11934-018-0846-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW To discuss the overall and latest observations of the effect of diet, lifestyle, supplements, and some prescription heart healthy medications for prostate cancer prevention. RECENT FINDINGS The concept of maximizing heart health to prevent aggressive prostate cancer continues to be solidified with the addition of more prospective observational and randomized controlled trial data. Heart healthy is prostate healthy, but heart unhealthy is prostate unhealthy. The primary goal of reducing the risk of all-cause and cardiovascular disease (CVD) morbidity and mortality also allows for maximizing prostate cancer prevention. The obesity epidemic in children and adults along with recent diverse research has only strengthened the nexus between heart and prostate health. Greater dietary adherence toward a variety of healthy foods is associated with a graded improved probability of CVD and potentially aggressive cancer risk reduction. Preventing prostate cancer via dietary supplements should encourage a "first do no harm", or less is more approach until future evidence can reverse the concerning trend that more supplementation has resulted in either no impact or an increased risk of prostate cancer. Supplements to reduce side effects of some cancer treatments appear to have more encouraging data. Medications that improve heart health including statins, aspirin, and metformin (S.A.M.), and specific beta-blocker medications are primarily generic or low-cost and should continue to garner research interest. A watershed moment in medical education has arrived where the past perception of a diverse number of trees seemingly separated by vast distances, in reality, now appear to exist within the same forest.
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16
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Abstract
PURPOSE OF REVIEW To investigate the association between obesity and prostate cancer (PCa). RECENT FINDINGS Obesity has been proposed to be involved in the pathogenesis of PCa through different biological mechanisms that include deregulation of the insulin axis, sex hormone secretion, adipokines signaling, and oxidative stress. Hypertrophic peritumoral adipocytes may also facilitate the local spread of PCa through the chemo-attraction of tumor cells. Clinical studies demonstrate that obesity might have clinical implications also in disease detection and management. Obese men have been shown to be less likely to be diagnosed with early-stage disease. Moreover, they are at increased risk of experiencing upgrading and upstaging when managed with active surveillance. However, the association between obesity and the risk of PCa recurrence and mortality after radical treatment is still debated. SUMMARY Obesity may facilitate the development and progression of PCa trough different biologic mechanisms that may pose obese men at higher risk of advanced and high-grade disease. However, the association between obesity and long-term oncologic outcome after radical treatments appears unclear.
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17
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Chow K, Mangiola S, Vazirani J, Peters JS, Costello AJ, Hovens CM, Corcoran NM. Obesity suppresses tumor attributable PSA, affecting risk categorization. Endocr Relat Cancer 2018; 25:561-568. [PMID: 29661963 DOI: 10.1530/erc-17-0466] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 03/27/2018] [Indexed: 01/09/2023]
Abstract
Obesity is linked with more aggressive prostate cancer and higher rates of disease recurrence post treatment. It is unclear if this is due to specific tumor-promoting effects of obesity or diagnostic bias. Patients undergoing prostatectomy were categorized according to their body mass index (BMI). Expected prostate-specific antigen (PSA) levels were calculated for each patient based on tumor characteristics. The effect of obesity on the accuracy of pre-treatment risk categorization was determined, and mediation analysis was used to identify the contribution of biologic vs non-biologic mechanisms to the observed increased risk of biochemical recurrence. Residual tumor-promoting effects were estimated in a survival model controlling for diagnostic error. The following results were obtained. The analysis included 1587 patients. Despite similar rates of adverse pathological features at prostatectomy, biochemical recurrence rates were significantly higher in very obese patients, which persisted after adjustment for stage, grade and PSA. Tumor volume however correlated significantly with BMI (P = 0.004), and the difference in predicted and observed 'tumor-attributable' PSA (Delta-PSA) in very obese patients was greater than three times higher than that of healthy patients (P = 0.0067). Regression analysis indicated that the effect of BMI on tumor volume was fully mediated indirectly by its effect on PSA. Inclusion of this diagnostic error as a covariate in the survival analysis attenuated the effect of BMI on recurrence. In conclusion, being very obese suppresses tumor-associated PSA resulting in a diagnostic bias that is responsible for errors in risk classification, and potentially contributes to a delay in initial presentation.
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Affiliation(s)
- Ken Chow
- Departments of Urology and Surgery, Royal Melbourne Hospital and The University of Melbourne, Parkville, Victoria, Australia
| | - Stefano Mangiola
- Departments of Urology and Surgery, Royal Melbourne Hospital and The University of Melbourne, Parkville, Victoria, Australia
- Division of Bioinformatics, Walter and Eliza Hall Institute, Parkville, Victoria, Australia
| | - Jaideep Vazirani
- Departments of Urology and Surgery, Royal Melbourne Hospital and The University of Melbourne, Parkville, Victoria, Australia
| | - Justin S Peters
- Departments of Urology and Surgery, Royal Melbourne Hospital and The University of Melbourne, Parkville, Victoria, Australia
| | - Anthony J Costello
- Departments of Urology and Surgery, Royal Melbourne Hospital and The University of Melbourne, Parkville, Victoria, Australia
- Australian Prostate Cancer Research Centre Epworth, Richmond, Victoria, Australia
| | - Christopher M Hovens
- Departments of Urology and Surgery, Royal Melbourne Hospital and The University of Melbourne, Parkville, Victoria, Australia
- Australian Prostate Cancer Research Centre Epworth, Richmond, Victoria, Australia
| | - Niall M Corcoran
- Departments of Urology and Surgery, Royal Melbourne Hospital and The University of Melbourne, Parkville, Victoria, Australia
- Australian Prostate Cancer Research Centre Epworth, Richmond, Victoria, Australia
- Department of Urology, Frankston Hospital, Frankston, Victoria, Australia
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18
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Albini A, Bruno A, Bassani B, D’Ambrosio G, Pelosi G, Consonni P, Castellani L, Conti M, Cristoni S, Noonan DM. Serum Steroid Ratio Profiles in Prostate Cancer: A New Diagnostic Tool Toward a Personalized Medicine Approach. Front Endocrinol (Lausanne) 2018; 9:110. [PMID: 29674995 PMCID: PMC5895774 DOI: 10.3389/fendo.2018.00110] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 03/05/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Serum steroids are crucial molecules altered in prostate cancer (PCa). Mass spectrometry (MS) is currently the elected technology for the analysis of steroids in diverse biological samples. Steroids have complex biological pathways and stoichiometry and it is important to evaluate their quantitative ratio. MS applications to patient hormone profiling could lead to a diagnostic approach. METHODS Here, we employed the Surface Activated Chemical Ionization-Electrospray-NIST (SANIST) developed in our laboratories, to obtain quantitative serum steroid ratio relationship profiles with a machine learning Bayesian model to discriminate patients with PCa. The approach is focused on steroid relationship profiles and disease association. RESULTS A pilot study on patients affected by PCa, benign prostate hypertrophy (BPH), and control subjects [prostate-specific antigen (PSA) lower than 2.5 ng/mL] was done in order to investigate the classification performance of the SANIST platform. The steroid profiles of 71 serum samples (31 controls, 20 patients with PCa and 20 subjects with benign prostate hyperplasia) were evaluated. The levels of 10 steroids were quantitated on the SANIST platform: Aldosterone, Corticosterone, Cortisol, 11-deoxycortisol, Androstenedione, Testosterone, dehydroepiandrosterone, dehydroepiandrosterone sulfate (DHEAS), 17-OH-Progesterone and Progesterone. We performed both traditional and a machine learning analysis. CONCLUSION We show that the machine learning approach based on the steroid relationships developed here was much more accurate than the PSA, DHEAS, and direct absolute value match method in separating the PCa, BPH and control subjects, increasing the sensitivity to 90% and specificity to 84%. This technology, if applied in the future to a larger number of samples will be able to detect the individual enzymatic disequilibrium associated with the steroid ratio and correlate it with the disease. This learning machine approach could be valid in a personalized medicine setting.
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Affiliation(s)
- Adriana Albini
- IRCCS MultiMedica, Milan, Italy
- Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy
| | | | | | | | - Giuseppe Pelosi
- IRCCS MultiMedica, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | | | | | | | - Simone Cristoni
- I.S.B.—Ion Source & Biotechnologies, Bresso, Italy
- *Correspondence: Simone Cristoni,
| | - Douglas M. Noonan
- IRCCS MultiMedica, Milan, Italy
- Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy
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