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Dissing N, Fode M, Østergren P, Sønksen J. Changes in Quality of Life and Sexual Function After Luteinizing Hormone-Releasing Hormone (LHRH) Agonists and Orchiectomy in Men With Metastatic Prostate Cancer: Results From a Randomized Trial. Cureus 2024; 16:e55934. [PMID: 38601370 PMCID: PMC11004837 DOI: 10.7759/cureus.55934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2024] [Indexed: 04/12/2024] Open
Abstract
Purpose To examine changes in quality of life (QoL) in men diagnosed with metastatic prostate cancer undergoing androgen deprivation therapy (ADT). Methods This was a phase IV trial where patients were randomized to either triptorelin or subcapsular orchiectomy. We report changes in QoL, functional and symptom scales, and sexual function. These were assessed using the validated questionnaires, namely, the European Organisation for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire (EORTC-QLQ-C30), European Organization of Research and Treatment of Cancer Quality of Life Questionnaire Prostate Cancer 25 (EORTC-QLQ-PR25), and Erectile Hardness Scale (EHS) before treatment and at 12, 24, and 48 weeks, respectively. Data were analyzed using linear mixed models for repeated measures. Results Fifty-seven men with a median age of 74 years were randomized. The pooled analyses showed that QoL (p=0.003), emotional function (p<0.001), urinary symptoms (p=0.011), and hormonal treatment-related symptoms (p<0.001) changed significantly between visits. Improvement from baseline in QoL (mean change: 6.8 points (95% confidence interval (CI 95% CI): 2.1; 11.5)), emotional function (6.9 points: 3.3, 10.6), and urinary symptoms (-7.7 points (-12.3; -3.0)) was most pronounced at 24 weeks. Hormonal treatment-related symptoms (8.9 points (95% CI: 5.9; 12.0)) worsened. No significant differences between treatment groups were observed. At baseline, 29 men (51%) reported interest in sex, 18 were sexually active, and 12 had erections hard enough for penetration. At 48 weeks seven reported interest in sex, five were sexually active, and one man had a hard enough erection for penetration. Conclusions Men with newly diagnosed metastatic prostate cancer experience improved QoL and emotional function after starting ADT. Urinary symptoms improved, while hormonal treatment-related symptoms worsened. Interest in sex and sexual activity was retained in a proportion of men despite ADT.
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Affiliation(s)
- Niklas Dissing
- Department of Urology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Copenhagen, DNK
| | - Mikkel Fode
- Department of Urology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Copenhagen, DNK
| | - Peter Østergren
- Department of Urology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Copenhagen, DNK
| | - Jens Sønksen
- Department of Urology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Copenhagen, DNK
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Mangar S, Abbadasari M, Carollo A, Esposito G, Ahmed H, Shah T, Dimitriou D. Understanding Sleep Disturbances in Prostate Cancer-A Scientometric Analysis of Sleep Assessment, Aetiology, and Its Impact on Quality of Life. Cancers (Basel) 2023; 15:3485. [PMID: 37444596 DOI: 10.3390/cancers15133485] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/12/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
Prostate cancer is the most commonly diagnosed cancer in the United Kingdom. While androgen-deprivation therapy is the most common treatment for prostate cancer, patients undergoing this treatment typically experience side effects in terms of sleep disturbances. However, the relation between prostate cancer and sleep and the way in which sleep interventions may benefit oncological patients is underinvestigated in the literature. The current study aims to review in a data-driven approach the existing literature on the field of prostate cancer and sleep to identify impactful documents and major thematic domains. To do so, a sample of 1547 documents was downloaded from Scopus, and a document co-citation analysis was conducted on CiteSpace software. In the literature, 12 main research domains were identified as well as 26 impactful documents. Research domains were examined regarding the link between prostate cancer and sleep, by taking into account variations in hormonal levels. A major gap in the literature was identified in the lack of use of objective assessment of sleep quality in patients with prostate cancer.
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Affiliation(s)
- Stephen Mangar
- Department of Clinical Oncology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK
- Sleep Education and Research Laboratory, UCL Institute of Education, London WC1H 0AA, UK
| | - Monica Abbadasari
- Sleep Education and Research Laboratory, UCL Institute of Education, London WC1H 0AA, UK
| | - Alessandro Carollo
- Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy
| | - Gianluca Esposito
- Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy
| | - Hashim Ahmed
- Department of Surgery and Cancer, Imperial College London, London W6 8RF, UK
- Imperial Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W2 1NY, UK
| | - Taimur Shah
- Department of Surgery and Cancer, Imperial College London, London W6 8RF, UK
- Imperial Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W2 1NY, UK
| | - Dagmara Dimitriou
- Sleep Education and Research Laboratory, UCL Institute of Education, London WC1H 0AA, UK
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Ternov KK, Sønksen J, Fode M, Lindberg H, Kistorp C, Bisbjerg R, Faber J, Klausen TW, Palapattu G, Østergren PB. Fatigue, health-related quality-of-life and metabolic changes in men treated with enzalutamide or abiraterone acetate plus prednisone for metastatic castration-resistant prostate cancer: A randomised clinical trial (HEAT). Eur J Cancer 2022; 171:75-84. [PMID: 35709600 DOI: 10.1016/j.ejca.2022.04.034] [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: 01/09/2022] [Revised: 04/04/2022] [Accepted: 04/24/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Enzalutamide and abiraterone acetate plus prednisone (AAP) have similar efficacy in metastatic castration-resistant prostate cancer (mCRPC). Herein, we compare fatigue, health-related quality-of-life (HRQoL) and metabolic changes in men with mCRPC treated with enzalutamide and AAP. MATERIALS AND METHODS In this single-centre, open-labelled, phase IV trial, patients with metastatic prostate cancer progressing on androgen deprivation therapy were randomly assigned to enzalutamide (160 mg daily) or AAP (1000 mg abiraterone acetate and 10 mg prednisone daily) as first-line mCRPC treatment. The primary outcome was the difference in changed fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue questionnaire). The secondary outcomes were differences in changed HRQoL (Functional Assessment of Cancer Therapy-Prostate questionnaire), body composition, weight, glucose homeostasis, lipid profile and blood pressure. All outcomes were assessed at baseline and at 12-week follow-up. TRIAL REGISTRATION clinicaltrialsregister.eu (2017-000099-27). RESULTS 170 patients were randomised (1:1) to enzalutamide or AAP. The primary outcome was positive with a clinically meaningful difference in fatigue, favouring AAP (3.4 points, 95% CI 1.2; 5.6, P = 0.003). The group difference in changed HRQoL did not reach clinical significance. The most important metabolic finding was a higher increase in glycated haemoglobin (HbA1c) for AAP than enzalutamide (3.4 mmol/mol, 95% CI 2.1; 4.8, P = 0.001). Eight patients developed type 2 diabetes (T2D) in the AAP group and none in the enzalutamide group. No treatment-related serious adverse event was observed. CONCLUSIONS AAP resulted in less fatigue than enzalutamide in a randomised setting. This was at the expense of a higher HbA1c increase and incidence of T2D.
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Affiliation(s)
- Klara K Ternov
- Department of Urology, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Jens Sønksen
- Department of Urology, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Fode
- Department of Urology, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Urology, Zealand University Hospital, Roskilde, Denmark
| | - Henriette Lindberg
- Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark
| | - Caroline Kistorp
- Department of Endocrinology, Copenhagen University Hospital, Rigshospitalet, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Bisbjerg
- Department of Urology, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark
| | - Jens Faber
- Department of Endocrinology, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tobias W Klausen
- Department of Haematology, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ganesh Palapattu
- Department of Urology, Michigan Medicine, Ann Arbor, USA; Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Peter B Østergren
- Department of Urology, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Urology, Zealand University Hospital, Roskilde, Denmark
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Maalouf NM, Chhabra A, Zafereo J, Querry R, Towler DA, Thakur UJ, Frankl J, Poindexter JR, Mogharrabi B, Xac M, Öz OK, Rubin CD. Androgen Deprivation Therapy Differentially Impacts Bone and Muscle in the Short Term in Physically Active Men With Prostate Cancer. JBMR Plus 2021; 6:e10573. [PMID: 35079681 PMCID: PMC8770993 DOI: 10.1002/jbm4.10573] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 09/20/2021] [Accepted: 10/08/2021] [Indexed: 12/30/2022] Open
Abstract
Androgen deprivation therapy (ADT) is a cornerstone of advanced prostate cancer (PCa) therapy. Its use is associated with a loss of bone mineral density (BMD) and a greater risk of falls and osteoporotic fractures. In this prospective cohort study, we examined the impact of ADT on muscle and bone strength in men initiating ADT for PCa. Participants were evaluated at three time points: immediately before (week 0), and 6 and 24 weeks after ADT initiation. Study measures included fasting blood levels (for markers of muscle and bone metabolic activity), MRI and QCT imaging (for muscle fat content, and bone density and architecture), and validated clinical tests of muscle strength and gait. Sixteen men completed all study visits. At baseline and throughout the study, participants exercised a median of four times/week, but still experienced weight gain (+2.0 kg at week 24 versus week 0, p = 0.004). Biochemically, all men sustained dramatic early and persistent reductions in sex hormones post-ADT, along with a progressive and significant increase in serum C-telopeptide of type I collagen (CTX, +84% at week 24 versus week 0). There was a trend for rise in serum sclerostin (p = 0.09) and interleukin 6 (IL-6) (p = 0.08), but no significant change in serum myostatin (p = 0.99). Volumetric BMD by QCT declined significantly at the femoral neck (-3.7% at week 24 versus week 0), particularly at the trabecular compartment. On MRI, there were no significant changes in thigh muscle fat fraction. On physical testing, men developed weaker grip strength, but experienced no worsening in lower extremity and lumbar spine muscle strength, or on functional tests of gait. In conclusion, in physically active men, ADT for 24 weeks results in a significant increase in bone resorption and reduction in BMD, but nonsignificant changes in thigh muscle quality (on imaging) or strength and gait (on functional testing). © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Naim M. Maalouf
- Charles and Jane Pak Center for Mineral Metabolism and Clinical ResearchUniversity of Texas Southwestern Medical CenterDallasTXUSA,Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTXUSA
| | - Avneesh Chhabra
- Department of RadiologyUniversity of Texas Southwestern Medical CenterDallasTXUSA
| | - Jason Zafereo
- Department of Physical TherapyUniversity of Texas Southwestern Medical CenterDallasTXUSA
| | - Ross Querry
- Department of Physical TherapyUniversity of Texas Southwestern Medical CenterDallasTXUSA
| | - Dwight A. Towler
- Charles and Jane Pak Center for Mineral Metabolism and Clinical ResearchUniversity of Texas Southwestern Medical CenterDallasTXUSA,Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTXUSA
| | - Uma J. Thakur
- Department of RadiologyUniversity of Texas Southwestern Medical CenterDallasTXUSA
| | - Joseph Frankl
- Department of RadiologyUniversity of Texas Southwestern Medical CenterDallasTXUSA
| | - John R. Poindexter
- Charles and Jane Pak Center for Mineral Metabolism and Clinical ResearchUniversity of Texas Southwestern Medical CenterDallasTXUSA
| | - Bayan Mogharrabi
- Medical SchoolUniversity of Texas Southwestern Medical CenterDallasTXUSA
| | - May Xac
- Medical SchoolUniversity of Texas Southwestern Medical CenterDallasTXUSA
| | - Orhan K. Öz
- Charles and Jane Pak Center for Mineral Metabolism and Clinical ResearchUniversity of Texas Southwestern Medical CenterDallasTXUSA,Department of RadiologyUniversity of Texas Southwestern Medical CenterDallasTXUSA
| | - Craig D. Rubin
- Charles and Jane Pak Center for Mineral Metabolism and Clinical ResearchUniversity of Texas Southwestern Medical CenterDallasTXUSA,Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTXUSA
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Singh B, Toohey K. The effect of exercise for improving bone health in cancer survivors - A systematic review and meta-analysis. J Sci Med Sport 2021; 25:31-40. [PMID: 34465518 DOI: 10.1016/j.jsams.2021.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 07/14/2021] [Accepted: 08/10/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of exercise for improving bone-related outcomes among cancer survivors. DESIGN Systematic review and meta-analysis. METHODS An electronic search using the following databases: SPORTDiscus, Science Direct, CINAHL, MEDLINE, Cochrane, Pubmed, Ebscohost, ProQuest Nursing and Allied Health Source. Randomised, controlled, exercise trials involving cancer survivors were eligible. Effect data on bone mineral content (BMC) and density (BMD) outcomes were extracted. Risk of bias was assessed using the Physiotherapy Evidence Database tool. Standardised mean differences (SMD) were calculated to compare differences between exercise and usual care. Subgroup analyses were conducted to assess whether effect differed by exercise mode, intervention length, supervision, treatment, cancer type and risk of bias. RESULTS Twenty-six trials were included, with intervention durations ranging between 12 weeks and 2 years. Most trials involved breast cancer (n = 13, 50%), and most interventions were supervised (n = 18, 69%) and evaluated mixed-mode (i.e., combined aerobic and resistance) exercise (n = 13, 50%). Significant effects in favour of exercise (aerobic, resistance, mixed-mode and other exercise) were observed for whole body BMD, hip BMD, trochanter BMD and femoral neck BMD (SMD range: 0.19-0.39, all p < 0.05) compared to usual care. CONCLUSION Participation in various modes (aerobic, resistance, mixed-mode and other) of supervised and unsupervised exercise is associated with improvements in BMD. The present results provide evidence for clinicians and other health care professionals (e.g., exercise physiologists and physiotherapists) to recommend exercise for cancer survivors to prevent bone loss during and following treatment.
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Affiliation(s)
| | - Kellie Toohey
- Faculty of Health, University of Canberra, Australia; Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Australia
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Cavka L, Pohar Perme M, Zakotnik B, Rotovnik Kozjek N, Seruga B. Nutritional Status and Health-Related Quality of Life in Men with Advanced Castrate-Resistant Prostate Cancer. Nutr Cancer 2021; 74:472-481. [PMID: 33576255 DOI: 10.1080/01635581.2021.1884731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Despite professional recommendations malnutrition is not adequately addressed in cancer patients. Here, we explored whether nutritional status (NS) is associated with HRQoL in men with metastatic castrate-resistant prostate cancer (mCRPC). Methods: Men with mCRPC enrolled into this prospective observational study were allocated to one of the four NS categories based on clinical, laboratory, and patient self-reported criteria: well-nourished (WN), nutritional risk without criteria for cachexia/sarcopenia (NR), sarcopenia, and cachexia. The HRQoL was evaluated by the Functional Assessment of Cancer Therapy-Prostate (FACT-P) questionnaire. Association between NS and self-reported HRQoL was sought by the linear regression model, which was adjusted for known prognostic variables and body mass index. Results: Over the period of two years, 141 patients were enrolled. Their median age was 74.1 years (IQR 68.6-79.4 years) and majority of them were minimally symptomatic. Fifty-nine patients (41.8%) were WN, followed by 24 (17%), 42 (29.8%), and 16 (11.4%) patients with NR, sarcopenia, and cachexia, respectively. As compared to WN patients, all three other NS categories were significant negative predictors of HRQoL (P < 0.04). Conclusions: Abnormal NS is highly prevalent in men with mCRPC and is negatively associated with their HRQoL, which supports the recommendation for management of malnutrition in these patients.
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Affiliation(s)
- Luka Cavka
- Divison of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia.,Department of Oncology, University Medical Center Maribor, Maribor, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Maja Pohar Perme
- Institute for Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Branko Zakotnik
- Divison of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Nada Rotovnik Kozjek
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Department for Clinical Nutrition, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Bostjan Seruga
- Divison of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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7
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Reliability of graded cycling test with talk test and 30-s chair-stand test in men with prostate cancer on androgen deprivation therapy. Support Care Cancer 2021; 29:4249-4256. [PMID: 33411043 DOI: 10.1007/s00520-020-05918-8] [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: 09/02/2020] [Accepted: 11/25/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To investigate the absolute and relative reliability of the "graded cycling test with talk test" (GCT-TT) and the "30-second chair-stand test" (30s-CST) in men with prostate cancer receiving androgen deprivation therapy (ADT). METHODS Men with prostate cancer on ADT were included in this test-retest study. GCT-TT and 30s-CST were performed twice with 1 hour between test sessions. All tests were conducted by two experienced physiotherapists and all patients were familiar with the tests. Only intra-tester reliability was investigated as the test and retest of each participant were performed by the same physiotherapist. Intraclass correlation coefficient (ICC2.1), standard error of measurement (SEM and SEM95), and smallest real difference (SRD) were calculated. RESULTS Sixty men were included with a mean age of 70.8 ± 6.6 (mean ± SD) years. All performed 30s-CST twice without any problems. Two participants were excluded from the analysis of the GCT-TT results. Relative reliability for 30s-CST (ICC2.1) was 0.97 [95% CI: 0.94-0.98] with low measurement error: SEM95, 1.9 repetitions, and SRD, 2.6 repetitions. The corresponding results for GCT-TT were ICC2.1, 0.90 [95% CI: 0.84-0.94]; SEM95, 19.9 W; and SRD, 28.2 W. CONCLUSIONS The reliability of 30s-CST and GCT-TT is substantial for men with prostate cancer receiving ADT. Overall, an average 30s-CST improvement of 1.9 repetitions on a group level and three repetitions for individual patients are considered real improvements. A GCT-TT improvement exceeding 19.9 W represents a real improvement for a group of patients. Individual patients need to improve two steps (30 W).
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8
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Hoogland AI, Jim HSL, Gonzalez BD, Small BJ, Gilvary D, Breen EC, Bower JE, Fishman M, Zachariah B, Jacobsen PB. Systemic inflammation and symptomatology in patients with prostate cancer treated with androgen deprivation therapy: Preliminary findings. Cancer 2020; 127:1476-1482. [PMID: 33378113 DOI: 10.1002/cncr.33397] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 06/29/2020] [Accepted: 10/05/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Increases in fatigue, depressive symptomatology, and cognitive impairment are common after the initiation of androgen deprivation therapy (ADT) for prostate cancer. To date, no studies have examined the potential role of inflammation in the development of these symptoms in ADT recipients. The goal of the current study was to examine circulating markers of inflammation as potential mediators of change in fatigue, depressive symptomatology, and cognitive impairment related to the receipt of ADT. METHODS Patients treated with ADT for prostate cancer (ADT+; n = 47) were assessed around the time of the initiation of ADT and 6 and 12 months later. An age- and education-matched group of men without a history of cancer (CA-; n = 82) was assessed at comparable time points. Fatigue, depressive symptomatology, and cognitive impairment were assessed with the Fatigue Symptom Inventory, the Center for Epidemiological Studies Depression Scale, and a battery of neuropsychological tests, respectively. Circulating markers of inflammation included interleukin 1 receptor antagonist (IL-1RA), interleukin 6 (IL-6), soluble tumor necrosis factor receptor II (sTNF-RII), and C-reactive protein (CRP). RESULTS Fatigue, depressive symptomatology, and serum IL-6 increased significantly over time in the ADT+ group versus the CA- group; rates of cognitive impairment also changed significantly between the groups. No significant changes in IL-1RA, sTNF-RII, or CRP over time were detected. Treatment-related increases in IL-6 were associated with worsening fatigue but not depressive symptomatology or cognitive impairment. CONCLUSIONS Results of this preliminary study suggest that increases in circulating IL-6, perhaps due to testosterone inhibition, may play a role in fatigue secondary to receipt of ADT. Additional research is needed to determine whether interventions to reduce circulating inflammation improve fatigue in this population.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Babu Zachariah
- James A. Haley Veterans Affairs' Medical Center, Tampa, Florida
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9
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The effect of exercise training on cardiometabolic health in men with prostate cancer receiving androgen deprivation therapy: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2020; 24:35-48. [PMID: 32860010 DOI: 10.1038/s41391-020-00273-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/19/2020] [Accepted: 08/11/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Growing evidence suggests that men exposed to androgen deprivation therapy (ADT) have an increased risk of cardiovascular disease. While exercise has shown to attenuate some adverse effects of ADT, the effects on cardiometabolic health have not been systematically evaluated. OBJECTIVE To evaluate the effect of exercise on cardiometabolic health in men with prostate cancer (PCa) receiving ADT. METHODS A systematic literature search of MEDLINE, EMBASE, CINHAL, SCOPUS, WEB OF SCIENCE and SPORTSDICUS from database inception to April 2020 was performed. A quantitative synthesis using Cohens d effect size and a meta-analysis using random-effects models were conducted. RESULTS Overall, fourteen randomised controlled trials (RCTs) and four non-randomised studies were included. Eleven RCTs (n = 939 patients) were included in the meta-analysis. Exercise training improved the 400-m-walk test (MD -10.11 s, 95% CI [-14.34, -5.88]; p < 0·00001), diastolic blood pressure (-2.22 mmHg, [-3.82, -0.61]; p = 0.007), fasting blood glucose (-0.38 mmol/L, [-0.65, -0.11]; p = 0.006), C-reactive protein (-1.16 mg/L, [-2.11, -0.20]; p = 0.02), whole-body lean mass (0.70 kg, [0.39, 1.01]; p < 0.0001), appendicular lean mass (0.59 kg, [0.43, 0.76]; p < 0.00001), whole-body fat mass (-0.67 kg, [-1.08, -0.27]; p = 0.001), whole-body fat percentage (-0.79%, [-1.16, -0.42]; p < 0.0001), and trunk fat mass (-0.49 kg, [-0.87, -0.12]; p = 0.01), compared to usual care. No significant effects on systolic blood pressure or blood lipid metabolism were detected. CONCLUSIONS In a small subset of evaluated studies, exercise may favourably improve some but not all markers of cardiometabolic health. Future exercise intervention trials with cardiometabolic outcomes as primary endpoints are needed to confirm these initial findings.
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10
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Gazova A, Samakova A, Laczo E, Hamar D, Polakovicova M, Jurikova M, Kyselovic J. Clinical utility of miRNA-1, miRNA-29g and miRNA-133s plasma levels in prostate cancer patients with high-intensity training after androgen-deprivation therapy. Physiol Res 2020; 68:S139-S147. [PMID: 31842577 DOI: 10.33549/physiolres.934298] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The randomized trials showed that the addition of training resistance program to androgen-deprivation therapy (ADT) had many beneficial effects for prostate cancer (PC) patients (significant protective effect on the volume of muscle mass) and the studies have revealed a panel of miRNAs, which are deregulate in PC and may serve as promising biomarkers of PC risk. The primary aim of our present study was to investigate the effect of exercise training to changes in body composition (muscle strength) and the secondary endpoint was to investigate the impact of an exercise training program on plasma levels of selected myogenic microRNAs (miRNAs) (miRNA-1, miRNA-29b, and miRNA-133) in PC patients undergoing the ADT. Effect of ADT and exercise intervention showed significant increase (experimental group vs. control group) the changes in body composition, free testosterone levels, IL-6 and plasma levels of myogenic miRNAs and significant reduced insulin serum levels. In conclusion, resistance training with ADT in the treatment of PC significantly changed the physical and metabolic function and the plasma levels of specific myogenic miRNAs. Our data support with the other publicized results.
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Affiliation(s)
- A Gazova
- Institute of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Comenius University Bratislava, Slovak Republic
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11
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Cormie P, Zopf EM. Exercise medicine for the management of androgen deprivation therapy-related side effects in prostate cancer. Urol Oncol 2020; 38:62-70. [DOI: 10.1016/j.urolonc.2018.10.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 07/23/2018] [Accepted: 10/03/2018] [Indexed: 12/23/2022]
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12
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Villumsen BR, Jorgensen MG, Frystyk J, Hørdam B, Borre M. Home-based 'exergaming' was safe and significantly improved 6-min walking distance in patients with prostate cancer: a single-blinded randomised controlled trial. BJU Int 2019; 124:600-608. [PMID: 31012238 DOI: 10.1111/bju.14782] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To explore the effects of 12 weeks of unsupervised home-based 'exergaming' (i.e., technology-driven exercise) compared to usual care on physical function, body composition, quality of life (QoL), and fatigue in patients with prostate cancer on androgen-deprivation therapy (ADT). PATIENTS AND METHODS In an assessor-blinded randomised controlled trial, 46 patients with prostate cancer (aged >65 years) with locally advanced or advanced stage disease undergoing ADT were randomised to 12 weeks of unsupervised home-based exergaming or usual care from two hospitals in Denmark. The primary outcome of the study was 6-min walking test (6MWT). Secondary outcomes were leg extensor power (LEP), body composition (lean- and fat-mass), self-reported physical functioning and global health status (European Organisation for Research and Treatment of Cancer quality of life questionnaire 30-item core [EORTC QLQ-C30]), QoL (Functional Assessment of Cancer Therapy - Prostate [FACT-P]) and fatigue (FACT - fatigue [FACT-F]). RESULTS There was significant improvement in the exergaming group compared to the usual care group in the primary outcome of 6MWT (mean difference: 21.5 m; 95% confidence interval ([CI]) 3.2-39.9; P = 0.023). There were no differences between the groups for LEP (P = 0.227), lean body mass (P = 0.100), fat body mass (P = 0.092), self-reported physical functioning (P = 0.084) and global health status (P = 0.113), QoL (P = 0.614), and fatigue (P = 0.147). CONCLUSION Unsupervised home-based exergaming for 12 weeks had an effect on the primary outcome of 6MWT in patients with prostate cancer receiving ADT. However, no significant effects were found in secondary outcomes. The exergaming intervention appeared safe and could be an alternative to traditional aerobic and resistance training in this patient group.
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Affiliation(s)
- Brigitta R Villumsen
- Department of Urology, Regional Hospital Holstebro, Holstebro, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Martin G Jorgensen
- Center for PREdiction and prevention of FALLs (PREFALL), Department of Geriatrics, Aalborg University Hospital, Aalborg, Denmark
| | - Jan Frystyk
- Medical Research Laboratory, Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.,Department of Endocrinology, Faculty of Health Sciences, Odense University Hospital & Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Michael Borre
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.,Department of Urology, Aarhus University Hospital, Aarhus, Denmark
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13
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Kvorning Ternov K, Sønksen J, Fode M, Lindberg H, Kistorp CM, Bisbjerg R, Palapattu G, Østergren PB. Fatigue, quality of life and metabolic changes in men treated with first-line enzalutamide versus abiraterone plus prednisolone for metastatic castration-resistant prostate cancer (HEAT): a randomised trial protocol. BMJ Open 2019; 9:e030218. [PMID: 31511288 PMCID: PMC6747677 DOI: 10.1136/bmjopen-2019-030218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Enzalutamide and abiraterone acetate plus prednisolone (AAP) are used in combination with androgen-deprivation therapy to further suppress the androgen stimulation of metastatic castration-resistant prostate cancer (mCRPC). First-line mCRPC treatment with enzalutamide and AAP yields similar overall survival and radiographic progression-free survival in phase III trials. Thus, treatment selection relies on patient choice, cost and side effects. The aim of this randomised trial is to investigate differences in fatigue, health-related quality of life (HRQoL) and metabolic side effects in men with mCRPC treated with first-line enzalutamide versus AAP. METHODS AND ANALYSIS In this ongoing open-label randomised (1:1) clinical trial, enzalutamide is compared with AAP as first-line treatment for men with mCRPC. The primary endpoint is fatigue assessed with the questionnaire Functional Assessment of Chronic Illness Therapy-Fatigue version 4. Secondary endpoints are changes in body composition (ie, fat mass, visceral adipose tissue, subcutaneous adipose tissue and lean body mass assessed with dual energy X-ray absorptiometry), glucose metabolism assessed with a 2-hour oral glucose tolerance test, serum lipids, blood pressure and HRQoL assessed with the questionnaire Functional Assessment of Cancer Therapy-Prostate (FACT-P). All study endpoints are assessed at baseline and 12-week postintervention. Blood and urine samples are collected at baseline and at time of progression on allocated treatment for future investigation of predictive and prognostic biomarkers in prostate cancer treatment. The planned sample size is 170 participants. All participants are recruited from Herlev and Gentofte Hospital, Denmark. Estimated last patient's last visit is February 2020. ETHICS AND DISSEMINATION The study received project approval from the National Committee on Health Research Ethics and Danish Data Protection Agency and Danish Medicines Agency (EudraCT no.: 2017-000027-99). The results of the study will be published in peer-reviewed international journals and will be presented at national and international conferences and symposiums. TRIAL REGISTRATION NUMBER Clinicaltrialsregister.eu (2017-000099-27).
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Affiliation(s)
| | - Jens Sønksen
- Department of Urology, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Mikkel Fode
- Department of Urology, Herlev and Gentofte Hospital, Herlev, Denmark
| | | | | | - Rasmus Bisbjerg
- Department of Urology, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Ganesh Palapattu
- Department of Urology, Michigan Medicine, Ann Arbor, Michigan, USA
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14
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Christensen JF, Simonsen C, Hojman P. Exercise Training in Cancer Control and Treatment. Compr Physiol 2018; 9:165-205. [PMID: 30549018 DOI: 10.1002/cphy.c180016] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Exercise training is playing an increasing role in cancer care, as accumulating evidence demonstrates that exercise may prevent cancer, control disease progression, interact with anti-cancer therapies, and improve physical functioning and psychosocial outcomes. In this overview article, we present the current state of the field of exercise oncology, which currently comprises of nearly 700 unique exercise intervention trials with more than 50,000 cancer patients. First, we summarize the range of these interventions with regard to diagnoses, clinical setting, timing, and type of intervention. Next, we provide a detailed discussion of the 292 trials, which have delivered structured exercise programs, outlining the impact of exercise training on cancer-specific, physiological, and psychosocial outcomes in the light of the challenges and physiological limitations cancer patients may experience. In summary, the safety and feasibility of exercise training is firmly established across the cancer continuum, and a wide range of beneficial effects on psychosocial and physiological outcomes are well documented. Many of these beneficial effects are linked to the general health-promoting properties of exercise. However, it is becoming increasing evident that exercise training can have direct effects on cancer and its treatment. This calls for future exercise oncology initiatives, which aim to target cancer-specific outcomes, and which are integrated into the concurrent cancer trajectory. Here, the field must bridge extensive knowledge of integrative exercise physiology with clinical oncology and cancer biology to provide a basis of individualized targeted approaches, which may place exercise training as an integrated component of standard cancer care. © 2019 American Physiological Society. Compr Physiol 9:165-205, 2019.
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Affiliation(s)
- Jesper Frank Christensen
- Centre of Inflammation and Metabolism (CIM) and Centre for Physical Activity Research (CFAS), Copenhagen University Hospital, Copenhagen, Denmark
| | - Casper Simonsen
- Centre of Inflammation and Metabolism (CIM) and Centre for Physical Activity Research (CFAS), Copenhagen University Hospital, Copenhagen, Denmark
| | - Pernille Hojman
- Centre of Inflammation and Metabolism (CIM) and Centre for Physical Activity Research (CFAS), Copenhagen University Hospital, Copenhagen, Denmark
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15
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Schmidt MLK, Østergren P, Cormie P, Ragle AM, Sønksen J, Midtgaard J. “Kicked out into the real world”: prostate cancer patients’ experiences with transitioning from hospital-based supervised exercise to unsupervised exercise in the community. Support Care Cancer 2018; 27:199-208. [DOI: 10.1007/s00520-018-4306-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 06/06/2018] [Indexed: 10/28/2022]
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16
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Kirk PS, Borza T, Shahinian VB, Caram ME, Makarov DV, Shelton JB, Leppert JT, Blake RM, Davis JA, Hollenbeck BK, Sales A, Skolarus TA. The implications of baseline bone-health assessment at initiation of androgen-deprivation therapy for prostate cancer. BJU Int 2018; 121:558-564. [PMID: 29124881 PMCID: PMC5878705 DOI: 10.1111/bju.14075] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To assess bone-density testing (BDT) use amongst prostate cancer survivors receiving androgen-deprivation therapy (ADT), and downstream implications for osteoporosis and fracture diagnoses, as well as pharmacological osteoporosis treatment in a national integrated delivery system. PATIENTS AND METHODS We identified 17 017 men with prostate cancer who received any ADT between 2005 and 2014 using the Veterans Health Administration cancer registry and administrative data. We identified claims for BDT within a 3-year period of ADT initiation. We then used multivariable regression to examine the association between BDT use and incident osteoporosis, fracture, and use of pharmacological treatment. RESULTS We found that a minority of patients received BDT (n = 2 502, 15%); however, the rate of testing increased to >20% by the end of the study period. Men receiving BDT were older at diagnosis and had higher-risk prostate cancer (both P < 0.001). Osteoporosis and fracture diagnoses, use of vitamin D ± calcium, and bisphosphonates were all more common in men who received BDT. After adjustment, BDT, and to a lesser degree ≥2 years of ADT, were both independently associated with incident osteoporosis, fracture, and osteoporosis treatment. CONCLUSIONS BDT is rare amongst patients with prostate cancer treated with ADT in this integrated delivery system. However, BDT was associated with substantially increased treatment of osteoporosis indicating an underappreciated burden of osteoporosis amongst prostate cancer survivors initiating ADT. Optimising BDT use and osteoporosis management in this at-risk population appears warranted.
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Affiliation(s)
- Peter S. Kirk
- Dow Division of Health Services Research, Department of Urology, University of Michigan Health System
| | - Tudor Borza
- Dow Division of Health Services Research, Department of Urology, University of Michigan Health System
| | - Vahakn B. Shahinian
- Division of Nephrology, Department of Internal Medicine, University of Michigan Health System
| | - Megan E.V. Caram
- Division of Hematology & Oncology, Department of Internal Medicine, University of Michigan Health System
- VA Health Services Research and Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System
| | - Danil V. Makarov
- Departments of Urology and Population Health, NYU Langone Medical Center
- VA New York Healthcare System, NY
| | | | - John T. Leppert
- Department of Urology, Stanford University School of Medicine
- VA Palo Alto Healthcare System, Palo Alto
| | - Ryan M. Blake
- Dow Division of Health Services Research, Department of Urology, University of Michigan Health System
| | - Jennifer A. Davis
- VA Health Services Research and Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System
| | - Brent K. Hollenbeck
- Dow Division of Health Services Research, Department of Urology, University of Michigan Health System
| | - Anne Sales
- VA Health Services Research and Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System
- Department of Learning Health Sciences, University of Michigan Medical School
| | - Ted A. Skolarus
- Dow Division of Health Services Research, Department of Urology, University of Michigan Health System
- VA Health Services Research and Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System
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17
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Dalla Via J, Daly RM, Fraser SF. The effect of exercise on bone mineral density in adult cancer survivors: a systematic review and meta-analysis. Osteoporos Int 2018; 29:287-303. [PMID: 28971226 DOI: 10.1007/s00198-017-4237-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 09/20/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE Certain cancer treatments are associated with bone loss and increased fracture risk. Weight-bearing impact exercise, resistance training or the combination, are recommended to preserve or improve bone mineral density (BMD) inhealthy older adults, but their efficacy in cancer survivors is less well understood. The aim of this systematic review with meta-analysis of randomised control trials (RCT) was to review the evidence regarding the role of exercise to counteract cancer treatment-induced bone loss. METHODS Four databases were searched systematically with 12 RCTs of at least 6-month duration investigating the effects of exercise on BMD compared to a control group in adult cancer survivors identified. RESULTS Meta-analysis was completed using available data from six studies enrolling 814 participants, with lumbar spine, femoral neck and/or total hip BMD as the primary outcome measures. Overall, there was no significant benefit of exercise compared to controls on BMD at the lumbar spine (0.0071 g/cm , 95% CI -0.0002 to 0.0145, p = 0.057), femoral neck (0.0044 g/cm , 95% CI -0.0005 to 0.0093, p = 0.077), or total hip (0.0024 g/cm , 95% CI -0.0038 to 0.0086, p = 0.443). Subgroup analysis revealed a positive effect on lumbar spine BMD in three studies implementing a combined resistance and impact exercise intervention (0.015 g/cm , 95% CI 0.003 to 0.028, p = 0.019). CONCLUSIONS From the evidence available, exercise may not be sufficient to improve bone health in cancer survivors, but given the heterogeneity in the participant characteristics and several exercise programs which may not have been designed to specifically optimise bone health, these findings should be interpreted with caution.
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Affiliation(s)
- J Dalla Via
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia.
| | - R M Daly
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
| | - S F Fraser
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
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Takayama KI. The biological and clinical advances of androgen receptor function in age-related diseases and cancer [Review]. Endocr J 2017; 64:933-946. [PMID: 28824023 DOI: 10.1507/endocrj.ej17-0328] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Hormonal alterations with aging contribute to the pathogenesis of several diseases. Androgens mediate their effects predominantly through binding to the androgen receptor (AR), a member of the ligand-dependent nuclear receptor superfamily. By androgen treatment, AR is recruited to specific genomic loci dependent on tissue specific pioneer factors to regulate target gene expression. Recent studies have revealed the epigenetic modulation by AR-associated histone modifiers and the roles of non-coding RNAs in AR signaling. Androgens are male sex hormone to induce differentiation of the male reproductive system required for the establishment of adult sexual function. As shown by several reports using AR knockout mouse models, androgens also have anabolic functions in several tissues such as bone, muscle and central nervous systems. Notably, AR has a central role in prostate cancer progression. Prostate cancer is the most frequently diagnosed cancer in men. Androgen-deprivation therapy for cancer patients and decline of serum androgen with aging promote several diseases associated with aging and quality of life of older men such as osteoporosis, sarcopenia and dementia. Thus, androgen replacement therapy for treating late onset hypogonadism (LOH) or new epigenetic regulators have the potential to overcome the symptoms caused by the low androgen, although adverse effects for cardiovascular diseases have been reported. Given the increasing longevity and consequent rise of age-related diseases and prostate cancer patients, a more understanding of the AR actions in male health remains a high research priority.
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Affiliation(s)
- Ken-Ichi Takayama
- Department of Functional Biogerontology, Tokyo Metropolitan Institute of Gerontology, Itabashi-ku, Tokyo 173-0015, Japan
- Department of Geriatric Medicine, Graduate School of Medicine, the University of Tokyo, Japan
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Holm HV, Dahl AA, Klepp OH, Fosså SD. Modern treatment of metastatic prostate cancer. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2017; 137:803-805. [PMID: 28597635 DOI: 10.4045/tidsskr.16.0265] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The treatment of prostate cancer with remote metastases has advanced greatly in recent years. Treatment options are dependent on the extent of the metastases, the patient’s general condition and wishes, and the treatment response. We present an overview of the latest options for systemic treatment of patients with metastatic prostate cancer, based on availability in Norway.
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Affiliation(s)
| | - Alv A Dahl
- Nasjonalt kompetansesenter for seneffekter etter kreftbehandling Oslo universitetssykehus, Radiumhospitalet
| | | | - Sophie D Fosså
- Nasjonalt kompetansesenter for seneffekter etter kreftbehandling Oslo universitetssykehus, Radiumhospitalet
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20
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Tang X, Li F, Jia J, Yang C, Liu W, Jin B, Wang X, Gao R, He D, Guo P. Synthesis of magnetic molecularly imprinted polymers with excellent biocompatibility for the selective separation and inhibition of testosterone in prostate cancer cells. Int J Nanomedicine 2017; 12:2979-2993. [PMID: 28442907 PMCID: PMC5396939 DOI: 10.2147/ijn.s133009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Androgen plays an important role in the progression of prostate cancer. In the present study, novel magnetic molecularly imprinted polymers (MMIPs) with good biocompatibility were produced for the selective separation and inhibition of testosterone in prostate cancer cells. MATERIALS AND METHODS MMIPs were prepared by using magnetic nanospheres, gelatin, and testosterone as the supporting materials, functional monomer, and the template molecule, respectively. The characterization of the resultant products was investigated by transmission electron microscopy, X-ray diffraction, and vibrating sample magnetometry. To test whether MMIPs can remove testosterone in biologic samples, human LNCaP (androgen-dependent) and C4-2 (androgen-independent) prostate cancer cells were selected as cell models. The translocation of androgen receptor (AR) was detected by immunofluorescence assay, and the expression of PSA mRNA was detected by real-time quantitative polymerase chain reaction analysis. Cell flow cytometry analysis was performed to detect cell cycle arrest. RESULTS The synthesized nanomaterials (MMIPs) possessed high crystallinity, satisfactory superparamagnetic properties, and uniform imprinted shell, and exhibited high adsorption capacity, fast kinetics, and high selectivity for testosterone. Moreover, the obtained imprinted nanomaterials could selectively enrich and detect testosterone in the LNCaP cell samples as a solid-phase extractant coupled with high-performance liquid chromatography. In addition, the MMIPs could freely enter prostate cancer cells and suppress the translocation of AR into the cell nucleus. We further found that MMIPs inhibited upregulation of AR downstream target genes in LNCaP and C4-2 cells; also, MMIPs inhibited cell growth and induced obvious cell cycle arrest in androgen-dependent LNCaP cells, but had no obvious effect on androgen-independent C4-2 cells. CONCLUSION Our results indicate that the obtained imprinted nanomaterials can specifically and effectively bind testosterone and recover it from prostate cancer cells. Moreover, the MMIPs can freely enter prostate cancer cells and block the activation of testosterone-AR pathway. Thus, the MMIPs may be a new option for antiandrogen therapy in prostate cancer.
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Affiliation(s)
- Xiaoshuang Tang
- Department of Urology, The First Affiliated Hospital of Xi’an Jiaotong University
- Department of Urology, The Second Affiliated Hospital of Xi’an Jiaotong University
| | - Feng Li
- Department of Urology, The First Affiliated Hospital of Xi’an Jiaotong University
| | - Jing Jia
- Department of Urology, The First Affiliated Hospital of Xi’an Jiaotong University
| | - Chao Yang
- Department of Urology, The First Affiliated Hospital of Xi’an Jiaotong University
| | - Wei Liu
- Department of Urology, The First Affiliated Hospital of Xi’an Jiaotong University
| | - Ben Jin
- Department of Urology, The First Affiliated Hospital of Xi’an Jiaotong University
| | - Xinyang Wang
- Department of Urology, The First Affiliated Hospital of Xi’an Jiaotong University
| | - Ruixia Gao
- Institute of Analytical Science, School of Science, Xi’an Jiaotong University
| | - Dalin He
- Department of Urology, The First Affiliated Hospital of Xi’an Jiaotong University
- Key laboratory for Tumor Precision Medicine of Shaanxi Province, Xi’an, Shaanxi, People’s Republic of China
| | - Peng Guo
- Department of Urology, The First Affiliated Hospital of Xi’an Jiaotong University
- Key laboratory for Tumor Precision Medicine of Shaanxi Province, Xi’an, Shaanxi, People’s Republic of China
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