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Lenfant L, Leon P, Cancel-Tassin G, Audouin M, Staerman F, Rouprêt M, Cussenot O. Testosterone replacement therapy (TRT) and prostate cancer: An updated systematic review with a focus on previous or active localized prostate cancer. Urol Oncol 2020; 38:661-670. [DOI: 10.1016/j.urolonc.2020.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/06/2020] [Accepted: 04/10/2020] [Indexed: 02/01/2023]
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2
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Gokcen C, Erbagci AB, Mutluer T, Orkmez M, Correll CU. Mullerian inhibiting substance, sex hormone binding globulin and sex hormone levels in stimulant-naïve, first-diagnosed prepubertal boys with attention-deficit/hyperactivity disorder: comparison with matched healthy controls as well as before and after oros-methylpenidate treatment. Int J Psychiatry Clin Pract 2019; 23:251-257. [PMID: 31339400 DOI: 10.1080/13651501.2019.1602657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: Attention-Deficit/Hyperactivity Disorder (ADHD) is a complex neurodevelopmental disorder with strong male predominance. Since Müllerian Inhibiting Substance (MIS) produces sex-linked bias in animal studies, we aimed to investigate the role of MIS, Sex Hormone Binding Globulin (SHBG) and sex hormone levels in boys with ADHD.Methods: We compared prepubertal, psychostimulant-naïve boys with ADHD with age-matched healthy control boys (HCs). Patients were re-evaluated after 30 days of methylphenidate treatment assessing ADHD severity, and serum MIS, testosterone, estradiol, and albumin concentrations.Results: Compared to 30 HCs, with ADHD (n = 49, age = 6.9 ± 0.2 years) had lower SHBG (p = .014), and higher free testosterone (p = 0.006) and bioavailable testosterone (p = .002) percentages. Methylphenidate improved ADHD measures (all p < .0001) and abnormal baseline hormonal levels, increasing SHBG levels (p = .024), and lowering free (p = .001) and bioavailable testosterone (p = .016) percentages so that only free testosterone percentages remained higher versus HCs post-treatment (p = .02).Conclusions: Compared to age- and sex-matched HCs, prepubertal, stimulant-naïve boys with ADHD had significantly lower SHBG and higher free and bioavailable testosterone percentages, suggesting a possible contribution of sex hormones to ADHD. Osmotic-release oral system methylphenidate treatment for 30 days significantly improved ADHD symptoms and abnormal sex hormone levels, normalizing SHBG and bioavailable testosterone percentages that were similar to HCs while free testosterone remained elevated versus HCs.Key pointsCompare to healthy matched controls prepubertal stimulant-naïve boys with ADHD had significantly lower SHBG and higher free and bioavailable testosterone percentages, suggesting a possible effect on sex hormones to ADHD.After 30-day methylphenidate treatment, ADHD symptoms significantly improved, and SHBG and bioavailable testosterone percentages normalized which were similar to HCs, while free testosterone remained elevated versus HCs.We found a negative relationship between MIS levels and hyperactivity scores in ADHD boys. This finding suggests that MIS may contribute to hyperactivity symptoms, either directly by affecting behavior or indirectly by affecting sex hormone levels.
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Affiliation(s)
- Cem Gokcen
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey
| | - Ayse Binnur Erbagci
- Department of Medical Biochemistry, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey
| | - Tuba Mutluer
- Child and Adolescent Psychiatry Clinic, Koc University Hospital, Istanbul, Turkey
| | - Mustafa Orkmez
- Department of Medical Biochemistry, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey
| | - Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA.,Hofstra Northwell School of Medicine, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA.,The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, NY, USA.,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
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Zakaria AS, Dragomir A, Kassouf W, Tanguay S, Aprikian A. Changes in the levels of testosterone profile over time in relation to clinical parameters in a cohort of patients with prostate cancer managed by active surveillance. World J Urol 2018; 36:1209-1217. [DOI: 10.1007/s00345-018-2270-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 03/13/2018] [Indexed: 12/29/2022] Open
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Ujike T, Uemura M, Kawashima A, Nagahara A, Fujita K, Miyagawa Y, Nonomura N. A novel model to predict positive prostate biopsy based on serum androgen level. Endocr Relat Cancer 2018; 25:59-67. [PMID: 29046289 PMCID: PMC5744473 DOI: 10.1530/erc-17-0134] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 10/18/2017] [Indexed: 12/13/2022]
Abstract
Circulating levels of prostate-specific antigen (PSA) and testosterone are widely used for the detection of prostate cancer prior to prostate biopsy; however, both remain controversial. Effective screening strategies based on quantitative factors could help avoid unnecessary biopsies. Here, we sought to clarify the predictive value of free testosterone (FT) vs total testosterone (TT) in identifying patients likely to have positive biopsies. This study aims to develop a novel model for predicting positive prostate biopsy based on serum androgen levels. This study included 253 Japanese patients who underwent prostate biopsy at our institution. TT and FT, %FT (=FT/TT), age, PSA, prostate volume (PV) and PSA density (PSAD = PSA/PV) were assessed for association with prostate biopsy findings. The following results were obtained. Of 253 patients, 145 (57.3%) had positive biopsies. Compared to the negative biopsy group, the positive biopsy group demonstrated higher age, PSA and PSAD but lower PV, FT and %FT by univariate analysis. Multivariate logistic regression analysis indicated PSA, PSAD and %FT were independent predictors of cancer detection. We developed a predictive model based on PSAD and %FT, for which the area under the curve was significantly greater than that of PSA (0.82 vs 0.66), a well-known predictor. Applying this analysis to the subset of patients with PSA <10 ng/mL yielded similar results. We confirmed the utility of this model in another independent cohort of 88 patients. In conclusion, lower %FT predicted a positive prostate biopsy. We constructed a predictive model based on %FT and PSAD, which are easily obtained prior to biopsy.
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Affiliation(s)
- Takeshi Ujike
- Department of UrologyOsaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Motohide Uemura
- Department of UrologyOsaka University Graduate School of Medicine, Suita, Osaka, Japan
- Department of Therapeutic Urologic OncologyOsaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Atsunari Kawashima
- Department of UrologyOsaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Akira Nagahara
- Department of UrologyOsaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Kazutoshi Fujita
- Department of UrologyOsaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yasushi Miyagawa
- Department of UrologyOsaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Norio Nonomura
- Department of UrologyOsaka University Graduate School of Medicine, Suita, Osaka, Japan
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5
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Porcaro AB, De Luyk N, Corsi P, Sebben M, Tafuri A, Cacciamani G, De Marchi D, Tamanini I, Inverardi D, Brunelli M, Cerruto MA, Salvagno GL, Guidi GC, Artibani W. Preoperative Plasma Levels of Total Testosterone Associated with High Grade Pathology-Detected Prostate Cancer: Preliminary Results of a Prospective Study in a Contemporary Cohort of Patients. Curr Urol 2017; 10:72-80. [PMID: 28785191 DOI: 10.1159/000447155] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 02/09/2016] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES To investigate the associations, if any, between preoperative plasma levels of total testosterone (TT) and pathology Gleason score (pGS) in a contemporary cohort of prostate cancer (PCa) patients. MATERIALS AND METHODS Between November 2014 and June 2015, plasma levels of TT were measured in 142 patients who underwent radical prostatectomy. Exclusion criteria were as follows: 5α-reductase inhibitors, LH-releasing hormone analogues, or testosterone replacement treatment. The entire cohort, assessed by continuous and categorical variables, was classified into two groups according to the pGS that included low-intermediate (pGS 6-7) and high grade (pGS > 7) cases. TT was evaluated as a continuous variable. RESULTS The cohort included 128 cases. High grade PCa was detected in 28 (21.8%) patients. Median plasma levels of both TT and prostate specific antigen (PSA) were significantly higher in these cases. In the clinical multivariate model, independent and positive predictors of pGS > 7 were TT (p = 0.041; OR = 1.004), PSA (p = 0.006; OR = 1.191), and bGS > 6 (p = 0.004; OR = 5.0); that is, a single unit increase in TT plasma levels increases the odds of having high grade PCa by 4%. CONCLUSION In a contemporary cohort of patients, preoperative plasma levels of TT directly and independently associated with high grade PCa. High baseline plasma levels of TT might have clinical applications for managing PCa. New and well designed prospective studies dealing with this subject are required.
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Affiliation(s)
- Antonio B Porcaro
- Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Nicolò De Luyk
- Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Paolo Corsi
- Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Marco Sebben
- Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Alessandro Tafuri
- Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Giovanni Cacciamani
- Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Davide De Marchi
- Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Irene Tamanini
- Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Davide Inverardi
- Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Matteo Brunelli
- Department of Pathology, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Maria A Cerruto
- Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Gian L Salvagno
- Department of Laboratory Medicine, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Gian C Guidi
- Department of Laboratory Medicine, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Walter Artibani
- Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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Grigorova M, Punab M, Poolamets O, Adler M, Vihljajev V, Laan M. Genetics of Sex Hormone-Binding Globulin and Testosterone Levels in Fertile and Infertile Men of Reproductive Age. J Endocr Soc 2017; 1:560-576. [PMID: 29264510 PMCID: PMC5686641 DOI: 10.1210/js.2017-00050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 04/06/2017] [Indexed: 01/01/2023] Open
Abstract
Context Testosterone (T) is a central androgenic hormone, and sex hormone-binding globulin (SHBG) is the major determinant of its bioactivity. There are no acknowledged genetic variants with clear-cut clinical implications, modulating T levels in men. Objective To confirm genetic associations of top loci (SHBG, GCKR, SLCO1B1, and JMJD1C) from genome-wide association (GWA) studies for serum SHBG and T. Design Patients Groups differing in general and reproductive parameters: young men (n = 540; 19.3 ± 1.8 years), severe idiopathic male infertility patients (n = 641; 31.6 ± 6.0 years), and male partners of pregnant women (n = 324; 31.9 ± 6.6 years). All patients were recruited at the Andrology Centre, Tartu University Hospital, Estonia. Main Outcome Measures Genetic associations with reproductive hormones, testicular and sperm parameters (linear regression, additive model); intergroup allele/genotype distribution comparisons. Results Associations with serum SHBG levels were robust for SHBG -68 G>A [rs1799941; meta-analysis: P = 3.7 × 10-14; allelic effect (standard error) = 4.67 (0.62) nmol/L], SHBG +1091 C>T [rs727428; P = 7.3 × 10-11; -3.74 (0.57)], SHBG Pro185Leu [rs6258; P = 1.2 × 10-4, -12.2 (3.17)], and GCKR Pro446Leu [rs1260326; P = 1.5 × 10-4; -2.2 (0.59)]. Measured T concentrations correlated with genetically modulated levels of SHBG (r = 0.48 to 0.74, P < 0.0001), guaranteeing stable availability of free T. Among infertile men, SHBG Pro185Leu substitution showed additional downstream effect on luteinizing hormone [P = 5.1 × 10-5; -1.66 (0.57) IU/L] and follicle-stimulating hormone [P = 3.4 × 10-3; -2.48 (1.23) IU/L]. No associations with male reproductive parameters were detected for SHBG Asp327Asn (rs6259), SLCO1B1 Val174Ala (rs4149056), and JMJD1C intronic variant rs7910927. Conclusions Claims were replicated and additional associations were detected for four of seven tested GWAS top loci. Perspective clinical investigations of these variants are hypotestosteronemia among aging men and pharmacogenetics of hormone replacement therapy.
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Affiliation(s)
- Marina Grigorova
- Institute of Biomedicine and Translational Medicine, University of Tartu, 50411 Tartu, Estonia.,Human Molecular Genetics Research Group, Institute of Molecular and Cell Biology, University of Tartu, 51010 Tartu, Estonia
| | - Margus Punab
- Andrology Unit, Tartu University Hospital, 50406 Tartu, Estonia
| | - Olev Poolamets
- Andrology Unit, Tartu University Hospital, 50406 Tartu, Estonia
| | - Mart Adler
- Institute of Biomedicine and Translational Medicine, University of Tartu, 50411 Tartu, Estonia.,Andrology Unit, Tartu University Hospital, 50406 Tartu, Estonia
| | | | - Maris Laan
- Institute of Biomedicine and Translational Medicine, University of Tartu, 50411 Tartu, Estonia.,Human Molecular Genetics Research Group, Institute of Molecular and Cell Biology, University of Tartu, 51010 Tartu, Estonia
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7
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Llukani E, Katz BF, Agalliu I, Lightfoot A, Yu SJS, Kathrins M, Lee Z, Su YK, Monahan Agnew K, McGill A, Eun DD, Lee DI. Low levels of serum testosterone in middle-aged men impact pathological features of prostate cancer. Prostate Int 2017; 5:17-23. [PMID: 28352619 PMCID: PMC5357970 DOI: 10.1016/j.prnil.2016.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 11/11/2016] [Accepted: 12/16/2016] [Indexed: 11/26/2022] Open
Abstract
Background Serum testosterone deficiency increases with aging. Age is also a major risk factor for prostate cancer (PrCa) and PCa tumors are more frequently diagnosed among men >65 years old. We evaluated the relationship between preoperative serum testosterone and clinical/ pathological features of PrCa in middle-aged and elderly patients. Methods A total of 605 PrCa patients who underwent robotic-assisted radical prostatectomy between September 2010 and January 2013 at the University of Pennsylvania, and who had serum testosterone levels measured using Elecsys Testosterone II Immunoassay were included in this IRB-approved protocol. Androgen deficiency was determined as serum free testosterone (FT) <47 pg/ml and total testosterone (TT) <193 ng/dl. Demographic, clinical and tumor characteristics of men with low vs. normal TT or FT were compared using t-test or chi-square tests. Logistic regression was used to determine associations of clinical and pathological variables with FT or TT levels. Results Among middle-aged men (45–64 years; n = 367), those with low FT and low TT had, on average, a higher BMI (29.7 vs. 27.4, P < 0.01; and 32.2 vs. 27.6; P < 0.01, respectively) and higher proportion of Gleason 8–10 PrCa (13.3% vs. 4.8%, P = 0.011; and 19.2% vs. 5.1%, P = 0.012) compared to men with normal FT and normal TT values. Patients with low FT had also higher number of positive cores on biopsy (3.9 vs. 3.1 P = 0.019) and greater tumor volume (7.9 ml vs. 6.1 ml, P = 0.045) compared to those with normal FT. Among men ≥65 years (n = 135) there was no difference in prostatectomy specimens of PrCa between patients with low or normal FT or TT. Conclusion Among men aged 45–64 years low serum pretreatment FT and TT predicted more aggressive features of PrCa in prostatectomy specimens. In middle-aged patients low testosterone levels measured pre-operatively may indicate more aggressive disease parameters.
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Affiliation(s)
- Elton Llukani
- Division of Urology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA; Department of Urology, New York University School of Medicine, New York, NY, USA
| | - Benjamin F Katz
- Division of Urology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Ilir Agalliu
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY, USA; Department of Urology, Albert Einstein College of Medicine, New York, NY, USA
| | - Andrew Lightfoot
- Division of Urology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Sue-Jean S Yu
- Division of Urology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Martin Kathrins
- Division of Urology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Ziho Lee
- Department of Urology, Temple University Health System, Philadelphia, PA, USA
| | - Yu-Kai Su
- Division of Urology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Kelly Monahan Agnew
- Division of Urology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Alice McGill
- Division of Urology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Daniel D Eun
- Department of Urology, Temple University Health System, Philadelphia, PA, USA
| | - David I Lee
- Division of Urology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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9
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Porcaro AB, Petroziello A, Brunelli M, De Luyk N, Cacciamani G, Corsi P, Sebben M, Tafuri A, Tamanini I, Caruso B, Ghimenton C, Monaco C, Artibani W. High Testosterone Preoperative Plasma Levels Independently Predict Biopsy Gleason Score Upgrading in Men with Prostate Cancer Undergoing Radical Prostatectomy. Urol Int 2016; 96:470-8. [DOI: 10.1159/000443742] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 12/30/2015] [Indexed: 11/19/2022]
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10
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De Nunzio C, Lombardo R, Albisinni S, Gacci M, Tubaro A. Serum levels of sex hormone binding globulin (SHBG) are not predictive of prostate cancer diagnosis and aggressiveness: results from an Italian biopsy cohort. Int Braz J Urol 2014; 39:793-9. [PMID: 24456771 DOI: 10.1590/s1677-5538.ibju.2013.06.04] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 08/15/2013] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To explore the association between serum levels of Sex Hormone Binding Globulin (SHBG) and the risk of developing prostate cancer (PCa) as well as high grade disease in men undergoing prostate biopsy. MATERIALS AND METHODS Between 2006 and 2012, we prospectively enrolled 740 patients with no history of PCa undergoing prostate biopsy. Before biopsy general data of the patient DRE, PSA and BMI were recorded. The risk of detecting cancer and high grade cancer was assessed as a function of SHBG using crude and adjusted logistic regressions. RESULTS Serum levels of SHBG were not associated with an increased risk of PCa or high grade disease. Age (OR 1.027 95% CI 1.003-1.052 p = 0.027), DRE (OR 3.391 95% CI 2.258-5.092 p = 0.000) and PSA (OR 1.078 95% CI 1.037-1.120 p = 0.000) were found to be independent predictors of prostate cancer risk. Age (OR 1.051 95% CI 1.009-1.095 p = 0.016), DRE (OR 2.519 95% CI 1.384-4.584 p = 0.000), BMI (OR 1.098 95% CI 1.011-1.193 p = 0.027) and PSA (OR 1.074 95% CI 1.014-1.137 p = 0.015) were found to be independent predictors of high grade disease. CONCLUSIONS In our cohort of patients, serum levels of SHBG are not predictive of PCa or high grade disease. According to our experience SHBG should not be considered a biomarker in PCa diagnosis neither a marker for high grade disease.
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Affiliation(s)
- Cosimo De Nunzio
- Department of Urology, Ospedale Sant'Andrea, University La Sapienza, Rome, Italy
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11
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DNA damage response and prostate cancer: defects, regulation and therapeutic implications. Oncogene 2014; 34:2815-22. [PMID: 25132269 PMCID: PMC4333141 DOI: 10.1038/onc.2014.238] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 06/25/2014] [Accepted: 06/25/2014] [Indexed: 02/07/2023]
Abstract
DNA damage response (DDR) includes the activation of numerous cellular activities that prevent duplication of DNA lesions and maintain genomic integrity, which is critical for the survival of normal and cancer cells. Specific genes involved in the DDR such as BRCA1/2 and P53 are mutated during prostate cancer progression, while various oncogenic signaling such as Akt and c-Myc are activated, enhancing the replication stress and increasing the genomic instability of cancer cells. These events may render prostate cancer cells particularly sensitive to inhibition of specific DDR pathways, such as PARP in homologous recombination (HR) DNA repair and Chk1 in cell cycle checkpoint and DNA repair, creating opportunities for synthetic lethality or synergistic cytotoxicity. Recent reports highlight the critical role of androgen receptor (AR) as a regulator of DDR genes, providing a rationale for combining DNA-damaging agents or targeted DDR inhibitors with hormonal manipulation or AR inhibition as treatment for aggressive disease. The aims of this review are to discuss specific DDR defects in prostate cancer that occur during disease progression, to summarize recent advances in understanding the regulation of DDR in prostate cancer, and to present potential therapeutic opportunities through combinational targeting of the intact components of DDR signaling pathways.
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12
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San Francisco IF, Rojas PA, DeWolf WC, Morgentaler A. Low free testosterone levels predict disease reclassification in men with prostate cancer undergoing active surveillance. BJU Int 2014; 114:229-35. [PMID: 24898919 DOI: 10.1111/bju.12682] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine whether total testosterone and free testosterone levels predict disease reclassification in a cohort of men with prostate cancer (PCa) on active surveillance (AS). PATIENTS AND METHODS Total testosterone and free testosterone concentrations were determined at the time the men began the AS protocol. Statistical analysis was performed using Student's t-test and a chi-squared test to compare groups. Odds ratios (ORs) with 95% confidence intervals (CIs) were obtained using univariate logistic regression. Receiver-operator characteristic curves were generated to determine the investigated testosterone thresholds. Kaplan-Meier curves were used to estimate time to disease reclassification. A Cox proportional hazard regression model was used for multivariate analysis. RESULTS A total of 154 men were included in the AS cohort, of whom 54 (35%) progressed to active treatment. Men who had disease reclassification had significantly lower free testosterone levels than those who were not reclassified (0.75 vs 1.02 ng/dL, P = 0.03). Men with free testosterone levels <0.45 ng/dL had a higher rate of disease reclassification than patients with free testosterone levels ≥0.45 (P = 0.032). Free testosterone levels <0.45 ng/dL were associated with a several-fold increase in the risk of disease reclassification (OR 4.3, 95% CI 1.25-14.73). Multivariate analysis showed that free testosterone and family history of PCa were independent predictors of disease reclassification. CONCLUSIONS Free testosterone levels were lower in men with PCa who had reclassification during AS. Men with moderately severe reductions in free testosterone level are at increased risk of disease reclassification.
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Affiliation(s)
- Ignacio F San Francisco
- Departamento de Urología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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13
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Porcaro AB, Petrozziello A, Ghimenton C, Migliorini F, Sava T, Caruso B, Romano M, Cavalleri S, Artibani W. Associations of Pretreatment Serum Total Testosterone Measurements with Pathology-Detected Gleason Score Cancer. Urol Int 2013; 93:269-78. [DOI: 10.1159/000354621] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 07/24/2013] [Indexed: 11/19/2022]
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15
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De Nunzio C, Lombardo R, Leonardo C, Franco G, Gacci M, Presicce F, Cancrini F, Tubaro A. Serum levels of 17-β-estradiol are not predictive of prostate cancer diagnosis and aggressiveness: results from an Italian biopsy cohort. Urol Oncol 2013; 32:35.e9-13. [PMID: 23510864 DOI: 10.1016/j.urolonc.2013.01.008] [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: 12/17/2012] [Revised: 01/14/2013] [Accepted: 01/25/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To explore the association between serum levels of 17-β-estradiol (17BE) and prostate cancer (PCa) risk in men undergoing prostate biopsy. METHODS AND MATERIALS Between 2006 and 2012, we prospectively enrolled 894 patients, with no history of PCa, undergoing prostate biopsy. Before biopsy was performed, general data, digital rectal examination (DRE), body mass index, 17BE, and prostate-specific antigen (PSA) were recorded. The risk of detecting cancer and high-grade cancer was assessed as a function of 17BE using crude and adjusted logistic regressions. RESULTS Serum levels of 17BE were not associated with an increased risk of PCa or high-grade disease. Age (odds ratio [OR] 1.05; 95% confidence interval [CI]: 1.03-1.07; P = 0.000), DRE(OR 2.81; 95% CI: 1.98-4.00; P = 0.000), and PSA(OR 1.07; 95% CI: 1.04-1.10; P = 0.000) were found to be independent predictors of PCa risk. Age (OR 1.05; 95% CI: 1.01-1.09; P = 0.007), DRE (OR 3.04; 95% CI: 1.79-5.17; P = 0.000), body mass index (OR 1.07; 95% CI: 1.01-1.150; P = 0.040), and PSA (OR 1.08; 95% CI: 1.03-1.12; P = 0.000) were found to be independent predictors of high-grade disease. CONCLUSION In our cohort of patients, serum levels of 17BE are not predictive of PCa or high-grade disease. In patients at risk of PCa, 17BE should not be considered a reliable marker to predict poorly differentiated PCa in the setting of initial prostate biopsy.
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Affiliation(s)
- Cosimo De Nunzio
- Department of Urology, Ospedale sant'Andrea, University La Sapienza, Rome, Italy.
| | - Riccardo Lombardo
- Department of Urology, Ospedale sant'Andrea, University La Sapienza, Rome, Italy
| | - Costantino Leonardo
- Department of Urology, Ospedale sant'Andrea, University La Sapienza, Rome, Italy
| | - Giorgio Franco
- Department of Urology, Ospedale sant'Andrea, University La Sapienza, Rome, Italy
| | - Mauro Gacci
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Fabrizio Presicce
- Department of Urology, Ospedale sant'Andrea, University La Sapienza, Rome, Italy
| | - Fabiana Cancrini
- Department of Urology, Ospedale sant'Andrea, University La Sapienza, Rome, Italy
| | - Andrea Tubaro
- Department of Urology, Ospedale sant'Andrea, University La Sapienza, Rome, Italy
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