1
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Marx G, Chowdhury S, Krieger L, Hovey E, Shapiro J, Tran B, Tan TH, Ng S, Woo HH. A practical guide for the use of apalutamide for non-metastatic castration-resistant prostate cancer in Australia. Asia Pac J Clin Oncol 2024; 20:435-443. [PMID: 38639402 DOI: 10.1111/ajco.14054] [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: 03/08/2023] [Revised: 06/01/2023] [Accepted: 02/25/2024] [Indexed: 04/20/2024]
Abstract
Studies of patients with castrate-resistant prostate cancer at high risk of developing overt metastases but with no current evidence of evaluable disease on computed tomography or bone scan non-metastatic castrate-resistant prostrate cancer have demonstrated increased metastasis-free survival and overall survival following treatment with the next-generation oral anti-androgen apalutamide (in addition to therapies that aim to lower testosterone to castrate levels) or luteinizing hormone-releasing hormone antagonist or surgical castration. Patients receiving apalutamide can be managed by medical oncologists, radiation oncologists, or urologists, preferably as part of a multidisciplinary team. However, the importance of additional safety monitoring for significant adverse effects and drug interactions should not be underestimated. The toxicities of apalutamide are manageable with experience and should be managed proactively to minimize their impact on patients. Monitoring of patients for apalutamide-specific toxicities, including skin rash, hypothyroidism, and QT prolongation should be carried out regularly, particularly in the first few months following initiation. Monitoring should continue alongside monitoring for toxicities of androgen deprivation, including cardiovascular risk, hot flashes, weight gain, bone health, muscle wasting, and diabetic risk. This review is a practical guide to the use of apalutamide describing the management of patients including dosing and administration, toxicities, potential drug interactions, and safety monitoring requirements.
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Affiliation(s)
- Gavin Marx
- San Clinical Trial Unit, Sydney Adventist Hospital, Integrated Cancer Centre, Wahroonga, Australia
- ANU Medical School, Australian National University, Canberra, Australia
| | | | | | - Elizabeth Hovey
- Department of Medical Oncology, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, Australia
- University of New South Wales, Sydney, Australia
| | - Jeremy Shapiro
- Department of Medical Oncology, Cabrini Haematology and Oncology Centre, Malvern, Australia
| | - Ben Tran
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Thean Hsiang Tan
- Department of Medical Oncology, Royal Adelaide Hospital, Adelaide and Icon Cancer Centre, Adelaide, Australia
| | - Siobhan Ng
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Henry H Woo
- San Prostate Centre of Excellence, Sydney Adventist Hospital, Wahroonga, Australia
- Department of Uro-Oncology, Chris O'Brien Lifehouse, Camperdown, Australia
- ANU College of Health and Medicine, Australian National University, Canberra, Australia
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2
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Solanki AJ, Kamrava M, Posadas EM, Freedland SJ, Ballas L, Sandler HM, Bairey Merz CN, Atkins KM, Nikolova AP. A practical guide for assessing and managing cardiovascular risk during androgen-deprivation therapy in patients with prostate cancer. Cancer 2024; 130:1916-1929. [PMID: 38529566 DOI: 10.1002/cncr.35285] [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: 12/14/2023] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 03/27/2024]
Abstract
Prostate cancer is the most common malignancy among men worldwide, and androgen-deprivation therapy (ADT) is a mainstay of treatment. There are observational data demonstrating an increased risk of cardiovascular events in patients who receive ADT, particularly those who have an elevated baseline cardiovascular risk. Because, for most patients with prostate cancer, death is predominantly from noncancer-related causes, cardiovascular disease and its risk factors should be optimized during cancer treatment. This review provides an overview of the landscape of ADT treatment and serves as a guide for appropriate cardiovascular screening and risk-mitigation strategies. The authors emphasize the importance of shared communication between the multidisciplinary cancer team and primary care to improve baseline cardiovascular screening and treatment of modifiable risk factors within this higher risk population.
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Affiliation(s)
- Aum J Solanki
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Mitchell Kamrava
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Edwin M Posadas
- Department of Medicine, Division of Hematology Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Stephen J Freedland
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Leslie Ballas
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Howard M Sandler
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - C Noel Bairey Merz
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Katelyn M Atkins
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Andriana P Nikolova
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
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3
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Orji R, Morgans A, Jahangir E, Markson F, Ilelaboye A, Tan A, Okwuosa TM. Androgen Deprivation Therapy/Androgen Receptor Signaling Inhibitor Treatments for Prostate Cancer: Pathophysiology and Review of Effects on Cardiovascular Disease. South Med J 2024; 117:245-253. [PMID: 38701845 DOI: 10.14423/smj.0000000000001687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Androgen deprivation therapy is the cornerstone of systemic management for prostate cancer but is associated with multiple adverse effects that must be considered during treatment. These effects occur because of the profound hypogonadism that is induced from lack of testosterone or due to the medications used in the treatment or in combination with androgen receptor signaling inhibitors. This article critically reviews the associations between androgen deprivation therapy, androgen receptor signaling inhibitors, and cardiovascular complications such as prolonged QT interval, atrial fibrillation, heart failure, atherosclerosis, coronary heart disease, venous thromboembolism, and peripheral arterial occlusive disease. These unfavorable outcomes reinforce the need for regular cardiovascular screening of patients undergoing androgen deprivation for the management of prostate cancer.
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Affiliation(s)
| | - Alicia Morgans
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Eiman Jahangir
- Division of Cardiovascular Medicine, Section of Cardio-Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Favor Markson
- Department of Internal Medicine, Lincoln Medical Center, Bronx, New York
| | - Ayodeji Ilelaboye
- Department of Internal Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Alan Tan
- Division of Hematology-Oncology, Rush University Medical Center, Chicago, Illinois
| | - Tochukwu M Okwuosa
- Division of Cardiovascular Medicine, Section of Cardio-Oncology, Rush University Medical Center, Chicago, Illinois
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4
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Chakroborty D, Singh AP. Prostate Cancer: Insights into Disease Progression and Therapeutic Challenges. Int J Mol Sci 2024; 25:2451. [PMID: 38473699 DOI: 10.3390/ijms25052451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/16/2024] [Indexed: 03/14/2024] Open
Abstract
Prostate cancer (PCa) is the second most common cancer and the fifth highest cause of cancer-related death among men in the world [...].
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Affiliation(s)
- Debanjan Chakroborty
- Department of Pathology, University of South Alabama, Mobile, AL 36617, USA
- Cancer Biology Program, Mitchell Cancer Institute, University of South Alabama, Mobile, AL 36604, USA
- Department of Biochemistry and Molecular Biology, University of South Alabama, Mobile, AL 36688, USA
| | - Ajay Pratap Singh
- Department of Pathology, University of South Alabama, Mobile, AL 36617, USA
- Cancer Biology Program, Mitchell Cancer Institute, University of South Alabama, Mobile, AL 36604, USA
- Department of Biochemistry and Molecular Biology, University of South Alabama, Mobile, AL 36688, USA
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5
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Shore ND, Mehlhaff BA, Cookson MS, Saltzstein DR, Tutrone R, Brown B, Lu S, Fallick M, Hanson S, Saad F. Impact of Concomitant Cardiovascular Therapies on Efficacy and Safety of Relugolix vs Leuprolide: Subgroup Analysis from HERO Study in Advanced Prostate Cancer. Adv Ther 2023; 40:4919-4927. [PMID: 37713020 PMCID: PMC10567896 DOI: 10.1007/s12325-023-02634-7] [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: 06/04/2023] [Accepted: 08/01/2023] [Indexed: 09/16/2023]
Abstract
INTRODUCTION Cardiovascular (CV) events are the leading cause of death in prostate cancer. Men with prostate cancer are likely to have CV risk factors and use CV-related concomitant medications. In the phase 3 HERO study, a 54% lower incidence of major adverse cardiac events was reported in men treated with the oral gonadotropin-releasing hormone (GnRH) receptor antagonist, relugolix, vs leuprolide. Herein, we characterize the impact of concomitant CV therapies on efficacy and safety in the HERO study. METHODS In HERO, 930 men with advanced prostate cancer (APC) were randomized 2:1 and treated with relugolix (120 mg orally once daily; after single 360 mg loading dose) or leuprolide (injections every 3 months) for 48 weeks. Subgroups analyzed included men who received antihypertensives, antithrombotics, or lipid-modifying therapies (LMAs), as well as the most common drug classes (> 10%) and single most common agent within each class. Assessments included sustained testosterone suppression to castrate levels (< 50 ng/dL) through 48 weeks and safety. RESULTS Antihypertensives, antithrombotics, and LMAs were utilized by 52.7%, 39.1%, and 39.6% of men in HERO, respectively. In the main subgroups, point estimates for sustained castration rates were generally consistent with overall estimates of relugolix and leuprolide observed in the overall population. Sustained castration rates were also mostly consistent for men taking the most common drug classes and individual agents in each class (losartan [n = 103]: relugolix, 95.4% vs leuprolide, 80.6%; amlodipine [n = 229]: 97.2% vs 85.5%; metoprolol [n = 88]: 95.7% vs 86.9%; acetylsalicylic acid [n = 259]: 97.0% vs 92.1%; clopidogrel [n = 43]: 96.4% vs 86.7%; simvastatin [n = 78]: 98.0% vs 87.3%). Incidence and types of adverse events (AEs) among men who received these medications were mostly consistent with overall population results, with some increases in grade ≥ 3 and fatal AEs. CONCLUSION Relugolix suppressed testosterone and was generally well tolerated when given with concomitant CV agents. TRIAL REGISTRATION Clinical Trial ID NCT03085095. PRIOR PRESENTATION Data presented at 15th Annual Genitourinary Cancers Symposium; February 17-19, 2022, San Francisco, CA, USA [Abstract 101, Poster board E11]. The published abstract from this presentation can be found at https://ascopubs.org/doi/10.1200/JCO.2022.40.6_suppl.101 .
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Affiliation(s)
- Neal D Shore
- Carolina Urologic Research Center, 823 82nd Pkwy, Suite B, Myrtle Beach, SC, 29572, USA.
| | | | - Michael S Cookson
- Department of Urology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | | | | | - Sophia Lu
- Myovant Sciences, Inc., Brisbane, CA, USA
| | | | | | - Fred Saad
- University of Montreal Hospital Centre, Montreal, QC, Canada
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6
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Kakkat S, Pramanik P, Singh S, Singh AP, Sarkar C, Chakroborty D. Cardiovascular Complications in Patients with Prostate Cancer: Potential Molecular Connections. Int J Mol Sci 2023; 24:ijms24086984. [PMID: 37108147 PMCID: PMC10138415 DOI: 10.3390/ijms24086984] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/21/2023] [Accepted: 03/30/2023] [Indexed: 04/29/2023] Open
Abstract
Cardiovascular diseases (CVDs) and complications are often seen in patients with prostate cancer (PCa) and affect their clinical management. Despite acceptable safety profiles and patient compliance, androgen deprivation therapy (ADT), the mainstay of PCa treatment and chemotherapy, has increased cardiovascular risks and metabolic syndromes in patients. A growing body of evidence also suggests that patients with pre-existing cardiovascular conditions show an increased incidence of PCa and present with fatal forms of the disease. Therefore, it is possible that a molecular link exists between the two diseases, which has not yet been unraveled. This article provides insight into the connection between PCa and CVDs. In this context, we present our findings linking PCa progression with patients' cardiovascular health by performing a comprehensive gene expression study, gene set enrichment (GSEA) and biological pathway analysis using publicly available data extracted from patients with advanced metastatic PCa. We also discuss the common androgen deprivation strategies and CVDs most frequently reported in PCa patients and present evidence from various clinical trials that suggest that therapy induces CVD in PCa patients.
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Affiliation(s)
- Sooraj Kakkat
- Department of Pathology, University of South Alabama, Mobile, AL 36617, USA
- Cancer Biology Program, Mitchell Cancer Institute, University of South Alabama, Mobile, AL 36604, USA
| | - Paramahansa Pramanik
- Department of Mathematics and Statistics, University of South Alabama, Mobile, AL 36688, USA
| | - Seema Singh
- Department of Pathology, University of South Alabama, Mobile, AL 36617, USA
- Cancer Biology Program, Mitchell Cancer Institute, University of South Alabama, Mobile, AL 36604, USA
- Department of Biochemistry and Molecular Biology, University of South Alabama, Mobile, AL 36688, USA
| | - Ajay Pratap Singh
- Department of Pathology, University of South Alabama, Mobile, AL 36617, USA
- Cancer Biology Program, Mitchell Cancer Institute, University of South Alabama, Mobile, AL 36604, USA
- Department of Biochemistry and Molecular Biology, University of South Alabama, Mobile, AL 36688, USA
| | - Chandrani Sarkar
- Department of Pathology, University of South Alabama, Mobile, AL 36617, USA
- Cancer Biology Program, Mitchell Cancer Institute, University of South Alabama, Mobile, AL 36604, USA
- Department of Biochemistry and Molecular Biology, University of South Alabama, Mobile, AL 36688, USA
| | - Debanjan Chakroborty
- Department of Pathology, University of South Alabama, Mobile, AL 36617, USA
- Cancer Biology Program, Mitchell Cancer Institute, University of South Alabama, Mobile, AL 36604, USA
- Department of Biochemistry and Molecular Biology, University of South Alabama, Mobile, AL 36688, USA
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7
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The Beneficial Effect of a Healthy Dietary Pattern on Androgen Deprivation Therapy-Related Metabolic Abnormalities in Patients with Prostate Cancer: A Meta-Analysis Based on Randomized Controlled Trials and Systematic Review. Metabolites 2022; 12:metabo12100969. [PMID: 36295871 PMCID: PMC9611951 DOI: 10.3390/metabo12100969] [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: 09/23/2022] [Revised: 10/10/2022] [Accepted: 10/10/2022] [Indexed: 12/24/2022] Open
Abstract
Metabolic abnormalities as side effects of androgen-deprivation therapy (ADT) can accelerate progression of prostate cancer (PCa) and increase risks of cardiovascular diseases. A healthy dietary pattern (DP) plays an important role in regulating glycolipid metabolism, while evidence about DP on ADT-related metabolic abnormalities is still controversial. To explore the effect of DP on metabolic outcomes in PCa patients with ADT, PubMed, Embase, Cochrane, and CINAHL were searched from inception to 10 September 2022. Risk of biases was evaluated through Cochrane Collaboration’s Tool. If heterogeneity was low, the fixed-effects model was carried out; otherwise, the random-effects model was used. Data were determined by calculating mean difference (MD) or standardized MD (SMD) with 95% confidence intervals (CIs). Nine studies involving 421 patients were included. The results showed that healthy DP significantly improved glycated hemoglobin (MD: −0.13; 95% CI: −0.24, −0.02; p = 0.020), body mass index (MD: −1.02; 95% CI: −1.29, −0.75; p < 0.001), body fat mass (MD: −1.78; 95% CI: −2.58, −0.97; p < 0.001), triglyceride (MD: −0.28; 95% CI: −0.51, −0.04; p = 0.020), systolic blood pressure (MD: −6.30; 95% CI: −11.15, −1.44; p = 0.010), and diastolic blood pressure (MD: −2.94; 95% CI: −5.63, −0.25; p = 0.030), although its beneficial effects on other glycolipid metabolic indicators were not found. Additionally, a healthy DP also lowered the level of PSA (MD: −1.79; 95% CI: −2.25, −1.33; p < 0.001). The meta-analysis demonstrated that a healthy DP could improve ADT-related metabolic abnormalities and be worthy of being recommended for PCa patients with ADT.
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8
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Castro-Torres Y, Triana-Díaz A, Cuellar-Gallardo ÁA, Rodríguez-León A, Rodríguez-González E. Androgen deprivation therapy mimicking acute coronary syndrome: A case report. Rev Port Cardiol 2022; 41:601.e1-601.e3. [DOI: 10.1016/j.repc.2020.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 01/23/2020] [Accepted: 06/11/2020] [Indexed: 10/18/2022] Open
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9
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Gryzinski GM, Bernie HL. Testosterone deficiency and the aging male. Int J Impot Res 2022; 34:630-634. [PMID: 35393533 DOI: 10.1038/s41443-022-00555-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 01/24/2022] [Accepted: 03/07/2022] [Indexed: 11/09/2022]
Abstract
Testosterone deficiency (TD), also known as male hypogonadism, is a complex syndrome encompassing physical, biochemical, and social aspects that increasingly affects the aging population. TD has been analyzed over recent decades, with an enhanced focus on etiologies relating to aging males. There is debate whether testosterone decline leading to hypogonadism is directly and primarily related to age-specific processes or if it is the subsequent result of accumulating comorbidities throughout a lifetime. Several studies have been done to further characterize this distinction. Chronic comorbidities that have commonly been associated with TD include hypertension (HTN), cardiovascular disease (CVD), diabetes mellitus (DM), obesity, metabolic syndrome (MetS), chronic kidney disease (CKD), and tobacco use. Although clear associations between hypogonadism and aging have been biochemically demonstrated, many large studies have illustrated the concomitant effects of highly prevalent chronic diseases and social behaviors in aging men. Given the significant impact of hypogonadism on the physical and mental health of men, this paper aims to delve into these studies and further define the complex relationship of testosterone deficiency in the aging male.
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Affiliation(s)
| | - Helen L Bernie
- Department of Urology, Indiana University, Indianapolis, IN, USA.
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10
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Conteduca V, Scarpi E, Wetterskog D, Brighi N, Ferroni F, Rossi A, Romanel A, Gurioli G, Bleve S, Gianni C, Schepisi G, Lolli C, Cortesi P, Matteucci F, Barone D, Paganelli G, Demichelis F, Beltran H, Attard G, De Giorgi U. Plasma tumor DNA is associated with increased risk of venous thromboembolism in metastatic castration-resistant cancer patients. Int J Cancer 2021; 150:1166-1173. [PMID: 34605002 DOI: 10.1002/ijc.33834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 11/12/2022]
Abstract
Cancer is a risk factor for venous thromboembolism (VTE). Plasma tumor DNA (ptDNA) is an independent predictor of outcome in metastatic castration-resistant prostate cancer (mCRPC). We aimed to investigate the association between ptDNA and VTE in mCRPC. This prospective biomarker study included 180 mCRPC patients treated with abiraterone and enzalutamide from April 2013 to December 2018. We excluded patients with a previous VTE history and/or ongoing anticoagulation therapy. Targeted next-generation sequencing was performed to determine ptDNA fraction from pretreatment plasma samples. VTE risk based on survival analysis was performed using cumulative incidence function and estimating sub-distributional hazard ratio (SHR). At a median follow-up of 58 months (range 0.5-111.0), we observed 21 patients who experienced VTE with a cumulative incidence at 12 months of 17.1% (95% confidence interval [CI] 10.3-23.9). Elevated ptDNA, visceral metastasis, prior chemotherapy and lactate dehydrogenase (LDH) were significantly associated with higher VTE incidence compared to patients with no thrombosis (12-month estimate, 18.6% vs 3.5%, P = .0003; 44.4% vs 14.8%, P = .015; 24.7% vs 4.5%, P = .006; and 30.0% vs 13.5%, P = .05, respectively). In the multivariate analysis including ptDNA level, visceral metastases, number of lesions and serum LDH, high ptDNA fraction was the only independent factor associated with the risk of thrombosis (HR 5.78, 95% CI 1.63-20.44, P = .006). These results first suggest that baseline ptDNA fraction in mCRPC patients treated with abiraterone or enzalutamide may be associated with increased VTE risk. These patients may be followed-up more closely for the VTE risk, and the need for a primary thromboprophylaxis should be taken into account in mCRPC with elevated ptDNA.
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Affiliation(s)
- Vincenza Conteduca
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy.,Unit of Medical Oncology and Biomolecular Therapy, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Emanuela Scarpi
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | | | - Nicole Brighi
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Fabio Ferroni
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Alice Rossi
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Alessandro Romanel
- Department of Cellular, Computational and Integrative Biology, University of Trento, Trento, Italy
| | - Giorgia Gurioli
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Sara Bleve
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Caterina Gianni
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Giuseppe Schepisi
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Cristian Lolli
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Pietro Cortesi
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Federica Matteucci
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Domenico Barone
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Giovanni Paganelli
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Francesca Demichelis
- Department of Cellular, Computational and Integrative Biology, University of Trento, Trento, Italy
| | - Himisha Beltran
- Dana Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Ugo De Giorgi
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
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11
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Serrano Domingo JJ, Alonso Gordoa T, Lorca Álvaro J, Molina-Cerrillo J, Barquín García A, Martínez Sáez O, Burgos Revilla J, Carrato A, Álvarez Rodríguez S. The effect of medical and urologic disorders on the survival of patients with metastatic castration resistant prostate cancer treated with abiraterone or enzalutamide. Ther Adv Urol 2021; 13:17562872211043341. [PMID: 34552666 PMCID: PMC8451255 DOI: 10.1177/17562872211043341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/15/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction: Androgenic deprivation therapies have been linked to the development of metabolic syndrome (MS) and cardiovascular diseases, which may lead to a poorer survival in patients with metastatic Castration-Resistant Prostate Cancer (mCRPC). We aimed to analyze whether some cardiovascular or neurological disorders, together with other medical and urological complications, may have an effect on survival outcomes, at baseline and during treatment from patients treated with androgen pathway inhibitors (API). Material and Methods: A retrospective study of a consecutive series of patients diagnosed with mCRPC between 2010 and 2018 treated with API in the first line setting in a single center. Results: Seventy-three patients met the inclusion criteria. Baseline prognostic factors associated with worse survival were diabetes mellitus (DM) with insulin needs compared to patients without DM [hazard ratio (HR) = 0.19, p = 0.025], hypertension (HTN) (HR = 0.46, p = 0.035), and a history of stroke (HR = 0.16, p < 0.001). However, previous history of hypercholesterolemia, arrythmias, and cognitive disorders did not result in a significant worsening on survival. During treatment, patients who developed de novo HTN had the best progression free survival (PFS) (HR = 0.38, p = 0.048) and overall survival (OS) (HR 0.08, p = 0.012) compared with patients with previous HTN. Other factors related to worse outcomes included the presence of heart failure (HR = 0.31, p = 0.001), the requirement for major opioids for pain relief (HR = 0.33, p = 0.023), and the presence of bilateral ureterohydronephrosis (HR = 0.12, p = 0.008). Conclusions: Some comorbidities may be strongly involved in patient outcomes when receiving API for mCRPC. In this sense, collaborative networking between specialists and caregivers treating prostate cancer (PC) patients should be recommended, focusing on MS features, cardiovascular and neurological disorders in order to anticipate medical and surgical complications.
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Affiliation(s)
| | - Teresa Alonso Gordoa
- Medical Oncology Department, University Hospital Ramon y Cajal, Ctra. Colmenar km9100, Madrid, 28034, Spain
| | | | | | - Arantzazu Barquín García
- Medical Oncology Department, Centro Integral Oncológico Clara Campal, Hospitales Madrid, Madrid, Spain
| | - Olga Martínez Sáez
- Medical Oncology Department, Hospital Clinic I Provincial, Barcelona, Spain
| | | | - Alfredo Carrato
- Medical Oncology Department, University Hospital Ramon y Cajal, Madrid, Spain
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12
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Masuda H, Sugiura M, Hou K, Araki K, Kojima S, Naya Y. Impact of Hypertension on Early Renal Dysfunction in Japanese Prostate Cancer Patients Treated With Androgen Deprivation Therapy. CANCER DIAGNOSIS & PROGNOSIS 2021; 1:179-183. [PMID: 35399311 PMCID: PMC8962788 DOI: 10.21873/cdp.10024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/03/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND/AIM Recently, it was reported that the use of androgen deprivation therapy (ADT) is significantly associated with an increased risk of acute kidney injury (AKI) in patients with newly diagnosed non-metastatic prostate cancer. This study aimed to investigate the incidence of early renal dysfunction in Japanese prostate cancer patients receiving ADT and the factors associated with it. PATIENTS AND METHODS A total of 135 patients who had been pathologically diagnosed with prostate cancer and had received ADT for at least 6 months were eligible for study inclusion. The estimated glomerular filtration rate (eGFR) before treatment, and at 1, 3, and 6 months of ADT were evaluated retrospectively. We assessed renal function using eGFR and investigated the rate of change in the eGFR (ΔeGFR) during ADT. Univariate and multivariate logistic analyses were carried out to identify clinical factors that were significantly associated with renal dysfunction after 6 months ADT. RESULTS A total of 110 cases were evaluated in this study. The incidence of renal dysfunction after 6 months ADT was 63% (69/110). The mean ΔeGFR after 1, 3, and 6 months of ADT were -0.6%, -3.1% and -1.7%, respectively (p<0.001). Multivariate analysis showed that renal dysfunction after 3 months of ADT and hypertension were independent risk factors for renal dysfunction after 6 months ADT. CONCLUSION Renal dysfunction occurs from 1 month of ADT and hypertensive prostate cancer patients receiving ADT are at high risk of developing renal dysfunction, and that such patients should be treated very carefully. Therefore, patients that are started on ADT should undergo periodic prostate-specific antigen, renal function, and urinary salt intake examinations.
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Affiliation(s)
- Hiroshi Masuda
- Department of Urology, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Masahiro Sugiura
- Department of Urology, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Kyokusin Hou
- Department of Urology, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Kazuhiro Araki
- Department of Urology, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Satoko Kojima
- Department of Urology, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Yukio Naya
- Department of Urology, Teikyo University Chiba Medical Center, Chiba, Japan
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13
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Perl L, Elkon-Tamir E, Segev-Becker A, Israeli G, Brener A, Oren A. Blood pressure dynamics after pubertal suppression with gonadotropin-releasing hormone analogs followed by estradiol treatment in transgender female adolescents: a pilot study. J Pediatr Endocrinol Metab 2021; 34:741-745. [PMID: 33823098 DOI: 10.1515/jpem-2021-0172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 03/22/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The benefits of gonadotropin-releasing hormone analogues (GnRHa) in the treatment of central precocious puberty are well established, and their use is regarded as both safe and effective. Possible adverse effects on blood pressure (BP) and cardiac outcomes, body composition, bone health and brain development, however, continue to be of some concern. The aim of this study was to analyze BP changes in transgender female adolescents before and after receiving GnRHa and after adding estrogen treatment. METHODS This was a retrospective pilot study. We analyzed systolic BP (SBP) and diastolic BP (DBP) before and after GnRHa initiation and after adding estrogen. RESULTS Nineteen transgender female adolescents received GnRHa and 15 continued to estrogen treatment. Their baseline SBP and DBP percentiles did not change significantly after either GnRHa or the addition of estrogen treatment. CONCLUSIONS Blood pressure is apparently not affected by GnRHa or GnRHa + estrogen treatment in transgender female adolescents. Further larger studies are indicated to confirm these findings.
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Affiliation(s)
- Liat Perl
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv,Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Erella Elkon-Tamir
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv,Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Segev-Becker
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv,Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Galit Israeli
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv,Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avivit Brener
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv,Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Oren
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv,Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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14
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Freedland SJ, Abrahamsson PA. Androgen deprivation therapy and side effects: are GnRH antagonists safer? Asian J Androl 2021; 23:3-10. [PMID: 32655041 PMCID: PMC7831824 DOI: 10.4103/aja.aja_22_20] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Androgen deprivation therapy (ADT) with gonadotropin-releasing hormone (GnRH) agonists and antagonists is the mainstay of advanced prostate cancer treatment. Both drug classes decrease levels of luteinizing hormone and follicle-stimulating hormones (FSH), thereby lowering testosterone to castrate levels. This is associated with adverse events (AEs), including cardiovascular (CV) disorders, bone fractures, metabolic dysfunction, and impaired cognitive function. This literature review discusses these AEs, with a focus on CV and bone-related events. A hypothesis-generating meta-analysis of six clinical trials showed a potentially increased risk for CV disorders with GnRH agonists versus the GnRH antagonist degarelix. While no study has directly compared GnRH agonists versus antagonists with a primary CV outcome, one hypothesis for this observation is that GnRH agonists lead to initial surges in FSH that may negatively impact CV health, whereas antagonists do not. GnRH agonists are associated with metabolic and cognitive AEs and while data are lacking for GnRH antagonists, no differences in risk are predicted. Other common AEs with ADT include injection site reactions, which are much more common with degarelix than with GnRH agonists, which may reflect differing administration and injection techniques. Future studies are needed to further evaluate and compare the safety profiles of GnRH agonists and antagonists, especially in patients with pre-existing CV disease and other co-morbidities. Physicians should carefully evaluate benefits and risks when prescribing ADT and ensure that side effects are well managed.
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Affiliation(s)
- Stephen J Freedland
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.,Section of Urology, Durham VA Medical Center, Durham, NC 27705, USA
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15
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Pseudotumor cerebri in patient on leuprolide acetate for central precocious puberty. INTERNATIONAL JOURNAL OF PEDIATRIC ENDOCRINOLOGY 2020; 2020:22. [PMID: 33292495 PMCID: PMC7712604 DOI: 10.1186/s13633-020-00092-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/12/2020] [Indexed: 11/19/2022]
Abstract
Background Gonadotropin releasing hormone agonists (GnRHa) are well established as a standard of care for the treatment of central precocious puberty (CPP) worldwide. While numerous delivery systems and routes of administration exist, depot intramuscular injections or sustained-release preparations have been most widely used. Leuprolide acetate is well tolerated among children though some can develop some complications. Case presentation We present a case report of a 6.5 year old girl with central precocious puberty who developed signs of pseudotumor cerebri after 2 doses of leuprolide acetate 3.75 mg given monthly. Systemic exam and other tests to look for the cause did not yield anything. However, fundoscopy showed marked papilloedema with blurred disc margins. After six weeks’ treatment with acetazolamide and withdrawal of the GRNHa the papilloedema resolved. Conclusions If a patient presents with complaints such as headache, nausea, vomiting, and double vision in pediatric patients treated with GnRH analogue one should highly consider the presence of pseudotumor cerebri and fundus examination be performed.
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16
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Conteduca V, Caffo O, Scarpi E, Sepe P, Galli L, Fratino L, Maines F, Chiuri VE, Santoni M, Zanardi E, Massari F, Toma I, Lolli C, Schepisi G, Sbrana A, Kinspergher S, Cursano MC, Casadei C, Modonesi C, Santini D, Procopio G, De Giorgi U. Immune Modulation in Prostate Cancer Patients Treated with Androgen Receptor (AR)-Targeted Therapy. J Clin Med 2020; 9:jcm9061950. [PMID: 32580478 PMCID: PMC7356925 DOI: 10.3390/jcm9061950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/12/2020] [Accepted: 06/19/2020] [Indexed: 11/16/2022] Open
Abstract
Androgen deprivation therapy (ADT) is a cornerstone of treatment for prostate cancer and, in recent years, androgen receptor (AR)-targeted therapies (abiraterone and enzalutamide) have both been used for the treatment of castration-resistant prostate cancer (CRPC). In our study, we sought to investigate the association between ADT and immune disorders, considering a potential role of androgens in the immune modulation. We retrospectively evaluated CRPC patients treated with abiraterone/enzalutamide between July 2011 and December 2018. We assessed the risk of developing immune alterations and their impact on outcome. We included 844 CRPC patients receiving AR-directed therapies, of whom 36 (4.3%) had autoimmune diseases and 47 (5.6%) second tumors as comorbidities. Median age was 70 years [interquartile range (IQR) = 63–75)]. We showed higher significant incidence of autoimmune diseases during their hormone sensitive status (p = 0.021) and the presence of autoimmune comorbidities before starting treatment with abiraterone/enzalutamide was significantly associated with worse overall survival (OS) (10.1 vs. 13.7 months, HR = 1.59, 95% CI 1.03–2.27, p = 0.038). In a multivariate analysis, the presence of autoimmune disorders was an independent predictor of OS (HR = 1.65, 95% CI 1.05–2.60, p = 0.031). In conclusion, CRPC patients with autoimmune alterations before starting AR-directed therapies may have worse prognosis. Further prospective studies are warranted to assess the role of immune modulation in the management of prostate cancer patients.
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Affiliation(s)
- Vincenza Conteduca
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via Piero Maroncelli 40, 47014 Meldola, Italy; (E.S.); (C.L.); (G.S.); (M.C.C.); (C.C.); (U.D.G.)
- Correspondence: ; Tel.: +39-0543-739100; Fax: +39-0543-739151
| | - Orazio Caffo
- Department of Oncology, Ospedale Santa Chiara, 38122 Trento, Italy; (O.C.); (F.M.); (S.K.)
| | - Emanuela Scarpi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via Piero Maroncelli 40, 47014 Meldola, Italy; (E.S.); (C.L.); (G.S.); (M.C.C.); (C.C.); (U.D.G.)
| | - Pierangela Sepe
- Medical Oncology Department, Fondazione Istituto Nazionale dei Tumori, 20133 Milano, Italy; (P.S.); (G.P.)
| | - Luca Galli
- Medical Oncology Unit 2, Polo Oncologico, Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, Italy; (L.G.); (A.S.)
| | - Lucia Fratino
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano, 33081 Aviano-Pordenone, Italy;
| | - Francesca Maines
- Department of Oncology, Ospedale Santa Chiara, 38122 Trento, Italy; (O.C.); (F.M.); (S.K.)
| | | | - Matteo Santoni
- Oncology Unit, Macerata Hospital, 62100 Macerata, Italy;
| | - Elisa Zanardi
- Academic Unit of Medical Oncology, IRCCS San Martino Polyclinic Hospital, 16132 Genoa, Italy;
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, 16132 Genoa, Italy
| | - Francesco Massari
- Division of Oncology, S.Orsola-Malpighi Hospital, 40138 Bologna, Italy;
| | - Ilaria Toma
- Clinical Oncology, Arcispedale Sant’Anna University Hospital, 44124 Ferrara, Italy;
| | - Cristian Lolli
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via Piero Maroncelli 40, 47014 Meldola, Italy; (E.S.); (C.L.); (G.S.); (M.C.C.); (C.C.); (U.D.G.)
| | - Giuseppe Schepisi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via Piero Maroncelli 40, 47014 Meldola, Italy; (E.S.); (C.L.); (G.S.); (M.C.C.); (C.C.); (U.D.G.)
| | - Andrea Sbrana
- Medical Oncology Unit 2, Polo Oncologico, Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, Italy; (L.G.); (A.S.)
| | - Stefania Kinspergher
- Department of Oncology, Ospedale Santa Chiara, 38122 Trento, Italy; (O.C.); (F.M.); (S.K.)
| | - Maria Concetta Cursano
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via Piero Maroncelli 40, 47014 Meldola, Italy; (E.S.); (C.L.); (G.S.); (M.C.C.); (C.C.); (U.D.G.)
- Department of Medical Oncology, Campus Bio-Medico University of Rome, 00128 Rome, Italy;
| | - Chiara Casadei
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via Piero Maroncelli 40, 47014 Meldola, Italy; (E.S.); (C.L.); (G.S.); (M.C.C.); (C.C.); (U.D.G.)
| | | | - Daniele Santini
- Department of Medical Oncology, Campus Bio-Medico University of Rome, 00128 Rome, Italy;
| | - Giuseppe Procopio
- Medical Oncology Department, Fondazione Istituto Nazionale dei Tumori, 20133 Milano, Italy; (P.S.); (G.P.)
| | - Ugo De Giorgi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via Piero Maroncelli 40, 47014 Meldola, Italy; (E.S.); (C.L.); (G.S.); (M.C.C.); (C.C.); (U.D.G.)
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17
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Seong JM, Shin D, Sung JW, Cho S, Yang J, Kang S, Moon HW, Lee KW, Ha US. Gonadotropin-releasing hormone agonists, anti-androgens and the risk of cardio-cerebrovascular disease in prostate cancer patients: an asian population-based observational study. J Cancer 2020; 11:4015-4022. [PMID: 32368283 PMCID: PMC7196249 DOI: 10.7150/jca.38237] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 02/20/2020] [Indexed: 11/05/2022] Open
Abstract
Purpose: To conduct a population-based study to determine whether the use of GnRH agonist and antiandrogens are associated with an increased risk of cardio-cerebrovascular disease (CCVD) in Asian patients with prostate cancer using the National Health Insurance Service-Elderly Cohort Database (NHIS-ECD). Materials and Methods: We included a total of 2,413 men aged 60 years or older with prostate cancer between January 2003 and December 2008. Outcomes of interest included the first occurrence of cardiovascular events [acute myocardial infarction (AMI), ischemic heart disease (IHD)] and cerebrovascular events [ischemic stroke (IS), and cerebrovascular disease (CVD)]. Results: The 5-year AMI-free rates of patients diagnosed with prostate cancer and treated with GnRH agonists, antiandrogens alone, or androgen deprivation therapy (ADT)-naïve interventions were 97.0%, 96.5%, and 98.3%, respectively, while the 5-year IHD-free rates were 93.2%, 92.3%, and 94.5%, respectively. Exposure to GnRH agonists or antiandrogen regimens did not significantly increase the risk of AMI or IHD compared to ADT-naïve treatment in multivariate Cox proportional-hazards models after adjusting for other covariates. Five-year IS-free rates of patients exposed to GnRH agonists, antiandrogens alone, and those with ADT-naïve prostate cancer were 94.8%, 94.7%, and 95.5%, respectively, while the five-year CVD-free rates were 92.9%, 93.3%, and 94.6%, respectively. Cox proportional-hazards models also failed to show that men who received GnRH agonist or antiandrogen treatment alone carried a significantly increased risk for IS or CVD compared to ADT-naïve patients. Conclusions: The current study based on Asian population suggests that treatment with neither GnRH agonist nor antiandrogens increases the risk of cardio-cerebrovascular disease compared to patients with ADT-naïve prostate cancer.
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Affiliation(s)
- Jong-Mi Seong
- Ewha womans university, Department of pharmacy, Seoul, Republic of Korea
| | - Dongho Shin
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Woo Sung
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Shinjay Cho
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jonghyup Yang
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sungmin Kang
- Department of Urology, Catholic Kwandong University College of Medicine, International St. Mary's Hospital, Incheon, Republic of Korea
| | - Hyong Woo Moon
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyu Won Lee
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - U-Syn Ha
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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18
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Melloni C, Nelson A. Effect of Androgen Deprivation Therapy on Metabolic Complications and Cardiovascular Risk. J Cardiovasc Transl Res 2019; 13:451-462. [PMID: 31833002 DOI: 10.1007/s12265-019-09942-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 11/25/2019] [Indexed: 12/13/2022]
Abstract
Androgen deprivation therapy (ADT) has been the cornerstone of prostate cancer treatment. ADT delays cancer progression, alleviates cancer-related symptoms, and is associated with survival gains. Despite these established benefits, the extended duration of therapy comes with known side effects. Furthermore, research from the past decade has generated increased awareness for more potentially lethal cardiometabolic consequences of ADT. In this review, we explore the relationship between ADT and cardiometabolic effects. Current literature on this complex relationship remains conflicting, due to a variety of factors, including study design (randomized vs. observational), treatment decision-making, and patient factors. Looking to the future, a combination of well-designed, randomized controlled trials and high-quality, real-world evidence are needed to definitely establish any ADT cardiovascular safety signal and to evaluate the efficacy of potential screening and therapeutic interventions. Furthermore, a collaborative, integrated approach among all health care professionals is critical to accurately delineate patients' potential risk/benefit treatment options.
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Affiliation(s)
- Chiara Melloni
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
| | - Adam Nelson
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
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19
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20
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Moustsen IR, Larsen SB, Duun-Henriksen AK, Tjønneland A, Kjær SK, Brasso K, Johansen C, Dalton SO. Risk of cardiovascular events in men treated for prostate cancer compared with prostate cancer-free men. Br J Cancer 2019; 120:1067-1074. [PMID: 31065112 PMCID: PMC6738102 DOI: 10.1038/s41416-019-0468-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 03/28/2019] [Accepted: 04/17/2019] [Indexed: 12/23/2022] Open
Abstract
Background The effect of lifestyle, anthropometry and cardiovascular risk factors on cardiovascular disease in men with prostate cancer (PCa) remains unclear. Methods Using a population-based cohort of 25,436 Danish, cancer-free men aged 50–64 years, we obtained information on self-reported pre-cancer lifestyle, objectively measured anthropometry and cardiovascular risk factors, and linked them to national health registers for information on major cardiovascular outcomes. We assessed hazard ratios (HRs) of incident acute myocardial infarction (MI), ischaemic stroke (IS) and heart failure (HF) among 1546 men diagnosed with PCa treated with first-line active surveillance, watchful waiting, intended curative or palliative treatment compared with PCa-free men during 18 years of follow-up. Results Men who received first-line palliative treatment had higher rates of IS and HF with adjusted HRs of 2.09 (95% CI 1.49–2.93) and 2.05 (95% CI 1.43–2.94), respectively, compared with PCa-free men. The risks were increased from start of treatment. We did not find the same relation for men in any other treatment group. No differences between men treated for PCa and cancer-free controls were observed for MI after adjustment for lifestyle, anthropometry, and cardiovascular risk factors. Conclusion Pre-diagnosis lifestyle, anthropometry or cardiovascular risk factors did not explain the risk of IS and HF in PCa patients receiving palliative treatment. The results emphasise the need for balancing disease management and monitoring of cardiovascular health in this patient group.
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Affiliation(s)
- Ida Rask Moustsen
- Survivorship, Danish Cancer Society Research Center, Copenhagen, Denmark.
| | - Signe Benzon Larsen
- Survivorship, Danish Cancer Society Research Center, Copenhagen, Denmark.,Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Anne Tjønneland
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Susanne K Kjær
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Klaus Brasso
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christoffer Johansen
- Survivorship, Danish Cancer Society Research Center, Copenhagen, Denmark.,The Oncology Clinic, Finsen Center, Rigshospitalet 5073, 2100 Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Oncology, Zealand University Hospital Naestved, Naestved, Denmark
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21
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Sifaki L, Cachat F, Theintz G, Chehade H. Transient Arterial Hypertension Induced by Gonadotropin-Releasing Hormone Agonist Treatment for Central Precocious Puberty. Front Pediatr 2019; 7:74. [PMID: 30941336 PMCID: PMC6433848 DOI: 10.3389/fped.2019.00074] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/22/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Gonadotropin-releasing hormone agonists (GnRHa) are a safe and effective treatment for precocious puberty. Triptorelin is one of the long lasting GnRHa, which reversibly suppresses the pituitary-gonadal axis. Triptorelin-induced hypertension (HTN) has rarely been reported in the literature. Clinical Case/Methods: We report a 10-year-old girl with central precocious puberty who, during treatment with triptorelin, developed an asymptomatic stage II HTN. Initial workup showed no renal, thyroid, or electrolytes abnormalities. The renal ultrasound showed no parenchymal disease and no increased renal resistance index suggestive of a renal artery stenosis. Echocardiography and ocular fundoscopy were normal. HTN (stage II) was confirmed with ambulatory blood pressure monitoring (ABPM). After extensive literature review, we found 3 other cases of HTN secondary to GnRHa, improving with endocrine treatment cessation. Therefore, antihypertensive treatment was not started immediately in our patient. Indeed, after completion of her treatment with triptorelin, we observed a complete normalization of her blood pressure (confirmed with ABPM) without any medication. Conclusion: Concomitantly to GnRHa treatment, our patient developed HTN, which completely subsided after stopping triptorelin. The complete normalization of her blood pressure, together with a negative workup for HTN strongly speaks for a causal effect of her endocrine treatment. In this setting, estrogen depletion might play a role, although this remains debated.
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Affiliation(s)
- Loukia Sifaki
- Department of Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Francois Cachat
- Department of Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Gerald Theintz
- Private Practice for Paediatric Endocrinology, Lausanne, Switzerland
| | - Hassib Chehade
- Department of Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
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22
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Conteduca V, Caffo O, Galli L, Maugeri A, Scarpi E, Maines F, Chiuri VE, Lolli C, Kinspergher S, Schepisi G, Santoni M, Santini D, Fratino L, Burgio SL, Salvi S, Menna C, De Giorgi U. Association among metabolic syndrome, inflammation, and survival in prostate cancer. Urol Oncol 2018; 36:240.e1-240.e11. [PMID: 29402534 DOI: 10.1016/j.urolonc.2018.01.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/22/2017] [Accepted: 01/09/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Metabolic syndrome (MS) and inflammation (INF) alterations are among the factors involved in cancer progression. The study aimed to assess the relationship between MS and INF and its effect on progression-free/overall survival (PFS/OS) in metastatic castration-resistant prostate cancer (mCRPC) treaed with abiraterone or enzalutamide. METHODS We, retrospectively, evaluated patients with mCRPC in 7 Italian Institutes between March 2011 and October 2016. MS was defined by modified adult treatment panel-III criteria. INF was characterized by at least one of these criteria: neutrophil to lymphocyte ratio ≥ 3, elevated erythrocyte sedimentation rate or C-reactive protein. RESULTS Eighty-three of 551 (15.1%) patients met MS criteria at baseline and 34 (6.2%) during treatment. MS patients (MS+) presented a greater INF profile compared to MS- (P<0.0001). Median PFS was 3.7 for MS+ vs. 8.7 months for MS- (hazard ratio [HR] = 2.77; 95% CI: 2.12-3.61; P<0.0001). Median OS was 6.9 and 19 months in MS+ and MS-, respectively (HR = 3.43; 95% CI: 2.56-4.58; P<0.0001). We also demonstrated INF led to shorter PFS and OS (4.5 vs. 8.5 months, HR = 1.48, 95% CI: 1.15-1.90, P = 0.002, and 11.2 vs. 18.8 months, HR =1.66, 95% CI: 1.26-2.18, P = 0.0003, respectively). The combination of MS with INF provided the identification of high-risk prognostic group (MS+/INF+ vs. MS-/INF-) with worse PFS (3.7 vs. 9 months, HR = 2.7, 95% CI: 1.88-3.89, P<0.0001) and OS (6.3 vs. 20.4 months, HR = 4.04, 95% CI: 2.75-5.93, P<0.0001). Multivariable analysis confirmed that MS was independently associated with PFS (HR = 2.07; 95% CI: 1.03-4.18; P = 0.041) and OS (HR = 4.87; 95% CI: 2.36-10.03; P<0.0001). The absence of INF as an independent predictor of survival underlined the correlation between MS/INF. CONCLUSIONS Pretreatment identification of MS and INF alterations might represent an available and easy tool for better prognostication of patients with mCRPC. A prospective evaluation is warranted.
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Affiliation(s)
- Vincenza Conteduca
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy.
| | - Orazio Caffo
- Medical Oncology Department, Santa Chiara Hospital, Trento, Italy
| | - Luca Galli
- Department of Oncology, Azienda Ospedaliero, Universitaria Pisana, Istituto Toscano Tumori, Santa Chiara Hospital, Trento, Italy
| | - Antonio Maugeri
- Oncology Pharmacy Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Emanuela Scarpi
- Department of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Francesca Maines
- Medical Oncology Department, Santa Chiara Hospital, Trento, Italy
| | | | - Cristian Lolli
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | - Giuseppe Schepisi
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Matteo Santoni
- Department of Medical Oncology, University Hospital of Ancona, Ancona, Italy
| | - Daniele Santini
- Medical Oncology Department, Campus Bio-Medico, University of Rome, Rome, Italy
| | - Lucia Fratino
- Medical Oncology Department, National Cancer Institute, Aviano, Italy
| | - Salvatore Luca Burgio
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Samanta Salvi
- Biosciences Laboratory Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Cecilia Menna
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Ugo De Giorgi
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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Chen DY, See LC, Liu JR, Chuang CK, Pang ST, Hsieh IC, Wen MS, Chen TH, Lin YC, Liaw CC, Hsu CL, Chang JWC, Kuo CF, Huang WK. Risk of Cardiovascular Ischemic Events After Surgical Castration and Gonadotropin-Releasing Hormone Agonist Therapy for Prostate Cancer: A Nationwide Cohort Study. J Clin Oncol 2017; 35:3697-3705. [DOI: 10.1200/jco.2016.71.4204] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Purpose Our aim was to determine whether cardiovascular (CV) risk in patients with prostate cancer (PCa) differs between those who receive androgen-deprivation therapy by surgical castration and those who receive gonadotropin-releasing hormone agonist (GnRHa) therapy. Patients and Methods By using the Taiwan National Health Insurance Research Database, we analyzed data from 14,715 patients with PCa diagnosed from January 1, 1997, through December 31, 2011. The patients were treated with bilateral orchiectomy or GnRHa therapy. We used inverse probability of treatment weighting with propensity scores to adjust for the imbalance in covariate baseline values between these two groups. Cox regression models were used to identify risk factors for myocardial infarction (MI), ischemic stroke (IS), and cardiac-related complications. Results Overall, 3,578 patients with PCa (24.3%) underwent bilateral orchiectomy and 11,137 patients (75.7%) received GnRHa therapy. Both groups had a similar risk of CV ischemic events (ie, MI or IS; hazard ratio, 1.16; 95% CI, 0.97 to 1.38) during a median follow-up time of 3.3 years. However, during the first 1.5 years of follow-up, there were higher CV ischemic events in the orchiectomy group than in the GnRHa group (hazard ratio, 1.40; 95% CI, 1.04 to 1.88), particularly in patients who were ≥ 65 years of age, had hypertension, had a Charlson comorbidity index score ≥ 3, and had a previous history of MI, IS, or coronary heart disease. Conclusion Compared with bilateral orchiectomy, use of GnRHa does not increase the risk of CV ischemic events in patients with PCa. Nonetheless, orchiectomy is associated with higher rates of CV ischemic events in older patients and those with a history of CV comorbidities within 1.5 years of initiating androgen-deprivation therapy. These findings can help clinicians decide on the optimal castration strategy for individual patients.
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Affiliation(s)
- Dong-Yi Chen
- Dong-Yi Chen, Lai-Chu See, Jia-Rou Liu, Cheng-Keng Chuang, See-Tong Pang, I-Chang Hsieh, Ming-Shien Wen, Yung-Chang Lin, Chuang-Chi Liaw, Cheng-Lung Hsu, John Wen-Cheng Chang, Chang-Fu Kuo and Wen-Kuan Huang, Chang Gung Memorial Hospital, Linkou, Chang Gung University College of Medicine; Taoyuan; Tien-Hsing Chen, Chang Gung Memorial Hospital, Keelung, Taiwan; and Wen-Kuan Huang, Karolinska Institutet, Stockholm, Sweden
| | - Lai-Chu See
- Dong-Yi Chen, Lai-Chu See, Jia-Rou Liu, Cheng-Keng Chuang, See-Tong Pang, I-Chang Hsieh, Ming-Shien Wen, Yung-Chang Lin, Chuang-Chi Liaw, Cheng-Lung Hsu, John Wen-Cheng Chang, Chang-Fu Kuo and Wen-Kuan Huang, Chang Gung Memorial Hospital, Linkou, Chang Gung University College of Medicine; Taoyuan; Tien-Hsing Chen, Chang Gung Memorial Hospital, Keelung, Taiwan; and Wen-Kuan Huang, Karolinska Institutet, Stockholm, Sweden
| | - Jia-Rou Liu
- Dong-Yi Chen, Lai-Chu See, Jia-Rou Liu, Cheng-Keng Chuang, See-Tong Pang, I-Chang Hsieh, Ming-Shien Wen, Yung-Chang Lin, Chuang-Chi Liaw, Cheng-Lung Hsu, John Wen-Cheng Chang, Chang-Fu Kuo and Wen-Kuan Huang, Chang Gung Memorial Hospital, Linkou, Chang Gung University College of Medicine; Taoyuan; Tien-Hsing Chen, Chang Gung Memorial Hospital, Keelung, Taiwan; and Wen-Kuan Huang, Karolinska Institutet, Stockholm, Sweden
| | - Cheng-Keng Chuang
- Dong-Yi Chen, Lai-Chu See, Jia-Rou Liu, Cheng-Keng Chuang, See-Tong Pang, I-Chang Hsieh, Ming-Shien Wen, Yung-Chang Lin, Chuang-Chi Liaw, Cheng-Lung Hsu, John Wen-Cheng Chang, Chang-Fu Kuo and Wen-Kuan Huang, Chang Gung Memorial Hospital, Linkou, Chang Gung University College of Medicine; Taoyuan; Tien-Hsing Chen, Chang Gung Memorial Hospital, Keelung, Taiwan; and Wen-Kuan Huang, Karolinska Institutet, Stockholm, Sweden
| | - See-Tong Pang
- Dong-Yi Chen, Lai-Chu See, Jia-Rou Liu, Cheng-Keng Chuang, See-Tong Pang, I-Chang Hsieh, Ming-Shien Wen, Yung-Chang Lin, Chuang-Chi Liaw, Cheng-Lung Hsu, John Wen-Cheng Chang, Chang-Fu Kuo and Wen-Kuan Huang, Chang Gung Memorial Hospital, Linkou, Chang Gung University College of Medicine; Taoyuan; Tien-Hsing Chen, Chang Gung Memorial Hospital, Keelung, Taiwan; and Wen-Kuan Huang, Karolinska Institutet, Stockholm, Sweden
| | - I-Chang Hsieh
- Dong-Yi Chen, Lai-Chu See, Jia-Rou Liu, Cheng-Keng Chuang, See-Tong Pang, I-Chang Hsieh, Ming-Shien Wen, Yung-Chang Lin, Chuang-Chi Liaw, Cheng-Lung Hsu, John Wen-Cheng Chang, Chang-Fu Kuo and Wen-Kuan Huang, Chang Gung Memorial Hospital, Linkou, Chang Gung University College of Medicine; Taoyuan; Tien-Hsing Chen, Chang Gung Memorial Hospital, Keelung, Taiwan; and Wen-Kuan Huang, Karolinska Institutet, Stockholm, Sweden
| | - Ming-Shien Wen
- Dong-Yi Chen, Lai-Chu See, Jia-Rou Liu, Cheng-Keng Chuang, See-Tong Pang, I-Chang Hsieh, Ming-Shien Wen, Yung-Chang Lin, Chuang-Chi Liaw, Cheng-Lung Hsu, John Wen-Cheng Chang, Chang-Fu Kuo and Wen-Kuan Huang, Chang Gung Memorial Hospital, Linkou, Chang Gung University College of Medicine; Taoyuan; Tien-Hsing Chen, Chang Gung Memorial Hospital, Keelung, Taiwan; and Wen-Kuan Huang, Karolinska Institutet, Stockholm, Sweden
| | - Tien-Hsing Chen
- Dong-Yi Chen, Lai-Chu See, Jia-Rou Liu, Cheng-Keng Chuang, See-Tong Pang, I-Chang Hsieh, Ming-Shien Wen, Yung-Chang Lin, Chuang-Chi Liaw, Cheng-Lung Hsu, John Wen-Cheng Chang, Chang-Fu Kuo and Wen-Kuan Huang, Chang Gung Memorial Hospital, Linkou, Chang Gung University College of Medicine; Taoyuan; Tien-Hsing Chen, Chang Gung Memorial Hospital, Keelung, Taiwan; and Wen-Kuan Huang, Karolinska Institutet, Stockholm, Sweden
| | - Yung-Chang Lin
- Dong-Yi Chen, Lai-Chu See, Jia-Rou Liu, Cheng-Keng Chuang, See-Tong Pang, I-Chang Hsieh, Ming-Shien Wen, Yung-Chang Lin, Chuang-Chi Liaw, Cheng-Lung Hsu, John Wen-Cheng Chang, Chang-Fu Kuo and Wen-Kuan Huang, Chang Gung Memorial Hospital, Linkou, Chang Gung University College of Medicine; Taoyuan; Tien-Hsing Chen, Chang Gung Memorial Hospital, Keelung, Taiwan; and Wen-Kuan Huang, Karolinska Institutet, Stockholm, Sweden
| | - Chuang-Chi Liaw
- Dong-Yi Chen, Lai-Chu See, Jia-Rou Liu, Cheng-Keng Chuang, See-Tong Pang, I-Chang Hsieh, Ming-Shien Wen, Yung-Chang Lin, Chuang-Chi Liaw, Cheng-Lung Hsu, John Wen-Cheng Chang, Chang-Fu Kuo and Wen-Kuan Huang, Chang Gung Memorial Hospital, Linkou, Chang Gung University College of Medicine; Taoyuan; Tien-Hsing Chen, Chang Gung Memorial Hospital, Keelung, Taiwan; and Wen-Kuan Huang, Karolinska Institutet, Stockholm, Sweden
| | - Cheng-Lung Hsu
- Dong-Yi Chen, Lai-Chu See, Jia-Rou Liu, Cheng-Keng Chuang, See-Tong Pang, I-Chang Hsieh, Ming-Shien Wen, Yung-Chang Lin, Chuang-Chi Liaw, Cheng-Lung Hsu, John Wen-Cheng Chang, Chang-Fu Kuo and Wen-Kuan Huang, Chang Gung Memorial Hospital, Linkou, Chang Gung University College of Medicine; Taoyuan; Tien-Hsing Chen, Chang Gung Memorial Hospital, Keelung, Taiwan; and Wen-Kuan Huang, Karolinska Institutet, Stockholm, Sweden
| | - John Wen-Cheng Chang
- Dong-Yi Chen, Lai-Chu See, Jia-Rou Liu, Cheng-Keng Chuang, See-Tong Pang, I-Chang Hsieh, Ming-Shien Wen, Yung-Chang Lin, Chuang-Chi Liaw, Cheng-Lung Hsu, John Wen-Cheng Chang, Chang-Fu Kuo and Wen-Kuan Huang, Chang Gung Memorial Hospital, Linkou, Chang Gung University College of Medicine; Taoyuan; Tien-Hsing Chen, Chang Gung Memorial Hospital, Keelung, Taiwan; and Wen-Kuan Huang, Karolinska Institutet, Stockholm, Sweden
| | - Chang-Fu Kuo
- Dong-Yi Chen, Lai-Chu See, Jia-Rou Liu, Cheng-Keng Chuang, See-Tong Pang, I-Chang Hsieh, Ming-Shien Wen, Yung-Chang Lin, Chuang-Chi Liaw, Cheng-Lung Hsu, John Wen-Cheng Chang, Chang-Fu Kuo and Wen-Kuan Huang, Chang Gung Memorial Hospital, Linkou, Chang Gung University College of Medicine; Taoyuan; Tien-Hsing Chen, Chang Gung Memorial Hospital, Keelung, Taiwan; and Wen-Kuan Huang, Karolinska Institutet, Stockholm, Sweden
| | - Wen-Kuan Huang
- Dong-Yi Chen, Lai-Chu See, Jia-Rou Liu, Cheng-Keng Chuang, See-Tong Pang, I-Chang Hsieh, Ming-Shien Wen, Yung-Chang Lin, Chuang-Chi Liaw, Cheng-Lung Hsu, John Wen-Cheng Chang, Chang-Fu Kuo and Wen-Kuan Huang, Chang Gung Memorial Hospital, Linkou, Chang Gung University College of Medicine; Taoyuan; Tien-Hsing Chen, Chang Gung Memorial Hospital, Keelung, Taiwan; and Wen-Kuan Huang, Karolinska Institutet, Stockholm, Sweden
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24
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Saglio G, le Coutre P, Cortes J, Mayer J, Rowlings P, Mahon FX, Kroog G, Gooden K, Subar M, Shah NP. Evaluation of cardiovascular ischemic event rates in dasatinib-treated patients using standardized incidence ratios. Ann Hematol 2017; 96:1303-1313. [PMID: 28534184 PMCID: PMC5486782 DOI: 10.1007/s00277-017-3012-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 04/27/2017] [Indexed: 12/18/2022]
Abstract
With high survival rates for chronic myeloid leukemia (CML) patients treated with BCR-ABL1 tyrosine kinase inhibitors (TKIs), emerging consequences, such as arterial ischemic events, require consideration when evaluating treatment options. Cardiovascular ischemic event incidence in clinical trials was evaluated in 2712 dasatinib-treated patients with Philadelphia chromosome-positive (Ph+) leukemias from 11 first- and second-line trials (pooled), newly diagnosed CML patients treated with dasatinib or imatinib (DASISION), and prostate cancer patients treated with dasatinib or placebo plus docetaxel/prednisone (READY). Overall, 2-4% of dasatinib-treated patients had cardiovascular ischemic events. Most dasatinib-treated patients with an event had a history of and/or risk factor for atherosclerosis (pooled 77 with history/risk and event/96 with events; DASISION 8/10; READY 15/18). Most cardiovascular ischemic events occurred within 1 year of initiating dasatinib (pooled 69/96; DASISION 7/10; READY 16/18). Comparison of observed and expected event rates through standardized incidence ratios indicates that dasatinib does not increase risk for cardiovascular ischemic events compared with external reference populations.
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Affiliation(s)
- Giuseppe Saglio
- Clinical and Biological Sciences of the University of Turin, San Luigi Hospital, 10043, Orbassano-Torino, Italy.
| | - Philipp le Coutre
- Charité, Campus Virchow Klinikum, Universitätsmedizin Berlin, Berlin, Germany
| | - Jorge Cortes
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jiří Mayer
- Department of Internal Medicine, Hematology and Oncology, Masaryk University Hospital Brno, Brno, Czech Republic
| | - Philip Rowlings
- Calvary Mater Newcastle Hospital, University of Newcastle, Waratah, NSW, Australia
| | - François-Xavier Mahon
- Laboratoire d'Hématologie et Service des Maladies du Sang, Bordeaux et Institut Bergonié, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | | | | | | | - Neil P Shah
- UCSF School of Medicine, San Francisco, CA, USA
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25
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Greiman AK, Keane TE. Approach to Androgen Deprivation in the Prostate Cancer Patient with Pre-existing Cardiovascular Disease. Curr Urol Rep 2017; 18:41. [PMID: 28417429 DOI: 10.1007/s11934-017-0688-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Androgen deprivation therapy (ADT) is a mainstay of treatment for advanced prostate cancer. Several studies have reported an association between ADT and an increase in cardiovascular events, especially in those receiving gonadotropin-releasing hormone (GnRH) agonists compared to GnRH antagonists. We review the body of literature reporting the association of ADT and cardiovascular morbidity, and discuss the proposed mechanism of cardiovascular disease due to ADT including metabolic changes that may promote atherosclerosis and local hormonal effects that may increase plaque rupture and thrombosis. RECENT FINDINGS GnRH agonists appear to increase the risk of cardiovascular morbidity by 20-25% in men on these agents compared those who do not receive ADT. GnRH antagonists may appear to have halve this risk while improving PSA progression-free survival. GnRH antagonists may be superior to GnRH agonists for patients with significant cardiovascular disease, significant metastatic disease burden, or severe lower urinary tract symptoms.
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Affiliation(s)
- Alyssa K Greiman
- Department of Urology, Medical University of South Carolina, 96 Jonathan Lucas St., CSB 644, Charleston, SC, USA.
| | - Thomas E Keane
- Department of Urology, Medical University of South Carolina, 96 Jonathan Lucas St., CSB 644, Charleston, SC, USA
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26
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Crawford ED, Schally AV, Pinthus JH, Block NL, Rick FG, Garnick MB, Eckel RH, Keane TE, Shore ND, Dahdal DN, Beveridge TJR, Marshall DC. The potential role of follicle-stimulating hormone in the cardiovascular, metabolic, skeletal, and cognitive effects associated with androgen deprivation therapy. Urol Oncol 2017; 35:183-191. [PMID: 28325650 DOI: 10.1016/j.urolonc.2017.01.025] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 01/20/2017] [Accepted: 01/24/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE To explore how follicle-stimulating hormone (FSH) may contribute to cardiovascular, metabolic, skeletal, and cognitive events in men treated for prostate cancer, with various forms of androgen deprivation therapy (ADT). MATERIALS AND METHODS A colloquium of prostate cancer experts was convened in May 2015, to discuss the role of FSH in the development of unwanted effects associated with ADT. Subsequently, a literature review (Medline, PubMed, and relevant congress abstract databases) was performed to further explore and evaluate the collected evidence. RESULTS It has become evident that, in the setting of ADT, FSH can promote the development of atherosclerotic plaque formation, metabolic syndrome, and insulin resistance. Data also suggest that FSH is an important mediator of bone remodeling, particularly bone resorption, and thereby increases the risk for bone fracture. Additional evidence implicates a role for FSH in bone metastasis as well. The influence of FSH on ADT-induced cognitive deficits awaits further elucidation; however, the possibility that FSH may be involved therein cannot be ruled out. CONCLUSIONS The widespread molecular and physiological consequences of FSH system activation in normal and pathological conditions are becoming better understood. Progress in this area has been achieved by the development of additional investigative and clinical measures to better evaluate specific adverse effects. More research is needed on FSH function in the development of cancer as well as its association with cardiovascular, metabolic, musculoskeletal, and cognitive effects in ADT.
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Affiliation(s)
- E David Crawford
- Department of Urologic Oncology, School of Medicine, University of Colorado, Denver, Denver, CO.
| | - Andrew V Schally
- Endocrine, Polypeptide and Cancer Institute, Miami Veterans Affairs Medical Center, Miami, FL; Department of Pathology, University of Miami School of Medicine, Miami, FL; Department of Medicine, University of Miami School of Medicine, Miami, FL
| | - Jehonathan H Pinthus
- Department of Surgery, Juravinski Cancer Centre, McMaster University, Hamilton, Ontario, Canada
| | - Norman L Block
- Endocrine, Polypeptide and Cancer Institute, Miami Veterans Affairs Medical Center, Miami, FL; Department of Pathology, University of Miami School of Medicine, Miami, FL; Department of Medicine, University of Miami School of Medicine, Miami, FL
| | - Ferenc G Rick
- Endocrine, Polypeptide and Cancer Institute, Miami Veterans Affairs Medical Center, Miami, FL; Department of Urology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL
| | - Marc B Garnick
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Robert H Eckel
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado, Denver, CO
| | - Thomas E Keane
- Department of Urology, Medical University of South Carolina, Charleston, SC
| | - Neal D Shore
- Carolina Urologic Research Center, Myrtle Beach, SC
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27
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Lester-Coll NH, Johnson S, Magnuson WJ, Goldhaber SZ, Sher DJ, D'Amico AV, Yu JB. Weighing Risk of Cardiovascular Mortality Against Potential Benefit of Hormonal Therapy in Intermediate-Risk Prostate Cancer. J Natl Cancer Inst 2016; 109:2758641. [PMID: 28040795 DOI: 10.1093/jnci/djw281] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 09/26/2016] [Accepted: 10/25/2016] [Indexed: 11/12/2022] Open
Abstract
Background The purpose of this study is to determine the optimal strategy for men with newly diagnosed intermediate-risk prostate cancer by age and cardiac risk. Methods A Markov model was calibrated to the EORTC 22991 trial, which randomly assigned men with intermediate-risk prostate cancer to radiation therapy (RT) with or without six months of hormonal therapy (HT). We compared quality-adjusted life-years (QALYs) in men age 50, 60, and 70 years by age decile and cardiac risk group. Competing risks of cardiovascular mortality were estimated from the published literature. Sensitivity analyses were used to assess the impact of varying model assumptions. Results HT was associated with a net decrease of 0.3 to 0.4 QALYs in men with a history of myocardial infarction. However, for all other men, HT improved QALYs (range = 0.4-2.6 QALYs). Younger men with fewer cardiac risk factors experienced the largest benefit from HT. In sensitivity analyses, the model was only found to be sensitive to the probability of biochemical failure. Men at low risk for biochemical failure (≤8.7% at five years) did not benefit from HT. Further, the benefits of HT did not begin to manifest until after 7.3 years of follow-up. Conclusions The optimal choice of therapy depends upon age, cardiac risk, and disease recurrence risk. Young men with intermediate-risk prostate cancer with no cardiac risk factors benefit most from HT. Men with a history of myocardial infarction who are at very low risk for biochemical failure may be negatively impacted by the addition of HT.
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Affiliation(s)
- Nataniel H Lester-Coll
- Affiliations of authors: Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT (NHLC, SJ, WJM, JBY); Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (SZG); Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX (DJS); Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA (AVD)
| | - Skyler Johnson
- Affiliations of authors: Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT (NHLC, SJ, WJM, JBY); Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (SZG); Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX (DJS); Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA (AVD)
| | - William J Magnuson
- Affiliations of authors: Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT (NHLC, SJ, WJM, JBY); Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (SZG); Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX (DJS); Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA (AVD)
| | - Samuel Z Goldhaber
- Affiliations of authors: Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT (NHLC, SJ, WJM, JBY); Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (SZG); Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX (DJS); Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA (AVD)
| | - David J Sher
- Affiliations of authors: Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT (NHLC, SJ, WJM, JBY); Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (SZG); Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX (DJS); Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA (AVD)
| | - Anthony V D'Amico
- Affiliations of authors: Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT (NHLC, SJ, WJM, JBY); Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (SZG); Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX (DJS); Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA (AVD)
| | - James B Yu
- Affiliations of authors: Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT (NHLC, SJ, WJM, JBY); Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (SZG); Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX (DJS); Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA (AVD)
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Gül Ü, Kaçar Bayram A, Kendirci M, Hatipoğlu N, Okdemir D, Gümüş H, Kurtoğlu S. Pseudotumour Cerebri Presentation in a Child Under the Gonadotropin-Releasing Hormone Agonist Treatment. J Clin Res Pediatr Endocrinol 2016; 8:365-7. [PMID: 27087351 PMCID: PMC5096505 DOI: 10.4274/jcrpe.2212] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Gonadotropin-releasing hormone analogues are common treatment option in central precocious puberty in childhood as well as in endometriosis, infertility, and prostate cancer in adults. Pseudotumor cerebri is a rare side effect observed in adults. We present the case of a girl with precocious puberty treated with triptorelin acetate who developed pseudotumor cerebri after the 4th dose. She had headaches, and her blood pressure was detected to be above the 99 percentile. There were no causes underlying of hypertension such as cardiac, renal, or endocrine. Neurological examination was normal except bilateral papilledema. Cranial magnetic resonance imaging was normal. Cerebrospinal fluid (CSF) opening pressure was elevated. Triptorelin therapy was ceased and acetazolamide was applied; CSF pressure returned to normal. We observed pseudotumor cerebri after precocious puberty treatment, a finding for the first time ever seen in childhood.
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Affiliation(s)
- Ülkü Gül
- Erciyes University Faculty of Medicine, Department of Pediatric Endocrinology, Kayseri, Turkey, Phone: +90 352 437 49 31 E-mail:
| | - Ayşe Kaçar Bayram
- Erciyes University Faculty of Medicine, Department of Pediatric Neurology, Kayseri, Turkey
| | - Mustafa Kendirci
- Erciyes University Faculty of Medicine, Department of Pediatric Endocrinology, Kayseri, Turkey
| | - Nihal Hatipoğlu
- Erciyes University Faculty of Medicine, Department of Pediatric Endocrinology, Kayseri, Turkey
| | - Deniz Okdemir
- Erciyes University Faculty of Medicine, Department of Pediatric Endocrinology, Kayseri, Turkey
| | - Hakan Gümüş
- Erciyes University Faculty of Medicine, Department of Pediatric Neurology, Kayseri, Turkey
| | - Selim Kurtoğlu
- Erciyes University Faculty of Medicine, Department of Pediatric Endocrinology, Kayseri, Turkey
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Bhatia N, Santos M, Jones LW, Beckman JA, Penson DF, Morgans AK, Moslehi J. Cardiovascular Effects of Androgen Deprivation Therapy for the Treatment of Prostate Cancer: ABCDE Steps to Reduce Cardiovascular Disease in Patients With Prostate Cancer. Circulation 2016; 133:537-41. [PMID: 26831435 DOI: 10.1161/circulationaha.115.012519] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Nirmanmoh Bhatia
- From Cardiovascular Division (N.B., J.A.B., J.M.), Cardio-Oncology Program (N.B., J.M.), Vanderbilt-Ingram Cancer Center (D.F.P., A.K.M., J.M.), and Department of Urologic Surgery (D.F.P., A.K.M.), Vanderbilt University School of Medicine, Nashville, TN; Cardio-Oncology Service, Sirio-Libanes Hospital, Sao Paulo, Brazil (M.S.); Department of Cardiology, Sao Paulo Cancer Institute (ICESP), University of Sao Paulo, Brazil (M.S.); and Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (L.W.J.)
| | - Marilia Santos
- From Cardiovascular Division (N.B., J.A.B., J.M.), Cardio-Oncology Program (N.B., J.M.), Vanderbilt-Ingram Cancer Center (D.F.P., A.K.M., J.M.), and Department of Urologic Surgery (D.F.P., A.K.M.), Vanderbilt University School of Medicine, Nashville, TN; Cardio-Oncology Service, Sirio-Libanes Hospital, Sao Paulo, Brazil (M.S.); Department of Cardiology, Sao Paulo Cancer Institute (ICESP), University of Sao Paulo, Brazil (M.S.); and Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (L.W.J.)
| | - Lee W Jones
- From Cardiovascular Division (N.B., J.A.B., J.M.), Cardio-Oncology Program (N.B., J.M.), Vanderbilt-Ingram Cancer Center (D.F.P., A.K.M., J.M.), and Department of Urologic Surgery (D.F.P., A.K.M.), Vanderbilt University School of Medicine, Nashville, TN; Cardio-Oncology Service, Sirio-Libanes Hospital, Sao Paulo, Brazil (M.S.); Department of Cardiology, Sao Paulo Cancer Institute (ICESP), University of Sao Paulo, Brazil (M.S.); and Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (L.W.J.)
| | - Joshua A Beckman
- From Cardiovascular Division (N.B., J.A.B., J.M.), Cardio-Oncology Program (N.B., J.M.), Vanderbilt-Ingram Cancer Center (D.F.P., A.K.M., J.M.), and Department of Urologic Surgery (D.F.P., A.K.M.), Vanderbilt University School of Medicine, Nashville, TN; Cardio-Oncology Service, Sirio-Libanes Hospital, Sao Paulo, Brazil (M.S.); Department of Cardiology, Sao Paulo Cancer Institute (ICESP), University of Sao Paulo, Brazil (M.S.); and Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (L.W.J.)
| | - David F Penson
- From Cardiovascular Division (N.B., J.A.B., J.M.), Cardio-Oncology Program (N.B., J.M.), Vanderbilt-Ingram Cancer Center (D.F.P., A.K.M., J.M.), and Department of Urologic Surgery (D.F.P., A.K.M.), Vanderbilt University School of Medicine, Nashville, TN; Cardio-Oncology Service, Sirio-Libanes Hospital, Sao Paulo, Brazil (M.S.); Department of Cardiology, Sao Paulo Cancer Institute (ICESP), University of Sao Paulo, Brazil (M.S.); and Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (L.W.J.)
| | - Alicia K Morgans
- From Cardiovascular Division (N.B., J.A.B., J.M.), Cardio-Oncology Program (N.B., J.M.), Vanderbilt-Ingram Cancer Center (D.F.P., A.K.M., J.M.), and Department of Urologic Surgery (D.F.P., A.K.M.), Vanderbilt University School of Medicine, Nashville, TN; Cardio-Oncology Service, Sirio-Libanes Hospital, Sao Paulo, Brazil (M.S.); Department of Cardiology, Sao Paulo Cancer Institute (ICESP), University of Sao Paulo, Brazil (M.S.); and Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (L.W.J.).
| | - Javid Moslehi
- From Cardiovascular Division (N.B., J.A.B., J.M.), Cardio-Oncology Program (N.B., J.M.), Vanderbilt-Ingram Cancer Center (D.F.P., A.K.M., J.M.), and Department of Urologic Surgery (D.F.P., A.K.M.), Vanderbilt University School of Medicine, Nashville, TN; Cardio-Oncology Service, Sirio-Libanes Hospital, Sao Paulo, Brazil (M.S.); Department of Cardiology, Sao Paulo Cancer Institute (ICESP), University of Sao Paulo, Brazil (M.S.); and Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (L.W.J.).
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[Cardiovascular risk of androgen deprivation therapy for treatment of hormone-dependent prostate cancer : Differences between GnRH antagonists and GnRH agonists]. Herz 2016; 41:697-705. [PMID: 27083586 DOI: 10.1007/s00059-016-4422-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 02/07/2016] [Indexed: 01/26/2023]
Abstract
BACKGROUND Several studies have indicated that reduction of testosterone levels in patients with prostate cancer undergoing androgen deprivation therapy (ADT) with gonadotropin-releasing hormone (GnRH) agonists can be associated with an increased risk of cardiovascular events. The GnRH antagonists have a different mode of action compared with GnRH agonists and may be preferred in ADT for patients with cardiovascular disease. OBJECTIVE This review article discusses potential mechanisms underlying the development of cardiovascular events associated with ADT when using GnRH agonists and explains the differences in mode of action between GnRH agonists and GnRH antagonists. Additionally, relevant studies are presented and practical recommendations for the clinical practice are provided. MATERIAL AND METHODS A literature search was performed. Full publications and abstracts published in the last 10 years up to September 2015 were considered to be eligible. RESULTS The GnRH antagonists were associated with a decreased risk of cardiovascular events compared with GnRH agonists in prostate cancer patients undergoing ADT and particularly in patients with cardiovascular risk factors or a history of cardiovascular disease. This decrease may be due to the different mode of action of GnRH antagonists compared with GnRH agonists. CONCLUSION Prostate cancer patients with either cardiovascular disease or an increased risk of experiencing a cardiovascular event undergoing ADT should be preferentially treated with GnRH antagonists.
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[Castration modalities in prostate cancer: Are they all equal?]. Prog Urol 2016; 26:319-28. [PMID: 27017327 DOI: 10.1016/j.purol.2016.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 01/13/2016] [Accepted: 02/23/2016] [Indexed: 11/22/2022]
Abstract
AIM The aim of this literature review was to focus on the new highlights regarding oncologic and safety outcomes depending on the type of castration used. MATERIAL Literature search using various algorithms "prostate cancer", "castration", "agonist", "antagonist", "orchiectomy", "GnRH", "FSH", "androgen deprivation therapy" has been performed in April 2015, through the PubMed and Embase databases. RESULTS GnRH agonists and antagonists are both currently used in clinical practice. Nevertheless, differences regarding their pharmacologic properties have been highlighted in recent studies, specifically regarding the rapidity, sustainability and depth of the castration, but also the decrease in FSH level. Such differences may have oncological impact on the patient, regarding the disease biological control and the time to progression, and a tolerability impact, especially on the cardiovascular risks. The role of the depth and the sustainability of the castration in one hand, the FSH impact in the other hand, as well as a direct inhibition on extra-pituitary GnRH receptors by antagonist might explain these differences. CONCLUSIONS Recent studies suggest differences between GnRH agonists and antagonist that could impact the patient clinical outcomes. However, further high level of evidence comparative studies remains warranted.
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Meng F, Zhu S, Zhao J, Vados L, Wang L, Zhao Y, Zhao D, Niu Y. Stroke related to androgen deprivation therapy for prostate cancer: a meta-analysis and systematic review. BMC Cancer 2016; 16:180. [PMID: 26940836 PMCID: PMC4778362 DOI: 10.1186/s12885-016-2221-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 02/28/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Whether androgen deprivation therapy (ADT) leads to stroke morbidity is still unclear because of inconsistent evidence. We performed a systematic review and meta-analysis to evaluate if ADT used in men with prostate cancer (PCa) is associated with stroke. METHODS AND RESULTS Medline, Embase and Cochrane Library databases up to September 30th 2014 were systematically searched with no date or language restriction, and reports from potentially relevant journals were complementally searched. Both randomized controlled trials and observational studies were included. Two reviewers independently extracted data and assessed study quality. Six observational studies finally met inclusion criteria, with 74,538 ADT users and 85,947 non-ADT users reporting stroke as an endpoint. Although no significant association was observed in pooled estimates, the incidence of stroke in ADT users was 12 % higher than control groups, (HR = 1.12, 95 % confidence interval [CI]: 0.95 to 1.32; P = 0.16). In subgroup-analyses of different ADT types, stroke was found to be significantly associated with gonadotropin-releasing hormone (GnRH) alone (HR = 1.20, 95 % CI: 1.12 to 1.28; P < 0.001), GnRH plus oral antiandrogen (AA) (HR = 1.23, 95 % CI: 1.13 to 1.34; P < 0.001) and orchiectomy (HR = 1.37, 95 % CI: 1.33 to 1. 46; P = 0.001), but not with AA alone (HR = 1.06, 95 % CI: 0.71 to 1.57; P = 0.78). CONCLUSIONS GnRH alone, GnRH plus AA and orchiectomy is significantly associated with stroke in patients with PCa.
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Affiliation(s)
- Fanzheng Meng
- />Department of Neurology, Tianjin Nankai Hospital, Nankai Clinical School of Tianjin Medical University, Tianjin, China
- />Department of Urology, Second Hospital of Tianjin Medical Unversity, Tianjin Institute of Urology, 23 Pingjiang Road, Tianjin, 300211 China
| | - Shimiao Zhu
- />Department of Urology, Second Hospital of Tianjin Medical Unversity, Tianjin Institute of Urology, 23 Pingjiang Road, Tianjin, 300211 China
| | - Jinsheng Zhao
- />Department of Neurology, Tianjin Nankai Hospital, Nankai Clinical School of Tianjin Medical University, Tianjin, China
| | - Larissa Vados
- />Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Lei Wang
- />Tianjin Institute of Medical and Pharmaceutical Sciences, Tianjin, China
| | - Yusheng Zhao
- />First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Dan Zhao
- />Department of Neurology, Tianjin Nankai Hospital, Nankai Clinical School of Tianjin Medical University, Tianjin, China
| | - Yuanjie Niu
- />Department of Urology, Second Hospital of Tianjin Medical Unversity, Tianjin Institute of Urology, 23 Pingjiang Road, Tianjin, 300211 China
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Wang H, Sun X, Zhao L, Chen X, Zhao J. Androgen deprivation therapy is associated with diabetes: Evidence from meta-analysis. J Diabetes Investig 2016; 7:629-36. [PMID: 27181717 PMCID: PMC4931216 DOI: 10.1111/jdi.12472] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 11/12/2015] [Accepted: 12/27/2015] [Indexed: 12/20/2022] Open
Abstract
Aims/Introduction There is still no obvious evidence proving that androgen deprivation therapy (ADT) would increase the risk of diabetes. To determine if ADT is associated with diabetes in men with prostate cancer, we carried out the present study. Materials and Methods We systematically searched Medline, Embase and the Cochrane Library Central Register through 2014. Studies comparing ADT vs control aimed at treating prostate cancer reporting diabetes as outcome were included. Data were extracted independently by two reviewers. This meta‐analysis was reported based on the Preferred Reporting Items for Systematic reviews and Meta‐Analyses checklist. Observational studies were evaluated through the Meta‐analysis Of Observational Studies in Epidemiology checklist. Results Eight studies were identified with 65,695 ADT users and 91,893 non‐ADT users. The pooled incidence of diabetes was 39% higher in ADT groups. A significant association was observed in the overall analysis (risk ratio [RR] 1.39, 95% confidence interval [CI] 1.27–1.53; P < 0.001). In subgroup analyses, diabetes was found to be significantly associated with gonadotropin‐releasing hormone (GnRH) alone (RR 1.45, 95% CI 1.36–1.54; P < 0.001), GnRH plus oral antiandrogen (RR 1.40, 95% CI 1.01–1.93; P = 0.04) and orchiectomy (RR 1.34, 95% CI 1.20–1.50; P < 0.001), but not with antiandrogen alone (RR 1.33, 95% CI 0.75–2.36; P = 0.33). Diabetes was strongly related to long duration of ADT (RR 1.43, 95% CI 1.22–1.68; P < 0.001), and was slightly associated with short duration of ADT (RR 1.29, 95% CI 1.12–1.49; P = 0.0004). Conclusions ADT, especially long duration (>6 months) of this treatment, GnRH alone, GnRH plus antiandrogen and orchiectomy can increase the incidence of diabetes.
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Affiliation(s)
- Huimin Wang
- Department of Neurology, Tianjin Nankai Hospital, Nankai Clinical School of Tianjin Medical University, Tianjin, China
| | | | - Lin Zhao
- International Medical School, Tianjin Medical University, Tianjin, China
| | - Xiuju Chen
- Department of Neurology, Tianjin Nankai Hospital, Nankai Clinical School of Tianjin Medical University, Tianjin, China
| | - Jinsheng Zhao
- Department of Neurology, Tianjin Nankai Hospital, Nankai Clinical School of Tianjin Medical University, Tianjin, China
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Conteduca V, Caffo O, Derosa L, Veccia A, Petracci E, Chiuri VE, Santoni M, Santini D, Fratino L, Maines F, Testoni S, De Giorgi U. Metabolic syndrome in castration-resistant prostate cancer patients treated with abiraterone. Prostate 2015; 75:1329-38. [PMID: 25982919 DOI: 10.1002/pros.23014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 04/16/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Metabolic syndrome (MS) has not yet been studied in castration-resistant prostate cancer (CRPC) men treated with novel hormonal therapies. The study aims to assess the impact of MS on outcome from time starting abiraterone. PATIENTS AND METHODS We retrospectively evaluated a consecutive series of metastatic CRPC patients treated with abiraterone after docetaxel failure. MS, as defined by modified Adult Treatment Panel (ATP) III criteria, was assessed at the time of initiation of abiraterone, during treatment and follow-up. RESULTS Sixty-seven of 178 patients evaluated (37.6%) met MS criteria at baseline, before abiraterone initiation, whereas for 11 (9.9%) without MS before treatment with abiraterone this occurred during treatment. Median PFS was equal to 4.7 months for patients with MS versus 9 months for those without MS. Patients with MS had an increased risk of 71% of progression or death for all causes than patients without MS (HR = 1.7, 95% CI [1.2-2.4], P = 0.03). Median OS was 14.7 months and 22.3 months in patients with and without MS, respectively. After adjusting for covariates, MS resulted not significantly associated to OS (HR = 1.42, 95% CI [0.91-2.22], P = 0.073). CONCLUSIONS The presence of MS is a significant risk factor for shorter PFS in CRPC patients treated with abiraterone, even if it does not show a significant impact on OS. A prospective evaluation is warranted.
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Affiliation(s)
- Vincenza Conteduca
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Orazio Caffo
- Medical Oncology Department, Santa Chiara Hospital, Trento, Italy
| | - Lisa Derosa
- Medical Oncology Department, Santa Chiara Hospital, Pisa, Italy
| | - Antonello Veccia
- Medical Oncology Department, Santa Chiara Hospital, Trento, Italy
| | - Elisabetta Petracci
- Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | - Matteo Santoni
- Medical Oncology Department, AOU Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Daniele Santini
- Medical Oncology Department, Campus Bio-Medico, University of Rome, Rome, Italy
| | - Lucia Fratino
- Medical Oncology Department, National Cancer Institute, Aviano, Italy
| | - Francesca Maines
- Medical Oncology Department, Santa Chiara Hospital, Trento, Italy
| | - Sara Testoni
- Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Ugo De Giorgi
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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Schmid M, Sammon JD, Reznor G, Kapoor V, Speed JM, Abdollah FA, Sood A, Chun FKH, Kibel AS, Menon M, Fisch M, Sun M, Trinh QD. Dose-dependent effect of androgen deprivation therapy for localized prostate cancer on adverse cardiac events. BJU Int 2015; 118:221-9. [DOI: 10.1111/bju.13203] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Marianne Schmid
- Division of Urologic Surgery and Center for Surgery and Public Health; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
- Department of Urology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Jesse D. Sammon
- Vattikuti Urology Institute Center for Outcomes Research Analytics and Evaluation; Henry Ford Health System; Detroit MI USA
| | - Gally Reznor
- Division of Urologic Surgery and Center for Surgery and Public Health; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Victor Kapoor
- Vattikuti Urology Institute Center for Outcomes Research Analytics and Evaluation; Henry Ford Health System; Detroit MI USA
| | - Jacqueline M. Speed
- Division of Urologic Surgery and Center for Surgery and Public Health; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Firas A. Abdollah
- Vattikuti Urology Institute Center for Outcomes Research Analytics and Evaluation; Henry Ford Health System; Detroit MI USA
| | - Akshay Sood
- Vattikuti Urology Institute Center for Outcomes Research Analytics and Evaluation; Henry Ford Health System; Detroit MI USA
| | - Felix K.-H. Chun
- Department of Urology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Adam S. Kibel
- Division of Urologic Surgery and Center for Surgery and Public Health; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Mani Menon
- Vattikuti Urology Institute Center for Outcomes Research Analytics and Evaluation; Henry Ford Health System; Detroit MI USA
| | - Margit Fisch
- Department of Urology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Maxine Sun
- Division of Urologic Surgery and Center for Surgery and Public Health; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Quoc-Dien Trinh
- Division of Urologic Surgery and Center for Surgery and Public Health; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
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Tivesten Å, Pinthus JH, Clarke N, Duivenvoorden W, Nilsson J. Cardiovascular risk with androgen deprivation therapy for prostate cancer: potential mechanisms. Urol Oncol 2015; 33:464-75. [PMID: 26141678 DOI: 10.1016/j.urolonc.2015.05.030] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 05/27/2015] [Accepted: 05/27/2015] [Indexed: 10/23/2022]
Abstract
Androgen deprivation therapy (ADT) is frequently used for the treatment of advanced prostate cancer. ADT is associated with numerous side effects related to its mode of action, namely the suppression of testosterone to castrate levels. Recently, several large retrospective studies have also reported an increased risk of diabetes and cardiovascular disease in men receiving ADT, although these risks have not been confirmed by prospective randomized trials. We review the literature to consider the risk of cardiovascular disease with different forms of ADT and examine in detail potential mechanisms by which any such risk could be mediated. Mechanisms discussed include the metabolic syndrome resulting from low testosterone level and the potential roles of testosterone flare, gonadotropin-releasing hormone receptors outside the pituitary gland, and altered levels of follicle-stimulating hormone. Finally, the clinical implications for men prescribed ADT for the treatment of advanced prostate cancer are considered.
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Affiliation(s)
- Åsa Tivesten
- Wallenberg Laboratory for Cardiovascular and Metabolic Research, Sahlgrenska University Hospital, Göteborg, Sweden.
| | - Jehonathan H Pinthus
- Department of Surgery, Division of Urology, McMaster University, Hamilton, Ontario, Canada
| | - Noel Clarke
- Department of Urology, The Christie and Salford Royal Hospitals, Manchester, UK
| | | | - Jan Nilsson
- Department of Clinical Sciences, Lund University, Malmö, Sweden
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Gandaglia G, Sun M, Popa I, Schiffmann J, Trudeau V, Shariat SF, Trinh QD, Graefen M, Widmer H, Saad F, Briganti A, Montorsi F, Karakiewicz PI. Cardiovascular Mortality in Patients With Metastatic Prostate Cancer Exposed to Androgen Deprivation Therapy: A Population-Based Study. Clin Genitourin Cancer 2015; 13:e123-30. [DOI: 10.1016/j.clgc.2014.12.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 11/25/2014] [Accepted: 12/01/2014] [Indexed: 02/03/2023]
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Teoh JYC, Chan SYS, Chiu PKF, Poon DMC, Cheung HY, Hou SSM, Ng CF. Risk of acute myocardial infarction after androgen-deprivation therapy for prostate cancer in a Chinese population. BJU Int 2015; 116:382-7. [PMID: 25327618 DOI: 10.1111/bju.12967] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To investigate the risk of acute myocardial infarction (AMI) after androgen-deprivation therapy (ADT) for prostate cancer in a Chinese population. PATIENTS AND METHODS All Chinese patients with prostate cancer who were treated primarily with radical prostatectomy or radiotherapy, with or without further ADT at our hospital from the year 2000 to 2009 were retrospectively reviewed. We compared the risk of AMI in the patients who were given further ADT (ADT group) with those who were not given any ADT (non-ADT group). Potential risk factors of AMI including age, diabetes mellitus, hypertension, hyperlipidaemia, history of stroke, ischaemic heart disease, Eastern Cooperative Oncology Group Performance Status (ECOG PS) and duration of ADT were reviewed. The risk of AMI after ADT was first analysed using the Kaplan-Meier method, followed by Cox regression analyses including the potential risk factors mentioned. RESULTS In all, 452 patients were included, with 200 patients in the non-ADT group and 252 patients in the ADT group. The mean (sd) age was 68.2 (5.9) years in the non-ADT group and 69.5 (6.5) years in the ADT group, and the difference was statistically significant (P = 0.031). There were no significant differences in their pre-existing medical conditions or ECOG PS. The ADT group was associated with an increased risk of AMI when compared with the non-ADT group (P = 0.004) upon Kaplan-Meier analysis. Upon multivariate Cox regression analysis, hyperlipidaemia, poor ECOG PS and the use of ADT were the only three significant factors that were associated with increased risk of developing new AMI. CONCLUSIONS There was increased risk of AMI after ADT for prostate cancer in a Chinese population. Hyperlipidaemia and poor ECOG PS were also significant risk factors for developing AMI. The risk of AMI should be considered when deciding on ADT, especially in patients with history of hyperlipidaemia and relatively poor ECOG PS.
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Affiliation(s)
- Jeremy Y C Teoh
- Division of Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, China
| | - Samson Y S Chan
- Division of Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, China
| | - Peter K F Chiu
- Division of Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, China
| | - Darren M C Poon
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, China
| | - Ho-Yuen Cheung
- Division of Urology, Department of Surgery, North District Hospital, Hong Kong, China
| | - Simon S M Hou
- Division of Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, China
| | - Chi-Fai Ng
- Division of Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, China
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Hopmans SN, Duivenvoorden WC, Werstuck GH, Klotz L, Pinthus JH. GnRH antagonist associates with less adiposity and reduced characteristics of metabolic syndrome and atherosclerosis compared with orchiectomy and GnRH agonist in a preclinical mouse model1Contributed equally and share first authorship. Urol Oncol 2014; 32:1126-34. [DOI: 10.1016/j.urolonc.2014.06.018] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 05/14/2014] [Accepted: 06/05/2014] [Indexed: 10/24/2022]
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Zhao J, Zhu S, Sun L, Meng F, Zhao L, Zhao Y, Tian H, Li P, Niu Y. Androgen deprivation therapy for prostate cancer is associated with cardiovascular morbidity and mortality: a meta-analysis of population-based observational studies. PLoS One 2014; 9:e107516. [PMID: 25264674 PMCID: PMC4180271 DOI: 10.1371/journal.pone.0107516] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 08/12/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is no consensus regarding whether androgen deprivation therapy (ADT) is associated with cardiovascular disease (CVD) and cardiovascular mortality (CVM). The objective of this study was to determine the role of ADT for prostate cancer (PCa) in development of cardiovascular events (CVD and CVM). METHODS AND FINDINGS We performed a meta-analysis from population-based observational studies comparing ADT vs control aimed at treating PCa in patients with PCa, reporting either CVD or CVM as outcome. Publications were searched using Medline, Embase, Cochrane Library Central Register of observational studies database up to May 31th 2014, and supplementary searches in publications from potentially relevant journals. 6 studies were identified with a total of 129,802 ADT users and 165,605 controls investigating the relationship between ADT and CVD. The incidence of CVD was 10% higher in ADT groups, although no significant association was observed (HR = 1.10, 95%CIs: 1.00-1.21; P = 0.06). For different types of ADT, CVD was related with gonadotropin-releasing hormone (GnRH) (HR = 1.19, 95%CIs: 1.04-1.36; P<0.001) and GnRH plus oral antiandrogen (AA) (HR = 1.46, 95%CIs: 1.03-2.08; P = 0.04), but not with AA alone or orchiectomy. For CVM, 119,625 ADT users and 150,974 controls from 6 eligible studies were included, pooled results suggested that ADT was associated with CVM (HR = 1.17, 95%CIs: 1.04-1.32; P = 0.01). Significantly increased CVM was also detected in GnRH and GnRH plus AA groups. When patients received other treatments (e.g. prostatectomy and radiotherapy) were ruled out of consideration, more increased CVD (HR = 1.19, 95%CIs: 1.08-1.30; P<0.001) and CVM (HR = 1.30, 95%CIs: 1.13-1.50; P<0.001) were found in men treated with ADT monotherapy. CONCLUSIONS ADT is associated with both CVD and CVM. Particularly, GnRH alone and GnRH plus AA can significantly increase the incidence of cardiovascular events in patients with PCa.
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Affiliation(s)
- Jinsheng Zhao
- Tianjin Medical University, Tianjin, China
- Department of Neurology, Tianjin Nankai Hospital, Tianjin, China
- Department of Urology, Tianjin Institute of Urology, Second Hospital of Tianjin Medical Unversity, Tianjin, China
| | - Shimiao Zhu
- Tianjin Medical University, Tianjin, China
- Department of Urology, Tianjin Institute of Urology, Second Hospital of Tianjin Medical Unversity, Tianjin, China
| | - Libin Sun
- Tianjin Medical University, Tianjin, China
- Department of Urology, Tianjin Institute of Urology, Second Hospital of Tianjin Medical Unversity, Tianjin, China
| | - Fanzheng Meng
- Department of Neurology, Tianjin Nankai Hospital, Tianjin, China
| | - Lin Zhao
- Tianjin Medical University, Tianjin, China
| | - Yusheng Zhao
- First teaching hospital of Tianjin University of TCM, Tianjin, China
| | - Hao Tian
- Tianjin Medical University, Tianjin, China
- Department of Urology, Tianjin Institute of Urology, Second Hospital of Tianjin Medical Unversity, Tianjin, China
| | - Ping Li
- Tianjin Third Central Hospital, Tianjin, China
| | - Yuanjie Niu
- Tianjin Medical University, Tianjin, China
- Department of Urology, Tianjin Institute of Urology, Second Hospital of Tianjin Medical Unversity, Tianjin, China
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Gandaglia G, Sun M, Popa I, Schiffmann J, Abdollah F, Trinh QD, Saad F, Graefen M, Briganti A, Montorsi F, Karakiewicz PI. The impact of androgen-deprivation therapy (ADT) on the risk of cardiovascular (CV) events in patients with non-metastatic prostate cancer: a population-based study. BJU Int 2014; 114:E82-E89. [PMID: 24612110 DOI: 10.1111/bju.12732] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To examine and quantify the contemporary association between androgen-deprivation therapy (ADT) and three separate endpoints: coronary artery disease (CAD), acute myocardial infarction (AMI), and sudden cardiac death (SCD), in a large USA contemporary cohort of patients with prostate cancer. PATIENTS AND METHODS In all, 140 474 patients diagnosed with non-metastatic prostate cancer between 1995 and 2009 within the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database were abstracted. Patients treated with ADT and those not receiving ADT were matched using propensity score methodology. The 10-year CAD, AMI, and SCD rates were estimated. Competing-risks regression analyses tested the association between the type of ADT (GnRH agonists vs bilateral orchidectomy) and CAD, AMI, and SCD, after adjusting for the risk of dying during follow-up. RESULTS Overall, the 10-year rates of CAD, AMI, and SCD were 25.9%, 15.6%, and 15.8%, respectively. After stratification according to ADT status (ADT-naïve vs GnRH agonists vs bilateral orchidectomy), the CAD rates were 25.1% vs 26.9% vs 23.2%, the AMI rates were 14.8% vs 16.6% vs 14.8%, and the SCD rates were 14.2% vs 17.7% vs 16.4%, respectively. In competing-risks multivariable regression analyses, the administration of GnRH agonists (all P < 0.001), but not bilateral orchidectomy (all P ≥ 0.7), was associated with higher risk of CAD, AMI, and SCD. CONCLUSIONS The administration of GnRH agonists, but not orchidectomy, is still associated with a significantly increased risk of CAD, AMI, and, especially, SCD in patients with non-metastatic prostate cancer. Alternative forms of ADT should be considered in patients at higher risk of CV events.
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Affiliation(s)
- Giorgio Gandaglia
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.,Urological Research Institute, Vita-Salute San Raffaele University, San Raffaele Hospital, San Raffaele Scientific Institute, Milan, Italy
| | - Maxine Sun
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
| | - Ioana Popa
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.,Department of Urology, University of Montreal Health Center, Montreal, Canada
| | - Jonas Schiffmann
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.,Martini-clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Firas Abdollah
- Urological Research Institute, Vita-Salute San Raffaele University, San Raffaele Hospital, San Raffaele Scientific Institute, Milan, Italy
| | - Quoc-Dien Trinh
- Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Fred Saad
- Department of Urology, University of Montreal Health Center, Montreal, Canada
| | - Markus Graefen
- Martini-clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alberto Briganti
- Urological Research Institute, Vita-Salute San Raffaele University, San Raffaele Hospital, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Montorsi
- Urological Research Institute, Vita-Salute San Raffaele University, San Raffaele Hospital, San Raffaele Scientific Institute, Milan, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.,Department of Urology, University of Montreal Health Center, Montreal, Canada
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Suardi N, Gandaglia G, Gallina A, Di Trapani E, Scattoni V, Vizziello D, Cucchiara V, Bertini R, Colombo R, Picchio M, Giovacchini G, Montorsi F, Briganti A. Long-term outcomes of salvage lymph node dissection for clinically recurrent prostate cancer: results of a single-institution series with a minimum follow-up of 5 years. Eur Urol 2014; 67:299-309. [PMID: 24571959 DOI: 10.1016/j.eururo.2014.02.011] [Citation(s) in RCA: 181] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 02/07/2014] [Indexed: 01/30/2023]
Abstract
BACKGROUND Prostate cancer (PCa) patients with lymph node recurrence after radical prostatectomy (RP) are usually managed with androgen-deprivation therapy. Despite the absence of prospective randomized studies, salvage lymph node dissection (LND) has been proposed as an alternative treatment option. OBJECTIVE To examine long-term outcomes of salvage LND in patients with nodal recurrent PCa documented by 11C-choline positron emission tomography/computed tomography (PET/CT) scan. DESIGN, SETTING, AND PARTICIPANTS Overall, 59 patients affected by biochemical recurrence (BCR) with 11C-choline PET/CT scan with pathologic activity treated between 2002 and 2008 were included. INTERVENTION Pelvic and/or retroperitoneal salvage LND. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSES Biochemical response (BR) was defined as prostate-specific antigen (PSA) <0.2 ng/ml at 40 d after surgery. BCR for those who achieved BR was defined as a PSA >0.2 ng/ml. Clinical recurrence (CR) was defined as a positive PET/CT scan after salvage LND in the presence of a rising PSA. Kaplan-Meier curves assessed time to BCR, CR, and cancer-specific mortality (CSM). Cox regression analyses were fitted to assess predictors of CR. RESULTS AND LIMITATIONS Median follow-up after salvage LND was 81.1 mo. Overall, 35 patients (59.3%) achieved BR. The 8-yr BCR-free survival rate in patients with complete BR was 23%. Overall, the 8-yr CR- and CSM-free survival rates were 38% and 81%, respectively. In multivariable analyses evaluating preoperative variables, PSA at salvage LND represented the only predictor of CR (p=0.03). When postoperative variables were considered, BR and the presence of retroperitoneal lymph node metastases were significantly associated with the risk of CR (all p ≤ 0.04). Our study is limited by the lack of a control group. CONCLUSIONS Salvage LND may represent a therapeutic option for patients with BCR after RP and nodal pathologic uptake at 11C-choline PET/CT scan. Although most patients progressed to BCR after salvage LND, roughly 40% of them experienced CR-free survival. PATIENT SUMMARY Salvage lymph node dissection may represent a therapeutic option for selected patients with nodal recurrence after radical prostatectomy. Roughly 40% of men did not show any further clinical recurrence at long-term follow-up after surgery.
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Affiliation(s)
- Nazareno Suardi
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Giorgio Gandaglia
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Gallina
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Ettore Di Trapani
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Vincenzo Scattoni
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Damiano Vizziello
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Vito Cucchiara
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Bertini
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Renzo Colombo
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Maria Picchio
- Department of Nuclear Medicine, San Raffaele Scientific Institute, Milan, Italy
| | | | - Francesco Montorsi
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Briganti
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy.
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Gonadotropin-releasing hormone agonists and acute kidney injury in patients with prostate cancer. Eur Urol 2014; 66:1125-32. [PMID: 24495466 DOI: 10.1016/j.eururo.2014.01.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 01/19/2014] [Indexed: 01/16/2023]
Abstract
BACKGROUND Androgen deprivation therapy (ADT) might increase the risk of acute kidney injury (AKI) in patients with prostate cancer (PCa). OBJECTIVE To examine the impact of ADT on AKI in a large contemporary cohort of patients with nonmetastatic PCa representing the US population. DESIGN, SETTING, AND PARTICIPANTS Overall, 69 292 patients diagnosed with nonmetastatic PCa between 1995 and 2009 were abstracted from the Surveillance Epidemiology and End Results-Medicare database. OUTCOMES MEASUREMENTS AND STATISTICAL ANALYSES Patient in both treatment arms (ADT vs. no ADT) were matched using propensity-score methodology. Ten-year AKI rates were estimated. Competing-risks regression analyses tested the association between ADT and AKI, after adjusting for the risk of death during follow-up. RESULTS AND LIMITATIONS Overall, the 10-yr AKI rates were 24.9% versus 30.7% for ADT-naive patients versus those treated with ADT, respectively (p<0.001). When patients were stratified according to the type of ADT, the 10-yr AKI rates were 31.1% versus 26.0% for men treated with gonadotropin-releasing hormone (GnRH) agonists and bilateral orchiectomy, respectively (p<0.001). In multivariable analyses, the administration of GnRH agonists (hazard ratio [HR]: 1.24; 95% confidence interval [CI], 1.18-1.31; p<0.001), but not bilateral orchiectomy (HR: 1.11; 95% CI, 0.96-1.29; p=0.1), was associated with the risk of experiencing AKI. Our study is limited by its retrospective design. CONCLUSIONS ADT is associated with an increased risk of AKI in patients with nonmetastatic PCa. In particular, the administration of GnRH agonists, but not surgical castration, may substantially increase the risk of experiencing AKI. These observations should help provide physicians with better patient selection to reduce the risk of AKI. PATIENT SUMMARY The administration of gonadotropin-releasing hormone agonists, but not bilateral orchiectomy, increases the risk of acute kidney injury (AKI) in patients with prostate cancer (PCa). These observations should help provide physicians with better patient selection to reduce the risk of AKI in PCa patients.
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Albertsen PC, Klotz L, Tombal B, Grady J, Olesen TK, Nilsson J. Cardiovascular morbidity associated with gonadotropin releasing hormone agonists and an antagonist. Eur Urol 2013; 65:565-73. [PMID: 24210090 DOI: 10.1016/j.eururo.2013.10.032] [Citation(s) in RCA: 243] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 10/22/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND Androgen deprivation therapy (ADT) is associated with increased cardiovascular morbidity. OBJECTIVE To determine whether cardiovascular morbidity differs following initiation of gonadotropin-releasing hormone (GnRH) agonists compared with an antagonist. DESIGN, SETTING, AND PARTICIPANTS Pooled data from six phase 3 prospective randomized trials that recruited 2328 men between 2005 and 2012 to compare the efficacy of GnRH agonists against an antagonist. Men recruited had pathologically confirmed prostate cancer, an Eastern Cooperative Oncology Group score <2, a minimum life expectancy of 12 mo, and were naïve to ADT. Men were excluded if they had a prolonged baseline QT/corrected QT interval, other risk factors for heart failure, hypokalemia or a family history of long QT syndrome, or had another cancer diagnosed within 5 yr. INTERVENTION Men were randomized to receive a GnRH agonist or an antagonist for either 3-7 mo (n=642) or 12 mo (n=1686). Treatment groups were balanced for common baseline characteristics. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Event analysis was based on death from any cause or cardiac events. Data documenting adverse experiences were classified based on the Medical Dictionary for Regulatory Activities. The following conditions defined a cardiac event: arterial embolic or thrombotic events, hemorrhagic or ischemic cerebrovascular conditions, myocardial infarction, and other ischemic heart disease. Kaplan-Meier curves and log-rank tests were used to compare time to a cardiovascular event or death. RESULTS AND LIMITATIONS Among men with preexisting cardiovascular disease, the risk of cardiac events within 1 yr of initiating therapy was significantly lower among men treated with a GnRH antagonist compared with GnRH agonists (hazard ratio: 0.44; 95% confidence interval, 0.26-0.74; p=0.002). Since our analysis is post hoc, our findings should only be interpreted as hypothesis generating. CONCLUSIONS GnRH antagonists appear to halve the number of cardiac events experienced by men with preexisting cardiovascular disease during the first year of ADT when compared to GnRH agonists.
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Affiliation(s)
| | | | - Bertrand Tombal
- University Clinics Saint Luc/Catholic University of Louvain, Brussels, Belgium
| | - James Grady
- University of Connecticut Health Center, Farmington, CT, USA
| | | | - Jan Nilsson
- Department of Clinical Sciences, Lund University, Sweden
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Conteduca V, Di Lorenzo G, Bozza G, Ardito R, Aieta M. Metabolic syndrome as a peculiar target for management of prostate cancer patients. Clin Genitourin Cancer 2013; 11:211-20. [PMID: 23701880 DOI: 10.1016/j.clgc.2013.04.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 02/21/2013] [Accepted: 04/02/2013] [Indexed: 12/16/2022]
Abstract
An interesting and reciprocal association between the metabolic syndrome and prostate cancer has been identified. Metabolic alterations, such as hyperinsulinemia, increased levels of insulin growth factor-1, and insulin resistance could be on the basis of development and progression of many tumors, including prostate cancer, and changes in body composition, in turn, can represent some side effects of androgen deprivation therapy and novel drugs, such as mammalian target of rapamycin inhibitors. This review evaluates this interrelation between metabolic syndrome and prostate tumor scanning in many clinical and preclinical epidemiological studies and describes possible pathogenetic biological mechanisms. Finally, this article discusses feasible clinical implications for the management, prevention, diagnosis, prognosis, and treatment of patients affected by metabolic syndrome and prostate cancer, with particular attention to the metformin action.
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Affiliation(s)
- Vincenza Conteduca
- Centro di Riferimento Oncologico della Basilicata IRCCS, Rionero in Vulture, Italy.
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Moran O, Galietta LJV, Zegarra-Moran O. Binding site of activators of the cystic fibrosis transmembrane conductance regulator in the nucleotide binding domains. Cell Mol Life Sci 2005; 62:446-60. [PMID: 15719171 DOI: 10.1007/s00018-004-4422-3] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The use of substances that could activate the defective chloride channels of the mutant cystic fibrosis transmembrane conductance regulator (CFTR) has been suggested as possible therapy for cystic fibrosis. Using epithelia formed by cells stably transfected with wildtype or mutant (G551D, G1349D) CFTR, we estimated the apparent dissociation constant, K(D), of a series of CFTR activators by measuring the increase in the apical membrane current. Modification of apparent K(D) of CFTR activators by mutations of the nucleotide-binding domains (NBDs) suggests that the binding site might be in these regions. The human NBD structure was predicted by homology with murine NBD1. An NBD1-NBD2 complex was constructed by overlying monomers to a bacterial ABC transporter NBD dimer in the "head-to-tail" conformation. Binding sites for CFTR activators were predicted by molecular docking. Comparison of theoretical binding free energy estimated in the model to free energy estimated from the apparent dissociation constants, K(D), resulted in a remarkably good correlation coefficient for one of the putative binding sites, located in the interface between NBD1 and NBD2.
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Affiliation(s)
- O Moran
- Istituto di Biofisica, CNR, Via DeMarini 6, 16149 Genoa, Italy.
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