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Liu BH, Mao YH, Li XY, Luo RX, Zhu WA, Su HB, Zeng HD, Chen CH, Zhao X, Zou C, Luo Y. Measurements of peri-prostatic adipose tissue by MRI predict bone metastasis in patients with newly diagnosed prostate cancer. Front Oncol 2024; 14:1393650. [PMID: 38737904 PMCID: PMC11082333 DOI: 10.3389/fonc.2024.1393650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/15/2024] [Indexed: 05/14/2024] Open
Abstract
Objectives To investigate the role of MRI measurements of peri-prostatic adipose tissue (PPAT) in predicting bone metastasis (BM) in patients with newly diagnosed prostate cancer (PCa). Methods We performed a retrospective study on 156 patients newly diagnosed with PCa by prostate biopsy between October 2010 and November 2022. Clinicopathologic characteristics were collected. Measurements including PPAT volume and prostate volume were calculated by MRI, and the normalized PPAT (PPAT volume/prostate volume) was computed. Independent predictors of BM were determined by univariate and multivariate logistic regression analysis, and a new nomogram was developed based on the predictors. Receiver operating characteristic (ROC) curves were used to estimate predictive performance. Results PPAT and normalized PPAT were associated with BM (P<0.001). Normalized PPAT positively correlated with clinical T stage(cT), clinical N stage(cN), and Grading Groups(P<0.05). The results of ROC curves indicated that PPAT and normalized PPAT had promising predictive value for BM with the AUC of 0.684 and 0.775 respectively. Univariate and multivariate analysis revealed that high normalized PPAT, cN, and alkaline phosphatase(ALP) were independently predictors of BM. The nomogram was developed and the concordance index(C-index) was 0.856. Conclusions Normalized PPAT is an independent predictor for BM among with cN, and ALP. Normalized PPAT may help predict BM in patients with newly diagnosed prostate cancer, thus providing adjunctive information for BM risk stratification and bone scan selection.
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Affiliation(s)
- Bo-Hao Liu
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yun-Hua Mao
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiao-Yang Li
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Rui-Xiang Luo
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wei-An Zhu
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hua-Bin Su
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Heng-Da Zeng
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chu-Hao Chen
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiao Zhao
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chen Zou
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yun Luo
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Department of Urology, Kashgar First People’s Hospital, Kashgar, Xinjiang, China
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Wang G, Hu J, Zhang Y, Xiao Z, Huang M, He Z, Chen J, Bai Z. A modified U-Net convolutional neural network for segmenting periprostatic adipose tissue based on contour feature learning. Heliyon 2024; 10:e25030. [PMID: 38318024 PMCID: PMC10839980 DOI: 10.1016/j.heliyon.2024.e25030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 02/07/2024] Open
Abstract
Objective This study trains a U-shaped fully convolutional neural network (U-Net) model based on peripheral contour measures to achieve rapid, accurate, automated identification and segmentation of periprostatic adipose tissue (PPAT). Methods Currently, no studies are using deep learning methods to discriminate and segment periprostatic adipose tissue. This paper proposes a novel and modified, U-shaped convolutional neural network contour control points on a small number of datasets of MRI T2W images of PPAT combined with its gradient images as a feature learning method to reduce feature ambiguity caused by the differences in PPAT contours of different patients. This paper adopts a supervised learning method on the labeled dataset, combining the probability and spatial distribution of control points, and proposes a weighted loss function to optimize the neural network's convergence speed and detection performance. Based on high-precision detection of control points, this paper uses a convex curve fitting to obtain the final PPAT contour. The imaging segmentation results were compared with those of a fully convolutional network (FCN), U-Net, and semantic segmentation convolutional network (SegNet) on three evaluation metrics: Dice similarity coefficient (DSC), Hausdorff distance (HD), and intersection over union ratio (IoU). Results Cropped images with a 270 × 270-pixel matrix had DSC, HD, and IoU values of 70.1%, 27 mm, and 56.1%, respectively; downscaled images with a 256 × 256-pixel matrix had 68.7%, 26.7 mm, and 54.1%. A U-Net network based on peripheral contour characteristics predicted the complete periprostatic adipose tissue contours on T2W images at different levels. FCN, U-Net, and SegNet could not completely predict them. Conclusion This U-Net convolutional neural network based on peripheral contour features can identify and segment periprostatic adipose tissue quite well. Cropped images with a 270 × 270-pixel matrix are more appropriate for use with the U-Net convolutional neural network based on contour features; reducing the resolution of the original image will lower the accuracy of the U-Net convolutional neural network. FCN and SegNet are not appropriate for identifying PPAT on T2 sequence MR images. Our method can automatically segment PPAT rapidly and accurately, laying a foundation for PPAT image analysis.
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Affiliation(s)
- Gang Wang
- Department of Urology, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou, 570208, Hainan Province, China
| | - Jinyue Hu
- Department of Radiology, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou, 570208, Hainan Province, China
| | - Yu Zhang
- College of Computer Science and Cyberspace Security, Hainan University, Haikou, 570228, China
| | - Zhaolin Xiao
- College of Computer Science, Xi'an University of Technology, Xi'an, 710048, China
| | - Mengxing Huang
- College of Information and Communication Engineering, Hainan University, Haikou, 70208, China
| | - Zhanping He
- Department of Radiology, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou, 570208, Hainan Province, China
| | - Jing Chen
- Department of Radiology, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou, 570208, Hainan Province, China
| | - Zhiming Bai
- Department of Urology, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou, 570208, Hainan Province, China
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Shahait M, Usamentiaga R, Tong Y, Sandberg A, Lee DI, Udupa JK, Torigian DA. Periprostatic Adipose Tissue MRI Radiomics-Derived Features Associated with Clinically Significant Prostate Cancer. J Endourol 2023; 37:1156-1161. [PMID: 37597206 DOI: 10.1089/end.2023.0215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2023] Open
Abstract
Background: Altered systemic and cellular lipid metabolism plays a pivotal role in the pathogenesis of prostate cancer (PCa). In this study, we aimed to characterize T1-magnetic resonance imaging (MRI)-derived radiomic parameters of periprostatic adipose tissue (PPAT) associated with clinically significant PCa (Gleason score ≥7 [3 + 4]) in a cohort of men who underwent robot-assisted prostatectomy. Methods: Preoperative MRI scans of 98 patients were identified. The volume of interest was defined by identifying an annular shell-like region on each MRI slice to include all surgically resectable visceral adipose tissue. An optimal biomarker method was used to identify features from 7631 intensity- and texture-based properties that maximized the classification of patients into clinically significant PCa and indolent tumors at the final pathology analysis. Results: Six highest ranked optimal features were derived, which demonstrated a sensitivity, specificity, and accuracy of association with the presence of clinically significant PCa, and area under a receiver operating characteristic curve of 0.95, 0.39 0.82, and 0.82, respectively. Conclusion: A highly independent set of PPAT features derived from MRI scans that predict patients with clinically significant PCa was developed and tested. With future external validation, these features may provide a more precise scientific basis for deciding to omit biopsies in patients with borderline prostate-specific antigen kinetics and multiparametric MRI readings and help in the decision of enrolling patients into active surveillance.
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Affiliation(s)
- Mohammed Shahait
- Department of Surgery, Clemenceau Medical Center, Dubai, United Arab Emirates
| | - Ruben Usamentiaga
- Department of Computer Science and Engineering, University of Oviedo, Gijon, Spain
| | - Yubing Tong
- Medical Image Processing Group, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alex Sandberg
- Temple Medical School, Temple University, Philadelphia, Pennsylvania, USA
| | - David I Lee
- Department of Urology, University of California Irvine, Irvine, California, USA
| | - Jayaram K Udupa
- Medical Image Processing Group, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Drew A Torigian
- Medical Image Processing Group, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Obesity-Related Cross-Talk between Prostate Cancer and Peripheral Fat: Potential Role of Exosomes. Cancers (Basel) 2022; 14:cancers14205077. [PMID: 36291860 PMCID: PMC9600017 DOI: 10.3390/cancers14205077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/06/2022] [Accepted: 10/13/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Obesity is involved in many aspects of prostate cancer progression as a risk factor for prostate cancer, especially in the process of biochemical recurrence in the prostate. Approximately 27–53% of prostate cancer patients can develop biochemical recurrence after radical prostatectomy, which poses difficulties in the clinical management of prostate cancer, and this is closely related to the release of exosomes from adipose tissue in the obese state. In this review, we summarize the crosstalk between prostate cancer peripheral adiposity and prostate cancer and discuss the potential role of exosomes in this process and the prospects for the use of adipose exosomes. Exosomes play an important role in the crosstalk between the two this may be a new basis to explain obesity as a biochemical recurrence after prostate cancer surgery and a potential avenue for future prostate therapy. Abstract The molecular mechanisms of obesity-induced cancer progression have been extensively explored because of the significant increase in obesity and obesity-related diseases worldwide. Studies have shown that obesity is associated with certain features of prostate cancer. In particular, bioactive factors released from periprostatic adipose tissues mediate the bidirectional communication between periprostatic adipose tissue and prostate cancer. Moreover, recent studies have shown that extracellular vesicles have a role in the relationship between tumor peripheral adipose tissue and cancer progression. Therefore, it is necessary to investigate the feedback mechanisms between prostate cancer and periglandular adipose and the role of exosomes as mediators of signal exchange to understand obesity as a risk factor for prostate cancer. This review summarizes the two-way communication between prostate cancer and periglandular adipose and discusses the potential role of exosomes as a cross-talk and the prospect of using adipose tissue as a means to obtain exosomes in vitro. Therefore, this review may provide new directions for the treatment of obesity to suppress prostate cancer.
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Interplay between Prostate Cancer and Adipose Microenvironment: A Complex and Flexible Scenario. Int J Mol Sci 2022; 23:ijms231810762. [PMID: 36142673 PMCID: PMC9500873 DOI: 10.3390/ijms231810762] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/09/2022] [Accepted: 09/13/2022] [Indexed: 11/17/2022] Open
Abstract
Adipose tissue is part of the prostate cancer (PCa) microenvironment not only in the periprostatic area, but also in the most frequent metastatic sites, such as bone marrow and pelvic lymph nodes. The involvement of periprostatic adipose tissue (PPAT) in the aggressiveness of PCa is strongly suggested by numerous studies. Many molecules play a role in the reciprocal interaction between adipocytes and PCa cells, including adipokines, hormones, lipids, and also lipophilic pollutants stored in adipocytes. The crosstalk has consequences not only on cancer cell growth and metastatic potential, but also on adipocytes. Although most of the molecules released by PPAT are likely to promote tumor growth and the migration of cancer cells, others, such as the adipokine adiponectin and the n-6 or n-3 polyunsaturated fatty acids (PUFAs), have been shown to have anti-tumor properties. The effects of PPAT on PCa cells might therefore depend on the balance between the pro- and anti-tumor components of PPAT. In addition, genetic and environmental factors involved in the risk and/or aggressiveness of PCa, including obesity and diet, are able to modulate the interactions between PPAT and cancer cells and their consequences on the growth and the metastatic potential of PCa.
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Perez-Cornago A, Dunneram Y, Watts EL, Key TJ, Travis RC. Adiposity and risk of prostate cancer death: a prospective analysis in UK Biobank and meta-analysis of published studies. BMC Med 2022; 20:143. [PMID: 35509091 PMCID: PMC9069769 DOI: 10.1186/s12916-022-02336-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 03/14/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The association of adiposity with prostate cancer specific mortality remains unclear. We examined how adiposity relates to fatal prostate cancer and described the cross-sectional associations of commonly used adiposity measurements with adiposity estimated by imaging in UK Biobank. We also conducted a dose-response meta-analysis to integrate the new data with existing prospective evidence. METHODS 218,237 men from UK Biobank who were free from cancer at baseline were included. Body mass index (BMI), total body fat percentage (using bioimpedance), waist circumference (WC) and waist-to-hip ratio (WHR) were collected at recruitment. Risk of dying from prostate cancer (primary cause) by the different adiposity measurements was estimated using multivariable-adjusted Cox proportional hazards models. Results from this and other prospective cohort studies were combined in a dose-response meta-analysis. RESULTS In UK Biobank, 661 men died from prostate cancer over a mean follow-up of 11.6 years. In the subsample of participants with magnetic resonance imaging and dual-energy X-ray absorptiometry, BMI, body fat percentage and WC were strongly associated with imaging estimates of total and central adiposity (e.g. visceral fat, trunk fat). The hazard ratios (HR) for prostate cancer death were 1.07 (95% confidence interval = 0.97-1.17) per 5 kg/m2 higher BMI, 1.00 (0.94-1.08) per 5% increase in total body fat percentage, 1.06 (0.99-1.14) per 10 cm increase in WC and 1.07 (1.01-1.14) per 0.05 increase in WHR. Our meta-analyses of prospective studies included 19,633 prostate cancer deaths for BMI, 670 for body fat percentage, 3181 for WC and 1639 for WHR, and the combined HRs for dying from prostate cancer for the increments above were 1.10 (1.07-1.12), 1.03 (0.96-1.11), 1.07 (1.03-1.11), and 1.06 (1.01-1.10), respectively. CONCLUSION Overall, we found that men with higher total and central adiposity had similarly higher risks of prostate cancer death, which may be biologically driven and/or due to differences in detection. In either case, these findings support the benefit for men of maintaining a healthy body weight.
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Affiliation(s)
- Aurora Perez-Cornago
- Nuffield Department of Population Health, Cancer Epidemiology Unit, University of Oxford, OX3 7LF Oxford, UK
| | - Yashvee Dunneram
- Nuffield Department of Population Health, Cancer Epidemiology Unit, University of Oxford, OX3 7LF Oxford, UK
| | - Eleanor L. Watts
- Nuffield Department of Population Health, Cancer Epidemiology Unit, University of Oxford, OX3 7LF Oxford, UK
| | - Timothy J. Key
- Nuffield Department of Population Health, Cancer Epidemiology Unit, University of Oxford, OX3 7LF Oxford, UK
| | - Ruth C. Travis
- Nuffield Department of Population Health, Cancer Epidemiology Unit, University of Oxford, OX3 7LF Oxford, UK
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The volume and thickness of preprostatic fat on MRIs are not associated with prostate cancer aggressiveness in men undergoing radical prostatectomy. Prog Urol 2022; 32:341-353. [DOI: 10.1016/j.purol.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/19/2022] [Accepted: 01/25/2022] [Indexed: 11/22/2022]
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8
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La Civita E, Liotti A, Cennamo M, Crocetto F, Ferro M, Liguoro P, Cimmino A, Imbimbo C, Beguinot F, Formisano P, Terracciano D. Peri-Prostatic Adipocyte-Released TGFβ Enhances Prostate Cancer Cell Motility by Upregulation of Connective Tissue Growth Factor. Biomedicines 2021; 9:biomedicines9111692. [PMID: 34829922 PMCID: PMC8615771 DOI: 10.3390/biomedicines9111692] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/09/2021] [Accepted: 11/12/2021] [Indexed: 12/14/2022] Open
Abstract
Periprostatic adipose tissue (PPAT) has emerged as a key player in the prostate cancer (PCa) microenvironment. In this study, we evaluated the ability of PPAT to promote PCa cell migration, as well as the molecular mechanisms involved. METHODS We collected conditioned mediums from in vitro differentiated adipocytes isolated from PPAT taken from PCa patients during radical prostatectomy. Migration was studied by scratch assay. RESULTS Culture with CM of human PPAT (AdipoCM) promotes migration in two different human androgen-independent (AI) PCa cell lines (DU145 and PC3) and upregulated the expression of CTGF. SB431542, a well-known TGFβ receptor inhibitor, counteracts the increased migration observed in presence of AdipoCM and decreased CTGF expression, suggesting that a paracrine secretion of TGFβ by PPAT affects motility of PCa cells. CONCLUSIONS Collectively, our study showed that factors secreted by PPAT enhanced migration through CTGF upregulation in AI PCa cell lines. These findings reveal the potential of novel therapeutic strategies targeting adipocyte-released factors and TGFβ/CTGF axis to fight advanced PCa dissemination.
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Affiliation(s)
- Evelina La Civita
- Department of Translational Medical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (E.L.C.); (A.L.); (M.C.); (P.L.); (F.B.)
| | - Antonietta Liotti
- Department of Translational Medical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (E.L.C.); (A.L.); (M.C.); (P.L.); (F.B.)
| | - Michele Cennamo
- Department of Translational Medical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (E.L.C.); (A.L.); (M.C.); (P.L.); (F.B.)
| | - Felice Crocetto
- Department of Neurosciences, Sciences of Reproduction and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (F.C.); (C.I.)
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology, 20141 Milan, Italy;
| | - Pasquale Liguoro
- Department of Translational Medical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (E.L.C.); (A.L.); (M.C.); (P.L.); (F.B.)
| | - Amelia Cimmino
- Institute of Genetics and Biophysic, National Research Council, 80131 Naples, Italy;
| | - Ciro Imbimbo
- Department of Neurosciences, Sciences of Reproduction and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (F.C.); (C.I.)
| | - Francesco Beguinot
- Department of Translational Medical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (E.L.C.); (A.L.); (M.C.); (P.L.); (F.B.)
| | - Pietro Formisano
- Department of Translational Medical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (E.L.C.); (A.L.); (M.C.); (P.L.); (F.B.)
- Correspondence: (P.F.); (D.T.)
| | - Daniela Terracciano
- Department of Translational Medical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (E.L.C.); (A.L.); (M.C.); (P.L.); (F.B.)
- Correspondence: (P.F.); (D.T.)
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Fatty Acid Metabolism Reprogramming in Advanced Prostate Cancer. Metabolites 2021; 11:metabo11110765. [PMID: 34822423 PMCID: PMC8618281 DOI: 10.3390/metabo11110765] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 11/01/2021] [Accepted: 11/03/2021] [Indexed: 12/23/2022] Open
Abstract
Prostate cancer (PCa) is a carcinoma in which fatty acids are abundant. Fatty acid metabolism is rewired during PCa development. Although PCa can be treated with hormone therapy, after prolonged treatment, castration-resistant prostate cancer can develop and can lead to increased mortality. Changes to fatty acid metabolism occur systemically and locally in prostate cancer patients, and understanding these changes may lead to individualized treatments, especially in advanced, castration-resistant prostate cancers. The fatty acid metabolic changes are not merely reflective of oncogenic activity, but in many cases, these represent a critical factor in cancer initiation and development. In this review, we analyzed the literature regarding systemic changes to fatty acid metabolism in PCa patients and how these changes relate to obesity, diet, circulating metabolites, and peri-prostatic adipose tissue. We also analyzed cellular fatty acid metabolism in prostate cancer, including fatty acid uptake, de novo lipogenesis, fatty acid elongation, and oxidation. This review broadens our view of fatty acid switches in PCa and presents potential candidates for PCa treatment and diagnosis.
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Tamalunas A, Westhofen T, Schott M, Keller P, Atzler M, Stief CG, Magistro G. How obesity affects the benefits of holmium laser enucleation of the prostate for the treatment of male lower urinary tract symptoms. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/20514158211043007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: Holmium laser enucleation of the prostate (HoLEP) can be used regardless of prostate size and offers durable long-term results for patients suffering from lower urinary tract symptoms (LUTS)/benign prostatic obstruction (BPO), with reduced perioperative morbidity. In most western societies almost half of the population are overweight, and obesity itself is often a risk factor for surgical treatment of patients. We therefore analysed the impact of body mass index (BMI) on outcomes and perioperative morbidity in patients undergoing HoLEP for LUTS at our tertiary referral centre. Methods: We retrospectively collected data for 877 patients who underwent HoLEP for LUTS/BPO between 2014 and 2018 and divided patients into group 1 (BMI<25), 2 (BMI 25<30), and 3 (BMI⩾30). We analysed perioperative parameters, safety, and short-term functional outcomes. Results: In preoperative patient characteristics we observed a similar LUTS profile throughout our patient cohorts. The highest proportion of ASA score ⩾III was observed in the obese patient cohort. Enucleation time was significantly prolonged in morbidly obese patients and operative speed was significantly slower, without difference in perioperative complications. Functional outcomes were assessed 30 days post-surgery with significant improvement in IPSS, quality of life (QoL) and Qmax for all groups. Conclusion: Although operating on overweight and obese patients takes significantly longer, HoLEP is efficient and offers acceptable perioperative complication rates even in morbidly obese patients (BMI⩾30). Level of evidence: Not applicable.
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Liotti A, La Civita E, Cennamo M, Crocetto F, Ferro M, Guadagno E, Insabato L, Imbimbo C, Palmieri A, Mirone V, Liguoro P, Formisano P, Beguinot F, Terracciano D. Periprostatic adipose tissue promotes prostate cancer resistance to docetaxel by paracrine IGF-1 upregulation of TUBB2B beta-tubulin isoform. Prostate 2021; 81:407-417. [PMID: 33734457 PMCID: PMC8251776 DOI: 10.1002/pros.24117] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/19/2021] [Accepted: 03/05/2021] [Indexed: 12/14/2022]
Abstract
Growing evidence supports the pivotal role played by periprostatic adipose tissue (PPAT) in prostate cancer (PCa) microenvironment. We investigated whether PPAT can affect response to Docetaxel (DCTX) and the mechanisms associated. Conditioned medium was collected from the in vitro differentiated adipocytes isolated from PPAT which was isolated from PCa patients, during radical prostatectomy. Drug efficacy was studied by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide citotoxicity assay. Culture with CM of human PPAT (AdipoCM) promotes DCTX resistance in two different human prostate cancer cell lines (DU145 and PC3) and upregulated the expression of BCL-xL, BCL-2, and TUBB2B. AG1024, a well-known IGF-1 receptor inhibitor, counteracts the decreased response to DCTX observed in presence of AdipoCM and decreased TUBB2B expression, suggesting that a paracrine secretion of IGF-1 by PPAT affect DCTX response of PCa cell. Collectively, our study showed that factors secreted by PPAT elicits DCTX resistance through antiapoptotic proteins and TUBB2B upregulation in androgen independent PCa cell lines. These findings reveal the potential of novel therapeutic strategies targeting adipocyte-released factors and IGF-1 axis to overcome DCTX resistance in patients with PCa.
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Affiliation(s)
- Antonietta Liotti
- Department of Translational Medical SciencesUniversity of Naples “Federico II”NaplesItaly
| | - Evelina La Civita
- Department of Translational Medical SciencesUniversity of Naples “Federico II”NaplesItaly
| | - Michele Cennamo
- Department of Translational Medical SciencesUniversity of Naples “Federico II”NaplesItaly
| | - Felice Crocetto
- Department of NeurosciencesUniversity of Naples Federico IINaplesItaly
| | - Matteo Ferro
- Department of Urology, European Institute of OncologyIRCCSMilanItaly
| | - Elia Guadagno
- Department of Advanced Biomedical Sciences, Anatomic Pathology Unit, School of MedicineUniversity of Naples Federico IINaplesItaly
| | - Luigi Insabato
- Department of Advanced Biomedical Sciences, Anatomic Pathology Unit, School of MedicineUniversity of Naples Federico IINaplesItaly
| | - Ciro Imbimbo
- Department of NeurosciencesUniversity of Naples Federico IINaplesItaly
| | | | - Vincenzo Mirone
- Department of NeurosciencesUniversity of Naples Federico IINaplesItaly
| | - Pasquale Liguoro
- Department of Translational Medical SciencesUniversity of Naples “Federico II”NaplesItaly
| | - Pietro Formisano
- Department of Translational Medical SciencesUniversity of Naples “Federico II”NaplesItaly
| | - Francesco Beguinot
- Department of Translational Medical SciencesUniversity of Naples “Federico II”NaplesItaly
| | - Daniela Terracciano
- Department of Translational Medical SciencesUniversity of Naples “Federico II”NaplesItaly
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12
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Skeletal Muscle-Adipose Tissue-Tumor Axis: Molecular Mechanisms Linking Exercise Training in Prostate Cancer. Int J Mol Sci 2021; 22:ijms22094469. [PMID: 33922898 PMCID: PMC8123194 DOI: 10.3390/ijms22094469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 12/13/2022] Open
Abstract
Increased visceral adiposity may influence the development of prostate cancer (PCa) aggressive tumors and cancer mortality. White adipose tissue (WAT), usually referred to as periprostatic adipose tissue (PPAT), surrounds the prostatic gland and has emerged as a potential mediator of the tumor microenvironment. Exercise training (ET) induces several adaptations in both skeletal muscle and WAT. Some of these effects are mediated by ET-induced synthesis and secretion of several proteins, known as myo- and adipokines. Together, myokines and adipokines may act in an endocrine-like manner to favor communication between skeletal muscle and WAT, as they may work together to improve whole-body metabolic health. This crosstalk may constitute a potential mechanism by which ET exerts its beneficial role in the prevention and treatment of PCa-related disorders; however, this has not yet been explored. Therefore, we reviewed the current evidence on the effects of skeletal muscle–WAT–tumor crosstalk in PCa, and the potential mediators of this process to provide a better understanding of underlying ET-related mechanisms in cancer.
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Mechanistic Insights into the Link between Obesity and Prostate Cancer. Int J Mol Sci 2021; 22:ijms22083935. [PMID: 33920379 PMCID: PMC8069048 DOI: 10.3390/ijms22083935] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 03/29/2021] [Accepted: 04/07/2021] [Indexed: 12/21/2022] Open
Abstract
Obesity is a pandemic of increasing worldwide prevalence. There is evidence of an association between obesity and the risk of prostate cancer from observational studies, and different biologic mechanisms have been proposed. The chronic low-level inflammation within the adipose tissue in obesity results in oxidative stress, activation of inflammatory cytokines, deregulation of adipokines signaling, and increased circulating levels of insulin and insulin-like growth factors (IGF). These mechanisms may be involved in epithelial to mesenchymal transformation into a malignant phenotype that promotes invasiveness, aggressiveness, and metastatic potential of prostate cancer. A thorough understanding of these mechanisms may be valuable in the development of effective prostate cancer prevention strategies and treatments. This review provides an overview of these mechanisms.
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14
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The Association of Periprostatic Fat and Grade Group Progression in Men with Localized Prostate Cancer on Active Surveillance. J Urol 2021; 205:122-128. [PMID: 32718204 PMCID: PMC9810079 DOI: 10.1097/ju.0000000000001321] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE Evidence suggests that visceral fat quantity may be associated with post-prostatectomy outcomes and risk of prostate cancer related death. We evaluated whether increased fat volume, normalized to prostate size, is associated with decreased risk of disease progression. MATERIALS AND METHODS Patients enrolled on a prospective active surveillance trial for at least 6 months who had magnetic resonance imaging within 2 years of enrollment were eligible. The surveillance protocol included a standardized followup regimen consisting of biennial prostate specific antigen and examination and yearly biopsy. Clinicopathological characteristics were collected at baseline. Three fat measurements were taken using prostate magnetic resonance imaging, including subcutaneous, linear periprostatic (pubic symphysis to prostate) and volumetrically defined periprostatic. Progression was defined as increase in Gleason grade group. Multivariable Cox proportional hazards models were used to evaluate fat volumes normalized by prostate size (stratified into tertiles). RESULTS A total of 175 patients were included in the study. Average age was 62.5 years (SD 7.4) and average prostate specific antigen was 5.4 ng/dl (SD 3.9). Median followup was 42 months (IQR 18-60) and 50 patients (28.6%) had progression. Compared to the lowest tertile, the highest tertile of volumetric periprostatic fat measurement (HR 2.63, 95% CI 1.23-5.60, p=0.01) and linear periprostatic fat measurement (HR 2.30, 95% CI 1.01-5.22, p=0.05) were associated with worsened progression-free survival, while subcutaneous fat measurement (p=0.97) was not. Importantly, the model did not substantively change when accounting for patient body mass index and other factors. CONCLUSIONS Increased periprostatic fat volume, normalized to prostate size, may be associated with shortened progression-free survival in men with prostate cancer on active surveillance.
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Di Bella CM, Howard LE, Oyekunle T, De Hoedt AM, Salama JK, Song H, Freedland SJ, Allott EH. Abdominal and pelvic adipose tissue distribution and risk of prostate cancer recurrence after radiation therapy. Prostate 2020; 80:1244-1252. [PMID: 32767683 DOI: 10.1002/pros.24054] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/28/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Fat distribution varies between individuals of similar body mass index (BMI). We hypothesized that visceral obesity is more strongly associated with poor prostate cancer outcomes than overall obesity defined by BMI. MATERIALS AND METHODS We quantified abdominal visceral and subcutaneous fat area (VFA and SFA), and pelvic periprostatic adipose tissue area (PPAT), using computed tomography scans from radiation-treated prostate cancer patients at the Durham North Carolina Veterans Administration Hospital. Multivariable-adjusted Cox regression examined associations between each adiposity measure and risk of recurrence, overall and stratified by race and receipt of androgen deprivation therapy (ADT). RESULTS Of 401 patients (59% black) treated from 2005 to 2011, 84 (21%) experienced recurrence during 9.3 years median follow-up. Overall, obesity defined by BMI was not associated with recurrence risk overall or stratified by race or ADT, nor was any measure of fat distribution related to the risk of recurrence overall or by race. However, higher VFA was associated with increased risk of recurrence in men who received radiation only (hazard ratio [HR], 1.79; 95% confidence interval [CI], 0.87-3.66), but inversely associated with recurrence risk in men treated with radiation and ADT (HR, 0.49; 95% CI, 0.24-1.03; P-interaction = .002), though neither association reached statistical significance. Similar patterns of ADT-stratified associations were observed for PPAT and SFA. CONCLUSIONS Associations between abdominal and pelvic adiposity measures and recurrence risk differed significantly by ADT receipt, with positive directions of association observed only in men not receiving ADT. If confirmed, our findings suggest that obesity may have varying effects on prostate cancer progression risk dependent on the hormonal state of the individual.
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Affiliation(s)
- Claire M Di Bella
- Division of Urology, Durham Veterans Affairs Health Care System, Durham, NC
| | - Lauren E Howard
- Division of Urology, Durham Veterans Affairs Health Care System, Durham, NC
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Taofik Oyekunle
- Division of Urology, Durham Veterans Affairs Health Care System, Durham, NC
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Amanda M De Hoedt
- Division of Urology, Durham Veterans Affairs Health Care System, Durham, NC
| | - Joseph K Salama
- Division of Urology, Durham Veterans Affairs Health Care System, Durham, NC
| | - Haijun Song
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC
| | - Stephen J Freedland
- Division of Urology, Durham Veterans Affairs Health Care System, Durham, NC
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Emma H Allott
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, Northern Ireland, UK
- Department of Histopathology and Morbid Anatomy, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
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16
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Estève D, Roumiguié M, Manceau C, Milhas D, Muller C. Periprostatic adipose tissue: A heavy player in prostate cancer progression. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.coemr.2020.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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17
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Pre-treatment ratio of periprostatic to subcutaneous fat thickness on MRI is an independent survival predictor in hormone-naïve men with advanced prostate cancer. Int J Clin Oncol 2019; 25:370-376. [PMID: 31617025 DOI: 10.1007/s10147-019-01559-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 10/01/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Epidemiological studies have shown an association between obesity and prostate cancer (PCa) aggressiveness. However, little is known about periprostatic fat (PPF) and its relationship with overall fat deposition in PCa. PPF is thought to contribute to PCa growth and migration via secreted factors and induction of chronic inflammation. We investigated if pre-treatment PPF thickness correlates with overall survival (OS). METHODS We reviewed 85 hormone-naïve men with advanced PCa who had received androgen deprivation therapy (ADT). PPF thickness was measured by magnetic resonance imaging (MRI) and compared with subcutaneous fat (SCF) thickness as an internal control. Visceral fat (VF) area measured by computed tomography served as an additional control. We evaluated the relationship between laboratory data, pathology results, and obesity parameters and OS. RESULTS Median follow-up was 50.6 months. Thirty-six patients died during follow-up. Univariate analysis revealed that nadir PSA titer, Gleason score, N stage, M stage, extent of disease by bone scan grade, hemoglobin, lactate dehydrogenase, alkaline phosphatase, and PPF/SCF ratio were associated with OS. Multivariate analysis revealed that nadir PSA titer, N stage, and PPF/SCF ratio were independent prognostic factors for survival. The 5-year OS in the patients with higher PPF/SCF ratio (≥ 1) and lower PPF/SCF ratio (< 1) was 49.5% and 66.5%, respectively (P = 0.039). CONCLUSIONS Pre-treatment ratio of PPF-to-SCF thickness on MRI is an independent predictor of survival in hormone-naïve men with advanced PCa. This could be useful for predicting which patients are more likely to develop castration-resistant PCa.
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Lu G, Zhou L. Localization of prostatic tumor's infection based on normalized mutual information MRI image segmentation. J Infect Public Health 2019; 14:432-436. [PMID: 31492598 DOI: 10.1016/j.jiph.2019.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/11/2019] [Accepted: 08/15/2019] [Indexed: 01/23/2023] Open
Abstract
To investigate the effect of normalized mutual information (MRI) image segmentation in accurate localization of prostate cancer with infection and the role in disease treatment, the normalized mutual information method is used to measure the similarity of images, so as to select the maps. Then, the popular global weighted voting method and normalized mutual information method are applied to calculate the weights and carry out the label image fusion. The map selection method based on mutual information substantially completes the segmentation of the MRI image prostate. The prostate position is basically found on the 10 test images, and the positioning of the prostate organs is deviated in the worst case. In the case of poor multi-map segmentation, it usually happens when those are not well represented in the map. Because of the structural similarity of medical images, multi-atlas segmentation based on normalized mutual information method can be done. Using the prior information of atlas, the atlas label image can be selected. After fusion, the final segmentation of the test image can be completed, which has a high accuracy for the location of prostate cancer. This method can accurately delineate the target area in radiotherapy of prostate cancer and reduce the damage of rectum, bladder and other organs caused by radiotherapy. However, there are still some problems in this study, such as inadequate segmentation accuracy, long data processing time and so on. There is still a certain distance from practicality, and further research is needed.
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Affiliation(s)
- Guoping Lu
- Department of Urology, Guangxi Minzu Hospital, Nanning, Guangxi 530001, China.
| | - Lixin Zhou
- Department of Radiology, Guangxi Minzu Hospital, Nanning, Guangxi 530001, China
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Huang H, Chen S, Li W, Bai P, Wu X, Xing J. Periprostatic Fat Thickness on MRI is an Independent Predictor of Time to Castration-resistant Prostate Cancer in Chinese Patients With Newly Diagnosed Prostate Cancer Treated With Androgen Deprivation Therapy. Clin Genitourin Cancer 2019; 17:e1036-e1047. [PMID: 31281063 DOI: 10.1016/j.clgc.2019.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/28/2019] [Accepted: 06/03/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the association between periprostatic fat thickness (PPFT) and time to castration-resistant prostate cancer (CRPC) in newly diagnosed patients with prostate cancer (PCa) treated with androgen deprivation therapy (ADT). PATIENTS AND METHODS We retrospectively reviewed the medical records of 150 patients with PCa treated with ADT at our hospital between June 2011 and June 2017. PPFT measured on magnetic resonance imaging (MRI) and PPFT/periprostatic fat volume (PPFV) measured on computed tomography (CT) were evaluated. Kaplan-Meier curves and log-rank tests were used to assess significant differences in time to CRPC between the 2 groups (high PPFT vs. low PPFT, determined by PPFT > or < the median value, respectively). Univariable and multivariable Cox regression analyses were employed to identify the potential prognostic factors for survival. RESULTS The median value of PPFT measured on MRI was 0.555 cm. PPFT was significantly associated with PPFV measured on CT images (with a correlation coefficient of 0.825; P < .001). A total of 66 patients (44%) progressed to CRPC during the follow-up period. Patients with high PPFT (measured on MRI) showed a significantly shorter PFS than patients with low PPFT. Multivariable Cox analysis demonstrated that T stage, presence of distant metastasis, shorter time to prostate-specific antigen nadir, higher prostate-specific antigen nadir, Gleason score (greater than 4 + 4), and high PPFT were significantly associated with shorter PFS. CONCLUSIONS PPFT is significantly associated with PPFV measured on CT images. PPFT measured on MRI is a readily available and significant predictor of time to CRPC in patients with PCa receiving ADT as the primary treatment.
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Affiliation(s)
- Haichao Huang
- Department of Urology, The First Affiliated Hospital of Xiamen University, Siming District, Xiamen, Fujian, China
| | - Shi Chen
- Department of Radiology, The First Affiliated Hospital of Xiamen University, Siming District, Xiamen, Fujian, China
| | - Wei Li
- Department of Urology, The First Affiliated Hospital of Xiamen University, Siming District, Xiamen, Fujian, China
| | - Peide Bai
- Department of Urology, The First Affiliated Hospital of Xiamen University, Siming District, Xiamen, Fujian, China
| | - Xiurong Wu
- Department of Radiology, The First Affiliated Hospital of Xiamen University, Siming District, Xiamen, Fujian, China
| | - Jinchun Xing
- Department of Urology, The First Affiliated Hospital of Xiamen University, Siming District, Xiamen, Fujian, China.
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Dahran N, Szewczyk-Bieda M, Vinnicombe S, Fleming S, Nabi G. Periprostatic fat adipokine expression is correlated with prostate cancer aggressiveness in men undergoing radical prostatectomy for clinically localized disease. BJU Int 2019; 123:985-994. [PMID: 29969844 DOI: 10.1111/bju.14469] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To investigate the relationship between periprostatic adipose tissue (PPAT) adipokine expression and prostate cancer (PCa) aggressiveness using both pathological features of radical prostatectomy (RP) and multiparametric magnetic resonance imaging ( MRI) variables. PATIENTS AND METHODS Sixty-nine men were recruited to assess immunohistochemical expression of tumour necrosis factor (TNF)α and vascular endothelial growth factor (VEGF) of periprostatic fat of RP specimens. Per cent immunopositivity was quantified on scanned slides using the Aperio Positive Pixel Count algorithm for PPAT TNFα, VEGF and androgen receptors. Periprostatic fat volume (PFV) was segmented on contiguous T1 -weighted axial MRI slices from the level of the prostate base to apex. PFV was normalized to prostate volume (PV) to account for variations in PV (normalized PFV = PFV/PV). MRI quantitative values (Kep , Ktrans and apparent diffusion coefficient) were measured from the PCa primary lesion using Olea Sphere software. Patients were stratified into three groups according to RP Gleason score (GS): ≤6, 7(3 + 4) and ≥7(4 + 3). RESULTS The mean rank of VEGF and TNFα was significantly different between the groups [H(2) = 11.038, P = 0.004] and [H(2) = 13.086, P = 0.001], respectively. Patients with stage pT3 had higher TNFα (18.2 ± 8.95) positivity than patients with stage pT2 (13.27 ± 10.66; t [67] = -2.03, P = 0.047). TNFα expression significantly correlated with Ktrans (ρ = 0.327, P = 0.023). TNFα (P = 0.043), and VEGF (P = 0.02) correlated with high grade PCa (GS ≥ 7) in RP specimens and also correlated significantly with upgrading of GS from biopsy to RP histology. CONCLUSIONS The expression levels of TNFα and VEGF on immunostaining significantly correlated with aggressivity of PCa. As biomarkers, these indicate the risk of having high grade PCa in men undergoing RP.
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Affiliation(s)
- Naief Dahran
- Division of Cancer Research, School of Medicine, University of Dundee, Dundee, UK.,Department of Anatomy, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | | | - Sarah Vinnicombe
- Division of Cancer Research, School of Medicine, University of Dundee, Dundee, UK
| | - Stewart Fleming
- Division of Cancer Research, School of Medicine, University of Dundee, Dundee, UK
| | - Ghulam Nabi
- Division of Cancer Research, School of Medicine, University of Dundee, Dundee, UK
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21
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Nassar ZD, Aref AT, Miladinovic D, Mah CY, Raj GV, Hoy AJ, Butler LM. Peri‐prostatic adipose tissue: the metabolic microenvironment of prostate cancer. BJU Int 2018; 121 Suppl 3:9-21. [DOI: 10.1111/bju.14173] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Zeyad D. Nassar
- University of Adelaide Medical School Adelaide SA Australia
- Freemasons Foundation Centre for Men's Health Adelaide SA Australia
- South Australian Health and Medical Research Institute Adelaide SA Australia
| | - Adel T. Aref
- University of Adelaide Medical School Adelaide SA Australia
- Freemasons Foundation Centre for Men's Health Adelaide SA Australia
- South Australian Health and Medical Research Institute Adelaide SA Australia
| | - Dushan Miladinovic
- Discipline of Physiology School of Medical Sciences and Bosch Institute Charles Perkins Centre University of Sydney Sydney NSWAustralia
| | - Chui Yan Mah
- University of Adelaide Medical School Adelaide SA Australia
- Freemasons Foundation Centre for Men's Health Adelaide SA Australia
- South Australian Health and Medical Research Institute Adelaide SA Australia
| | - Ganesh V. Raj
- Departments of Urology and Pharmacology UT Southwestern Medical Center at Dallas Dallas TX USA
| | - Andrew J. Hoy
- Discipline of Physiology School of Medical Sciences and Bosch Institute Charles Perkins Centre University of Sydney Sydney NSWAustralia
| | - Lisa M. Butler
- University of Adelaide Medical School Adelaide SA Australia
- Freemasons Foundation Centre for Men's Health Adelaide SA Australia
- South Australian Health and Medical Research Institute Adelaide SA Australia
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22
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Zhai L, Fan Y, Sun S, Wang H, Meng Y, Hu S, Wang X, Yu W, Jin J. PI-RADS v2 and periprostatic fat measured on multiparametric magnetic resonance imaging can predict upgrading in radical prostatectomy pathology amongst patients with biopsy Gleason score 3 + 3 prostate cancer. Scand J Urol 2018; 52:333-339. [PMID: 30895901 DOI: 10.1080/21681805.2018.1545799] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE An underestimated biopsy Gleason score 3 + 3 can result in unfounded optimism amongst patients and cause physicians to miss the window for prostate cancer (PCa) cure. This study aims to evaluate the effectiveness of Prostate Imaging Reporting and Data System (PI-RADS) version 2 as well as periprostatic fat (PPF) measured on multiparametric magnetic resonance imaging (mp-MRI) at predicting pathological upgrading amongst patients with biopsy Gleason score 3 + 3 disease. PATIENTS AND METHODS A retrospective analysis of 56 patients with biopsy Gleason score 6 PCa who underwent prebiopsy mp-MRI and radical prostatectomy (RP) between November 2013 and March 2018 was conducted. Two radiologists performed PI-RADS v2 score evaluation and different fat measurements on mp-MRI. The associations amongst clinical information, PI-RADS v2 score, different fat parameters and pathologic findings were analyzed. A nomogram predicting upgrading was established based on the results of logistic regression analysis. RESULTS A total of 38 (67.9%) patients were upgraded to Gleason ≥7 disease on RP specimens. Prostate-specific antigen density (PSAD) (p < .001), positive core (p < .001), single-core positivity (p = .039), PI-RADS score (p < .001), front PPF area (p = .007) and front-to-total ratio (the ratio of front PPF area to total contour area) (p < .001) were risk factors for upgrading. On multivariate analysis, Epstein criteria (p = .02), PI-RADS score >3 (p = .024), and front-to-total ratio (p = .006) were independent risk factors for pathologic upgrading. The AUC value of the nomogram was 0.893 (95% CI, 0.787-0.999). CONCLUSION The combination of PI-RADS v2 and periprostatic fat measured on mp-MRI can help predict pathologic upgrading amongst patients with biopsy Gleason score 3 + 3 PCa.
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Affiliation(s)
- Lingyun Zhai
- a Department of Urology , Peking University First Hospital , Beijing , China.,b Institute of Urology , Peking University, National Urological Cancer Center , Beijing , China
| | - Yu Fan
- a Department of Urology , Peking University First Hospital , Beijing , China.,b Institute of Urology , Peking University, National Urological Cancer Center , Beijing , China
| | - Shaoshuai Sun
- c Department of Radiology , Peking University First Hospital , Beijing , China
| | - Huihui Wang
- c Department of Radiology , Peking University First Hospital , Beijing , China
| | - Yisen Meng
- a Department of Urology , Peking University First Hospital , Beijing , China.,b Institute of Urology , Peking University, National Urological Cancer Center , Beijing , China
| | - Shuai Hu
- d Department of Genitourinary Pathology , Peking University First Hospital , Beijing , China
| | - Xiaoying Wang
- c Department of Radiology , Peking University First Hospital , Beijing , China
| | - Wei Yu
- a Department of Urology , Peking University First Hospital , Beijing , China.,b Institute of Urology , Peking University, National Urological Cancer Center , Beijing , China
| | - Jie Jin
- a Department of Urology , Peking University First Hospital , Beijing , China.,b Institute of Urology , Peking University, National Urological Cancer Center , Beijing , China
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