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Abed AS, Mokdad-Gargouri R, Raoof WM. Association between interleuleukin-1β polymorphism (rs16944) and biomarkers levels in Iraqi patients with prostate cancer. Mol Biol Rep 2023; 50:1157-1165. [PMID: 36417078 DOI: 10.1007/s11033-022-08077-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/01/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Prostate cancer (PCa) is the second-leading cause of mortality in men and the most commonly diagnosed non-cutaneous male malignancy. Host genetic factors, and inflammation-induced cytokines, play a key role in prostate oncogenesis. Single Nucleotide Polymorphisms (SNP) in cytokine genes were suggested to increase the susceptibility for PCa development and progression. This study aimed to investigate the association between the SNP (rs16944) in the interleukin-1 β (IL-1β) gene and the serum levels of Prostate Specific Antigen (PSA) Prolactine (PRL), testosterone, and IL-1β in Iraqi PCa patients versus healthy controls. METHODS Taqman Real Time-PCR, was performed to investigate the IL-1β (rs16944) polymorphism in 100 Iraqi PCa patients and 50 age-matched healthy controls in a case-control study. Serum levels of PSA, PRL, and testosterone were determined by ELISA and FIA, and associated with the IL-1β serum level as well as with the SNP (rs 16944). The association between the clinico-pathological parameters and the genotype distribution of PCa patients was also studied. RESULTS There level of IL-1β was significant increased in the serum of PCa patients compared to controls (P = 8.19 10-7). Serum levels for other biomarkers such as PSA, PRL and testosterone were also significantly elevated in patients compared to controls (P < 0.0001). No differences were seen for genotype and allele distribution between PCa patients and controls. Nevertheless, in the group of controls, we found that 36% carried the GG genotype against only 26% in the patients group.This suggests that this could be a protective genotype (OR 0.62, P = 0.254). In addition, we found that the GA genotype is slightly more frequent in patients as compared to controls (OR 1.22, P = 0.605). Interestingly, serum levels of IL-1β, PSA, PRL and testosterone were significantly higher in PCa patients carrying the GA genotype, and the GA and AA genotypes are strongly associated with the aggressive behavior of the disease such as advanced TNM, and high Gleason score. CONCLUSION Our data suggest that both serum IL-1β level and IL-1β SNP (rs16944) may be considered as candidate biomarkers for PCa. Moreover, the GA, and AA genotypes carriers along with high sera levels of IL-1β, PSA and PRL, have an increased risk for PCa with aggressive behavior in Iraqi men.
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Affiliation(s)
- Arwa Shtaiwi Abed
- Department of Biology, Faculty of Science, University of Sfax, Sfax, Tunisia.,Laboratory of Molecular Biotechnology of Eukaryotes, Center of Biotechnology of Sfax, University of Sfax, Sidi Mansour Street Km 6, BP 1177, 3038, Sfax, Tunisia
| | - Raja Mokdad-Gargouri
- Laboratory of Molecular Biotechnology of Eukaryotes, Center of Biotechnology of Sfax, University of Sfax, Sidi Mansour Street Km 6, BP 1177, 3038, Sfax, Tunisia.
| | - Waad Mahmood Raoof
- Department of Biology, College of Science, University of Tikrit, Tikrit, Iraq
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2
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Rajan P, Tharakan T, Chen R. Safety of androgen therapy in men with prostate cancer. Best Pract Res Clin Endocrinol Metab 2022; 36:101628. [PMID: 35248487 DOI: 10.1016/j.beem.2022.101628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Prostate cancer is one of the most frequently diagnosed malignancies in men worldwide and the life expectancy for men with prostate cancer is improving due to advancements in diagnostics and treatment. Male hypogonadism is associated with obesity, diabetes, and other comorbidities and also has been linked with increasing age; the primary therapy modality for this condition is testosterone replacement therapy (TRT). There are concerns that testosterone therapy may cause prostate cancer disease progression. However, contemporary evidence suggests that testosterone replacement therapy may be safe in specific groups of patients with prostate cancer. This chapter will summarise the contemporary literature regarding TRT use in hypogonadal men with prostate cancer, including limitations and future research goals.
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Affiliation(s)
- Prabhakar Rajan
- Centre for Cancer Cell and Molecular Biology, Barts Cancer Institute, Queen Mary University of London, London EC1M 6BQ, UK.
| | - Tharu Tharakan
- Urology Department, Charing Cross Hospital, Fulham Palace Rd, London W6 8RF, UK.
| | - Runzhi Chen
- Sir Alexander Fleming Building, Imperial College Rd, London SW7 2AZ, UK.
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3
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Diokno AC. The role of testosterone in men's health: is it time for a new approach? Int Urol Nephrol 2022; 54:2767-2774. [PMID: 35909146 DOI: 10.1007/s11255-022-03292-4] [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: 04/22/2022] [Accepted: 06/28/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Because of many unanswered questions regarding men's health, a literature review was performed to better understand the role of testosterone and testosterone replacement therapy (TRT) in the management of hypogonadism and aging related prostate gland diseases (ARPGD) including prostate cancer (PCa) and benign prostatic hyperplasia (BPH) with lower urinary tract symptoms (LUTS). METHODS The PubMed database was screened for pertinent peer reviewed articles published during the last four decades that culminated in the positions and recommendations in this paper. RESULTS Hypogonadism seriously impacts men's health, and the diagnosis remains controversial. The incidence of ARPGD is projected to increase worldwide and treatment still has significant limitations. There is compelling evidence that lower, not higher, testosterone levels trigger the development of PCa and BPH through androgen receptor over-expression. TRT was found to be safe and effective in treating hypogonadism including in PCa survivors and those harboring PCa. There is also evidence that TRT might reduce the incidence and prevalence of ARPGD. CONCLUSIONS AND RECOMMENDATIONS This review synthesizes a wide-ranging compendium of basic science and clinical research that strongly encourages altering the present approach to diagnosing and treating men with hypogonadism and ARPGD. These findings underscore the importance of avoiding significant testosterone decline and support the use of TRT. Ten recommendations are offered as a framework for the way forward. It is now time for clinicians, payers, researchers, funding agencies, professional associations, and patient advocacy groups to embrace this new paradigm to increase longevity and improve the quality of life.
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Affiliation(s)
- Ananias C Diokno
- Department of Urology, Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
- Department of Clinical Sciences, University of Central Florida College of Medicine, Orlando, FL, USA.
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Bommareddy K, Hamade H, Lopez-Olivo MA, Wehner M, Tosh T, Barbieri JS. Association of Spironolactone Use With Risk of Cancer: A Systematic Review and Meta-analysis. JAMA Dermatol 2022; 158:275-282. [PMID: 35138351 PMCID: PMC8829743 DOI: 10.1001/jamadermatol.2021.5866] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
IMPORTANCE While originally approved for the management of heart failure, hypertension, and edema, spironolactone is commonly used off label in the management of acne, hidradenitis, androgenetic alopecia, and hirsutism. However, spironolactone carries an official warning from the US Food and Drug Administration regarding potential for tumorigenicity. OBJECTIVE To determine the pooled occurrence of cancers, in particular breast and prostate cancers, among those who were ever treated with spironolactone. DATA SOURCES PubMed, Cochrane Library, Embase, and Web of Science were searched from inception through June 11, 2021. The search was restricted to studies in the English language. STUDY SELECTION Included studies reported the occurrence of cancers in men and women 18 years and older who were exposed to spironolactone. DATA EXTRACTION AND SYNTHESIS Two independent reviewers (K.B. and H.H.) selected studies, extracted data, and appraised the risk of bias using the Newcastle-Ottawa Scale. Studies were synthesized using random effects meta-analysis. MAIN OUTCOMES AND MEASURES Cancer occurrence, with a focus on breast and prostate cancers. RESULTS Seven studies met eligibility criteria, with sample sizes ranging from 18 035 to 2.3 million and a total population of 4 528 332 individuals (mean age, 62.6-72.0 years; in the studies without stratification by sex, women accounted for 17.2%-54.4%). All studies were considered to be of low risk of bias. No statistically significant association was observed between spironolactone use and risk of breast cancer (risk ratio [RR], 1.04; 95% CI, 0.86-1.22; certainty of evidence very low). There was an association between spironolactone use and decreased risk of prostate cancer (RR, 0.79; 95% CI, 0.68-0.90; certainty of evidence very low). There was no statistically significant association between spironolactone use and risk of ovarian cancer (RR, 1.52; 95% CI, 0.84-2.20; certainty of evidence very low), bladder cancer (RR, 0.89; 95% CI, 0.71-1.07; certainty of evidence very low), kidney cancer (RR, 0.96; 95% CI, 0.85-1.07; certainty of evidence low), gastric cancer (RR, 1.02; 95% CI, 0.80-1.24; certainty of evidence low), or esophageal cancer (RR, 1.09; 95% CI, 0.91-1.27; certainty of evidence low). CONCLUSIONS AND RELEVANCE In this systematic review and meta-analysis, spironolactone use was not associated with a substantial increased risk of cancer and was associated with a decreased risk of prostate cancer. However, the certainty of the evidence was low and future studies are needed, including among diverse populations such as younger individuals and those with acne or hirsutism.
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Affiliation(s)
- Kanthi Bommareddy
- University of Miami Miller School of Medicine, Holy Cross Health, Fort Lauderdale, Florida
| | - Hassan Hamade
- Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Maria A. Lopez-Olivo
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston
| | - Mackenzie Wehner
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston,Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston
| | - Traci Tosh
- Schaffer Library of Health Sciences, Albany Medical College, Albany, New York
| | - John S. Barbieri
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts,CME/Clinical Review and Education Editor, JAMA Dermatology
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Gargus ES, Rogers HB, McKinnon KE, Edmonds ME, Woodruff TK. Engineered reproductive tissues. Nat Biomed Eng 2020; 4:381-393. [PMID: 32251392 PMCID: PMC7416444 DOI: 10.1038/s41551-020-0525-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 02/05/2020] [Indexed: 12/14/2022]
Abstract
Engineered male and female biomimetic reproductive tissues are being developed as autonomous in vitro units or as integrated multi-organ in vitro systems to support germ cell and embryo function, and to display characteristic endocrine phenotypic patterns, such as the 28-day human ovulatory cycle. In this Review, we summarize how engineered reproductive tissues facilitate research in reproductive biology, and overview strategies for making engineered reproductive tissues that might eventually allow the restoration of reproductive capacity in patients.
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Affiliation(s)
- Emma S Gargus
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Hunter B Rogers
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kelly E McKinnon
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Maxwell E Edmonds
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Teresa K Woodruff
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Hillebrand AC, Pizzolato LS, Branchini G, Brum IS. Androgenic modulation of AR-Vs. Endocrine 2018; 62:477-486. [PMID: 30027434 DOI: 10.1007/s12020-018-1682-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 07/09/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE The importance of androgen receptor variants (AR-Vs) is recognized in prostate cancer. AR-Vs have been the focus of many studies. Expression of AR-Vs has been proposed as a biomarker for resistance to androgen deprivation therapy for metastatic disease. Herein, we show dynamic changes in AR-Vs expression in response to androgen modulation. METHODS The C4-2B cell line was exposed to low (10-13 M) and high (10-8 M) androgen (dihydrotestosterone, DHT) levels, with or without flutamide. mRNA and protein expression levels were assessed by qPCR and immunohistochemistry, respectively. RESULTS We demonstrated that high levels of DHT downregulate AR-FL and AR-Vs. Even though AR-Vs did not present ligand-binding domain, thus were not capable of binding to DHT, they present dynamic changes under androgen treatment. Treatment with flutamide alone or in association with low levels of DHT stimulates growth of prostatic cells. CONCLUSIONS Importantly, we provide evidence that AR-Vs respond differently to androgenic modulation. These findings have implications for a better understanding of the role of AR-Vs in prostate carcinogenesis.
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Affiliation(s)
- Ana Caroline Hillebrand
- Laboratory of Molecular Endocrine and Tumoral Biology, Department of Physiology, Institute of Basic Sciences of Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, 90050-170, Brazil
| | - Lolita Schneider Pizzolato
- Laboratory of Molecular Endocrine and Tumoral Biology, Department of Physiology, Institute of Basic Sciences of Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, 90050-170, Brazil
| | - Gisele Branchini
- Department of Basic Sciences of Health, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, 90050-170, Brazil
| | - Ilma Simoni Brum
- Laboratory of Molecular Endocrine and Tumoral Biology, Department of Physiology, Institute of Basic Sciences of Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, 90050-170, Brazil.
- Laboratory of Molecular Obstetrics and Gynecology, Experimental Research Center, Department of Obstetrics and Gynecology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, 90035-903, Brazil.
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Attenuation of Metabolic Syndrome by EPA/DHA Ethyl Esters in Testosterone-Deficient Obese Rats. Mar Drugs 2018; 16:md16060182. [PMID: 29794984 PMCID: PMC6024942 DOI: 10.3390/md16060182] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 05/12/2018] [Accepted: 05/22/2018] [Indexed: 12/21/2022] Open
Abstract
Inducing testosterone deficiency, as the standard treatment of prostate cancer, may cause metabolic disorders including insulin resistance, dyslipidemia, central obesity, cardiovascular diseases, and type 2 diabetes. This study measured responses to testosterone deficiency in high-carbohydrate, high-fat (H) diet-fed rats. We then tested whether eicosapentaenoic acid (EPA)/docosahexaenoic acid (DHA) ethyl esters (Omacor) reversed these metabolic changes. Male Wistar rats (8–9 weeks old) were divided into eight groups with four groups fed corn starch and four groups fed H diet. For each diet, one group received diet only; one group was orchidectomized; one group was given leuprolide (gonadotrophin-releasing hormone agonist, 2 mg/kg every 4th week); and the last group was treated with leuprolide and their diet was supplemented with 3% Omacor for the last eight weeks. The protocol was for 16 weeks. Leuprolide worsened metabolic syndrome symptoms and cardiovascular function, and orchidectomy produced greater responses. In H fed leuprolide-treated rats, Omacor decreased systolic blood pressure and left ventricular diastolic stiffness, reduced infiltration of inflammatory cells and collagen deposition in the heart, and reduced lipid accumulation and inflammatory cell infiltration without improving liver damage. These results suggest that Omacor has potential to attenuate metabolic complications in prostate cancer patients with induced testosterone deprivation.
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8
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Yanase T, Kawanami T, Tanaka T, Tanabe M, Nomiyama T. Impact of metabolic disorders on prostate cancer growth: Androgen and insulin resistance perspectives. Reprod Med Biol 2017; 16:252-257. [PMID: 29259475 PMCID: PMC5715889 DOI: 10.1002/rmb2.12039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 05/06/2017] [Indexed: 12/24/2022] Open
Abstract
Background A high prevalence of cancers in metabolic disorders, like metabolic syndrome (MetS) and type 2 diabetes mellitus (T2DM), recently has been noted, including prostate cancer (PC), which is androgen-sensitive. However, the pathological relationship among testosterone and insulin and insulin-like growth factor (IGF)-1 signaling in relation to MetS and T2DM with PC remains unclear. Methods Papers were reviewed, including those by the authors. Results In MetS or the initial stage of T2DM accompanying insulin resistance, insulin and IGF-1 signaling could be essential for PC growth. In the advanced stage of T2DM, the decrease in insulin secretion might work against PC growth. A decrease in testosterone concentration with T2DM also might suppress PC proliferation. Androgen deprivation therapy in patients with PC might increase the risk of MetS and/or T2DM and consequently cardiovascular events. Certain drugs for T2DM treatment, such as metformin and glucagon-like peptide-1 analog, potentially might be useful for the treatment of PC. Conclusion The improvement of insulin resistance appears to be essential for the prevention of PC growth. Further studies are needed to clarify the complicated pathophysiology of metabolic disorders in PC growth.
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Affiliation(s)
- Tashihiko Yanase
- Department of Endocrinology and Diabetes MellitusSchool of MedicineFukuoka UniversityFukuokaJapan
- Department of Bioregulatory Science of Life‐related DiseasesFukuoka UniversityFukuokaJapan
| | - Takako Kawanami
- Department of Endocrinology and Diabetes MellitusSchool of MedicineFukuoka UniversityFukuokaJapan
| | - Tomoko Tanaka
- Department of Endocrinology and Diabetes MellitusSchool of MedicineFukuoka UniversityFukuokaJapan
- Department of Bioregulatory Science of Life‐related DiseasesFukuoka UniversityFukuokaJapan
| | - Makito Tanabe
- Department of Endocrinology and Diabetes MellitusSchool of MedicineFukuoka UniversityFukuokaJapan
| | - Takashi Nomiyama
- Department of Endocrinology and Diabetes MellitusSchool of MedicineFukuoka UniversityFukuokaJapan
- Department of Bioregulatory Science of Life‐related DiseasesFukuoka UniversityFukuokaJapan
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9
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Zhou Y, Copeland B, Otto-Duessel M, He M, Markel S, Synold TW, Jones JO. Low Testosterone Alters the Activity of Mouse Prostate Stem Cells. Prostate 2017; 77:530-541. [PMID: 27976414 PMCID: PMC9135143 DOI: 10.1002/pros.23290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 11/22/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND Low serum testosterone (low T) has been repeatedly linked to worse outcomes in men with newly diagnosed prostate cancer (PC). How low T contributes to these outcomes is unknown. Here we demonstrate that exposure to low T causes significant changes in the mouse prostate and prostate stem cells. METHODS Mice were castrated and implanted with capsules to achieve castrate, normal, or sub-physiological levels of T. After 6 weeks of treatment, LC-MS/MS was used to quantify the levels of T and dihydrotestosterone (DHT) in serum and prostate tissue. FACS was used to quantify the percentages of purported prostate stem and transit amplifying (TA) cells in mouse prostates. Prostate tissues were also stained for the presence of CD68+ cells and RNA was extracted from prostate tissue or specific cell populations to measure changes in transcript levels with low T treatment. RESULTS Despite having significantly different levels of T and DHT in the serum, T and DHT concentrations in prostate tissue from different T treatment groups were similar. Low T treatment resulted in significant alterations in the expression of androgen biosynthesis genes, which may be related to maintaining prostate androgen levels. Furthermore, the expression of androgen-regulated genes in the prostate was similar among all T treatment groups, demonstrating that the mouse prostate can maintain functional levels of androgens despite low serum T levels. Low T increased the frequency of prostate stem and TA cells in adult prostate tissue and caused major transcriptional changes in those cells. Gene ontology analysis suggested that low T caused inflammatory responses and immunofluorescent staining indicated that low T treatment led to the increased presence of CD68+ macrophages in prostate tissue. CONCLUSIONS Low T alters the AR signaling axis which likely leads to maintenance of functional levels of prostate androgens. Low T also induces quantitative and qualitative changes in prostate stem cells which appear to lead to inflammatory macrophage infiltration. These changes are proposed to lead to an aggressive phenotype once cancers develop and may contribute to the poor outcomes in men with low T. Prostate 77:530-541, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
| | | | | | | | | | | | - Jeremy O. Jones
- Correspondence to: Jeremy Jones, 1500 E Duarte Rd, Beckman 2310, Duarte, CA 91010.
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10
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Ory J, Flannigan R, Lundeen C, Huang JG, Pommerville P, Goldenberg SL. Testosterone Therapy in Patients with Treated and Untreated Prostate Cancer: Impact on Oncologic Outcomes. J Urol 2016; 196:1082-9. [PMID: 27131465 PMCID: PMC5025358 DOI: 10.1016/j.juro.2016.04.069] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2016] [Indexed: 01/09/2023]
Abstract
PURPOSE Testosterone deficiency and prostate cancer have an increasing prevalence with age. However, because of the relationship between prostate cancer and androgen receptor activation, testosterone therapy among patients with known prostate cancer has been approached with caution. MATERIALS AND METHODS We identified a cohort of 82 hypogonadal men with prostate cancer who were treated with testosterone therapy. They included 50 men treated with radiation therapy, 22 treated with radical prostatectomy, 8 on active surveillance, 1 treated with cryotherapy and 1 who underwent high intensity focused ultrasound. We monitored prostate specific antigen, testosterone, hemoglobin, biochemical recurrence and prostate specific antigen velocity. RESULTS Median patient age was 75.5 years and median followup was 41 months. We found an increase in testosterone (p <0.001) and prostate specific antigen (p = 0.001) in the entire cohort. Prostate specific antigen increased in patients on active surveillance. However, no patients were upgraded to higher Gleason score on subsequent biopsies and none have yet gone on to definitive treatment. We did not note any biochemical recurrence among patients treated with radical prostatectomy but 3 (6%) treated with radiation therapy experienced biochemical recurrence. It is unclear whether these cases were related to testosterone therapy or reflected the natural biology of the disease. We calculated mean prostate specific antigen velocity as 0.001, 0.12 and 1.1 μg/l per year in the radical prostatectomy, radiation therapy and active surveillance groups, respectively. CONCLUSIONS In the absence of randomized, placebo controlled trials our study supports the hypothesis that testosterone therapy may be oncologically safe in hypogonadal men after definitive treatment or in those on active surveillance for prostate cancer.
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Affiliation(s)
- Jesse Ory
- Department of Urological Sciences, University of British Columbia, Vancouver, British Columbia; Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Ryan Flannigan
- Department of Urological Sciences, University of British Columbia, Vancouver, British Columbia
| | - Colin Lundeen
- Department of Urological Sciences, University of British Columbia, Vancouver, British Columbia
| | - James G Huang
- Department of Urological Sciences, University of British Columbia, Vancouver, British Columbia; Western Hospital, University of Melbourne and Monash Medical Centre, Monash University, Melbourne, Victoria, Australia
| | - Peter Pommerville
- Department of Urological Sciences, University of British Columbia, Vancouver, British Columbia
| | - S Larry Goldenberg
- Department of Urological Sciences, University of British Columbia, Vancouver, British Columbia
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Sridhar R, Bond V, Dunmore-Griffith J, Cousins VM, Zhang R, Millis RM. Relationship Between Aerobic Fitness, the Serum IGF-1 Profiles of Healthy Young Adult African American Males, and Growth of Prostate Cancer Cells. Am J Mens Health 2016; 11:92-98. [PMID: 25990510 DOI: 10.1177/1557988315587740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The growth of prostate tumors is mediated by the bioavailability of androgens and insulin-like growth factors. This study tested the hypothesis that healthy young adult African American men exhibiting low aerobic capacity (fitness) have serum insulin-like growth Factor-1 (IGF-1) and testosterone levels that promote growth of prostate cancer cells. A cross-sectional data research design was used to study groups of 18- to 26-year-old healthy men exhibiting low and moderate aerobic fitness, based on their peak oxygen consumption (VO2peak). The individual serum levels of IGF-1, IGF-1 binding protein-3 (IGFBP-3), and testosterone were measured. In vitro growth of androgen-dependent LNCaP prostate tumor cells was measured after incubation in culture medium fortified with each subject's serum. Aerobic capacity was significantly greater in the moderate-fitness group than in the low-fitness group without an intergroup difference in body mass index. The serum IGF-1 concentration was significantly higher in the low-fitness group in the absence of an intergroup difference in serum testosterone. The serum IGFBP-3 concentration was significantly lower in the low-fitness group. Prostate tumor cell growth was significantly greater in the cultures incubated in media containing the sera of the low-fitness group than in the sera of the moderate-fitness group. These findings suggest that moderate aerobic fitness in young adults may decrease the circulating levels of free IGF-1 and lower the potential to support growth of prostate cancer cells.
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Affiliation(s)
| | | | | | | | | | - Richard M Millis
- 2 The American University of Antigua College of Medicine, St. John's, Antigua & Barbuda
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Choi SM, Lee BM. Comparative safety evaluation of selective androgen receptor modulators and anabolic androgenic steroids. Expert Opin Drug Saf 2015; 14:1773-85. [DOI: 10.1517/14740338.2015.1094052] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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13
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Kühn CM, Strasser H, Romming A, Wullich B, Goebell PJ. Testosterone Replacement Therapy in Hypogonadal Men Following Prostate Cancer Treatment: A Questionnaire-Based Retrospective Study among Urologists in Bavaria, Germany. Urol Int 2015; 95:153-9. [DOI: 10.1159/000371725] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 12/20/2014] [Indexed: 11/19/2022]
Abstract
Background: Several reports suggest testosterone replacement therapy (TRT) may be an option in selected hypogonadal patients with a history of prostate cancer (PCa) and no evidence of disease after curative treatment. Our aim was to assess TRT experience and patient management among urologists in Bavaria. Materials and Methods: Questionnaires were developed and mailed to all registered urologists in Bavaria (n = 420) regarding their experience with TRT in patients with treated PCa. Results: One hundred and ninety-three (46%) urologists returned the questionnaire and reported their experience with TRT in hypogonadal patients after curative treatment for PCa. Complete data was available for 32 men. Twenty-six patients (81%) received TRT after prostatectomy, 1 patient after external beam radiation, 3 patients after high-dose brachytherapy and 2 patients after high-intensity focused ultrasound. Of the PCa cases, 88.5% (23/26) were organ confined (pT2a-c), and 3 were pT3 tumors. All patients were pN0/cN0, and only 1 patient (pT3a) had a positive surgical margin status postoperatively. After a mean follow-up of 39.8 months, no biochemical relapse was observed. Conclusion: To date, there is no clear evidence to withhold TRT from hypogonadal men after curative PCa treatment. Our findings, although with limitations, fit in with the available data showing that TRT does not put patients at an increased risk after curative treatment of PCa.
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14
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Dupree JM, Langille GM, Khera M, Lipshultz LI. The safety of testosterone supplementation therapy in prostate cancer. Nat Rev Urol 2014; 11:526-30. [PMID: 25069737 DOI: 10.1038/nrurol.2014.163] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patients with prostate cancer can present with hypogonadism and experience health and quality-of-life declines related to low testosterone levels. Despite generations of urological dogma suggesting that testosterone supplementation therapy (TST) for hypogonadism causes prostate-cancer progression, a review of the contemporary literature provides evidence to the contrary. The prostate saturation model suggests that the androgen receptor (AR) is saturated at serum testosterone levels of 150-200 ng/dl, and that additional serum testosterone above this level has limited, if any, effects within the prostate. Indeed, studies in the modern era of PSA assessments indicate that TST does not affect prostate size, intraprostatic testosterone levels, or prostate-cancer progression, provided the baseline serum testosterone level is greater than this AR saturation point. However, the body of data on this subject comes from a small number of cases, and TST should only be administered to patients with prostate cancer after thorough discussions of the risks and benefits, with subsequent careful monitoring.
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Affiliation(s)
- James M Dupree
- Scott Department of Urology, Baylor College of Medicine, 6624 Fannin Street, Houston, TX 77030, USA
| | - Gavin M Langille
- Scott Department of Urology, Baylor College of Medicine, 6624 Fannin Street, Houston, TX 77030, USA
| | - Mohit Khera
- Scott Department of Urology, Baylor College of Medicine, 6624 Fannin Street, Houston, TX 77030, USA
| | - Larry I Lipshultz
- Scott Department of Urology, Baylor College of Medicine, 6624 Fannin Street, Houston, TX 77030, USA
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15
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Üçer O, Gümüş B. The treatment of late-onset hypogonadism. Turk J Urol 2014; 40:170-9. [PMID: 26328172 DOI: 10.5152/tud.2013.97752] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Accepted: 08/27/2013] [Indexed: 11/22/2022]
Abstract
Late-onset hypogonadism (LOH) in aging men is a clinical and biochemical syndrome caused by an age-related decline in testosterone. Despite published in guidelines and recommendations, uncertainty surrounds the profile of clinical symptoms as well as the biochemical threshold of diagnosis. The only evidence-based treatment of late-onset hypogonadism is testosterone replacement therapy. The actual available evidence of the long-term risks and outcomes of testosterone-replacement therapy remains very limited, and carefully designed placebo-controlled trials of testosterone administration to assess the risks and benefits of such a therapy are required. Until such evidence is available, testosterone treatment should be restricted to elderly men with very low testosterone levels in the presence of clinical symptoms, and the advantages and disadvantages need to be accurately assessed. Careful monitoring of potential side effects is necessary. The purpose of this review is to discuss what is known and what remains unclear with respect to the benefits and risks of testosterone replacement treatment.
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Affiliation(s)
- Oktay Üçer
- Department of Urology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Bilal Gümüş
- Department of Urology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
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16
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Van Hemelrijck M, Michaelsson K, Nelson WG, Kanarek N, Dobbs A, Platz EA, Rohrmann S. Association of serum calcium with serum sex steroid hormones in men in NHANES III. Aging Male 2013; 16:151-8. [PMID: 23672276 PMCID: PMC4005327 DOI: 10.3109/13685538.2013.772133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Bone is a positive regulator of male fertility, which indicates a link between regulation of bone remodeling and reproduction or more specifically a link between calcium and androgens. This possibly suggests how calcium is linked to prostate cancer development through its link with the reproductive system. We studied serum calcium and sex steroid hormones in the Third National Health and Nutrition Examination Survey (NHANES III). METHODS Serum calcium and sex steroid hormones were measured for 1262 men in NHANES III. We calculated multivariable-adjusted geometric means of serum concentrations of total and estimated free testosterone and estradiol, androstanediol glucuronide (AAG), and sex hormone binding globulin (SHBG) by categories of calcium (lowest 5% [<1.16 mmol/L], mid 90%, top 5% [≥1.30 mmol/L]). RESULTS Levels of total and free testosterone, total estradiol or AAG did not differ across categories of serum calcium. Adjusted SHBG concentrations were 36.4 for the bottom 5%, 34.2 for the mid 90% and 38.9 nmol/L for the top 5% of serum calcium (Ptrend = 0.006), free estradiol levels were 0.88, 0.92 and 0.80 pg/ml (Ptrend = 0.048). CONCLUSIONS This link between calcium and sex steroid hormones, in particular the U-shaped pattern with SHBG, may, in part, explain why observational studies have found a link between serum calcium and risk of prostate cancer.
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Affiliation(s)
- Mieke Van Hemelrijck
- King’s College London, School of Medicine, Division of Cancer Studies, Cancer Epidemiology Unit, London, UK
| | - Karl Michaelsson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - William G Nelson
- Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
- Departments of Oncology, Pathology, Pharmacology and Molecular Sciences, Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Norma Kanarek
- Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Adrian Dobbs
- Johns Hopkins University School of Medicine, Division of Endocrinology and Metabolism, Baltimore, MD, USA
| | - Elizabeth A Platz
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, USA
| | - Sabine Rohrmann
- University of Zurich, Institute of Social and Preventive Medicine, Zurich, Switzerland
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17
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Diabetes protects from prostate cancer by downregulating androgen receptor: new insights from LNCaP cells and PAC120 mouse model. PLoS One 2013; 8:e74179. [PMID: 24058525 PMCID: PMC3769234 DOI: 10.1371/journal.pone.0074179] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 07/29/2013] [Indexed: 11/19/2022] Open
Abstract
Type 2 diabetes has been associated with decreased risk of prostate cancer in observational studies, and this inverse association has been recently confirmed in several large cohort studies. However the mechanisms involved in this protective effect remain to be elucidated. The aim of the present study was to explore whether different features of type 2 diabetes (hyperinsulinemia, hyperglycemia and tumor necrosis factor alpha [TNF-α]) protect against the development of prostate cancer. For this purpose LNCaP cells were used for in vitro experiments and nude mice in which PAC120 (hormone-dependent human prostate cancer) xenografts had been implanted were used for in vivo examinations. We provide evidence that increasing glucose concentrations downregulate androgen receptor (AR) mRNA and protein levels through NF-κB activation in LNCaP cells. Moreover, there was a synergic effect of glucose and TNFα in downregulating the AR in LNCaP cells. By contrast, insulin had no effect on AR regulation. In vivo experiments showed that streptozotocin-induced diabetes (STZ-DM) produces tumor growth retardation and a significant reduction in AR expression in PAC120 prostate cancer mice. In conclusion, our results suggest that hyperglycemia and TNF-α play an important role in protecting against prostate cancer by reducing androgen receptor levels via NF-κB.
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18
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Polackwich AS, Ostrowski KA, Hedges JC. Testosterone replacement therapy and prostate health. Curr Urol Rep 2013; 13:441-6. [PMID: 22927059 DOI: 10.1007/s11934-012-0275-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
There is an emerging evolution in the understanding of the relationship between the prostate and testosterone. It has long been generally believed that with testosterone replacement therapy (TRT), increasing serum testosterone levels led to prostatic growth and worsening of voiding dysfunction and associated complications. A new theory, the Saturation Model of Testosterone and its effect on the Prostate has gained attention. This theory suggests that the prostate's response to increasing levels of serum testosterone reaches a limit beyond which there is minimal effect. This model predicts that testosterone replacement therapy occurs above this saturation point, and replacing testosterone to eugonadal levels should not worsen prostate related benign disease. We evaluated the recent published data, with an emphasis on clinical studies done within the last 3 years, for the effects of testosterone supplementation on benign prostatic disease.
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Affiliation(s)
- A Scott Polackwich
- Department of Urology, Oregon Health & Science University, Portland, 97239, USA.
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19
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Zhou Y, Otto-Duessel M, He M, Markel S, Synold T, Jones JO. Low systemic testosterone levels induce androgen maintenance in benign rat prostate tissue. J Mol Endocrinol 2013; 51:143-53. [PMID: 23709748 PMCID: PMC3826535 DOI: 10.1530/jme-13-0060] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Prostate cancer (PC) is both an age- and an androgen-dependent disease. Paradoxically, systemic levels of androgens decline with age as the risk of PC rises. While there is no correlation between systemic androgen levels and the risk of PC, systemic androgen levels do not reflect the levels of androgens in prostate tissue. In metastatic PC, changes in the androgen biosynthesis pathway during hormone therapy result in increased levels of androgens in cancer tissue and contribute to continued androgen receptor (AR) signaling. It is possible that similar changes occur in normal prostate tissue as androgen levels decline with age and that this contributes to tumorigenesis. In the present study, we sought to determine whether the rat prostate is able to maintain functional levels of androgens despite low serum testosterone levels. Rats were castrated and implanted with capsules to achieve castrate, normal, sub-physiological, and supra-physiological levels of testosterone. After 6 weeks of treatment, LC-MS/MS was used to quantify the levels of testosterone and dihydrotestosterone (DHT) in the serum and prostate tissue. Quantitative RT-PCR was used to quantify the expression of genes involved in the androgen/AR signaling axis. Despite significantly different levels of testosterone and DHT being present in the serum, testosterone and DHT concentrations in prostate tissue from different testosterone-treatment groups were very similar. Furthermore, the expression of androgen-regulated genes in the prostate was similar among all the testosterone-treatment groups, demonstrating that the rat prostate can maintain a functional level of androgens despite low serum testosterone levels. Low-testosterone treatment resulted in significant alterations in the expression of androgen biosynthesis genes, which may be related to maintaining functional androgen levels.
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Affiliation(s)
- Ye Zhou
- Department of Molecular Pharmacology, Beckman Research Institute, City of Hope National Medical Center, 1500 E Duarte Road, Beckman 2310, Duarte, California 91010, USA
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20
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Abstract
Metabolic disorders such as diabetes, obesity and the metabolic syndrome have been shown to modulate prostate cancer (PCa) risk and aggressiveness in population-based and experimental studies. While associations between these conditions are modest and complex, two consistent findings have emerged. First, there is observational evidence that obesity and associated insulin excess are linked to increased PCa aggressiveness and worse outcomes. Secondly and somewhat paradoxically, long-standing diabetes may be protective against PCa development. This apparent paradox may be due to the fact that long-standing diabetes is associated with insulin depletion and decreased IGF1 signalling. Men with obesity or diabetes have moderate reductions in their androgen levels. The interconnectedness of metabolic and androgen status complicates the dissection of the individual roles of these factors in PCa development and progression. Metabolic factors and androgens may promote prostate carcinogenesis via multiple mechanisms including inflammation, adipokine action, fatty acid metabolism and IGF signalling. Moreover, androgen deprivation, given to men with PCa, has adverse metabolic consequences that need to be taken into account when estimating the risk benefit ratio of this therapy. In this review, we will discuss the current epidemiological and mechanistic evidence regarding the interactions between metabolic conditions, sex steroids and PCa risk and management.
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Affiliation(s)
- Mathis Grossmann
- Department of Medicine Austin Health, University of Melbourne, Heidelberg, Victoria, Australia
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