Osteoporosis and obesity in men receiving hormone therapy for prostate cancer

Berberine-induced glucagon-like peptide-1 and its mechanism for controlling type 2 diabetes mellitus: a comprehensive pathway review

Introduction: A growing number of studies have thus far showed the association between type 2 diabetes mellitus (DM) and the intestinal microbiome homoeostasis. As reported, the gut microflora can be significantly different in patients with type 2 DM (T2DM) compared to those in healthy individuals.Methods: The authors collected the relevant articles published until 2022 and these are carefully selected from three scientific databases based on keywords.Discussion: This review highlights research on the anti-diabetic properties of berberine (BBR)-induced glucagon-like peptide-1 (GLP-1), as a glucose-lowering factor and a balance regulator in the microbial flora of the intestines, which plays an important role in adjusting the signalling pathways affecting insulin secretion.Results: Considering the anti-diabetic characteristics of the BBR-induced GLP-1, BBR makes a promising complementary treatment for reducing the clinical symptoms of DM by reducing the hyperglycaemia. Berberin might be a safe and effective drug for T2DM with little or no adverse effects.HighlightsBerberine induces GLP-1 insulin secretion by PLC2 pathway in the intestinalBerberine-induced GLP-1 decreases mitochondrial stress and relocates cytochrome c out of the mitochondria.Berberine induces GLP-1 secretion in the intestine by altering the bacterial profile, thus could possibly lighten diabetes symptomsBerberine-induced SCFA production, SCFA causes GLP-1 secretion from the intestinal L-Cell.Preventing mitochondrial damage, reducing adipose tissue fat, and reducing oxidative stress are thus among the results of BBR-induced GLP-1.The lower costs of BBR, and its limited side effects and higher availability, make it a promising supplementary medicine for DM.

Cancer Type Does Not Affect Exercise-Mediated Improvements in Cardiorespiratory Function and Fatigue

Purpose. Despite mounting evidence indicating that exercise training has a positive effect on cancer recovery, the influence of cancer type on the response to exercise training remains uncharacterized. Therefore, the adaptations to exercise training were compared between groups composed of 7 different forms of cancer. Methods. A total of 319 cancer survivors completed fatigue inventories and participated in assessments of cardiorespiratory function, which encompassed aerobic capacity (VO2peak), pulmonary function (forced vital capacity [FVC] and forced expiratory volume in 1 second [FEV1]), and resting blood pressure and heart rate. Participants were divided into 7 groups based on cancer type, including breast cancer (BC, n = 170), prostate cancer and other male urogenital neoplasia (PC, n = 38), hematological malignancies (HM, n = 34), colorectal cancer (CC, n = 25), gynecological cancers (GC, n = 20), glandular and epithelial neoplasms (GEN, n = 20), and lung cancer (LC, n = 12). All participants completed an individualized, multimodal exercise intervention consisting of cardiorespiratory, flexibility, balance, and muscular strength training 3 days per week for 3 months. Following the intervention, all subjects were reassessed. Generalized Estimating Equations with exchangeable working correlation structure was used to model each response; the group by time interaction effect represented the effect of cancer type on exercise-associated improvements. Results. No significant ( P > .05) group by time interaction effects were observed between different types of cancer for any parameter. Pre- to postexercise contrasts revealed significant improvements in VO2peak in BC, PC, HM, and GEN at the Bonferroni adjusted significance level (.00714). Heart rate was significantly lowered in the BC and CC groups. Mean fatigue indices decreased by at least 17% in all groups, but these changes were only significant in the BC, HM, CC, and GC groups. Systolic blood pressure decreased significantly in BC and GC, and diastolic blood pressure decreased significantly only in the BC group while pulmonary function remained unchanged in all cancer types. Conclusion. Although trends toward improved cardiorespiratory and fatigue parameters only reached significance in some groups, there were no significant differences between cancer types. This suggests that cardiorespiratory and fatigue improvements following rehabilitative exercise are not dependent on cancer type. Further research investigating alternative physiological parameters are needed to confirm the relationship between cancer type and exercise-mediated rehabilitation.

Berberine moderates glucose metabolism through the GnRH-GLP-1 and MAPK pathways in the intestine

Background

Berberine is known to improve glucose and lipid metabolism disorders, but it poorly absorbed into the blood stream from the gut. Therefore, the exact underlying mechanism for berberine is still unknown. In this study, we investigated the effect of berberine on glucose metabolism in diabetic rats and tested the hypothesis that berberine acts directly in the terminal ileums.

Methods

Rats were divided into a control group, diabetic group (DM), low dose of berberine group (BerL) and high dose of berberine group (BerH). Ileum samples were analyzed using a Roche NimbleGen mRNA array, qPCR and immunohistochemistry.

Results

We found that 8 weeks of treatment with berberine significantly decreased fasting blood glucose levels. An oral glucose tolerance test (OGTT) showed that blood glucose was significantly reduced in the BerL and BerH groups before and at 30 min, 60 min and 120 min after oral glucose administration. Plasma postprandial glucagon-like peptide-1 (GLP-1) levels were increased in the berberine-treated groups. The ileum from the BerH group had 2112 genes with significantly changed expression (780 increased, 1332 decreased). KEGG pathway analyses indicated that all differentially expressed genes included 9 KEGG pathways. The top two pathways were the MAPK signaling pathway and the GnRH signaling pathway. Q-RT-PCR and immunohistochemistry verified that glucagon-like peptide 1 receptor (Glp1r) and mitogen activated protein kinase 10 (Mapk10) were significantly up-regulated, in contrast, gonadotropin releasing hormone receptor (Gnrhr) and gonadotropin-releasing hormone 1 (Gnrh1) were down-regulated in the BerH group.

Conclusion

Our data suggest that berberine can improve blood glucose levels in diabetic rats. The mechanisms involved may be in the MAPK and GnRh-Glp-1 pathways in the ileum.

Exisulind in the treatment of prostate cancer

Prostate cancer represents the most common noncutaneous malignancy in men. With the widespread use of prostate-specific antigen screening, as many as one in six men in the USA will be diagnosed with prostate cancer. Significant healthcare resources are currently devoted to the treatment of this disease, specifically aimed at improving the side effects of successful treatment. Surgery or radiation therapy provides the best chance of cure from this disease. However, as many as 50% of patients treated with curative intent will develop a recurrence 10-15 years following treatment. Hormonal ablation via medical or surgical castration provides disease control, but is associated with significant hot flushes, loss of libido and impotence. Selective, apoptotic antineoplastic drugs, such as exisulind, may provide an alternative method to treating or preventing prostate cancer. This drug profile reviews the evidence for the use of exisulind in the treatment of prostate cancer.

Denosumab: a new option in the treatment of bone metastases from urological cancers

BONE METASTASES OFTEN CREATE SERIOUS CLINICAL PROBLEMS: they lead to poor performance status due to pathologic fractures, spinal cord compression and intractable pain, commonly referred to as skeletal-related events. The receptor activator of nuclear factor-κB (RANK), the RANK ligand (RANKL), and osteoprotegerin, a decoy receptor for RANK, regulate osteoclastogenesis and may play a key role in bone metastasis. Denosumab (XGEVA; Amgen, Thousand Oaks, CA), a fully human monoclonal antibody that binds to and neutralizes RANKL, inhibits osteoclast function, prevents generalized bone resorption and local bone destruction, and has become a therapeutic option for preventing or delaying first on-study skeletal-related events in various malignancies. In the context of urological cancer, three main Phase III clinical studies have been published in prostate cancer. This article provides a brief overview of the characteristics of bone metastasis in urological cancers, reviews the mechanisms of bone metastasis, including the RANK/RANKL/osteoprotegerin axis, the current standard of care, zoledronic acid, and describes the efficacy of the novel bone-targeted agent denosumab in bone metastasis. Denosumab is emerging as a key therapeutic option in the treatment of bone metastases from urological cancers.

Prostate cancer treatments and their side effects are associated with increased insomnia

OBJECTIVE

Between 25% and 40% of prostate cancer patients report insomnia symptoms. Although a possible role of androgen deprivation therapy (ADT) and radiation therapy (RTH) and some of their side effects have been postulated, this issue has rarely been investigated. This study aimed to (1) compare the evolution of insomnia symptoms and somatic symptoms, which may affect sleep quality (i.e., hot flashes, night sweats, and urinary symptoms), in patients receiving combined ADT and RTH with that in patients receiving RTH only and (2) assess the mediating role of somatic symptoms in the relationship of ADT and RTH with insomnia symptoms.

METHODS

Sixty men scheduled to receive RTH for prostate cancer, with (n = 28) or without (n = 32) ADT, were assessed prior to receiving any treatment (baseline) and at seven additional times over 16 months (1, 2, 4, 6, 8, 12, and 16 months) using the Insomnia Severity Index and the Physical Symptoms Questionnaire.

RESULTS

A significant interaction effect was found indicating an increase in insomnia scores in ADT-RTH patients at 2, 4, and 6 months, as compared with baseline, and stable scores in RTH patients. A significant mediating role of hot flashes and night sweats was found in the relationship between ADT and insomnia symptoms. The relationship with RTH was also significantly mediated by these two symptoms albeit more strongly by excessive urinary frequency.

CONCLUSIONS

Androgen deprivation therapy is associated with an increased risk for insomnia, and side effects of ADT and RTH appear to play a role in the development of insomnia in this population.

Muscle function, physical performance and body composition changes in men with prostate cancer undergoing androgen deprivation therapy

Prostate cancer (PCa) is the most common visceral malignancy in men with androgen deprivation therapy (ADT) the preferred therapy to suppress testosterone production and hence tumor growth. Despite its effectiveness in lowering testosterone, ADT is associated with side effects including loss of muscle mass, diminished muscle strength, decrements in physical performance, earlier fatigue and declining quality of life. This review reports a survey of the literature with a focus on changes in muscle strength, physical function and body composition, due to short-term and long-term ADT. Studies in these areas are sparse, especially well-controlled, prospective randomized trials. Cross-sectional and longitudinal data (up to 2 years) for men with PCa treated with ADT as well as patients with PCa not receiving ADT and age-matched healthy men are presented when available. Based on limited longitudinal data, the adverse effects of ADT on muscle function, physical performance and body composition occur shortly after the onset of ADT and tend to persist and worsen over time. Exercise training is a safe and effective intervention for mitigating these changes and initial guidelines for exercise program design for men with PCa have been published by the American College of Sports Medicine. Disparities in study duration, types of studies and other patient-specific variables such as time since diagnosis, cancer stage and comorbidities may all affect an understanding of the influence of ADT on health, physical performance and mortality.

The correlation between intestinal gonadotropin-releasing hormone (GnRH) and proglucagon in hyperlipidemic rats and Goto-Kakizaki (GK) rats

Our experiment investigated the mRNA expression of intestinal gonadotropin-releasing hormone (GnRH), proglucagon (PG), and glucagon-like peptide 1 receptor (GLP-1R) in the jejunum, ileum, and colon of rats fed with high-fat diet and Goto-Kakizaki (GK) rats and revealed the physiological role of intestinal GnRH. We found that the GnRH and PG mRNA levels in high-cholesterol (HCh) diet were higher than in the control. However, the GnRH receptor (GnRHR) and GLP-1R mRNA levels did not differ significantly between HCh and control. The GnRH, PG, and GLP-1R mRNA levels in GK rats were lower, respectively, than those in control rats, while the GnRHR levels did not differ significantly between GK rats and control rats. There were no difference in GnRH, PG, GnRHR, and GLP-1R mRNA levels in the ileum and colon tissue between HCh and control rats. The GnRH mRNA levels of GK rats were lower than those in control rats; however, the PG, GLP-1R, and GnRHR levels did not differ significantly between GK and control rats. The GLP-1R mRNA levels of GK rats were lower than those in control rats. The GnRH mRNA expression showed positive correlation with PG mRNA expression in different intestinal sections. The GnRH level in the jejunum showed a significant effect on blood glucose level, while the PG level in the jejunum showed a significant effect on insulin level. This may imply that, compared with the ileum and colon, the jejunum had greater impact on glucose metabolism; furthermore, GnRH might interact with intestinal GLP-1 and GLP-2 through the paracrine and autocrine ways and then regulate glucose metabolism and insulin secretion.

Management of complications of androgen deprivation therapy in the older man

Prostate cancer is the most common malignancy in older men. With the aging of the population, the number of older men with prostate cancer will grow rapidly. Androgen deprivation therapy (ADT) is the mainstay of treatment for men with systemic disease and is increasingly utilized as primary therapy or in combination with other therapies for localized disease. Side effects of therapy are multifold and include hot flashes, osteoporosis, and adverse psychological and metabolic effects. Recent research has illustrated that ADT can negatively impact the functional, cognitive, and physical performance of older men. Patients with prostate cancer, despite recurrence of the disease, have a long life expectancy and may be subjected to the side effects of ADT for many years. This review highlights the complications of ADT and approaches to management. We also provide recommendations for assessment and management of ADT complications among the most vulnerable and frail older male patients.

Androgen deprivation therapy for the treatment of prostate cancer: consider both benefits and risks

CONTEXT

Androgen deprivation therapy (ADT) is increasingly used for the treatment of prostate cancer (PCa), even in clinical settings in which there is no evidence-based proof of prolonged overall survival (OS). ADT, however, may be associated with numerous side effects, including an increased therapy-related cardiovascular mortality.

OBJECTIVE

To discuss different clinical settings in which ADT is currently used and to critically weigh the benefits of ADT against its possible side effects.

EVIDENCE ACQUISITION

A MEDLINE search was conducted to identify original articles and review articles addressing the efficacy and side effects of ADT for the treatment of PCa. Keywords consisted of prostate cancer, hormonal therapy, adverse effects, radical prostatectomy, and radiotherapy. The articles with the highest level of evidence for the various examined end points were identified with the consensus of all authors and were reviewed.

EVIDENCE SYNTHESIS

Even short-term use of ADT may lead to numerous side effects, such as osteoporosis, obesity, sarcopenia, lipid alterations, insulin resistance, and increased risk for diabetes and cardiovascular morbidity. Despite these side effects, ADT is commonly used in various clinical settings in which a clear effect on improved OS has not been shown.

CONCLUSIONS

ADT is associated with an increased risk of multiple side effects that may reduce quality of life and/or OS. Consequently, these issues should be discussed in detail with patients and their families before initiation of ADT. ADT should be used with knowledge of its potential long-term side effects and with possible lifestyle interventions, especially in settings with the highest risk-benefit ratio, to alleviate comorbidities.

Correlation of obesity and osteoporosis: effect of fat mass on the determination of osteoporosis

It was previously believed that obesity and osteoporosis were two unrelated diseases, but recent studies have shown that both diseases share several common genetic and environmental factors. Body fat mass, a component of body weight, is one of the most important indices of obesity, and a substantial body of evidence indicates that fat mass may have beneficial effects on bone. Contrasting studies, however, suggest that excessive fat mass may not protect against osteoporosis or osteoporotic fracture. Differences in experimental design, sample structure, and even the selection of covariates may account for some of these inconsistent or contradictory results. Despite the lack of a clear consensus regarding the impact of effects of fat on bone, a number of mechanistic explanations have been proposed to support the observed epidemiologic and physiologic associations between fat and bone. The common precursor stem cell that leads to the differentiation of both adipocytes and osteoblasts, as well the secretion of adipocyte-derived hormones that affect bone development, may partially explain these associations. Based on our current state of knowledge, it is unclear whether fat has beneficial effects on bone. We anticipate that this will be an active and fruitful focus of research in the coming years.

Relationship of obesity with osteoporosis

CONTEXT

The relationship between obesity and osteoporosis has been widely studied, and epidemiological evidence shows that obesity is correlated with increased bone mass. Previous analyses, however, did not control for the mechanical loading effects of total body weight on bone mass and may have generated a confounded or even biased relationship between obesity and osteoporosis.

OBJECTIVE

The objective of this study was to reevaluate the relationship between obesity and osteoporosis by accounting for the mechanical loading effects of total body weight on bone mass.

METHODS

We measured whole body fat mass, lean mass, percentage fat mass, body mass index, and bone mass in two large samples of different ethnicity: 1988 unrelated Chinese subjects and 4489 Caucasian subjects from 512 pedigrees. We first evaluated the Pearson correlations among different phenotypes. We then dissected the phenotypic correlations into genetic and environmental components with bone mass unadjusted or adjusted for body weight. This allowed us to compare the results with and without controlling for mechanical loading effects of body weight on bone mass.

RESULTS

In both Chinese and Caucasian subjects, when the mechanical loading effect of body weight on bone mass was adjusted for, the phenotypic correlation (including its genetic and environmental components) between fat mass (or percentage fat mass) and bone mass was negative. Further multivariate analyses in subjects stratified by body weight confirmed the inverse relationship between bone mass and fat mass, after mechanical loading effects due to total body weight were controlled.

CONCLUSIONS

Increasing fat mass may not have a beneficial effect on bone mass.

Role of Quality of Life in Men with Metastatic Hormone-Refractory Prostate Cancer: How Does Atrasentan Influence Quality of Life?

OBJECTIVE

Progression of hormone-refractory prostate cancer (HRPC) is associated with skeletal complications and bone pain, which contribute to deterioration in quality of life (QOL). The effects of new HRPC therapies on patients' QOL need to be studied. Patient-based assessments that help quantify the risk-benefit profile of HRPC therapies are warranted. This review summarizes the known QOL literature and estimates the potential effect of atrasentan, a novel, selective endothelin A receptor antagonist (SERA), on the QOL of HRPC patients.

METHODS

Published studies were identified through a structured, detailed literature review. Clinical studies that report QOL data were reviewed, along with recent QOL data from atrasentan studies.

RESULTS

HRPC studies have begun to use QOL assessments as primary endpoints, but different assessments and therapies are not comparable. Very few data integrate QOL with clinical endpoints. Atrasentan clinical trials demonstrated a statistically significant difference in the prostate cancer-specific QOL in favor of atrasentan (p=.032) and an increased quality-adjusted time to progression in men with HRPC.

CONCLUSIONS

Atrasentan provides QOL benefits relevant to HRPC. The quality-adjusted analyses applied in the atrasentan studies have begun to lay the foundation for interpreting clinical endpoints in conjunction with QOL. These analyses will facilitate better QOL comparisons within studies and across trials. Further evaluation of atrasentan in HRPC is warranted.

Genitourinary malignancies in solid organ transplant recipients

Malignancy is a recognized complication of transplantation. Genitourinary cancers are the second most common tumors in transplant recipients with prostate cancer and renal cell carcinoma the most common. Unlike the more common skin malignancies, genitourinary tumors have a significant impact on both graft and patient survival. Surgical and radiation treatments need to consider the location of heterotopic transplants and administration of chemotherapy may need alteration in light of immunosuppression being used. The major genitourinary malignancies and their management will be reviewed in this article with emphasis on the concerns that arise in a transplant recipient.

Bone loss after initiation of androgen deprivation therapy in patients with prostate cancer

CONTEXT

Although androgen deprivation therapy (ADT) for prostate cancer is associated with bone loss, little is known about when this bone loss occurs.

OBJECTIVE

We postulated that men on ADT would experience the greatest bone loss acutely after initiation of ADT.

DESIGN AND SETTING

We conducted a 12-month prospective study at an academic medical center.

PATIENTS OR OTHER PARTICIPANTS

We studied 152 men with prostate cancer (30 with acute ADT, < 6 months; 50 with chronic ADT, > or = 6 months; and 72 with no ADT) and 43 healthy age-matched controls.

MAIN OUTCOME MEASURES

We assessed bone mineral density (BMD) of the hip, wrist, total body, and spine; body composition; and markers of bone turnover.

RESULTS

After 12 months, men receiving acute ADT had a significant reduction in BMD of 2.5 +/- 0.6% at the total hip, 2.4 +/- 1.0% at the trochanter, 2.6 +/- 0.5% at the total radius, 3.3 +/- 0.5% at the total body, and 4.0 +/- 1.5% at the posteroanterior spine (all P < 0.05). Men with chronic ADT had a 2.0 +/- 0.6% reduction in BMD at the total radius (P < 0.05). Healthy controls and men with prostate cancer not receiving ADT had no significant reduction in BMD. Both use and duration of ADT were associated with change in bone mass at the hip (P < 0.05). Men receiving acute ADT had a 10.4 +/- 1.7% increase in total body fat and a 3.5 +/- 0.5% reduction in total body lean mass at 12 months, whereas body composition did not change in men with prostate cancer on chronic ADT or in healthy controls (P < 0.05). Markers of bone formation and resorption were elevated in men receiving acute ADT after 6 and 12 months compared with the other men with prostate cancer and controls (P < 0.05). Men in the highest tertile of bone turnover markers at 6 months had the greatest loss of bone density at 12 months.

CONCLUSIONS

Men with prostate cancer who are initiating ADT have a 5- to 10-fold increased loss of bone density at multiple skeletal sites compared with either healthy controls or men with prostate cancer who are not on ADT, placing them at increased risk of fracture. Bone loss is maximal in the first year after initiation of ADT, suggesting initiation of early preventive therapy.

Promoting general health during androgen deprivation therapy (ADT): a rapid 10-step review for your patients

Androgen deprivation for prostate cancer use to be applied only in the latter stage of the disease process, thus, the issue of promoting general health during this time was not a concern because the subject of life and death was more paramount. However, thanks to earlier detection of prostate cancer, there has been a general stage migration in this disease. Men are choosing these traditionally late stage therapies earlier and earlier. Therefore, the subject of quality of life on this treatment has now garnered as much attention as the survival issues. Cognitive or mental health concerns, cholesterol changes, hot flashes, osteoporosis, and other side effects are being addressed and treated with a variety of conventional medicines. However, the issue of the role of the patient or what men can do personally to promote better mental and physical health is desperately needed in this area. A variety of beneficial lifestyle changes and over-the-counter agents may have an enormous impact on men's health during androgen deprivation. Calcium and vitamin D supplements, aerobic and resistance exercise, cholesterol awareness and reduction, weight loss, and other individual changes could have an enormous impact on the quality and quantity of a man's life. Some of these so called "bottom line" recommendations are reviewed in this article to empower the patient during this time, and to send clearly the message that he has a role to play apart from just picking up and using a prescription drug for side effects, and his role is just as critical for improving the probability of living longer and better.