The implications of ageing and life expectancy in prostate cancer treatment

Determination of pharmacokinetics and tissue distribution of a novel lutetium-labeled PSMA-targeted ligand, 177Lu-DOTA-PSMA-GUL, in rats by using LC–MS/MS

Prostate specific membrane antigen (PSMA) is known to be overexpressed in prostate cancer cells, providing as a diagnostic and therapeutic target for prostate cancer. A lutetium-labeled PSMA targeted ligand, ¹⁷⁷Lu-DOTA-PSMA-GUL is a novel radiopharmaceutical, which has been developed for the treatment of prostate cancer. While the GUL domain of ¹⁷⁷Lu-DOTA-PSMA-GUL binds to the antigen, the beta-emitting radioisotope, ¹⁷⁷Lu-labeled DOTA, interacts with prostate cancer cells. However, the in vivo pharmacokinetics of intact ¹⁷⁷Lu-DOTA-PSMA-GUL has never been characterized. This study aimed to evaluate the pharmacokinetics and tissue distribution of the radiopharmaceutical in rats by using its stable isotope-labeled analog, ¹⁷⁵Lu-DOTA-PSMA-GUL. A sensitive liquid chromatography-tandem mass spectrometry (LC–MS/MS) analysis of ¹⁷⁵Lu-DOTA-PSMA-GUL was developed and validated. Following intravenous injection, the plasma concentration–time profiles of ¹⁷⁵Lu-DOTA-PSMA-GUL showed a multi-exponential decline with the average elimination half-life of 0.30 to 0.33 h. Systemic exposure increased with the dose and renal excretion is the major elimination route. Tissue distribution of ¹⁷⁵Lu-DOTA-PSMA-GUL was most substantial in kidneys, followed by the prostate. The developed LC–MS/MS assay and the in vivo pharmacokinetic data of ¹⁷⁵Lu-DOTA-PSMA-GUL would provide helpful information for further clinical studies to be developed as a novel therapeutic agent for prostate cancer.

Circ_0006404 Accelerates Prostate Cancer Progression Through Regulating miR-1299/CFL2 Signaling

Background

Circular RNAs (circRNAs) have been proven to function as pivotal regulators in cancer occurrence and progression. However, the function of circ_0006404 (circRNA Forkhead box O3 (circFOXO3)in prostate cancer (PCa) is poorly understood.

Methods

The enrichment of circ_0006404, FOXO3, microRNA-1299 (miR-1299) and cofilin 2 (CFL2) was measured by quantitative real-time polymerase chain reaction (qRT-PCR). The viability, metastasis and proliferation were determined by 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, transwell and colony formation assays, respectively. Flow cytometry was used to assess cell cycle progression and apoptosis. Circ_0006404/miRNAs interactions were explored using Circular RNA Interactome database, while TargetScan software was used for seeking the targets of miR-1299. Dual-luciferase reporter assay, RNA-pull down and RNA immunoprecipitation (RIP) assays were conducted to verify the target interaction between miR-1299 and circ_0006404 or CFL2. CFL2 protein level was analyzed by Western blot assay. Animal experiments were performed to test the role of circ_0006404 in PCa tumor growth in vivo.

Results

Circ_0006404 level was notably elevated in PCa. Circ_0006404 contributed to the viability, metastasis and proliferation and impaired the apoptosis of PCa cells. Circ_0006404 directly targeted miR-1299, and miR-1299 silencing largely reversed circ_0006404 interference-induced influences in PCa cells. CFL2 directly bound to miR-1299, and miR-1299-induced effects in PCa cells were largely attenuated by CFL2 overexpression. CFL2 was regulated by circ_0006404/miR-1299 axis in PCa cells. Circ_0006404 promoted PCa progression via miR-1299/CFL2 axis in vivo.

Conclusion

Circ_0006404 accelerated the survival, motility and proliferation while impeded the apoptosis of PCa cells via miR-1299/CFL2 axis. Circ_0006404 might be a stable potential bio-marker for PCa diagnosis and treatment.

Circular RNA ITCH suppressed prostate cancer progression by increasing HOXB13 expression via spongy miR-17-5p

BACKGROUND

Circular RNA Itchy E3 ubiquitin protein ligase (Circ-ITCH) is significantly down-regulated in various kinds of tumors, however, the mechanisms of action and functions of circITCH gene in prostate cancer (PC) are still under investigation. The mail goal of this research was to study the functional role of Circ-ITCH gene in prostate cancer and to illuminate the function role of circ-ITCH gene in prostate cancer by targeting miR-17-5p/HOXB13.

METHODS

RT-qPCR was applied to measure the expression level of circ-ITCH and miR-17-5p in PC cell lines and tissues. CCK-8, colony formation, Brdu incorporation labeling and flow cytometry assays were applied to detect the effects of circ-ITCH and miR-17-5p on proliferation and cell apoptosis. Target gene prediction and screening, luciferase reporter gene assays were utilized to assess downstream target genes of miR-17-5p and Circ-ITCH. The protein and expression of HOXB13 gene were measured by Western blotting and RT-qPCR.

RESULTS

CircITCH was significantly reduced in PC cell lines and tissues. Low circITCH expression level was highly related with preoperative PSA, tumor stage and Gleason score. Overexpression of circITCH can inhibit the malignant phenotype of prostate cancer. There was a high negative relationship between the expression level of microRNA-17-5p and circITCH in PC tissues, however, there existed a positive relationship between the expression of HOXB13 and circITCH. CircITCH acted as a sponge of miR-17-5p to increase HOXB13 gene expression. In addition, miR-17-5p overexpression or HOXB13 silencing can reduce the carcinogenic effects of circICCH in prostate cancer.

CONCLUSION

CircITCH promoted prostate cancer progression by regulating the HOXB13/miR-17-5p axis, and circITCH have a potential usage as therapeutic target for PC tumors.

Postoperative upgrading of prostate cancer in men ≥75 years: a propensity score-matched analysis

PURPOSE

Gleason score upgrading should be considered when indicating surgery in prostate cancer (PCa) patients. In elderly patients, definitive treatment of low-risk PCa must be weighed with the risks of overtreatment. Our aim was to evaluate rates of Gleason score upgrading in patients ≥75 years undergoing radical prostatectomy (RP) for localized PCa and to identify predictors associated with upgrading.

METHODS

3296 patients undergoing RP were retrospectively evaluated and categorized into age groups: <70 years (n = 2971) vs. ≥75 years (n = 325). We analyzed prostate-specific antigen (PSA), biopsy counts, Gleason score, pathologic T- and N-stage, and surgical margin. Propensity score matching was performed to compare rates of up- and downgrading on surgical specimen using the new five-tier pathologic grading system. Logistic regression was used to identify independent predictors of upgrading.

RESULTS

Preoperatively, patients ≥75 years had higher PSA (8.8 vs. 7.3 ng/mL) and lower proportion of grade group 1 (Gleason score 6) at biopsy (29.2 vs. 47.9%; both p < 0.001) compared to patients <70 years. At RP, patients ≥75 years were more likely to have extraprostatic disease (50 vs. 30%) and lower rates of grade group 1 (14.1 vs. 34.8%; both p < 0.001). Postoperative downgrading was similar (15.1 vs. 19.5%). However, patients ≥75 years had higher rates of postoperative upgrading (46.6 vs. 27.9%; p < 0.001). Age ≥75 years, higher PSA levels at RP, and an increased number of positive biopsy cores were associated with upgrading.

CONCLUSIONS

Patients ≥75 years not only demonstrated higher rates of advanced disease but more frequent upgrading on RP specimen. Age ≥75 years, higher PSA levels at RP, and an increased number of positive biopsy cores were predictive for upgrading. The increased risk of upgrading should be taken into consideration when discussing optimal treatment for this specific cohort.

Metastatic castration-resistant prostate cancer in very elderly patients: challenges and solutions

The treatment of elderly patients with cancer is usually viewed by clinicians as a challenge, because of the age-related decline in normal organ function and the frequent concomitant administration of multiple drugs for comorbid conditions. Clinicians therefore tend not to prescribe antineoplastic agents (mainly in the case of chemotherapy) to elderly patients, with the fear of excess toxicity leading to an unfavorable cost:benefit ratio. The cutoff age defining a cancer patient as elderly is usually 70 years, but over the last 10 years clinicians have paid more attention to functional status, as evaluated by means of a comprehensive geriatric assessment and comorbidity burden, rather than chronological age. In the case of metastatic castration-resistant prostate cancer (mCRPC), depending on their age at the time of diagnosis of PC, many (if not most) of the patients are more than 70 years old, and a fair number are very elderly patients aged ≥80 years. The availability of various agents capable of significantly prolonging survival has dramatically changed the therapeutic landscape of mCRPC patients, but very elderly patients are usually underrepresented in pivotal trials. This narrative review considers the available data concerning elderly and very elderly mCRPC patients enrolled in pivotal trials and the information provided by reports of everyday clinical practice, in order to explore the challenges related to the clinical management of this special population.

Healthy life expectancy of oral squamous cell carcinoma patients aged 75years and older

OBJECTIVES

Healthy life expectancy, an extension of the concept of life expectancy, is a summary measure of population health that takes into account the mortality and morbidity of a population. The aim of the present study was to retrospectively analyze the self-reliance survival times of oral squamous cell carcinoma (OSCC) patients.

MATERIALS AND METHODS

One hundred and twelve patients aged 75years or older with primary OSCC were included and examined at Shinshu University Hospital. To investigate healthy life expectancy, OSCC patients older than 75years were divided into 3 groups: 75-79, 80-84, and older than 85years. The Kaplan-Meier method was used to estimate the median times of healthy life expectancy. The Log-rank test was used to test significant differences between actual curves.

RESULTS

The median self-reliance survival times of patients aged 75-79, 80-84, and older than 85years were 5.7, 1.6, and 1.4years, respectively. Most patients with early stage cancers underwent curative treatments and showed a health expectancy of more than 5years. In patients with advanced cancers, health expectancy was poor (less than one year), except among patients aged 75-79years who underwent standard treatments.

CONCLUSIONS

It seems that in patients with advanced cancers, health expectancy was poor (less than 1year), except among patients aged 75-79years who underwent standard treatments. In elderly patients, healthy life expectancy (self-reliance survival time) may be one of the measures of patient prognosis as well as overall survival times.