1
|
Castro-Larefors S, Marti-Laosa MM, Lopez-Honrubia V, Rey-Lopez I, Ruiz-Herrero B, Murria-Perez Y, Andres I, Jimenez-Garcia IE, Berenguer R, Aguayo-Martos M, Sánchez-Prieto R, Rovirosa A, Jimenez-Jimenez E, Arenas M, Sabater S. Longer time to testosterone recovery impacts favorably on outcomes for prostate cancer following androgen deprivation and radiotherapy. Strahlenther Onkol 2024; 200:691-697. [PMID: 38416163 DOI: 10.1007/s00066-024-02208-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/23/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE To evaluate the impact of sustained hypogonadism after androgen deprivation therapy (ADT) associated with radiotherapy in prostate cancer (PCa) patients with biochemical relapse-free survival (bRFS). METHODS A retrospective cohort analysis of 213 consecutive PCa patients referred for radiotherapy plus ADT was carried out. Follow-up times including time to testosterone recovery (TTR) and bRFS were calculated from the end of ADT. Univariate and multivariate Cox regression analyses predicting bRFS were used. The optimal cutoffs for TTR and duration of ADT were determined using the maximally selected rank statistics (MSRS). RESULTS After a median follow-up of 104 months, 18 patients relapsed among those who had recovered testosterone levels and 9 among those who did not. Median ADT duration was 36 months. The optimal cutoff for TTR was determined using MSRS. TTR >48 months was significantly associated with better bRFS (logrank, p < 0.0027). Five-year bRFS was 100% for >48 months vs. 85% for <48 months. TTR was the only significant variable for bRFS in multivariate Cox analysis. CONCLUSION Our data show an association between longer TTR and bRFS values among PCa patients treated with ADT.
Collapse
Affiliation(s)
- Susana Castro-Larefors
- Dept. of Radiation Oncology, Complejo Hospitalario Universitario de Albacete (CHUA), C/ Hnos Falcó 37, 02006, Albacete, Spain
| | - Maria Magdalena Marti-Laosa
- Dept. of Radiation Oncology, Complejo Hospitalario Universitario de Albacete (CHUA), C/ Hnos Falcó 37, 02006, Albacete, Spain
| | - Veronica Lopez-Honrubia
- Dept. of Radiation Oncology, Complejo Hospitalario Universitario de Albacete (CHUA), C/ Hnos Falcó 37, 02006, Albacete, Spain
| | - Irene Rey-Lopez
- Dept. of Radiation Oncology, Complejo Hospitalario Universitario de Albacete (CHUA), C/ Hnos Falcó 37, 02006, Albacete, Spain
| | - Beatriz Ruiz-Herrero
- Dept. of Radiation Oncology, Complejo Hospitalario Universitario de Albacete (CHUA), C/ Hnos Falcó 37, 02006, Albacete, Spain
| | - Yasmina Murria-Perez
- Dept. of Radiation Oncology, Complejo Hospitalario Universitario de Albacete (CHUA), C/ Hnos Falcó 37, 02006, Albacete, Spain
| | - Ignacio Andres
- Dept. of Radiation Oncology, Complejo Hospitalario Universitario de Albacete (CHUA), C/ Hnos Falcó 37, 02006, Albacete, Spain
| | - Isabel Elvira Jimenez-Garcia
- Dept. of Radiation Oncology, Complejo Hospitalario Universitario de Albacete (CHUA), C/ Hnos Falcó 37, 02006, Albacete, Spain
| | - Roberto Berenguer
- Dept. of Radiation Oncology, Complejo Hospitalario Universitario de Albacete (CHUA), C/ Hnos Falcó 37, 02006, Albacete, Spain
| | - Manuel Aguayo-Martos
- Dept. of Radiation Oncology, Complejo Hospitalario Universitario de Albacete (CHUA), C/ Hnos Falcó 37, 02006, Albacete, Spain
| | - Ricardo Sánchez-Prieto
- Laboratorio de Oncología. Unidad de Medicina Molecular, Centro Regional de Investigaciones Biomédicas, Unidad Asociada de Biomedicina UCLM, Unidad asociada al CSIC, Universidad de Castilla-La Mancha, Albacete, Spain
- Departamento de Ciencias Médicas, Facultad de Medicina de Albacete, Universidad de Castilla-La Mancha, Albacete, Spain
| | - Angeles Rovirosa
- Gynecological Cancer Unit, Radiation Oncology Department, ICMHO, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | | | - Sebastià Sabater
- Dept. of Radiation Oncology, Complejo Hospitalario Universitario de Albacete (CHUA), C/ Hnos Falcó 37, 02006, Albacete, Spain.
| |
Collapse
|
2
|
Dias A, Brook MN, Bancroft EK, Page EC, Chamberlain A, Saya S, Amin J, Mikropoulos C, Taylor N, Myhill K, Thomas S, Saunders E, Dadaev T, Leongamornlert D, Dyrsø Jensen T, Evans DG, Cybulski C, Liljegren A, Teo SH, Side L, Kote‐Jarai Z, Eeles RA. Serum testosterone and prostate cancer in men with germline BRCA1/2 pathogenic variants. BJUI COMPASS 2023; 4:361-373. [PMID: 37025481 PMCID: PMC10071088 DOI: 10.1002/bco2.156] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/10/2022] [Accepted: 04/12/2022] [Indexed: 01/11/2023] Open
Abstract
Objectives The relation of serum androgens and the development of prostate cancer (PCa) is subject of debate. Lower total testosterone (TT) levels have been associated with increased PCa detection and worse pathological features after treatment. However, data from the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) and Prostate Cancer Prevention (PCPT) trial groups indicate no association. The aim of this study is to investigate the association of serum androgen levels and PCa detection in a prospective screening study of men at higher genetic risk of aggressive PCa due to BRCA1/2 pathogenic variants (PVs), the IMPACT study. Methods Men enrolled in the IMPACT study provided serum samples during regular visits. Hormonal levels were calculated using immunoassays. Free testosterone (FT) was calculated from TT and sex hormone binding globulin (SHBG) using the Sodergard mass equation. Age, body mass index (BMI), prostate-specific antigen (PSA) and hormonal concentrations were compared between genetic cohorts. We also explored associations between age and TT, SHBG, FT and PCa, in the whole subset and stratified by BRCA1/2 PVs status. Results A total of 777 participants in the IMPACT study had TT and SHBG measurements in serum samples at annual visits, giving 3940 prospective androgen levels, from 266 BRCA1 PVs carriers, 313 BRCA2 PVs carriers and 198 non-carriers. The median number of visits per patient was 5. There was no difference in TT, SHBG and FT between carriers and non-carriers. In a univariate analysis, androgen levels were not associated with PCa. In the analysis stratified by carrier status, no significant association was found between hormonal levels and PCa in non-carriers, BRCA1 or BRCA2 PVs carriers. Conclusions Male BRCA1/2 PVs carriers have a similar androgen profile to non-carriers. Hormonal levels were not associated with PCa in men with and without BRCA1/2 PVs. Mechanisms related to the particularly aggressive phenotype of PCa in BRCA2 PVs carriers may therefore not be linked with circulating hormonal levels.
Collapse
Affiliation(s)
- Alexander Dias
- Oncogenetics TeamThe Institute of Cancer ResearchLondonUK
- Instituto Nacional de Cancer Jose de Alencar Gomes da Silva INCARio de JaneiroBrazil
| | - Mark N. Brook
- Oncogenetics TeamThe Institute of Cancer ResearchLondonUK
| | - Elizabeth K. Bancroft
- Oncogenetics TeamThe Institute of Cancer ResearchLondonUK
- Academic Urology UnitRoyal Marsden NHS Foundation TrustLondonUK
| | | | | | - Sibel Saya
- Oncogenetics TeamThe Institute of Cancer ResearchLondonUK
| | - Jan Amin
- Clinical Biochemistry SectionRoyal Marsden NHS Foundation TrustLondonUK
| | - Christos Mikropoulos
- Oncogenetics TeamThe Institute of Cancer ResearchLondonUK
- Academic Urology UnitRoyal Marsden NHS Foundation TrustLondonUK
| | - Natalie Taylor
- Oncogenetics TeamThe Institute of Cancer ResearchLondonUK
- Academic Urology UnitRoyal Marsden NHS Foundation TrustLondonUK
| | - Kathryn Myhill
- Oncogenetics TeamThe Institute of Cancer ResearchLondonUK
- Academic Urology UnitRoyal Marsden NHS Foundation TrustLondonUK
| | - Sarah Thomas
- Oncogenetics TeamThe Institute of Cancer ResearchLondonUK
| | | | - Tokhir Dadaev
- Oncogenetics TeamThe Institute of Cancer ResearchLondonUK
| | | | | | - D. Gareth Evans
- Genetic Medicine, Manchester Academic Health Sciences CentreCentral Manchester University Hospitals NHS Foundation TrustManchesterUK
| | - Cezary Cybulski
- International Hereditary Cancer Center, Department of Genetics and PathologyPomeranian Medical University in SzczecinSzczecinPoland
| | - Annelie Liljegren
- Karolinska University Hospital and Karolinska InstitutetStockholmSweden
| | - Soo H. Teo
- Cancer Research Initiatives FoundationSubang Jaya Medical CentreSelangorDarul EhsanMalaysia
| | - Lucy Side
- Wessex Clinical Genetics ServicePrincess Anne HospitalSouthamptonUK
| | | | | | - Rosalind A. Eeles
- Oncogenetics TeamThe Institute of Cancer ResearchLondonUK
- Academic Urology UnitRoyal Marsden NHS Foundation TrustLondonUK
| |
Collapse
|
3
|
Porcaro AB, Panunzio A, Bianchi A, Cerrato C, Gallina S, Serafin E, Mazzucato G, Vidiri S, D’Aietti D, Orlando R, Brusa D, Brunelli M, Siracusano S, Pagliarulo V, Cerruto MA, Tafuri A, Antonelli A. Normal preoperative endogenous testosterone levels predict prostate cancer progression in elderly patients after radical prostatectomy. Ther Adv Urol 2023; 15:17562872231154150. [PMID: 36846295 PMCID: PMC9950604 DOI: 10.1177/17562872231154150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 01/13/2023] [Indexed: 02/24/2023] Open
Abstract
Background The impact of senior age on prostate cancer (PCa) oncological outcomes following radical prostatectomy (RP) is controversial, and further clinical factors could help stratifying risk categories in these patients. Objective We tested the association between endogenous testosterone (ET) and risk of PCa progression in elderly patients treated with RP. Design Data from PCa patients treated with RP at a single tertiary referral center, between November 2014 and December 2019 with available follow-up, were retrospectively evaluated. Methods Preoperative ET (classified as normal if >350 ng/dl) was measured for each patient. Patients were divided according to a cut-off age of 70 years. Unfavorable pathology consisted of International Society of Urologic Pathology (ISUP) grade group >2, seminal vesicle, and pelvic lymph node invasion. Cox regression models tested the association between clinical/pathological tumor features and risk of PCa progression in each age subgroup. Results Of 651 included patients, 190 (29.2%) were elderly. Abnormal ET levels were detected in 195 (30.0%) cases. Compared with their younger counterparts, elderly patients were more likely to have pathological ISUP grade group >2 (49.0% versus 63.2%). Disease progression occurred in 108 (16.6%) cases with no statistically significant difference between age subgroups. Among the elderly, clinically progressing patients were more likely to have normal ET levels (77.4% versus 67.9%) and unfavorable tumor grades (90.3% versus 57.9%) than patients who did not progress. In multivariable Cox regression models, normal ET [hazard ratio (HR) = 3.29; 95% confidence interval (CI) = 1.27-8.55; p = 0.014] and pathological ISUP grade group >2 (HR = 5.62; 95% CI = 1.60-19.79; p = 0.007) were independent predictors of PCa progression. On clinical multivariable models, elderly patients were more likely to progress for normal ET levels (HR = 3.42; 95% CI = 1.34-8.70; p = 0.010), independently by belonging to high-risk category. Elderly patients with normal ET progressed more rapidly than those with abnormal ET. Conclusion In elderly patients, normal preoperative ET independently predicted PCa progression. Elderly patients with normal ET progressed more rapidly than controls, suggesting that longer exposure time to high-grade tumors could adversely impact sequential cancer mutations, where normal ET is not anymore protective on disease progression.
Collapse
Affiliation(s)
| | | | - Alberto Bianchi
- Department of Urology, University of Verona and
Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Clara Cerrato
- Department of Urology, University of Verona and
Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Sebastian Gallina
- Department of Urology, University of Verona and
Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Emanuele Serafin
- Department of Urology, University of Verona and
Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Giovanni Mazzucato
- Department of Urology, University of Verona and
Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Stefano Vidiri
- Department of Urology, University of Verona and
Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Damiano D’Aietti
- Department of Urology, University of Verona and
Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Rossella Orlando
- Department of Urology, University of Verona
and Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Davide Brusa
- Department of Urology, University of Verona
and Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Matteo Brunelli
- Department of Pathology, University of Verona,
Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Salvatore Siracusano
- Department of Life, Health and Environmental
Sciences, University of L’Aquila, L’Aquila, Italy
| | | | - Maria Angela Cerruto
- Department of Urology, University of Verona
and Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Alessandro Antonelli
- Department of Urology, University of Verona
and Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| |
Collapse
|
4
|
Preoperative endogenous testosterone density predicts disease progression from localized impalpable prostate cancer presenting with PSA levels elevated up to 10 ng/mL. Int Urol Nephrol 2023; 55:85-92. [PMID: 36197572 PMCID: PMC9807534 DOI: 10.1007/s11255-022-03366-3] [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: 09/04/2022] [Accepted: 09/13/2022] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To investigate endogenous testosterone density (ETD) predicting disease progression from clinically localized impalpable prostate cancer (PCa) presenting with prostate-specific antigen (PSA) levels elevated up to 10 ng/mL and treated with radical prostatectomy. MATERIALS AND METHODS In a period ranging from November 2014 to December 2019, 805 consecutive PCa patients who were not under androgen blockade had endogenous testosterone (ET, ng/dL) measured before surgery. ETD was evaluated as the ratio of ET on prostate volume (PV). Unfavorable disease was defined as including ISUP ≥ 3 and/or seminal vesicle invasion in the surgical specimen. The risk of disease progression was evaluated by statistical methods. RESULTS Overall, the study selected 433 patients, of whom 353 (81.5%) had available follow-up. Unfavorable disease occurred in 46.7% of cases and was predicted by tumor quantitation features that were positively associated with ETD. Disease progression, which occurred for 46 (13%) cases, was independently predicted only by ETD (hazard ratio, HR = 1.037; 95% CI 1.004-1.072; p = 0.030) after adjusting for unfavorable disease. According to a multivariate model, ETD above the third quartile was confirmed to be an independent predictor for PCa progression (HR = 2.479; 95% CI 1.355-4.534; p = 0.003) after adjusting for unfavorable disease. The same ETD measurements, ET mean levels were significantly lower in progressing cancers. CONCLUSIONS In this particular subset of patients, increased ETD with low ET levels, indicating androgen independence, resulted in a more aggressive disease with poorer prognosis.
Collapse
|
5
|
Manceau C, Fromont G, Beauval JB, Barret E, Brureau L, Créhange G, Dariane C, Fiard G, Gauthé M, Mathieu R, Renard-Penna R, Roubaud G, Ruffion A, Sargos P, Rouprêt M, Ploussard G. Biomarker in Active Surveillance for Prostate Cancer: A Systematic Review. Cancers (Basel) 2021; 13:4251. [PMID: 34503059 PMCID: PMC8428218 DOI: 10.3390/cancers13174251] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 12/13/2022] Open
Abstract
Active surveillance (AS) in prostate cancer (PCa) represents a curative alternative for men with localised low-risk PCa. Continuous improvement of AS patient's selection and surveillance modalities aims at reducing misclassification, simplifying modalities of surveillance and decreasing need for invasive procedures such repeated biopsies. Biomarkers represent interesting tools to evaluate PCa diagnosis and prognosis, of which many are readily available or under evaluation. The aim of this review is to investigate the biomarker performance for AS selection and patient outcome prediction. Blood, urinary and tissue biomarkers were studied and a brief description of use was proposed along with a summary of major findings. Biomarkers represent promising tools which could be part of a more tailored risk AS strategy aiming to offer personalized medicine and to individualize the treatment and monitoring of each patient. The usefulness of biomarkers has mainly been suggested for AS selection, whereas few studies have investigated their role during the monitoring phase. Randomized prospective studies dealing with imaging are needed as well as larger prospective studies with long-term follow-up and strong oncologic endpoints.
Collapse
Affiliation(s)
- Cécile Manceau
- Department of Urology, CHU-IUC Toulouse, F-31000 Toulouse, France
| | - Gaëlle Fromont
- Department of Pathology, CHRU Tours, F-37000 Tours, France;
| | - Jean-Baptiste Beauval
- Department of Urology, La Croix du Sud Hospital, F-31130 Quint Fonsegrives, France; (J.-B.B.); (G.P.)
| | - Eric Barret
- Department of Urology, Institut Mutualiste Montsouris, F-75014 Paris, France;
| | - Laurent Brureau
- Department of Urology, CHU de Pointe-à-Pitre, University of Antilles, University of Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)–UMR_S 1085, F-97110 Pointe-à-Pitre, France;
| | - Gilles Créhange
- Department of Radiation Oncology, Curie Institute, F-75005 Paris, France;
| | - Charles Dariane
- Department of Urology, Hôpital Européen Georges-Pompidou, APHP, Paris–Paris University–U1151 Inserm-INEM, Necker, F-75015 Paris, France;
| | - Gaëlle Fiard
- Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, F-38000 Grenoble, France;
| | - Mathieu Gauthé
- AP-HP Health Economics Research Unit, INSERM-UMR1153, F-75004 Paris, France;
| | - Romain Mathieu
- Department of Urology, CHU Rennes, F-35033 Rennes, France;
| | - Raphaële Renard-Penna
- Department of Radiology, Sorbonne University, AP-HP, Pitie-Salpetriere Hospital, F-75013 Paris, France;
| | - Guilhem Roubaud
- Department of Medical Oncology, Institut Bergonié, F-33000 Bordeaux, France;
| | - Alain Ruffion
- Service d’Urologie Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, F-69002 Lyon, France;
- Equipe 2–Centre d’Innovation en Cancérologie de Lyon (EA 3738 CICLY)–Faculté de Médecine Lyon Sud–Université Lyon 1, F-69002 Lyon, France
| | - Paul Sargos
- Department of Radiotherapy, Institut Bergonié, 33000 Bordeaux, France;
| | - Morgan Rouprêt
- Department of Urology, Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Pitie-Salpetriere Hospital, F-75013 Paris, France;
| | - Guillaume Ploussard
- Department of Urology, La Croix du Sud Hospital, F-31130 Quint Fonsegrives, France; (J.-B.B.); (G.P.)
- Institut Universitaire du Cancer Oncopole, F-31000 Toulouse, France
| | | |
Collapse
|
6
|
Ferro M, Lucarelli G, Buonerba C, Terracciano D, Boccia G, Cerullo G, Cosimato V. Narrative review of Mediterranean diet in Cilento: longevity and potential prevention for prostate cancer. Ther Adv Urol 2021; 13:17562872211026404. [PMID: 35173812 PMCID: PMC8842148 DOI: 10.1177/17562872211026404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 05/24/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Matteo Ferro
- Division of Urology, European Institute of Oncology (IEO) - IRCCS, Milan, Italy
| | - Giuseppe Lucarelli
- Department of Emergency and Organ Transplantation – Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Carlo Buonerba
- Regional Reference Center for Rare Tumors, Department of Oncology and Hematology, AOU Federico II of Naples, Naples, Campania, Italy
- National Reference Center for Environmental Health, Zoo-prophylactic Institute of Southern Italy, Portici, Italy
| | - Daniela Terracciano
- Department of Translational Medical Sciences, University Federico II, Naples, Campania, Italy
| | - Giovanni Boccia
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Giuseppe Cerullo
- Department of Movement Sciences and Wellbeing, University of Naples “Parthenope”, Naples, Italy
| | - Vincenzo Cosimato
- Division of Laboratory Medicine – Civil Hospital “Maria SS. Addolorata”– Eboli, Salerno, Italy
| |
Collapse
|
7
|
Ferro M, Lucarelli G, de Cobelli O, Vartolomei MD, Damiano R, Cantiello F, Crocerossa F, Perdonà S, Del Prete P, Cordima G, Musi G, Del Giudice F, Busetto GM, Chung BI, Porreca A, Ditonno P, Battaglia M, Terracciano D. Circulating preoperative testosterone level predicts unfavourable disease at radical prostatectomy in men with International Society of Urological Pathology Grade Group 1 prostate cancer diagnosed with systematic biopsies. World J Urol 2020; 39:1861-1867. [PMID: 32683462 PMCID: PMC8217017 DOI: 10.1007/s00345-020-03368-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/13/2020] [Indexed: 01/02/2023] Open
Abstract
Purpose The association between circulating total testosterone (T) levels and clinically significant PCa is still a matter of debate. In this study, we evaluated whether serum testosterone levels may have a role in predicting unfavorable disease (UD) and biochemical recurrence (BCR) in patients with clinically localized (≤ cT2c) ISUP grade group 1 PCa at biopsy. Methods 408 patients with ISUP grade group 1 prostate cancer, undergone to radical prostatectomy and T measurement were included. The outcome of interest was the presence of unfavourable disease (UD) defined as ISUP grade group \documentclass[12pt]{minimal}
\usepackage{amsmath}
\usepackage{wasysym}
\usepackage{amsfonts}
\usepackage{amssymb}
\usepackage{amsbsy}
\usepackage{mathrsfs}
\usepackage{upgreek}
\setlength{\oddsidemargin}{-69pt}
\begin{document}$$\ge$$\end{document}≥ 3 and/or pT \documentclass[12pt]{minimal}
\usepackage{amsmath}
\usepackage{wasysym}
\usepackage{amsfonts}
\usepackage{amssymb}
\usepackage{amsbsy}
\usepackage{mathrsfs}
\usepackage{upgreek}
\setlength{\oddsidemargin}{-69pt}
\begin{document}$$\ge$$\end{document}≥ 3a. Results Statistically significant differences resulted between serum testosterone values and ISUP grade groups (P < 0.0001). Significant correlation was found analyzing testosterone values versus age (P < 0.0001), and versus PSA (P = 0.008). BCR-free survival was significantly decreased in patients with low levels of testosterone (P = 0.005). These findings were confirmed also in the ISUP 1–2 subgroups (P = 0.01). ROC curve analysis showed that T outperformed PSA in predicting UD (AUC 0.718 vs AUC 0.525; P < 0.001) and was and independent risk factor for BCR. Conclusion Our findings suggested that circulating total T was a significant predictor of UD at RP in patients with preoperative low- to intermediate-risk diseases, confirming the potential role of circulating androgens in preoperative risk assessment of PCa patients.
Collapse
Affiliation(s)
- Matteo Ferro
- Division of Urology, European Institute of Oncology (IEO), IRCCS, via Ripamonti 435, 20141, Milan, Italy.
| | - Giuseppe Lucarelli
- Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Piazza G. Cesare 11, 70124, Bari, Italy.
| | - Ottavio de Cobelli
- Division of Urology, European Institute of Oncology (IEO), IRCCS, via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hematology-Oncology, Università Degli Studi Di Milano, Milan, Italy
| | - Mihai Dorin Vartolomei
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Department of Cell and Molecular Biology, University of Medicine, Pharmacy, Sciences and Technology, Targu-Mures, Romania
| | - Rocco Damiano
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Francesco Cantiello
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Fabio Crocerossa
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Sisto Perdonà
- Division of Urology, Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Naples, Italy
| | - Paola Del Prete
- Scientific Directorate, Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Naples, Italy
| | - Giovanni Cordima
- Division of Urology, European Institute of Oncology (IEO), IRCCS, via Ripamonti 435, 20141, Milan, Italy
| | - Gennaro Musi
- Division of Urology, European Institute of Oncology (IEO), IRCCS, via Ripamonti 435, 20141, Milan, Italy
| | | | | | - Benjamin I Chung
- Department of Urology, Stanford University Medical Center, Palo Alto, CA, USA
| | - Angelo Porreca
- Department of Urology, Policlinico Abano Terme, Abano Terme, Italy
| | - Pasquale Ditonno
- Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Piazza G. Cesare 11, 70124, Bari, Italy.,National Cancer Institute "Giovanni Paolo II", Bari, Italy
| | - Michele Battaglia
- Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Piazza G. Cesare 11, 70124, Bari, Italy
| | - Daniela Terracciano
- Department of Translational Medical Sciences, University of Naples "Federico II", 8031, Naples, Italy
| |
Collapse
|
8
|
European Society for Sexual Medicine Consensus Statement on the Use of the Cavernous Nerve Injury Rodent Model to Study Postradical Prostatectomy Erectile Dysfunction. Sex Med 2020; 8:327-337. [PMID: 32674971 PMCID: PMC7471127 DOI: 10.1016/j.esxm.2020.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/16/2020] [Accepted: 06/14/2020] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Rodent animal models are currently the most used in vivo model in translational studies looking into the pathophysiology of erectile dysfunction after nerve-sparing radical prostatectomy. AIM This European Society for Sexual Medicine (ESSM) statement aims to guide scientists toward utilization of the rodent model in an appropriate, timely, and proficient fashion. METHODS MEDLINE and EMBASE databases were searched for basic science studies, using a rodent animal model, looking into the consequence of pelvic nerve injury on erectile function. MAIN OUTCOME MEASURES The authors present a consensus on how to best perform experiments with this rodent model, the details of the technique, and highlight possible pitfalls. RESULTS Owing to the specific issue-basic science-Oxford 2011 Levels of Evidence criteria cannot be applied. However, ESSM statements on this topic will be provided in which we summarize the ESSM position on various aspects of the model such as the use of the Animal Research Reporting In Vivo Experiments guideline and the of common range parameter for nerve stimulation. We also highlighted the translational limits of the model. CONCLUSION The following statements were formulated as a suggestive guidance for scientists using the cavernous nerve injury model. With this, we hope to standardize and further improve the quality of research in this field. It must be noted that this model has its limitations. Weyne E, Ilg MM, Cakir OO, et al. European Society for Sexual Medicine Consensus Statement on the Use of the Cavernous Nerve Injury Rodent Model to Study Postradical Prostatectomy Erectile Dysfunction. Sex Med 2020;8:327-337.
Collapse
|
9
|
Lévesque E, Caron P, Lacombe L, Turcotte V, Simonyan D, Fradet Y, Aprikian A, Saad F, Carmel M, Chevalier S, Guillemette C. A Comprehensive Analysis of Steroid Hormones and Progression of Localized High-Risk Prostate Cancer. Cancer Epidemiol Biomarkers Prev 2019; 28:701-706. [PMID: 30733309 DOI: 10.1158/1055-9965.epi-18-1002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 11/01/2018] [Accepted: 02/02/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In men with localized prostate cancer who are undergoing radical prostatectomy (RP), it is uncertain whether their systemic hormonal environment is associated with outcomes. The objective of the study was to examine the association between the circulating steroid metabolome with prognostic factors and progression. METHODS The prospective PROCURE cohort was recruited from 2007 to 2012, and comprises 1,766 patients with localized prostate cancer who provided blood samples prior to RP. The levels of 15 steroids were measured in plasma using mass spectrometry, and their association with prognostic factors and disease-free survival (DFS) was established with logistic regression and multivariable Cox proportional hazard models. RESULTS The median follow-up time after surgery was 73.2 months. Overall, 524 patients experienced biochemical failure and 75 developed metastatic disease. Testosterone and androsterone levels were higher in low-risk disease. Associations were observed between adrenal precursors and risk of cancer progression. In high-risk patients, a one-unit increment in log-transformed androstenediol (A5diol) and dehydroepiandrosterone-sulfate (DHEA-S) levels were linked to DFS with HR of 1.47 (P = 0.0017; q = 0.026) and 1.24 (P = 0.043; q = 0.323), respectively. Although the number of metastatic events was limited, trends with metastasis-free survival were observed for A5diol (HR = 1.51; P = 0.057) and DHEA-S levels (HR = 1.43; P = 0.054). CONCLUSIONS In men with localized prostate cancer, our data suggest that the preoperative steroid metabolome is associated with the risk of recurrence of high-risk disease. IMPACT The associations of adrenal androgens with progression of localized high-risk disease could help refine hormonal strategies for these patients.
Collapse
Affiliation(s)
- Eric Lévesque
- Centre Hospitalier Universitaire (CHU) de Québec Research Centre and Faculty of Medicine, Laval University, Québec, Canada.
| | - Patrick Caron
- CHU de Québec Research Centre and Faculty of Pharmacy, Laval University, Québec, Canada
| | - Louis Lacombe
- Centre Hospitalier Universitaire (CHU) de Québec Research Centre and Faculty of Medicine, Laval University, Québec, Canada
| | - Véronique Turcotte
- CHU de Québec Research Centre and Faculty of Pharmacy, Laval University, Québec, Canada
| | - David Simonyan
- Statistical and Clinical Research Platform, CHU de Québec Research Centre, Québec, Canada
| | - Yves Fradet
- Centre Hospitalier Universitaire (CHU) de Québec Research Centre and Faculty of Medicine, Laval University, Québec, Canada
| | - Armen Aprikian
- McGill University Health Centre, McGill University, Faculty of Medicine, Québec, Canada
| | - Fred Saad
- Centre Hospitalier de l'Université de Montréal, Faculty of Medicine, Université de Montréal, Québec, Canada
| | - Michel Carmel
- Université de Sherbrooke, Faculty of Medicine, Québec, Canada
| | - Simone Chevalier
- McGill University Health Centre, McGill University, Faculty of Medicine, Québec, Canada
| | - Chantal Guillemette
- CHU de Québec Research Centre and Faculty of Pharmacy, Laval University, Québec, Canada.
| |
Collapse
|
10
|
Abstract
PURPOSE OF REVIEW The role of testosterone in the development of prostate cancer and the safety of testosterone therapy (TTh) after prostate cancer treatment, or in the setting of active surveillance, remains controversial. There are many concerns about using TTh in men, particularly those with a history of prostate cancer, ranging from a possible increased risk of cardiovascular disease to cancer progression or recurrence. With many prostate cancer patients living longer, and hypogonadism having significant morbidity, much care must go into the decision to treat. Here, we review the literature investigating the effects of testosterone on the prostate as well as the efficacy and safety of exogenous testosterone in men with a history of prostate cancer. RECENT FINDINGS The improvement in quality of life with TTh is well studied and understood, while the argument for significantly increased risk of cancer or other adverse effects is much less robust. Neither increased rates of prostate cancer, cancer recurrence, or cardiovascular risk have been well established. In men with high-risk prostate cancer, evidence in the setting of TTh is very limited, and TTh should be used with caution. The fears of TTh causing or worsening prostate cancer do not appear to be well supported by available data. Though more studies are needed to definitively determine the safety of TTh in men with prostate cancer, consideration should be given to treatment of hypogonadal men with a history of CaP.
Collapse
|
11
|
Thompson JE, Egger S, Böhm M, Siriwardana AR, Haynes AM, Matthews J, Scheltema MJ, Stricker PD. Superior Biochemical Recurrence and Long-term Quality-of-life Outcomes Are Achievable with Robotic Radical Prostatectomy After a Long Learning Curve-Updated Analysis of a Prospective Single-surgeon Cohort of 2206 Consecutive Cases. Eur Urol 2017; 73:664-671. [PMID: 29273404 DOI: 10.1016/j.eururo.2017.11.035] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 11/28/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Our earlier analysis suggested that robot-assisted radical prostatectomy (RARP) achieved superiority over open radical prostatectomy (ORP) in terms of positive surgical margin (PSM) rates and functional outcomes. OBJECTIVE With larger sample size and longer follow-up, the objective of this study update is to assess whether our previous findings are upheld and whether the improved PSM rates for RARP after an initial learning curve compared with ORP-as observed in our earlier analysis-ultimately resulted in improved biochemical control. DESIGN, SETTING, AND PARTICIPANTS Prospective observational study comparing two surgical techniques; 2271 consecutive men underwent RARP (1520) or ORP (751) at a single centre from 2006 to 2016. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Demographic and clinicopathological data were prospectively collected. The EPIC-QOL questionnaire was administered at baseline and 1.5, 3, 6, 12, and 24 mo. Multivariate linear regression modelled the difference in quality of life (QOL) domains against case number; logistic and Cox regression modelled the differences in PSM and biochemical recurrence (BCR) hazard ratios (HR), respectively. RESULTS AND LIMITATIONS A total of 2206 men were included in BCR/PSM analysis and 1045 consented for QOL analysis. Superior pT2 surgical margins, early and late sexual outcomes, and early urinary outcomes were upheld and became more robust (narrowing of 95% confidence intervals [CIs]). The risk of BCR was initially higher for RARP, improved after 191 RARPs, and was 35% lower (hazard ratio [HR] 0.65, 95% CI 0.47-0.90) at final RARP, plateauing after 226 RARPs. Improved late (12-24 mo) urinary bother scores (adjusted mean difference [AMD]=4.7, 95% CI 1.3-8.0) and irritative-obstructive scores (AMD=3.8, 95% CI 0.9-5.6) at final RARP were demonstrated. Limitations include observational single surgeon data, possible residual confounding, and short follow-up. CONCLUSIONS The results from this updated analysis demonstrate that RARP can be beneficial for patients of high-volume surgeons, although more randomised studies and studies with survival outcomes are needed. PATIENT SUMMARY Robot-assisted radical prostatectomy was able to improve functional and oncological outcomes in this single surgeon's learning curve.
Collapse
Affiliation(s)
- James E Thompson
- St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia; Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia; The University of New South Wales, Kensington, NSW, Australia.
| | - Sam Egger
- Cancer Council NSW, Woolloomooloo, NSW, Australia
| | - Maret Böhm
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia
| | - Amila R Siriwardana
- St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia; Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia
| | - Anne-Maree Haynes
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia
| | - Jayne Matthews
- St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia
| | - Matthijs J Scheltema
- St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia; Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia; Academic Medical Center, Amsterdam, The Netherlands
| | - Phillip D Stricker
- St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia; Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia; The University of New South Wales, Kensington, NSW, Australia
| |
Collapse
|
12
|
Ferro M, Lucarelli G, Bruzzese D, Di Lorenzo G, Perdonà S, Autorino R, Cantiello F, La Rocca R, Busetto GM, Cimmino A, Buonerba C, Battaglia M, Damiano R, De Cobelli O, Mirone V, Terracciano D. Low serum total testosterone level as a predictor of upstaging and upgrading in low-risk prostate cancer patients meeting the inclusion criteria for active surveillance. Oncotarget 2017; 8:18424-18434. [PMID: 27793023 PMCID: PMC5392340 DOI: 10.18632/oncotarget.12906] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 10/14/2016] [Indexed: 12/22/2022] Open
Abstract
Active surveillance (AS) is currently a widely accepted treatment option for men with clinically localized prostate cancer (PCa). Several reports have highlighted the association of low serum testosterone levels with high-grade, high-stage PCa. However, the impact of serum testosterone as a predictor of progression in men with low-risk PCa has been little assessed. In this study, we evaluated the association of circulating testosterone concentrations with a staging/grading reclassification in a cohort of low-risk PCa patients meeting the inclusion criteria for the AS protocol but opting for radical prostatectomy. Radical prostatectomy (RP) was performed in 338 patients, eligible for AS according to the following criteria: clinical stage T2a or less, PSA<10ng/ml, two or fewer cancer cores, Gleason score (GS)=6 and PSA density<0.2 ng/mL/cc. Reclassification was defined as upstaging (stage>pT2) and upgrading (GS=7; primary Gleason pattern 4) disease. Unfavorable disease was defined as the occurrence of pathological stage>pT2 and predominant Gleason score 4. Total testosterone was measured before surgery. Low serum testosterone levels (<300 ng/dL) were significantly associated with upgrading, upstaging, unfavorable disease and positive surgical margins. The addition of testosterone to a base model, including age, PSA, PSA density, clinical stage and positive cancer involvement in cores, showed a significant independent influence of this variable on upstaging, upgrading and unfavorable disease. In conclusion, our results support the idea that total testosterone should be a selection criterion for inclusion of low-risk PCa patients in AS programs and suggest that testosterone level less than 300 ng/dL should be considered a discouraging factor when a close AS program is considered as treatment option
Collapse
Affiliation(s)
- Matteo Ferro
- Department of Urology, European Institute of Oncology, Via Ripamonti, Milan, Italy
| | - Giuseppe Lucarelli
- Department of Emergency & Organ Transplantation - Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Dario Bruzzese
- Department of Public Health, University of Naples 'Federico II', Naples, Italy
| | - Giuseppe Di Lorenzo
- Department of Clinical Medicine, Medical Oncology Unit, University of Naples 'Federico II', Naples, Italy
| | - Sisto Perdonà
- Department of Urology, "Istituto Nazionale Tumori Fondazione Giovanni Pascale - IRCCS", Naples, Italy
| | | | | | - Roberto La Rocca
- Department of Urology, University of Naples 'Federico II', Naples, Italy
| | | | - Amelia Cimmino
- Institute of Genetics and Biophysics "A. Buzzati Traverso", National Research Council, Naples, Italy
| | - Carlo Buonerba
- Department of Clinical Medicine, Medical Oncology Unit, University of Naples 'Federico II', Naples, Italy
| | - Michele Battaglia
- Department of Emergency & Organ Transplantation - Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Rocco Damiano
- Division of Urology, Magna Graecia University, Catanzaro, Italy
| | - Ottavio De Cobelli
- Department of Urology, European Institute of Oncology, Via Ripamonti, Milan, Italy.,University of Milan, Milan, Italy.,University of Medicine Iuliu Hatieganu, Cluj-Napoca, Romania
| | - Vincenzo Mirone
- Department of Urology, University of Naples 'Federico II', Naples, Italy
| | - Daniela Terracciano
- Department of Translational Medical Sciences, University of Naples 'Federico II', Naples, Italy
| |
Collapse
|
13
|
Porcaro AB, De Luyk N, Corsi P, Sebben M, Tafuri A, Cacciamani G, De Marchi D, Tamanini I, Inverardi D, Brunelli M, Cerruto MA, Salvagno GL, Guidi GC, Artibani W. Preoperative Plasma Levels of Total Testosterone Associated with High Grade Pathology-Detected Prostate Cancer: Preliminary Results of a Prospective Study in a Contemporary Cohort of Patients. Curr Urol 2017; 10:72-80. [PMID: 28785191 DOI: 10.1159/000447155] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 02/09/2016] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES To investigate the associations, if any, between preoperative plasma levels of total testosterone (TT) and pathology Gleason score (pGS) in a contemporary cohort of prostate cancer (PCa) patients. MATERIALS AND METHODS Between November 2014 and June 2015, plasma levels of TT were measured in 142 patients who underwent radical prostatectomy. Exclusion criteria were as follows: 5α-reductase inhibitors, LH-releasing hormone analogues, or testosterone replacement treatment. The entire cohort, assessed by continuous and categorical variables, was classified into two groups according to the pGS that included low-intermediate (pGS 6-7) and high grade (pGS > 7) cases. TT was evaluated as a continuous variable. RESULTS The cohort included 128 cases. High grade PCa was detected in 28 (21.8%) patients. Median plasma levels of both TT and prostate specific antigen (PSA) were significantly higher in these cases. In the clinical multivariate model, independent and positive predictors of pGS > 7 were TT (p = 0.041; OR = 1.004), PSA (p = 0.006; OR = 1.191), and bGS > 6 (p = 0.004; OR = 5.0); that is, a single unit increase in TT plasma levels increases the odds of having high grade PCa by 4%. CONCLUSION In a contemporary cohort of patients, preoperative plasma levels of TT directly and independently associated with high grade PCa. High baseline plasma levels of TT might have clinical applications for managing PCa. New and well designed prospective studies dealing with this subject are required.
Collapse
Affiliation(s)
- Antonio B Porcaro
- Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Nicolò De Luyk
- Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Paolo Corsi
- Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Marco Sebben
- Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Alessandro Tafuri
- Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Giovanni Cacciamani
- Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Davide De Marchi
- Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Irene Tamanini
- Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Davide Inverardi
- Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Matteo Brunelli
- Department of Pathology, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Maria A Cerruto
- Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Gian L Salvagno
- Department of Laboratory Medicine, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Gian C Guidi
- Department of Laboratory Medicine, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Walter Artibani
- Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| |
Collapse
|
14
|
Abstract
The use of exogenous testosterone to treat hypogonadism in the men with a history of prostate cancer (CaP) remains controversial due to fears of cancer recurrence or progression. Due to the detrimental impact of hypogonadism on patient quality of life, recent work has examined the safety of testosterone therapy (TTh) in men with a history of CaP. In this review, we evaluate the literature with regards to the safety of TTh in men with a history of CaP. TTh results in improvements in quality of life with little evidence of biochemical recurrence or progression in men with a history of CaP, or de novo cancer in unaffected men. An insufficient amount of evidence is currently available to truly demonstrate the safe use of TTh in men with low risk CaP. In men with high-risk cancer, more limited data suggest that TTh may be safe, but these findings remain inconclusive. Despite the historic avoidance of TTh in men with a history of CaP, the existing body of evidence largely supports the safe and effective use of testosterone in these men, although additional study is needed before unequivocal safety can be demonstrated.
Collapse
Affiliation(s)
- Alexander W Pastuszak
- Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA;; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | | | | | - Mohit Khera
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
15
|
Nguyen TM, Pastuszak AW. Testosterone Therapy Among Prostate Cancer Survivors. Sex Med Rev 2016; 4:376-88. [PMID: 27474995 PMCID: PMC5026903 DOI: 10.1016/j.sxmr.2016.06.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/22/2016] [Accepted: 06/23/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The use of testosterone in men with a history of prostate cancer remains controversial in light of established findings linking androgens to prostate cancer growth. However, hypogonadism significantly affects quality of life and has negative sequelae, and the risks and benefits of testosterone therapy might be worthwhile to consider in all men, even those with a history of high-risk prostate cancer. AIM To discuss the effects of testosterone on the prostate and the use of testosterone therapy in hypogonadal men with a history of prostate cancer. METHODS Review of the literature examining the effects of testosterone on the prostate and the efficacy and safety of exogenous testosterone in men with a history of prostate cancer. MAIN OUTCOME MEASURES Summary of effects of exogenous and endogenous testosterone on prostate tissue in vitro and in vivo, with a focus on effects in men with a history of prostate cancer. RESULTS Testosterone therapy ameliorates the symptoms of hypogonadism, decreases the risk for its negative sequelae, and can significantly improve quality of life. Recent studies do not support an increased risk for de novo prostate cancer, progression of the disease, or biochemical recurrence in hypogonadal men with a history of non-high-risk prostate cancer treated with testosterone therapy. Evidence supporting the use of testosterone in the setting of high-risk prostate cancer is less clear. CONCLUSION Despite the historical reluctance toward the use of testosterone therapy in men with a history of prostate cancer, modern evidence suggests that testosterone replacement is a safe and effective treatment option for hypogonadal men with non-high-risk prostate cancer. Additional work to definitively demonstrate the efficacy and safety of testosterone therapy in men with prostate cancer is needed, and persistent vigilance and surveillance of treated men remains necessary.
Collapse
Affiliation(s)
| | - Alexander W Pastuszak
- Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.
| |
Collapse
|
16
|
Fuentes-Pastor J, Pellejero P, Ortiz I, Ramírez-Backhaus M, de Gracia A, Marrugo C, Gomez-Ferrer A, Calatrava A, Rubio-Briones J, Rodriguez-Torreblanca C, Solsona-Narbón E. Association between late-onset hypogonadism syndrome plus metabolic syndrome and prostate cancer and its aggressiveness. Actas Urol Esp 2016; 40:440-5. [PMID: 27091367 DOI: 10.1016/j.acuro.2016.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 02/07/2016] [Accepted: 02/08/2016] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To assess the relationship between prostate cancer (PC) and the presence of metabolic syndrome and late-onset hypogonadism (LOH) syndrome. MATERIAL AND METHOD A retrospective study was conducted on 686 patients who underwent prostate biopsy. We analysed the demographic variables, clinical data and biopsy results. To diagnose metabolic syndrome, we employed the criteria of the American Heart Association. For the diagnosis of LOH syndrome, we employed the Androgen Deficiency in the Aging Male questionnaire and testosterone levels (TT). We evaluated the relationship between free testosterone (FT) and bioavailable testosterone (BT) on one hand and PC and its aggressiveness on the other, as well as the usefulness of the TT to prostate specific antigen (TT/PSA) ratio in the PC diagnosis. RESULTS The patient's median age was 65 years. Metabolic syndrome is not associated with PC (39.4% vs. 35%; P=.1) but is associated with a PC Gleason score >7 (50.4% vs. 29.44%; P=.002). LOH, low FT and low BT are associated with an increased presence of PC (51% vs. 35%, P=.02; 44.86% vs. 33.33%, P=.03; and 46.46% vs. 33.08%, P=.01, respectively) and with an increased probability of a PC Gleason score >7 (61.54% vs. 37.5%, P=.02; 54.17% vs. 34.12%, P=.02; 54.35% vs. 34.48%, P=.02, respectively). Additionally, the median TT/PSA ratio was significantly lower in patients with positive biopsies (P=.022). CONCLUSIONS Metabolic syndrome was not associated with the probability of having PC but was associated with a PC Gleason score >7. Moreover, LOH syndrome had a higher percentage of PC and a greater presence of PC Gleason scores >7, as did low levels of FT and low levels of BT.
Collapse
Affiliation(s)
- J Fuentes-Pastor
- Servicio de Urología, Hospital Universitario de Marqués de Valdecilla (HUMV), Santander, España
| | - P Pellejero
- Servicio de Urología, Hospital Universitario Central de Asturias (HUCA), Oviedo, España
| | - I Ortiz
- Departamento de Matemática Aplicada, Universidad de Almería, Almería, España
| | - M Ramírez-Backhaus
- Servicio de Urología, Fundación Instituto Valenciano de Oncología (IVO), Valencia, España.
| | - A de Gracia
- Servicio de Urología, Fundación Instituto Valenciano de Oncología (IVO), Valencia, España
| | - C Marrugo
- Servicio de Urología, Fundación Instituto Valenciano de Oncología (IVO), Valencia, España
| | - A Gomez-Ferrer
- Servicio de Urología, Fundación Instituto Valenciano de Oncología (IVO), Valencia, España
| | - A Calatrava
- Servicio de Anatomía Patológica, Fundación Instituto Valenciano de Oncología (IVO), Valencia, España
| | - J Rubio-Briones
- Servicio de Urología, Fundación Instituto Valenciano de Oncología (IVO), Valencia, España
| | | | - E Solsona-Narbón
- Servicio de Urología, Fundación Instituto Valenciano de Oncología (IVO), Valencia, España
| |
Collapse
|
17
|
Eisenberg ML. Testosterone Replacement Therapy and Prostate Cancer Incidence. World J Mens Health 2015; 33:125-9. [PMID: 26770932 PMCID: PMC4709428 DOI: 10.5534/wjmh.2015.33.3.125] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 10/16/2015] [Indexed: 11/25/2022] Open
Abstract
While early studies demonstrated a positive association between testosterone and prostate cancer, evidence on the nature of the relationship has evolved with time and newer data. Studies examining links between baseline testosterone levels as well as testosterone therapy and incident prostate cancer, reveal a more complex relationship. Moreover, investigators have reported their initial experiences with supplementing testosterone in men with a history of both treated and untreated prostate cancer.
Collapse
Affiliation(s)
- Michael Louis Eisenberg
- Departments of Urology, Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
18
|
Regis L, Planas J, Celma A, de Torres I, Ferrer R, Morote J. Behavior of total and free serum testosterone as a predictor for the risk of prostate cancer and its aggressiveness. Actas Urol Esp 2015; 39:573-81. [PMID: 25944770 DOI: 10.1016/j.acuro.2015.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 03/12/2015] [Accepted: 03/13/2015] [Indexed: 10/23/2022]
Abstract
CONTEXT Serum testosterone is mostly bound to the sex hormone-binding globulin and albumin. A small metabolically active part is present in the form of free testosterone (FT). The relationship between serum total testosterone (TT) levels and prostate carcinogenesis is debated. Our hypothesis is that the serum FT concentration is more closely associated with the risk of prostate cancer (PC) and its aggressiveness than TT. OBJECTIVE To analyze the scientific evidence that relates serum TT and/or FT levels with the diagnosis of PC and its aggressiveness. ACQUISITION OF EVIDENCE A systematic review was conducted in PubMed up to January 2015 using the following mesh terms: prostate cancer, sex hormone, androgen, testosterone and free testosterone. SYNTHESIS OF THE EVIDENCE We found 460 publications, 124 of which were reviewed to analyze the evidence. The relationship between serum TT levels and the diagnosis of PC and its aggressiveness is highly heterogeneous. The variability in the design of the studies, the quantification methods and other variables could explain this heterogeneity. In a number of studies that evaluated the estimated or measured FT, the evidence remains equally conflicting. CONCLUSIONS Based on the current evidence, we cannot recommend the measurement of serum TT and/or TL levels for the diagnosis of PC or for assessing its aggressiveness.
Collapse
|
19
|
Pichon A, Neuzillet Y, Botto H, Raynaud JP, Radulescu C, Molinié V, Herve JM, Lebret T. Preoperative low serum testosterone is associated with high-grade prostate cancer and an increased Gleason score upgrading. Prostate Cancer Prostatic Dis 2015; 18:382-7. [PMID: 26439747 DOI: 10.1038/pcan.2015.44] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 08/06/2015] [Accepted: 08/25/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND To compare histological feature of prostate cancer (PCa) according androgenic status in patients who underwent radical prostatectomy (RP). METHODS Between March 2007 and September 2013, we prospectively analysed 937 patients who were referred to our centre for RP. Clinical, pathological and biological data have been prospectively collected. Preoperative total testosterone (TT) and bioavailable testosterone (BT) serum determinations were carried out. The threshold for low serum testosterone was set at TT<3 ng/ml. Preoperative PSA value was registered. Gleason score (GS) and predominant Gleason pattern were determined in prostate biopsies and in prostate tissue specimens, crosschecked by two uro-pathologists. RESULTS Nine hundred and thirty-seven consecutive patients were included. In all, 14.9% patients had low TT in the population. An exact match between biopsy and prostate specimens in GS grading was observed for 50.6% patients (n=474). Also, 40.9% of all patients were upgraded (n=383): 45.3% (n=63) in low serum testosterone patients and 40.1% (n=320) in normal serum testosterone patients. For prostate specimens, the proportion of patients with predominant Gleason pattern 4 was higher in patients with low TT compared with normal TT (41.7% vs 29.1%, P=0.0029). In all, 20.1% were upgraded from predominant Gleason pattern 3 on biopsies specimen to predominant Gleason 4 pattern on the prostate specimen in patients with low TT, whereas 11.6% were upgraded for normal TT patients (P=0.002). CONCLUSIONS Low serum testosterone is an independent risk factor for predominant Gleason pattern 4 on prostate specimen after RP and for upgrading from low- to high-grade cancer between prostate needle biopsies and RP specimen. This observation should be taken into account in localised PCa management, especially for active surveillance or when a nerve-sparing approach is considered.
Collapse
Affiliation(s)
- A Pichon
- Department of Urology, Foch Hospital, Suresnes, France
| | - Y Neuzillet
- Department of Urology, Foch Hospital, Suresnes, France
| | - H Botto
- Department of Urology, Foch Hospital, Suresnes, France
| | - J-P Raynaud
- Department of Physiology, University Pierre and Marie Curie, Paris, France
| | - C Radulescu
- Department of Pathology, Foch Hospital, Suresnes, France
| | - V Molinié
- Department of Pathology, CHU de Fort-de-France, Fort-de-France, France
| | - J-M Herve
- Department of Urology, Foch Hospital, Suresnes, France
| | - T Lebret
- Department of Urology, Foch Hospital, Suresnes, France
| |
Collapse
|
20
|
Thaler MA, Seifert-Klauss V, Luppa PB. The biomarker sex hormone-binding globulin - from established applications to emerging trends in clinical medicine. Best Pract Res Clin Endocrinol Metab 2015; 29:749-60. [PMID: 26522459 DOI: 10.1016/j.beem.2015.06.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Sex hormone-binding globulin (SHBG) is a serum glycoprotein exhibiting the unique feature of binding sex steroids with high affinity and specificity. Its serum levels are regulated not only by androgens and estrogens but also by thyroid hormones and other metabolic factors. Several disease conditions are accompanied by altered SHBG levels such as hyper- and hypoandrogenism, thyroid disorders, pituitary diseases, liver disorders, and breast as well as prostate cancer. Additionally, several drugs and alcohol consumption influence serum concentrations of SHBG. In some cases, altered SHBG levels are a specific result of the underlying pathology. In others, they merely constitute an epiphenomenon, which still might offer the possibility of using serum measurements of SHBG as surrogate marker. This review article portrays the different disorders associated with altered SHBG levels and discusses the usefulness of SHBG as disease biomarker from a clinicians as well as from an endocrinological researchers point of view.
Collapse
Affiliation(s)
- Markus A Thaler
- Institut für Klinische Chemie und Pathobiochemie, Klinikum rechts der Isar der TU München, Ismaninger Str. 22, 81675 München, Germany.
| | - Vanadin Seifert-Klauss
- Frauenklinik und Poliklinik, Klinikum rechts der Isar der TU München, Ismaninger Str. 22, 81675 München, Germany.
| | - Peter B Luppa
- Institut für Klinische Chemie und Pathobiochemie, Klinikum rechts der Isar der TU München, Ismaninger Str. 22, 81675 München, Germany.
| |
Collapse
|
21
|
Lee JK, Byun SS, Lee SE, Hong SK. Preoperative Serum Sex Hormone-Binding Globulin Level Is an Independent Predictor of Biochemical Outcome After Radical Prostatectomy. Medicine (Baltimore) 2015; 94:e1185. [PMID: 26181566 PMCID: PMC4617085 DOI: 10.1097/md.0000000000001185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To investigate the significance of preoperative serum sex hormone-binding globulin (SHBG) level regarding the postoperative biochemical outcome in patients who were followed up for relative longer periods after undergoing radical prostatectomy (RP). Preoperative serum levels of testosterone (T), free T, and SHBG level were prospectively analyzed in 307 consecutive patients who underwent RP at our institution between January 2006 and July 2007. We analyzed potential associations of sex hormones with postoperative biochemical recurrence (BCR)-free survival via multivariate Cox proportional regression analysis. Mean postoperative follow-up duration for 307 total patients was 72.1 ± 19.6 months. Kaplan-Meier curve demonstrated that BCR-free survival was significantly worse in patients with higher (≥ 40 ng/mL) SHBG level than others (P < 0.001). Serum T (P = 0.280) and free T (P = 0.606) levels showed no significant association with biochemical outcome. In multivariate analysis encompassing postoperative variables along with PSA, T, and free T, SHBG level (HR 1.825, 1.061-3.138; P = 0.030) was observed to be independently associated with BCR-free survival. Addition of SHBG level to the multivariate model for prediction of BCR-free survival resulted in increased accuracy (83.5% vs. 82.2%; P = 0.164). Our study of patients who were followed up for relative longer periods after RP shows that preoperative serum SHBG level, but not T, is an independent predictor of postoperative BCR-free survival. According to our findings, SHBG measurement may be useful in the selection of candidates for adjuvant treatment following RP.
Collapse
Affiliation(s)
- Jung Keun Lee
- From the Department of Urology, Seoul National University of Hospital, Seoul (JKL); and Department of Urology, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea (S-SB, SEL, SKH)
| | | | | | | |
Collapse
|
22
|
The Relationship between Total Testosterone Levels and Prostate Cancer: A Review of the Continuing Controversy. J Urol 2015; 193:403-13. [DOI: 10.1016/j.juro.2014.07.123] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2014] [Indexed: 11/17/2022]
|
23
|
Khera M, Crawford D, Morales A, Salonia A, Morgentaler A. A new era of testosterone and prostate cancer: from physiology to clinical implications. Eur Urol 2013; 65:115-23. [PMID: 24011426 DOI: 10.1016/j.eururo.2013.08.015] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Accepted: 08/07/2013] [Indexed: 01/02/2023]
Abstract
CONTEXT Decades-old beliefs regarding androgens and prostate cancer (PCa) have undergone dramatic shifts in light of modern evidence and new theoretical constructs, but considerable confusion remains on this topic, particularly with regard to the use of testosterone therapy in men with any history of PCa. OBJECTIVE To review current literature regarding the relationship of serum testosterone on PCa and in particular the effect of testosterone therapy on PCa progression and recurrence. EVIDENCE ACQUISITION A Medline search was conducted to identify all original and review articles assessing the effect of androgens on the prostate and the use of testosterone in men with a history of treated and untreated PCa. EVIDENCE SYNTHESIS Contrary to traditional teaching, high endogenous serum testosterone does not increase the risk of developing PCa, and low serum testosterone does not protect against PCa. Although limited in size and duration, current studies similarly fail to indicate any increased risk of PCa in men receiving testosterone therapy. These results indicate a finite ability of androgens to stimulate PCa growth (the saturation model). A majority of studies demonstrate an association between low serum testosterone and poor prognostic features of PCa, including high-grade disease, advanced pathologic stage, and increased risk of biochemical recurrence following radical prostatectomy. The prostate-specific antigen-to-testosterone ratio predicted PCa risk in several biopsy studies. Multiple reports of testosterone therapy in men after treatment for localized PCa have shown low or absent recurrence rates. Some men with untreated PCa have received testosterone therapy without evidence for PCa progression. CONCLUSIONS The long-held belief that PCa risk is related to high serum androgen concentrations can no longer be supported. Current evidence indicates that maximal androgen-stimulated PCa growth is achieved at relatively low serum testosterone concentrations. It may therefore be reasonable to consider testosterone therapy in selected men with PCa and symptomatic hypogonadism.
Collapse
Affiliation(s)
- Mohit Khera
- Baylor College of Medicine, Houston, TX, USA.
| | | | | | | | | |
Collapse
|
24
|
Circulating sex steroids and prostate cancer: introducing the time-dependency theory. World J Urol 2013; 31:267-73. [PMID: 23283410 DOI: 10.1007/s00345-012-1009-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 12/09/2012] [Indexed: 10/27/2022] Open
Abstract
PURPOSE We sought whether serum total testosterone (tT), estradiol (E2), tT/E2 ratio, and sex hormone-binding globulin (SHBG) significantly fluctuate throughout time in men with prostate cancer (PCa). METHODS Circulating hormones were measured in a cohort of 631 candidates for radical prostatectomy. Hormone levels were analyzed according to either patient age, stratified into quartiles, or body mass index (BMI). Linear regression analyses tested the association between sex steroids and continuously coded patient age and BMI values. RESULTS No significant differences were found among age quartiles regarding serum tT levels and tT/E2 ratio. Conversely, E2 and SHBG levels significantly increased throughout time (all, p ≤ 0.001). Total T did not linearly change according to continuously coded patient age; in contrast, E2 and SHBG linearly increased (all, p ≤ 0.001), whereas tT/E2 decreased (p = 0.016) with aging. Rate of hypogonadism significantly increased with aging (p = 0.04). Total T, T/E2 ratio, and SHBG linearly decreased along with BMI increases (all p ≤ 0.02), whereas serum E2 did not significantly change. Rate of hypogonadism significantly increased with BMI increases (p < 0.001). CONCLUSIONS In contrast with longitudinal studies in the general male population, these data indirectly suggest that serum tT levels could be stable over time in PCa patients. This finding led to formulation of a "time-dependency theory", which postulates that the endocrine biology of prostate tissue is dependent on the exposure time at a given concentration of sex steroid, which, in turn, fluctuates throughout the lifespan of the individual.
Collapse
|
25
|
Dias SJ, Zhou X, Ivanovic M, Gailey MP, Dhar S, Zhang L, He Z, Penman AD, Vijayakumar S, Levenson AS. Nuclear MTA1 overexpression is associated with aggressive prostate cancer, recurrence and metastasis in African Americans. Sci Rep 2013; 3:2331. [PMID: 23900262 PMCID: PMC3728596 DOI: 10.1038/srep02331] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 07/16/2013] [Indexed: 01/28/2023] Open
Abstract
Metastasis-associated protein 1 (MTA1), a negative epigenetic modifier, plays a critical role in prostate cancer (PCa) progression. We hypothesized that MTA1 overexpression in primary tumor tissues can predict PCa aggressiveness and metastasis. Immunohistochemical staining of MTA1 was done on archival PCa specimens from University of Mississippi Medical Center and University of Iowa. We found that nuclear MTA1 overexpression was positively correlated with the severity of disease progression reaching its highest levels in metastatic PCa. Nuclear MTA1 overexpression was significantly associated with Gleason > 7 tumors in African Americans but not in Caucasians. It was also a predictor of recurrent disease. We concluded that MTA1 nuclear overexpression may be a prognostic indicator and a future therapeutic target for aggressive PCa in African American men. Our findings may be useful for categorizing African American patients with a higher probability of recurrent disease and metastasis from those who are likely to remain metastasis-free.
Collapse
Affiliation(s)
- Steven J. Dias
- Cancer Institute, University of Mississippi Medical Center, Jackson, MS, USA
- These authors contributed equally to this work
| | - Xinchun Zhou
- Department of Pathology, University of Mississippi Medical Center, Jackson, MS, USA
- These authors contributed equally to this work
| | - Marina Ivanovic
- Department of Pathology, University of Iowa, Iowa City, IA, USA
| | | | - Swati Dhar
- Cancer Institute, University of Mississippi Medical Center, Jackson, MS, USA
| | - Liangfen Zhang
- Cancer Institute, University of Mississippi Medical Center, Jackson, MS, USA
| | - Zhi He
- Department of Pathology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Alan D. Penman
- Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Srinivasan Vijayakumar
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Anait S. Levenson
- Cancer Institute, University of Mississippi Medical Center, Jackson, MS, USA
- Department of Pathology, University of Mississippi Medical Center, Jackson, MS, USA
| |
Collapse
|