1
|
Kassab JG, Meeks RH, de Riese WTW. Current Clinical Aspects of Androgen Deprivation Therapy for Locally Advanced and Metastatic Prostate Cancer: A Scoping Review for Urologists and Medical Providers. Res Rep Urol 2024; 16:187-193. [PMID: 39310217 PMCID: PMC11414637 DOI: 10.2147/rru.s467344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 09/05/2024] [Indexed: 09/25/2024] Open
Abstract
Prostate cancer (PCa) currently stands as the most common malignancy and the second most common cause of death in men worldwide. Dr. C. Huggins revolutionized the field of PCa treatment through his work investigating the therapeutic effects of androgen deprivation. These early surgical castration methods were expanded upon by integrating reversible pharmacologic castration via biologic agonists. Following this, intermittent ADT (iADT) became a medical substitute for its continuous counterpart. This data synthesis aims to highlight and assess the pertinent adverse effects of ADT, to compare mortality for PCa treatment plans, and consequently provide direction for clinicians in choosing the suitable systemic ADT approach. We performed a thorough systematic search across the PubMed database to identify prospective randomized clinical trials (RCTs) comparing continuous and intermittent androgen deprivation therapy (cADT and iADT). Our qualitative analysis aimed to evaluate the potential of iADT as an alternative treatment approach, emphasizing recent clinical outcomes. The analysis of randomized control trials in the literature revealed no discernable statistical difference in PCa-specific mortality in comparison of iADT and cADT treatments. Further, in the analysis of mortality due to non-PCa causes, iADT patients fared more favorably compared to cADT. Due to iADT's characteristics of being more cost-efficient and less likely to cause undesirable side effects, urologic healthcare professionals should be made aware of these findings when counseling patients on the optimal form of ADT and consulting for future treatment guidelines.
Collapse
Affiliation(s)
- Jordan G Kassab
- Department of Urology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - R Hayden Meeks
- Department of Urology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Werner T W de Riese
- Department of Urology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| |
Collapse
|
2
|
Zhou W, Zhang W, Yan S, Zhang K, Wu H, Chen H, Shi M, Zhou T. Novel Therapeutic Targets on the Horizon: An Analysis of Clinical Trials on Therapies for Bone Metastasis in Prostate Cancer. Cancers (Basel) 2024; 16:627. [PMID: 38339378 PMCID: PMC10854912 DOI: 10.3390/cancers16030627] [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: 10/28/2023] [Revised: 12/03/2023] [Accepted: 12/11/2023] [Indexed: 02/12/2024] Open
Abstract
In the absence of early detection and initial treatment, prostate cancer often progresses to an advanced stage, frequently spreading to the bones and significantly impacting patients' well-being and healthcare resources. Therefore, managing patients with prostate cancer that has spread to the bones often involves using bone-targeted medications like bisphosphonates and denosumab to enhance bone structure and minimize skeletal complications. Additionally, researchers are studying the tumor microenvironment and biomarkers to understand the mechanisms and potential treatment targets for bone metastases in prostate cancer. A literature search was conducted to identify clinical studies from 2013 to 2023 that focused on pain, performance status, or quality of life as primary outcomes. The analysis included details such as patient recruitment, prior palliative therapies, baseline characteristics, follow-up, and outcome reporting. The goal was to highlight the advancements and trends in bone metastasis research in prostate cancer over the past decade, with the aim of developing strategies to prevent and treat bone metastases and improve the quality of life and survival rates for prostate cancer patients.
Collapse
Affiliation(s)
- Wenhao Zhou
- Department of Urology, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai 200434, China; (W.Z.); (S.Y.); (K.Z.); (H.W.)
| | - Wei Zhang
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai 200433, China;
| | - Shi Yan
- Department of Urology, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai 200434, China; (W.Z.); (S.Y.); (K.Z.); (H.W.)
| | - Kaixuan Zhang
- Department of Urology, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai 200434, China; (W.Z.); (S.Y.); (K.Z.); (H.W.)
| | - Han Wu
- Department of Urology, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai 200434, China; (W.Z.); (S.Y.); (K.Z.); (H.W.)
| | - Hongyu Chen
- School of Medicine, Tongji University, Shanghai 200092, China;
| | - Minfeng Shi
- Reproduction Center, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Tie Zhou
- Department of Urology, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai 200434, China; (W.Z.); (S.Y.); (K.Z.); (H.W.)
| |
Collapse
|
3
|
Alibhai SMH, Papadopoulos E, Mina DS, Ritvo P, Tomlinson G, Sabiston CM, Durbano S, Bremner KE, Chiarotto J, Matthew A, Warde P, O'Neill M, Culos-Reed SN. Home-based versus supervised group exercise in men with prostate cancer on androgen deprivation therapy: A randomized controlled trial and economic analysis. J Geriatr Oncol 2024; 15:101646. [PMID: 37976654 DOI: 10.1016/j.jgo.2023.101646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/01/2023] [Accepted: 10/04/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Differences between health outcomes, participation/adoption, and cost-effectiveness of home-based (HOME) interventions and supervised group-based training (GROUP) in men with prostate cancer (PC) on androgen deprivation therapy (ADT) are currently unknown. The objective of this study was to assess the clinical efficacy, adherence, and cost-effectiveness of HOME versus GROUP in men on ADT for PC. MATERIALS AND METHODS This was a multicentre, 2-arm non-inferiority randomized controlled trial and companion cost-effectiveness analysis. Men with PC on ADT were recruited from August 2016 to March 2020 from four Canadian centres and randomized 1:1 to GROUP or HOME. All study participants engaged in aerobic and resistance training four to five days weekly for six months. Fatigue [Functional Assessment of Cancer Therapy-Fatigue (FACT-F)] and functional endurance [6-min walk test (6MWT)] at six months were the co-primary outcomes. Secondary outcomes included quality of life, physical fitness, body composition, blood markers, sedentary behaviour, and adherence. Between-group differences in primary outcomes were compared to margins of 3 points for FACT-F and 40 m for 6MWT using a Bayesian analysis of covariance (ANCOVA). Secondary outcomes were compared with ANCOVA, Costs included Ministry of Health costs, program costs, patient out-of-pocket, and time costs. TRIAL REGISTRATION #NCT02834416. RESULTS Thirty-eight participants (mean [standard deviation (SD)] age, 70 [9.0] years) were enrolled (GROUP n = 20; HOME n = 18). There was an 89.8% probability that HOME was non-inferior to GROUP for both fatigue and functional endurance and a 9.5% probability that HOME reduced fatigue compared to GROUP (mean [SD] change, 12.1 [8.1] vs 3.6 [6.1]; p = 0.040) at six months. Adherence was similar among study arms. HOME was cost-saving (mean difference: -$4122) relative to GROUP. DISCUSSION A HOME exercise intervention appears non-inferior to GROUP for fatigue and functional endurance and requires fewer resources to implement. HOME appears to ameliorate fatigue more than GROUP, but has comparable effects on other clinically relevant outcomes. Although limited by sample size and attrition, these results support further assessment of home-based programs.
Collapse
Affiliation(s)
- Shabbir M H Alibhai
- Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; Department of Medicine, University Health Network, Toronto, ON, Canada.
| | | | - Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Paul Ritvo
- Department of Psychology, School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - George Tomlinson
- Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Catherine M Sabiston
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Sara Durbano
- Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Karen E Bremner
- Department of Medicine, University Health Network, Toronto, ON, Canada
| | - James Chiarotto
- Department of Medicine, Division of Hematology/Oncology, Scarborough Health Network, Scarborough, ON, Canada
| | - Andrew Matthew
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Padraig Warde
- Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Meagan O'Neill
- Department of Medicine, University Health Network, Toronto, ON, Canada
| | - S Nicole Culos-Reed
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
4
|
Wong CHM, Xu N, Lim J, Feng KK, Chan WKW, Chan MTY, Leung SC, Chen DN, Lin YZ, Chiu PKF, Yee CH, Teoh JYC, Huang CY, Yeoh WS, Ong TA, Wei Y, Ng CF. Adverse metabolic consequences of androgen deprivation therapy (ADT) on Asian patients with prostate cancer: Primary results from the real-life experience of ADT in Asia (READT) study. Prostate 2023; 83:801-808. [PMID: 36938957 DOI: 10.1002/pros.24519] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 02/10/2023] [Accepted: 03/02/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND Androgen deprivation therapy (ADT) use in prostate cancer (PCa) has seen a rising trend. We investigated the relationship between ADT and adverse changes in metabolic parameters in an Asian population. METHODS This is an international prospective multicenter single-arm cohort yielded from the real-life experience of ADT in Asia (READT) registry. Consecutive ADT-naïve patients diagnosed of PCa and started on ADT were prospectively recruited from 2016 and analyzed. Baseline patient characteristics, PCa disease status, and metabolic parameters were documented. Patients were followed up at 6-month interval for up to 5 years. Metabolic parameters including body weight, lipid profiles, and glycemic profiles were recorded and analyzed. RESULTS 589 patients were eligible for analysis. ADT was associated with adverse glycemic profiles, being notable at 6 months upon ADT initiation and persisted beyond 1 year. Comparing to baseline, fasting glucose level and hemoglobin A1c level increased by 4.8% (p < 0.001) and 2.7% (p < 0.001), respectively. Triglycerides level was also elevated by 16.1% at 6th month and by 20.6% at 12th month compared to baseline (p < 0.001). Mean body weight was 1.09 kg above baseline at 18th month (p < 0.001). CONCLUSION ADT was associated with adverse metabolic parameters in terms of glycemic profiles, lipid profiles, and body weight in the Asian population. These changes developed early in the treatment and can persist beyond the first year. Regular monitoring of the biochemical profiles during treatment is paramount in safeguarding the patients' metabolic health.
Collapse
Affiliation(s)
- Chris H M Wong
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Department of Surgery, Division of Urology, Prince of Wales Hospital, Shatin, Hong Kong
| | - Ning Xu
- Department of Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Jasmine Lim
- Department of Surgery, Urology Unit, University of Malaya, Kuala Lumpur, Malaysia
| | - Kuo-Kang Feng
- Department of Urology, Hsin-Chu BioMedical Park Hospital, National Taiwan University Hospital, Taipei, Taiwan
| | - Wayne K W Chan
- Department of Surgery, Division of Urology, Kwong Wah Hospital, Mongkok, Kowloon, Hong Kong
| | - Marco T Y Chan
- Department of Surgery, Division of Urology, Tuen Mun Hospital, Hong Kong, Hong Kong
| | - Steven Ch Leung
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Department of Surgery, Division of Urology, Prince of Wales Hospital, Shatin, Hong Kong
| | - Dong-Ning Chen
- Department of Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yun-Zhi Lin
- Department of Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Peter K F Chiu
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Department of Surgery, Division of Urology, Prince of Wales Hospital, Shatin, Hong Kong
| | - Chi Hang Yee
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Department of Surgery, Division of Urology, Prince of Wales Hospital, Shatin, Hong Kong
| | - Jeremy Y C Teoh
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Department of Surgery, Division of Urology, Prince of Wales Hospital, Shatin, Hong Kong
| | - Chiu-Yuen Huang
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Sien Yeoh
- Department of Surgery, Urology Unit, University of Malaya, Kuala Lumpur, Malaysia
| | - Teng-Aik Ong
- Department of Surgery, Urology Unit, University of Malaya, Kuala Lumpur, Malaysia
| | - Yong Wei
- Department of Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Chi-Fai Ng
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Department of Surgery, Division of Urology, Prince of Wales Hospital, Shatin, Hong Kong
| |
Collapse
|
5
|
Lin E, Garmo H, Hagström E, Van Hemelrijck M, Adolfsson J, Stattin P, Zethelius B, Crawley D. Association between atherogenic lipids and GnRH agonists for prostate cancer in men with T2DM: a nationwide, population-based cohort study in Sweden. Br J Cancer 2023; 128:814-824. [PMID: 36522475 PMCID: PMC9977763 DOI: 10.1038/s41416-022-02091-z] [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] [Received: 01/07/2022] [Revised: 11/15/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Gonadotropin-releasing hormone agonists (GnRH) used in prostate cancer (PCa) are associated with atherogenic dyslipidaemia. It can be assumed that GnRH need to be used with greater caution in men with type 2 diabetes mellitus (T2DM). This study investigated association of GnRH with atherogenic lipids (AL) in PCa men with T2DM. METHODS Two cohorts including 38,311 men with 11 years follow-up based on Swedish national registers were defined (PCa-Exposure cohort and GnRH-Exposure cohort). Based on European guidelines on cardiovascular diseases (CVD), primary outcomes were defined as: 1.0 mmol/L increase in AL and lipid-lowering therapy (LLT) intensification. We used Cox proportional-hazards models and Kaplan-Meier curves to assess the association. RESULTS There was an association between GnRH and increased AL (i.e., triglyceride, PCa-Exposure cohort: HR 1.77, 95% CI 1.48-2.10; GnRH-Exposure cohort: HR 1.88, 95% CI 1.38-2.57). There was also an association between PCa diagnosis and increased AL. In contrast, no association between LLT intensification and GnRH was found. CONCLUSION In this large population-based study, men with T2DM on GnRH for PCa had an increased risk of increased atherogenic lipids. These results highlight the need to closely monitor lipids and to be ready to intensify lipid-lowering therapy in men with T2DM on GnRH for PCa.
Collapse
Affiliation(s)
- E Lin
- School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), King's College London, London, UK.
| | - Hans Garmo
- School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), King's College London, London, UK.,Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Emil Hagström
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.,Uppsala Clinical Research Centre, Uppsala, Sweden
| | - Mieke Van Hemelrijck
- School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), King's College London, London, UK
| | - Jan Adolfsson
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Björn Zethelius
- Department of Public Health/Geriatrics, Uppsala University, Uppsala, Sweden
| | - Danielle Crawley
- School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), King's College London, London, UK
| |
Collapse
|
6
|
Relationship between Androgen Deprivation Therapy and Abdominal Adipose Tissue. URO 2022. [DOI: 10.3390/uro2040030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
The role of androgens in body composition is well known. Androgen deprivation therapy (ADT) has shown beneficial effects in the treatment of advanced prostate cancer (PCa). Given that androgens are important for the homeostasis of different organs, the effects of ADT can affect body composition and therefore adipose tissue. Computed tomography (CT) and magnetic resonance imaging (MRI) are non-invasive methods that allow for quantification of the different fat compartments. In this review we describe the effects of ADT on abdominal adipose tissue in PCa patients.
Collapse
|
7
|
Wong C, Chu P, Teoh J, Chiu P, Yee CH, Chau L, Chan M, Wan H, Leung S, Ng CF. Risks of metabolic diseases and androgen deprivation therapy for prostate cancer in a Chinese population: a prospective multi-centre cohort study. Int Urol Nephrol 2022; 54:993-1000. [PMID: 35217907 DOI: 10.1007/s11255-022-03151-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 02/06/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Androgen deprivation therapy (ADT) use in prostate cancer (PCa) has seen a rising trend. We are looking into the relationship between ADT and development of metabolic diseases in Chinese patients. METHODS This is a prospective multi-centre cohort yielded from the READT database (Real-life experience of ADT in Asia), in which patients diagnosed of PCa and offered ADT were prospectively recruited since 2016. Chinese patients recruited from Hong Kong were selected and compared to another cohort of newly diagnosed PCa patients in Hong Kong (HK-Cap database), which was collected prospectively and retrieved retrospectively for this study. Patient outcomes are followed through for 2 years. We compared between the groups the new diagnoses of hypertension, diabetes and hyper-lipidaemia, as well as the initiation of related medication for these conditions. Baseline characteristics including pre-treatment comorbidities, medications and tumour characteristics are documented. RESULTS 151 patients receiving ADT (from READT database) and 447 patients not receiving ADT (from HK-Cap database) were analysed. ADT is related to higher risks of developing any of concerned medical co-morbidities (23.8% vs 13.0*, p = 0.001) and new-onset DM (16.6% vs 4.4%, p < 0.001). Initiation of new medications is also more common in ADT patients. New anti-hypertensives (37.8% vs 12.5%, p < 0.001), oral hypoglycemic agents (12.6% vs 4.9%, p = 0.001), insulin (4.0% vs 0.05%, p = 0.001) and statin (23.7% vs 12.8%, p = 0.023) are more commonly added in ADT cohort. CONCLUSION Chinese receiving ADT are exposed to increased risks of new-onset hypertension, diabetes and hyper-lipidaemia, and a higher likelihood of stepping up pharmaceutical control for pre-existing comorbidities. This highlights physicians' role to monitor metabolic profiles in at-risk men upon offering ADT.
Collapse
Affiliation(s)
- Chris Wong
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.,Division of Urology, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Peggy Chu
- Urology Division, Department of Surgery, Tuen Mun Hospital, Tuen Mun, Hong Kong, China.,Urology Division, Department of Surgery, Pok Oi Hospital, Yuen Long, Hong Kong, China
| | - Jeremy Teoh
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.,Division of Urology, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Peter Chiu
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.,Division of Urology, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - C H Yee
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.,Division of Urology, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Lysander Chau
- Urology Division, Department of Surgery, Tuen Mun Hospital, Tuen Mun, Hong Kong, China.,Urology Division, Department of Surgery, Pok Oi Hospital, Yuen Long, Hong Kong, China
| | - Marco Chan
- Urology Division, Department of Surgery, Tuen Mun Hospital, Tuen Mun, Hong Kong, China.,Urology Division, Department of Surgery, Pok Oi Hospital, Yuen Long, Hong Kong, China
| | - Helen Wan
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Steven Leung
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - C F Ng
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China. .,Division of Urology, Department of Surgery, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong, China. .,Division of Urology, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China. .,Division of Urology, Department of Surgery, North District Hospital, Sheung Shui, Hong Kong, China.
| |
Collapse
|
8
|
KIM JINSOO, WILSON REBEKAHL, TAAFFE DENNISR, GALVÃO DANIELA, GRAY ELIN, NEWTON ROBERTU. Myokine Expression and Tumor-Suppressive Effect of Serum after 12 wk of Exercise in Prostate Cancer Patients on ADT. Med Sci Sports Exerc 2022; 54:197-205. [PMID: 34559721 PMCID: PMC8754092 DOI: 10.1249/mss.0000000000002783] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Although several mechanisms have been proposed for the tumor-suppressive effect of exercise, little attention has been given to myokines, even though skeletal muscle is heavily recruited during exercise resulting in myokine surges. We measured resting serum myokine levels before and after an exercise-based intervention and the effect of this serum on prostate cancer cell growth. METHODS Ten prostate cancer patients undertaking androgen deprivation therapy (age, 73.3 ± 5.6 yr) undertook a 12-wk exercise-based intervention including supervised resistance training, self-directed aerobic exercise, and protein supplementation. Body composition was assessed by dual-energy x-ray absorptiometry and muscle strength by the one-repetition maximum method. Fasting blood was collected at baseline and postintervention, and serum levels of myokines-secreted protein acidic and rich in cysteine, oncostatin M (OSM), decorin, insulin-like growth factor-1, and insulin-like growth factor binding protein-3 (IGFBP-3)-were measured. The growth of the prostate cancer cell line DU145 with baseline and postintervention serum was measured. RESULTS Body weight (P = 0.011), fat mass (P = 0.012), and percent body fat (P = 0.033) were reduced, whereas percent lean mass (P = 0.001) increased, as did strength (leg press, P = 0.006; chest press, P = 0.020) across the intervention. Serum OSM levels (P = 0.020) and relative serum OSM levels (P = 0.020) increased compared with baseline. A significant reduction in DU145 Cell Index (P = 0.012) and growth rate (P = 0.012) was observed after applying postintervention serum compared with baseline serum. CONCLUSIONS This study provides evidence for enhanced myokine expression and tumor-suppressive effects of serum from chronically exercise-trained prostate cancer patients on androgen deprivation therapy.
Collapse
Affiliation(s)
- JIN-SOO KIM
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, AUSTRALIA
| | - REBEKAH L. WILSON
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, AUSTRALIA
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - DENNIS R. TAAFFE
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, AUSTRALIA
| | - DANIEL A. GALVÃO
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, AUSTRALIA
| | - ELIN GRAY
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, AUSTRALIA
- Centre of Precision Health, Edith Cowan University, Joondalup, WA, AUSTRALIA
| | - ROBERT U. NEWTON
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, AUSTRALIA
| |
Collapse
|
9
|
Sushentsev N, McLean MA, Warren AY, Benjamin AJV, Brodie C, Frary A, Gill AB, Jones J, Kaggie JD, Lamb BW, Locke MJ, Miller JL, Mills IG, Priest AN, Robb FJL, Shah N, Schulte RF, Graves MJ, Gnanapragasam VJ, Brindle KM, Barrett T, Gallagher FA. Hyperpolarised 13C-MRI identifies the emergence of a glycolytic cell population within intermediate-risk human prostate cancer. Nat Commun 2022; 13:466. [PMID: 35075123 PMCID: PMC8786834 DOI: 10.1038/s41467-022-28069-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 12/02/2021] [Indexed: 02/08/2023] Open
Abstract
Hyperpolarised magnetic resonance imaging (HP 13C-MRI) is an emerging clinical technique to detect [1-13C]lactate production in prostate cancer (PCa) following intravenous injection of hyperpolarised [1-13C]pyruvate. Here we differentiate clinically significant PCa from indolent disease in a low/intermediate-risk population by correlating [1-13C]lactate labelling on MRI with the percentage of Gleason pattern 4 (%GP4) disease. Using immunohistochemistry and spatial transcriptomics, we show that HP 13C-MRI predominantly measures metabolism in the epithelial compartment of the tumour, rather than the stroma. MRI-derived tumour [1-13C]lactate labelling correlated with epithelial mRNA expression of the enzyme lactate dehydrogenase (LDHA and LDHB combined), and the ratio of lactate transporter expression between the epithelial and stromal compartments (epithelium-to-stroma MCT4). We observe similar changes in MCT4, LDHA, and LDHB between tumours with primary Gleason patterns 3 and 4 in an independent TCGA cohort. Therefore, HP 13C-MRI can metabolically phenotype clinically significant disease based on underlying metabolic differences in the epithelial and stromal tumour compartments.
Collapse
Affiliation(s)
- Nikita Sushentsev
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Mary A McLean
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Anne Y Warren
- Department of Pathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Arnold J V Benjamin
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Cara Brodie
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Amy Frary
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Andrew B Gill
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Julia Jones
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Joshua D Kaggie
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Benjamin W Lamb
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- School of Allied Health, Anglia Ruskin University, Cambridge, UK
| | - Matthew J Locke
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Jodi L Miller
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Ian G Mills
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
- Centre for Cancer Biomarkers, University of Bergen, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Andrew N Priest
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | | | - Nimish Shah
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Martin J Graves
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Vincent J Gnanapragasam
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Division of Urology, Department of Surgery, University of Cambridge, Cambridge, UK
- Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
| | - Kevin M Brindle
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
- Department of Biochemistry, University of Cambridge, Cambridge, UK
| | - Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
| | - Ferdia A Gallagher
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| |
Collapse
|
10
|
Fidelito G, Watt MJ, Taylor RA. Personalized Medicine for Prostate Cancer: Is Targeting Metabolism a Reality? Front Oncol 2022; 11:778761. [PMID: 35127483 PMCID: PMC8813754 DOI: 10.3389/fonc.2021.778761] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/21/2021] [Indexed: 02/06/2023] Open
Abstract
Prostate cancer invokes major shifts in gene transcription and metabolic signaling to mediate alterations in nutrient acquisition and metabolic substrate selection when compared to normal tissues. Exploiting such metabolic reprogramming is proposed to enable the development of targeted therapies for prostate cancer, yet there are several challenges to overcome before this becomes a reality. Herein, we outline the role of several nutrients known to contribute to prostate tumorigenesis, including fatty acids, glucose, lactate and glutamine, and discuss the major factors contributing to variability in prostate cancer metabolism, including cellular heterogeneity, genetic drivers and mutations, as well as complexity in the tumor microenvironment. The review draws from original studies employing immortalized prostate cancer cells, as well as more complex experimental models, including animals and humans, that more accurately reflect the complexity of the in vivo tumor microenvironment. In synthesizing this information, we consider the feasibility and potential limitations of implementing metabolic therapies for prostate cancer management.
Collapse
Affiliation(s)
- Gio Fidelito
- Department of Anatomy & Physiology, The University of Melbourne, Melbourne, VIC, Australia
| | - Matthew J. Watt
- Department of Anatomy & Physiology, The University of Melbourne, Melbourne, VIC, Australia
- *Correspondence: Renea A. Taylor, ; Matthew J. Watt,
| | - Renea A. Taylor
- Department of Physiology, Biomedicine Discovery Institute, Cancer Program, Monash University, Melbourne, VIC, Australia
- Prostate Cancer Research Program, Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
- *Correspondence: Renea A. Taylor, ; Matthew J. Watt,
| |
Collapse
|
11
|
Haskins C, Cohen J, Kotecha R, Kaiser A. Low Carbohydrate Diets in Cancer Therapeutics: Current Evidence. Front Nutr 2021; 8:662952. [PMID: 34901101 PMCID: PMC8655114 DOI: 10.3389/fnut.2021.662952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 10/25/2021] [Indexed: 01/22/2023] Open
Abstract
Low carbohydrate diets have a promising mechanistic rationale in the treatment of cancer with favorable preclinical data. The strongest data suggest synergistic effects of dietary interventions with traditional cancer therapies. Recent prospective clinical trials suggest that low carbohydrate diets are safely and feasibly added within a busy oncology clinic, with hopeful additive effects in treatment enhancement.
Collapse
Affiliation(s)
- Christopher Haskins
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, United States
| | - Justin Cohen
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, United States
| | - Rupesh Kotecha
- Miami Cancer Institute, Baptist Health, Miami, FL, United States.,Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
| | - Adeel Kaiser
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, United States.,Miami Cancer Institute, Baptist Health, Miami, FL, United States.,Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
| |
Collapse
|
12
|
PCK1 regulates neuroendocrine differentiation in a positive feedback loop of LIF/ZBTB46 signalling in castration-resistant prostate cancer. Br J Cancer 2021; 126:778-790. [PMID: 34815524 DOI: 10.1038/s41416-021-01631-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/24/2021] [Accepted: 11/03/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Castration-resistant prostate cancer (CRPC) patients frequently develop neuroendocrine differentiation, with high mortality and no effective treatment. However, the regulatory mechanism that connects neuroendocrine differentiation and metabolic adaptation in response to therapeutic resistance of prostate cancer remain to be unravelled. METHODS By unbiased cross-correlation between RNA-sequencing, database signatures, and ChIP analysis, combining in vitro cell lines and in vivo animal models, we identified that PCK1 is a pivotal regulator in therapy-induced neuroendocrine differentiation of prostate cancer through a LIF/ZBTB46-driven glucose metabolism pathway. RESULTS Upregulation of PCK1 supports cell proliferation and reciprocally increases ZBTB46 levels to promote the expression of neuroendocrine markers that are conducive to the development of neuroendocrine characteristic CRPC. PCK1 and neuroendocrine marker expressions are regulated by the ZBTB46 transcription factor upon activation of LIF signalling. Targeting PCK1 can reduce the neuroendocrine phenotype and decrease the growth of prostate cancer cells in vitro and in vivo. CONCLUSION Our study uncovers LIF/ZBTB46 signalling activation as a key mechanism for upregulating PCK1-driven glucose metabolism and neuroendocrine differentiation of CRPC, which may yield significant improvements in prostate cancer treatment after ADT using PCK1 inhibitors.
Collapse
|
13
|
Caffo O, Messina M, Veccia A, Kinspergher S, Maines F, Messina C. Severe acute respiratory syndrome coronavirus 2 infection in patients with prostate cancer: A critical review. Crit Rev Oncol Hematol 2021; 167:103491. [PMID: 34626792 PMCID: PMC8492888 DOI: 10.1016/j.critrevonc.2021.103491] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 12/27/2022] Open
Abstract
Real-world data suggest a possible interplay between androgen deprivation therapy (ADT) and susceptibility to and the severity of SARS-CoV-2 infection. As ADT is the backbone of prostate cancer treatment, various authors have evaluated different patient cohorts but the evidence provided is conflicting. The aim of this review is to assess the available publications concerning the role of ADT in preventing or reducing the severity of SARS-CoV-2 infection. After a literature search we identified four full papers, five letters, and four meeting abstracts, but these used different search methods and the quality of the evidence varied. They frequently had different endpoints, did not report the status of the prostate cancer patients and evaluated heterogeneous populations. The available data do not support the view that ADT protects against SARS-CoV-2 infection. Larger and more precise studies are warranted, considering variables that affect infection outcomes as these significantly influence the reliability of the findings.
Collapse
Affiliation(s)
- Orazio Caffo
- Medical OncologyDepartments of Santa Chiara Hospital, Trento, Italy,Corresponding author at: Department of Medical Oncology, Santa Chiara Hospital, Largo Medaglie d’Oro 9, Trento, 38122, Italy
| | - Marco Messina
- Medical Oncology Departments of Civic Hospital, Palermo, Italy
| | - Antonello Veccia
- Medical OncologyDepartments of Santa Chiara Hospital, Trento, Italy
| | | | - Francesca Maines
- Medical OncologyDepartments of Santa Chiara Hospital, Trento, Italy
| | - Carlo Messina
- Medical Oncology Departments of Civic Hospital, Palermo, Italy
| |
Collapse
|
14
|
Serrano Domingo JJ, Alonso Gordoa T, Lorca Álvaro J, Molina-Cerrillo J, Barquín García A, Martínez Sáez O, Burgos Revilla J, Carrato A, Álvarez Rodríguez S. The effect of medical and urologic disorders on the survival of patients with metastatic castration resistant prostate cancer treated with abiraterone or enzalutamide. Ther Adv Urol 2021; 13:17562872211043341. [PMID: 34552666 PMCID: PMC8451255 DOI: 10.1177/17562872211043341] [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] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/15/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction: Androgenic deprivation therapies have been linked to the development of metabolic syndrome (MS) and cardiovascular diseases, which may lead to a poorer survival in patients with metastatic Castration-Resistant Prostate Cancer (mCRPC). We aimed to analyze whether some cardiovascular or neurological disorders, together with other medical and urological complications, may have an effect on survival outcomes, at baseline and during treatment from patients treated with androgen pathway inhibitors (API). Material and Methods: A retrospective study of a consecutive series of patients diagnosed with mCRPC between 2010 and 2018 treated with API in the first line setting in a single center. Results: Seventy-three patients met the inclusion criteria. Baseline prognostic factors associated with worse survival were diabetes mellitus (DM) with insulin needs compared to patients without DM [hazard ratio (HR) = 0.19, p = 0.025], hypertension (HTN) (HR = 0.46, p = 0.035), and a history of stroke (HR = 0.16, p < 0.001). However, previous history of hypercholesterolemia, arrythmias, and cognitive disorders did not result in a significant worsening on survival. During treatment, patients who developed de novo HTN had the best progression free survival (PFS) (HR = 0.38, p = 0.048) and overall survival (OS) (HR 0.08, p = 0.012) compared with patients with previous HTN. Other factors related to worse outcomes included the presence of heart failure (HR = 0.31, p = 0.001), the requirement for major opioids for pain relief (HR = 0.33, p = 0.023), and the presence of bilateral ureterohydronephrosis (HR = 0.12, p = 0.008). Conclusions: Some comorbidities may be strongly involved in patient outcomes when receiving API for mCRPC. In this sense, collaborative networking between specialists and caregivers treating prostate cancer (PC) patients should be recommended, focusing on MS features, cardiovascular and neurological disorders in order to anticipate medical and surgical complications.
Collapse
Affiliation(s)
| | - Teresa Alonso Gordoa
- Medical Oncology Department, University Hospital Ramon y Cajal, Ctra. Colmenar km9100, Madrid, 28034, Spain
| | | | | | - Arantzazu Barquín García
- Medical Oncology Department, Centro Integral Oncológico Clara Campal, Hospitales Madrid, Madrid, Spain
| | - Olga Martínez Sáez
- Medical Oncology Department, Hospital Clinic I Provincial, Barcelona, Spain
| | | | - Alfredo Carrato
- Medical Oncology Department, University Hospital Ramon y Cajal, Madrid, Spain
| | | |
Collapse
|
15
|
Schmidt DR, Patel R, Kirsch DG, Lewis CA, Vander Heiden MG, Locasale JW. Metabolomics in cancer research and emerging applications in clinical oncology. CA Cancer J Clin 2021; 71:333-358. [PMID: 33982817 PMCID: PMC8298088 DOI: 10.3322/caac.21670] [Citation(s) in RCA: 304] [Impact Index Per Article: 101.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/07/2021] [Accepted: 03/09/2021] [Indexed: 12/12/2022] Open
Abstract
Cancer has myriad effects on metabolism that include both rewiring of intracellular metabolism to enable cancer cells to proliferate inappropriately and adapt to the tumor microenvironment, and changes in normal tissue metabolism. With the recognition that fluorodeoxyglucose-positron emission tomography imaging is an important tool for the management of many cancers, other metabolites in biological samples have been in the spotlight for cancer diagnosis, monitoring, and therapy. Metabolomics is the global analysis of small molecule metabolites that like other -omics technologies can provide critical information about the cancer state that are otherwise not apparent. Here, the authors review how cancer and cancer therapies interact with metabolism at the cellular and systemic levels. An overview of metabolomics is provided with a focus on currently available technologies and how they have been applied in the clinical and translational research setting. The authors also discuss how metabolomics could be further leveraged in the future to improve the management of patients with cancer.
Collapse
Affiliation(s)
- Daniel R. Schmidt
- Koch Institute, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Rutulkumar Patel
- Department of Radiation Oncology, Duke University School of Medicine, Durham, NC 27708 USA
| | - David G. Kirsch
- Department of Radiation Oncology, Duke University School of Medicine, Durham, NC 27708 USA
- Department of Pharmacology and Cancer Biology, Duke University, Durham, NC 27708 USA
| | - Caroline A. Lewis
- Whitehead Institute for Biomedical Research, Cambridge, MA 02142, USA
| | - Matthew G. Vander Heiden
- Koch Institute, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Jason W. Locasale
- Department of Pharmacology and Cancer Biology, Duke University, Durham, NC 27708 USA
| |
Collapse
|
16
|
Sattar S, Haase KR, Bradley C, Papadopoulos E, Kuster S, Santa Mina D, Tippe M, Kaur A, Campbell D, Joshua AM, Rediger C, Souied O, Alibhai S. Barriers and facilitators related to undertaking physical activities among men with prostate cancer: a scoping review. Prostate Cancer Prostatic Dis 2021; 24:1007-1027. [PMID: 34108646 DOI: 10.1038/s41391-021-00399-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/30/2021] [Accepted: 05/19/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Prostate cancer (PC) and its treatments lead to significant acute, chronic, or latent adverse effects that result in declines in patients' physical functions, quality of life and reduced sense of masculinities. Robust evidence shows that physical activity (PA) can improve many health outcomes in men with PC; however, less is known about the facilitators, preferences, and barriers to PA engagement in this population. The purpose of this scoping review is to document the nature and extent of literature related to these aspects of PA participation among men with PC. METHODS We conducted a scoping review of PA among men with PC. Databases searched included Medline, CINAHL, Embase, Rehabilitation & Sports Medicine Source, and SportDiscus from inception to June 30, 2020. Multiple reviewers were used in all screening and data abstractions. RESULTS The search yielded 2788 individual citations after duplicates were removed. Following title and abstract screening, 129 underwent full-text review, and 46 articles were included. Quantitative data related to our research question showed that structured group exercise was the most commonly reported facilitator/preference among men with PC, whereas treatment-related effects and lack of time are the most common barriers. In terms of qualitative data, the most prominent theme noted related to masculinities and gender-specific needs within the context of having PC. CONCLUSION Men with PC have unique facilitators and barriers concerning PA. More work is needed from the research and clinical practice perspectives to enable this population to engage and remain in regular PA.
Collapse
Affiliation(s)
- S Sattar
- College of Nursing, University of Saskatchewan, Regina, SK, Canada.
| | - K R Haase
- Faculty of Applied Science, School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - C Bradley
- Library, University of Regina, Regina, SK, Canada
| | - E Papadopoulos
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - S Kuster
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, SK, Canada
| | - D Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada
| | - M Tippe
- Patient consultant, Toronto, ON, Canada
| | - A Kaur
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada
| | - D Campbell
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada
| | - A M Joshua
- Department of Medical Oncology, Kinghorn Cancer Centre; Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - C Rediger
- Saskatchewan Health Authority, Regina, SK, Canada
| | - O Souied
- Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - S Alibhai
- University Health Network, Toronto, ON, Canada.,Department of Medicine, Institute of Health Policy, Management, and Evaluation, Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
17
|
Knura M, Garczorz W, Borek A, Drzymała F, Rachwał K, George K, Francuz T. The Influence of Anti-Diabetic Drugs on Prostate Cancer. Cancers (Basel) 2021; 13:cancers13081827. [PMID: 33921222 PMCID: PMC8068793 DOI: 10.3390/cancers13081827] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/27/2021] [Accepted: 04/08/2021] [Indexed: 12/13/2022] Open
Abstract
The incidences of prostate cancer (PC) and diabetes are increasing, with a sustained trend. The occurrence of PC and type 2 diabetes mellitus (T2DM) is growing with aging. The correlation between PC occurrence and diabetes is noteworthy, as T2DM is correlated with a reduced risk of incidence of prostate cancer. Despite this reduction, diabetes mellitus increases the mortality in many cancer types, including prostate cancer. The treatment of T2DM is based on lifestyle changes and pharmacological management. Current available drugs, except insulin, are aimed at increasing insulin secretion (sulfonylureas, incretin drugs), improving insulin sensitivity (biguanides, thiazolidinediones), or increasing urinary glucose excretion (gliflozin). Comorbidities should be taken into consideration during the treatment of T2DM. This review describes currently known information about the mechanism and impact of commonly used antidiabetic drugs on the incidence and progression of PC. Outcomes of pre-clinical studies are briefly presented and their correlations with available clinical trials have also been observed. Available reports and meta-analyses demonstrate that most anti-diabetic drugs do not increase the risk during the treatment of patients with PC. However, some reports show a potential advantage of treatment of T2DM with specific drugs. Based on clinical reports, use of metformin should be considered as a therapeutic option. Moreover, anticancer properties of metformin were augmented while combined with GLP-1 analogs.
Collapse
|
18
|
Siltari A, Auvinen A, Murtola TJ. Pharmacoepidemiological Evaluation in Prostate Cancer-Common Pitfalls and How to Avoid Them. Cancers (Basel) 2021; 13:cancers13040696. [PMID: 33572236 PMCID: PMC7914977 DOI: 10.3390/cancers13040696] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/28/2021] [Accepted: 02/05/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Pharmacoepidemiologic research provides opportunities to evaluate how commonly used drug groups, such as cholesterol-lowering drugs, may affect the prostate cancer risk or mortality. However, such studies need to be carefully designed in order to avoid biases caused by systematic differences between medication users and non-users. Similarly, data must be carefully analyzed and interpreted while acknowledging possible biases that can lead to erroneous conclusions. Here, we review common pitfalls in such studies and describe ways to avoid them in an effort to aid future research. Abstract Pharmacoepidemiologic research provides opportunities to evaluate how commonly used drug groups, such as cholesterol-lowering or antidiabetic drugs, may affect the prostate cancer risk or mortality. This type of research is valuable in estimating real-life drug effects. Nonetheless, pharmacoepidemiological studies are prone to multiple sources of bias that mainly arise from systematic differences between medication users and non-users. If these are not appreciated and properly controlled for, there is a risk of obtaining biased results and reaching erroneous conclusions. Therefore, in order to improve the quality of future research, we describe common biases in pharmacoepidemiological studies, particularly in the context of prostate cancer research. We also list common ways to mitigate these biases and to estimate causality between medication use and cancer outcomes.
Collapse
Affiliation(s)
- Aino Siltari
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland;
- Department of Pharmacology, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
| | - Anssi Auvinen
- Faculty of Social Sciences, Tampere University, 33014 Tampere, Finland;
| | - Teemu J. Murtola
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland;
- Department of Urology, TAYS Cancer Center, 33520 Tampere, Finland
- Correspondence:
| |
Collapse
|
19
|
Cannarella R, Condorelli RA, Barbagallo F, La Vignera S, Calogero AE. Endocrinology of the Aging Prostate: Current Concepts. Front Endocrinol (Lausanne) 2021; 12:554078. [PMID: 33692752 PMCID: PMC7939072 DOI: 10.3389/fendo.2021.554078] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 01/05/2021] [Indexed: 12/11/2022] Open
Abstract
Benign prostate hyperplasia (BPH), one of the most common diseases in older men, adversely affects quality-of-life due to the presence of low urinary tract symptoms (LUTS). Numerous data support the presence of an association between BPH-related LUTS (BPH-LUTS) and metabolic syndrome (MetS). Whether hormonal changes occurring in MetS play a role in the pathogenesis of BPH-LUTS is a debated issue. Therefore, this article aimed to systematically review the impact of hormonal changes that occur during aging on the prostate, including the role of sex hormones, insulin-like growth factor 1, thyroid hormones, and insulin. The possible explanatory mechanisms of the association between BPH-LUTS and MetS are also discussed. In particular, the presence of a male polycystic ovarian syndrome (PCOS)-equivalent may represent a possible hypothesis to support this link. Male PCOS-equivalent has been defined as an endocrine syndrome with a metabolic background, which predisposes to the development of type II diabetes mellitus, cardiovascular diseases, prostate cancer, BPH and prostatitis in old age. Its early identification would help prevent the onset of these long-term complications.
Collapse
|
20
|
Wilk M, Waśko-Grabowska A, Szmit S. Cardiovascular Complications of Prostate Cancer Treatment. Front Pharmacol 2020; 11:555475. [PMID: 33414715 PMCID: PMC7783464 DOI: 10.3389/fphar.2020.555475] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 10/15/2020] [Indexed: 12/18/2022] Open
Abstract
Treatment of prostate cancer (PC) is a rapidly evolving field of pharmacology research. In recent years, numerous novel therapeutics that improve survival and ameliorate disease control have been approved. Currently, the systemic treatment for prostate neoplasm consists of hormonal therapy, chemotherapy, immunotherapy, radiopharmaceuticals, targeted therapy, and supportive agents (e.g., related to bone health). Unfortunately, many of them carry a risk of cardiovascular complications, which occasionally pose a higher mortality threat than cancer itself. This article provides a unique and comprehensive overview of the prevalence and possible mechanisms of cardiovascular toxicities of all PC therapies, including state-of-the-art antineoplastic agents. Additionally, this article summarizes available recommendations regarding screening and prevention of the most common cardiac complications among patients with advanced cancer disease.
Collapse
Affiliation(s)
- Michał Wilk
- Department of Clinical Oncology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
| | - Anna Waśko-Grabowska
- Department of Clinical Oncology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
| | - Sebastian Szmit
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
| |
Collapse
|
21
|
Cornford P, van den Bergh RCN, Briers E, Van den Broeck T, Cumberbatch MG, De Santis M, Fanti S, Fossati N, Gandaglia G, Gillessen S, Grivas N, Grummet J, Henry AM, der Kwast THV, Lam TB, Lardas M, Liew M, Mason MD, Moris L, Oprea-Lager DE, der Poel HGV, Rouvière O, Schoots IG, Tilki D, Wiegel T, Willemse PPM, Mottet N. EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer. Part II-2020 Update: Treatment of Relapsing and Metastatic Prostate Cancer. Eur Urol 2020; 79:263-282. [PMID: 33039206 DOI: 10.1016/j.eururo.2020.09.046] [Citation(s) in RCA: 618] [Impact Index Per Article: 154.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 09/24/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To present a summary of the 2020 version of the European Association of Urology (EAU)-European Association of Nuclear Medicine (EANM)-European Society for Radiotherapy & Oncology (ESTRO)-European Society of Urogenital Radiology (ESUR)-International Society of Geriatric Oncology (SIOG) guidelines on the treatment of relapsing, metastatic, and castration-resistant prostate cancer (CRPC). EVIDENCE ACQUISITION The working panel performed a literature review of the new data (2016-2019). The guidelines were updated, and the levels of evidence and/or grades of recommendation were added based on a systematic review of the literature. EVIDENCE SYNTHESIS Prostate-specific membrane antigen positron emission tomography computed tomography scanning has developed an increasingly important role in men with biochemical recurrence after local therapy. Early salvage radiotherapy after radical prostatectomy appears as effective as adjuvant radiotherapy and, in a subset of patients, should be combined with androgen deprivation. New treatments have become available for men with metastatic hormone-sensitive prostate cancer (PCa), nonmetastatic CRPC, and metastatic CRPC, along with a role for local radiotherapy in men with low-volume metastatic hormone-sensitive PCa. Also included is information on quality of life outcomes in men with PCa. CONCLUSIONS The knowledge in the field of advanced and metastatic PCa and CRPC is changing rapidly. The 2020 EAU-EANM-ESTRO-ESUR-SIOG guidelines on PCa summarise the most recent findings and advice for use in clinical practice. These PCa guidelines are first endorsed by the EANM and reflect the multidisciplinary nature of PCa management. A full version is available from the EAU office or online (http://uroweb.org/guideline/prostate-cancer/). PATIENT SUMMARY This article summarises the guidelines for the treatment of relapsing, metastatic, and castration-resistant prostate cancer. These guidelines are evidence based and guide the clinician in the discussion with the patient on the treatment decisions to be taken. These guidelines are updated every year; this summary spans the 2017-2020 period of new evidence.
Collapse
Affiliation(s)
- Philip Cornford
- Department of Urology, Liverpool University Hospitals NHS Trust, Liverpool, UK.
| | | | | | | | | | - Maria De Santis
- Department of Urology, Charité Universitätsmedizin, Berlin, Germany; Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Stefano Fanti
- Department of Nuclear Medicine, Policlinico S. Orsola, University of Bologna, Italy
| | - Nicola Fossati
- Unit of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giorgio Gandaglia
- Unit of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Silke Gillessen
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Università della Svizzera Italiana, Lugano, Switzerland; University of Bern, Bern, Switzerland; Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Nikolaos Grivas
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jeremy Grummet
- Department of Surgery, Central Clinical School, Monash University, Caulfield North, Victoria, Australia
| | - Ann M Henry
- Leeds Cancer Centre, St. James's University Hospital and University of Leeds, Leeds, UK
| | | | - Thomas B Lam
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Michael Lardas
- Department of Urology, Metropolitan General Hospital, Athens, Greece
| | - Matthew Liew
- Department of Urology, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Malcolm D Mason
- Division of Cancer & Genetics, School of Medicine Cardiff University, Velindre Cancer Centre, Cardiff, UK
| | - Lisa Moris
- Department of Urology, University Hospitals Leuven, Leuven, Belgium; Laboratory of Molecular Endocrinology, KU Leuven, Leuven, Belgium
| | - Daniela E Oprea-Lager
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands
| | - Henk G van der Poel
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Olivier Rouvière
- Hospices Civils de Lyon, Department of Urinary and Vascular Imaging, Hôpital Edouard Herriot, Lyon, France; Faculté de Médecine Lyon Est, Université de Lyon, Université Lyon 1, Lyon, France
| | - Ivo G Schoots
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | - Peter-Paul M Willemse
- Department of Urology, Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nicolas Mottet
- Department of Urology, University Hospital, St. Etienne, France
| |
Collapse
|
22
|
Kenk M, Grégoire JC, Coté MA, Connelly KA, Davis MK, Dresser G, Ghosh N, Goodman S, Johnson C, Fleshner N. Optimizing screening and management of cardiovascular health in prostate cancer: A review. Can Urol Assoc J 2020; 14:E458-E464. [PMID: 32569573 DOI: 10.5489/cuaj.6685] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
In clinical practice, cancer management does not consistently encompass screening and identification of cardiovascular (CV) risk. The use of androgen deprivation therapy (ADT) in prostate cancer has been associated with increased CV risk and development of metabolic syndrome, necessitating identification of patients at risk in this population (e.g., those with pre-existing CV disease). A multidisciplinary team of Canadian physicians was assembled to develop a series of recommendations intended to identify patients who may benefit from optimal management of their CV disease and/or modification of cardiac risk factors. A key goal was the development of a simple screening tool for identification of patients with pre-existing CV disease. This simple and inclusive set of recommendations are intended for use within urology clinics to facilitate holistic approaches and simplify the management of patients.
Collapse
Affiliation(s)
- Miran Kenk
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Marc-Andre Coté
- Centre hospitalier universitaire de Quebec, Québec City, QC, Canada
| | - Kim A Connelly
- St. Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, ON, Canada
| | - Margot K Davis
- University of British Columbia Diamond Health Care Center, Vancouver, BC, Canada
| | - George Dresser
- Division of Clinical Pharmacology, Department of Medicine, Western University, London, ON, Canada
| | - Nina Ghosh
- Queensway Carleton Hospital, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Shaun Goodman
- Division of Cardiology, St. Michael's Hospital, Toronto, ON, Canada
| | | | - Neil Fleshner
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| |
Collapse
|
23
|
Lam T, Birzniece V, McLean M, Gurney H, Hayden A, Cheema BS. The Adverse Effects of Androgen Deprivation Therapy in Prostate Cancer and the Benefits and Potential Anti-oncogenic Mechanisms of Progressive Resistance Training. SPORTS MEDICINE-OPEN 2020; 6:13. [PMID: 32056047 PMCID: PMC7018888 DOI: 10.1186/s40798-020-0242-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 02/05/2020] [Indexed: 12/25/2022]
Abstract
Prostate cancer has the second highest incidence of all cancers amongst men worldwide. Androgen deprivation therapy (ADT) remains a common form of treatment. However, in reducing serum testosterone to castrate levels and rendering men hypogonadal, ADT contributes to a myriad of adverse effects which can affect prostate cancer prognosis. Physical activity is currently recommended as synergistic medicine in prostate cancer patients to alleviate the adverse effects of treatment. Progressive resistance training (PRT) is an anabolic exercise modality which may be of benefit in prostate cancer patients given its potency in maintaining and positively adapting skeletal muscle. However, currently, there is a scarcity of RCTs which have evaluated the use of isolated PRT in counteracting the adverse effects of prostate cancer treatment. Moreover, although physical activity in general has been found to reduce relapse rates and improve survival in prostate cancer, the precise anti-oncogenic effects of specific exercise modalities, including PRT, have not been fully established. Thus, the overall objective of this article is to provide a rationale for the in-depth investigation of PRT and its biological effects in men with prostate cancer on ADT. This will be achieved by (1) summarising the metabolic effects of ADT in patients with prostate cancer and its effect on prostate cancer progression and prognosis, (2) reviewing the existing evidence regarding the metabolic benefits of PRT in this cohort, (3) exploring the possible oncological pathways by which PRT can affect prostate cancer prognosis and progression and (4) outlining avenues for future research.
Collapse
Affiliation(s)
- Teresa Lam
- School of Medicine, Western Sydney University, Penrith, NSW, Australia. .,Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, NSW, Australia. .,Department of Diabetes and Endocrinology, Blacktown Hospital, Blacktown, NSW, Australia.
| | - Vita Birzniece
- School of Medicine, Western Sydney University, Penrith, NSW, Australia.,Department of Diabetes and Endocrinology, Blacktown Hospital, Blacktown, NSW, Australia.,School of Medicine, UNSW Sydney, Sydney, NSW, Australia.,Garvan Institute of Medical Research, Darlinghurst, NSW, Australia.,Translational Health Research Institute, Penrith, NSW, Australia
| | - Mark McLean
- School of Medicine, Western Sydney University, Penrith, NSW, Australia.,Department of Diabetes and Endocrinology, Blacktown Hospital, Blacktown, NSW, Australia
| | - Howard Gurney
- Crown Princess Mary Cancer Centre, Westmead, NSW, Australia
| | - Amy Hayden
- Crown Princess Mary Cancer Centre, Westmead, NSW, Australia.,Department of Radiation Oncology, Blacktown Hospital, Blacktown, NSW, Australia
| | - Birinder S Cheema
- School of Science and Health, Western Sydney University, Penrith, NSW, Australia
| |
Collapse
|
24
|
Gupta D, Lee Chuy K, Yang JC, Bates M, Lombardo M, Steingart RM. Cardiovascular and Metabolic Effects of Androgen-Deprivation Therapy for Prostate Cancer. J Oncol Pract 2019; 14:580-587. [PMID: 30312560 DOI: 10.1200/jop.18.00178] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Androgen-deprivation therapy (ADT) entails lowering serum testosterone levels to castrate levels and forms a cornerstone of the management of hormone-sensitive advanced prostate cancer; however, the benefit of ADT is partially offset by its detrimental metabolic and cardiovascular adverse effects. ADT decreases insulin sensitivity while promoting dyslipidemia and sarcopenic obesity, which leads to an increased risk of cardiovascular morbidity and potentially mortality. The risk seems to be highest in elderly patients who have had recent cardiovascular events before starting ADT. It is prudent to engage in an individualized risk-benefit discussion and develop a cohesive multidisciplinary management plan to medically optimize and closely observe these patients before and during treatment with ADT.
Collapse
Affiliation(s)
- Dipti Gupta
- Memorial Sloan Kettering Cancer Center; Weill Cornell Medical College; and New York-Presbyterian Hospital, New York, NY
| | - Katherine Lee Chuy
- Memorial Sloan Kettering Cancer Center; Weill Cornell Medical College; and New York-Presbyterian Hospital, New York, NY
| | - Ji Can Yang
- Memorial Sloan Kettering Cancer Center; Weill Cornell Medical College; and New York-Presbyterian Hospital, New York, NY
| | - Megan Bates
- Memorial Sloan Kettering Cancer Center; Weill Cornell Medical College; and New York-Presbyterian Hospital, New York, NY
| | - Marissa Lombardo
- Memorial Sloan Kettering Cancer Center; Weill Cornell Medical College; and New York-Presbyterian Hospital, New York, NY
| | - Richard M Steingart
- Memorial Sloan Kettering Cancer Center; Weill Cornell Medical College; and New York-Presbyterian Hospital, New York, NY
| |
Collapse
|
25
|
Kaiser A, Haskins C, Siddiqui MM, Hussain A, D’Adamo C. The evolving role of diet in prostate cancer risk and progression. Curr Opin Oncol 2019; 31:222-229. [PMID: 30893147 PMCID: PMC7379157 DOI: 10.1097/cco.0000000000000519] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW This overview examines the rationale for dietary interventions for prostate cancer by summarizing the current evidence base and biological mechanisms for the involvement of diet in disease incidence and progression. RECENT FINDINGS Recent data have further solidified the association between insulin resistance and prostate cancer with the homeostatic model assessment of insulin resistance. Data also show that periprostatic adipocytes promote extracapsular extension of prostate cancer through chemokines, thereby providing a mechanistic explanation for the association observed between obesity and high-grade cancer. Regarding therapeutics, hyperinsulinemia may be the cause of resistance to phosphatidylinositol-3 kinase inhibitors in the treatment of prostate cancer, leading to new investigations combining these drugs with ketogenic diets. SUMMARY Given the recently available data regarding insulin resistance and adipokine influence on prostate cancer, dietary strategies targeting metabolic syndrome, diabetes, and obesity should be further explored. In macronutrient-focused therapies, low carbohydrate/ketogenic diets should be favored in such interventions because of their superior impact on weight loss and metabolic parameters and encouraging clinical data. Micronutrients, including the carotenoid lycopene which is found in highest concentrations in tomatoes, may also play a role in prostate cancer prevention and prognosis through complementary metabolic mechanisms. The interplay between genetics, diet, and prostate cancer is an area of emerging focus that might help optimize therapeutic dietary response in the future through personalization.
Collapse
Affiliation(s)
- Adeel Kaiser
- Department of Radiation Oncology, Univ. of Maryland School of Medicine, Baltimore, MD USA
| | - Christopher Haskins
- Department of Radiation Oncology, Univ. of Maryland School of Medicine, Baltimore, MD USA
| | - Mohummad M. Siddiqui
- Division of of Urology, Department of Surgery, Univ. of Maryland School of Medicine, Baltimore, MD USA
- Baltimore Veterans Affairs Medical Center, Baltimore, MD USA
| | - Arif Hussain
- Department of Medicine and University of Maryland Greenebaum Comprehensive Cancer Center, Univ. of Maryland School of Medicine, Baltimore, MD USA
- Baltimore Veterans Affairs Medical Center, Baltimore, MD USA
| | - Christopher D’Adamo
- Department of Family and Community Medicine, Univ. of Maryland School of Medicine, Baltimore, MD USA
| |
Collapse
|
26
|
Mangiola S, Stuchbery R, McCoy P, Chow K, Kurganovs N, Kerger M, Papenfuss A, Hovens CM, Corcoran NM. Androgen deprivation therapy promotes an obesity-like microenvironment in periprostatic fat. Endocr Connect 2019; 8:547-558. [PMID: 30959474 PMCID: PMC6499921 DOI: 10.1530/ec-19-0029] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 04/04/2019] [Indexed: 12/18/2022]
Abstract
Prostate cancer is a leading cause of morbidity and cancer-related death worldwide. Androgen deprivation therapy (ADT) is the cornerstone of management for advanced disease. The use of these therapies is associated with multiple side effects, including metabolic syndrome and truncal obesity. At the same time, obesity has been associated with both prostate cancer development and disease progression, linked to its effects on chronic inflammation at a tissue level. The connection between ADT, obesity, inflammation and prostate cancer progression is well established in clinical settings; however, an understanding of the changes in adipose tissue at the molecular level induced by castration therapies is missing. Here, we investigated the transcriptional changes in periprostatic fat tissue induced by profound ADT in a group of patients with high-risk tumours compared to a matching untreated cohort. We find that the deprivation of androgen is associated with a pro-inflammatory and obesity-like adipose tissue microenvironment. This study suggests that the beneficial effect of therapies based on androgen deprivation may be partially counteracted by metabolic and inflammatory side effects in the adipose tissue surrounding the prostate.
Collapse
Affiliation(s)
- Stefano Mangiola
- Bioinformatics Division, Walter and Eliza Hall Institute, Parkville, Victoria, Australia
- Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia
- Department of Urology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Ryan Stuchbery
- Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia
| | - Patrick McCoy
- Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia
- Department of Urology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Ken Chow
- Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia
- Department of Urology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Natalie Kurganovs
- Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia
- Australian Prostate Cancer Research Centre Epworth, Richmond, Victoria, Australia
- Ontario Institute for Cancer Research, Toronto, Canada
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Michael Kerger
- Australian Prostate Cancer Research Centre Epworth, Richmond, Victoria, Australia
| | - Anthony Papenfuss
- Bioinformatics Division, Walter and Eliza Hall Institute, Parkville, Victoria, Australia
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
- Department of Mathematics and Statistics, University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher M Hovens
- Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia
- Department of Urology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Niall M Corcoran
- Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia
- Department of Urology, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Urology, Frankston Hospital, Frankston, Victoria, Australia
| |
Collapse
|
27
|
Xu W, Morford J, Mauvais-Jarvis F. Emerging role of testosterone in pancreatic β-cell function and insulin secretion. J Endocrinol 2019; 240:JOE-18-0573.R1. [PMID: 30601759 PMCID: PMC6602868 DOI: 10.1530/joe-18-0573] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 12/24/2018] [Indexed: 12/16/2022]
Abstract
One of the most sexually dimorphic aspects of metabolic regulation is the bidirectional modulation of glucose homeostasis by testosterone in male and females. Severe testosterone deficiency predisposes men to type 2 diabetes (T2D), while in contrast, androgen excess predisposes women to hyperglycemia. The role of androgen deficiency and excess in promoting visceral obesity and insulin resistance in men and women respectively is well established. However, although it is established that hyperglycemia requires β cell dysfunction to develop, the role of testosterone in β cell function is less understood. This review discusses recent evidence that the androgen receptor (AR) is present in male and female β cells. In males, testosterone action on AR in β cells enhances glucose-stimulated insulin secretion by potentiating the insulinotropic action of glucagon-like peptide-1. In females, excess testosterone action via AR in β cells promotes insulin hypersecretion leading to oxidative injury, which in turn predisposes to T2D.
Collapse
Affiliation(s)
- Weiwei Xu
- W Xu, Division of Endocrinology and Metabolism, Tulane University, New Orleans, United States
| | - Jamie Morford
- J Morford, Division of Endocrinology and Metabolism, Tulane University, New Orleans, United States
| | - Franck Mauvais-Jarvis
- F Mauvais-Jarvis, Division of Endocrinology and Metabolism, Tulane University, New Orleans, United States
| |
Collapse
|
28
|
Sarkar PL, Lee W, Williams ED, Lubik AA, Stylianou N, Shokoohmand A, Lehman ML, Hollier BG, Gunter JH, Nelson CC. Insulin Enhances Migration and Invasion in Prostate Cancer Cells by Up-Regulation of FOXC2. Front Endocrinol (Lausanne) 2019; 10:481. [PMID: 31379747 PMCID: PMC6652804 DOI: 10.3389/fendo.2019.00481] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 07/03/2019] [Indexed: 12/28/2022] Open
Abstract
Androgen deprivation therapy (ADT) is the standard treatment for advanced prostate cancer (PCa), yet many patients relapse with lethal metastatic disease. With this loss of androgens, increased cell plasticity has been observed as an adaptive response to ADT. This includes gain of invasive and migratory capabilities, which may contribute to PCa metastasis. Hyperinsulinemia, which develops as a side-effect of ADT, has been associated with increased tumor aggressiveness and faster treatment failure. We investigated the direct effects of insulin in PCa cells that may contribute to this progression. We measured cell migration and invasion induced by insulin using wound healing and transwell assays in a range of PCa cell lines of variable androgen dependency (LNCaP, 22RV1, DuCaP, and DU145 cell lines). To determine the molecular events driving insulin-induced invasion we used transcriptomics, quantitative real time-PCR, and immunoblotting in three PCa cell lines. Insulin increased invasiveness of PCa cells, upregulating Forkhead Box Protein C2 (FOXC2), and activating key PCa cell plasticity mechanisms including gene changes consistent with epithelial-to-mesenchymal transition (EMT) and a neuroendocrine phenotype. Additionally, analysis of publicly available clinical PCa tumor data showed metastatic prostate tumors demonstrate a positive correlation between insulin receptor expression and the EMT transcription factor FOXC2. The insulin receptor is not suitable to target clinically however, our data shows that actions of insulin in PCa cells may be suppressed by inhibiting downstream signaling molecules, PI3K and ERK1/2. This study identifies for the first time, a mechanism for insulin-driven cancer cell motility and supports the concept that targeting insulin signaling at the level of the PCa tumor may extend the therapeutic efficacy of ADT.
Collapse
Affiliation(s)
- Phoebe L. Sarkar
- Queensland University of Technology (QUT), Australian Prostate Cancer Research Centre-Queensland, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Faculty of Health, Translational Research Institute, Brisbane, QLD, Australia
| | - Wendy Lee
- Queensland University of Technology (QUT), Australian Prostate Cancer Research Centre-Queensland, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Faculty of Health, Translational Research Institute, Brisbane, QLD, Australia
| | - Elizabeth D. Williams
- Queensland University of Technology (QUT), Australian Prostate Cancer Research Centre-Queensland, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Faculty of Health, Translational Research Institute, Brisbane, QLD, Australia
| | - Amy A. Lubik
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Nataly Stylianou
- Queensland University of Technology (QUT), Australian Prostate Cancer Research Centre-Queensland, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Faculty of Health, Translational Research Institute, Brisbane, QLD, Australia
| | - Ali Shokoohmand
- Queensland University of Technology (QUT), Australian Prostate Cancer Research Centre-Queensland, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Faculty of Health, Translational Research Institute, Brisbane, QLD, Australia
| | - Melanie L. Lehman
- Queensland University of Technology (QUT), Australian Prostate Cancer Research Centre-Queensland, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Faculty of Health, Translational Research Institute, Brisbane, QLD, Australia
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Brett G. Hollier
- Queensland University of Technology (QUT), Australian Prostate Cancer Research Centre-Queensland, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Faculty of Health, Translational Research Institute, Brisbane, QLD, Australia
| | - Jennifer H. Gunter
- Queensland University of Technology (QUT), Australian Prostate Cancer Research Centre-Queensland, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Faculty of Health, Translational Research Institute, Brisbane, QLD, Australia
- *Correspondence: Jennifer H. Gunter
| | - Colleen C. Nelson
- Queensland University of Technology (QUT), Australian Prostate Cancer Research Centre-Queensland, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Faculty of Health, Translational Research Institute, Brisbane, QLD, Australia
| |
Collapse
|
29
|
Nguyen C, Lairson DR, Swartz MD, Du XL. Risks of Major Long-Term Side Effects Associated with Androgen-Deprivation Therapy in Men with Prostate Cancer. Pharmacotherapy 2018; 38:999-1009. [PMID: 30080934 DOI: 10.1002/phar.2168] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
STUDY OBJECTIVE To examine the risks and compare the occurrences of major long-term side effects (sexual dysfunction, bone fractures, diabetes, cardiovascular morbidity, acute myocardial infarction [MI], and dementia) in patients with prostate cancer who received androgen-deprivation therapy (ADT) with those who did not. DESIGN Propensity score-matched retrospective cohort study using Medicare claims data. DATA SOURCE National Cancer Institute's Surveillance, Epidemiology, and End Results Program-Medicare linked database. PATIENTS A total of 201,797 patients 66 years or older who were diagnosed with any stage of prostate cancer between 1992 and 2009; of these, 94,528 patients received ADT; 107,269 patients did not. MEASUREMENTS AND MAIN RESULTS We identified receipt of ADT and number of claims for ADT, and ascertained the long-term treatment-related side effects that occurred during 19 years of follow-up, from 1992-2010, from Medicare claims data. Cox proportional hazards models were used to estimate the incidences and hazard ratios (HRs) of newly developed side effects. Among all potential long-term side effects, the risk of bone fractures was highest (HR 1.39, 95% confidence interval [CI] 1.35-1.43), followed by diabetes (HR 1.21, 95% CI 1.18-1.24), dementia (HR 1.16, 95% CI 1.13-1.20), coronary heart disease (HR 1.12, 95% CI 1.09-1.14), and acute MI (HR 1.11, 95% CI 1.08-1.15) in those who received ADT compared with those who did not. The HRs for bone fractures and diabetes increased steadily as the number of ADT doses increased, indicating a linear trend in the dose-response relationship. Compared with patients who received active surveillance, ADT was associated with a 12% increased risk of sexual dysfunction (HR 1.12, 95% CI 1.05-1.20). The HR for sexual dysfunction increased to 1.68 (95% CI 1.59-1.77) when ADT was combined with radiation therapy and to 3.54 (95% CI 3.26-3.85) when ADT was combined with radiation and surgery. CONCLUSION The results of this study demonstrated that in men with prostate cancer, receipt of ADT was associated with higher risks of bone fractures, diabetes, dementia, coronary heart disease, acute MI, and sexual dysfunction than in those who did not receive ADT.
Collapse
Affiliation(s)
- Chi Nguyen
- Department of Epidemiology, Human Genetics, and Environmental Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas
| | - David R Lairson
- Department of Management Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas
| | - Michael D Swartz
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas
| | - Xianglin L Du
- Department of Epidemiology, Human Genetics, and Environmental Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas
| |
Collapse
|
30
|
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize recent findings on hepatic actions of androgens in the regulation of protein, lipid and glucose metabolism. The rationale for liver-targeted testosterone use will be provided. RECENT FINDINGS Liver-targeted testosterone administration, via the oral route, induces protein anabolic effect by reducing the rate of protein oxidation to a similar extent to that of systemic testosterone administration. Recent evidence indicates that testosterone exerts whole-body anabolic effect through inhibition of nitrogen loss via the hepatic urea cycle. Several hepatic effects of androgens, particularly on glucose metabolism, are direct and take place before any changes in body composition occur. This includes an increase in insulin secretion and sensitivity, and reduction in hepatic glucose output by testosterone. Furthermore, lack of testosterone in the liver exacerbates diet-induced impairment in glucose metabolism. In the liver, androgens induce the full spectrum of metabolic changes through interaction with growth hormone or aromatization to estradiol. SUMMARY Liver-targeted testosterone therapy may open up a new approach to achieve whole-body anabolism without systemic side-effects. Aromatizable androgens may be superior to nonaromatizable androgens in inducing a complex spectrum of direct, estrogen-mediated and other hormone-mediated effects of androgens.
Collapse
Affiliation(s)
- Vita Birzniece
- School of Medicine, Western Sydney University, Sydney
- Department of Diabetes and Endocrinology, Blacktown Hospital, Blacktown
- Garvan Institute of Medical Research, Sydney
- School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
31
|
Chuang SM, Lee CC, Chien MN, Sun FJ, Wang CH. The Associations between Serum total Testosterone Levels, Anthropometric Measurements and Metabolic Parameters in Elderly and Young Male Patients with Type 2 Diabetes Mellitus in Taiwan. INT J GERONTOL 2017. [DOI: 10.1016/j.ijge.2016.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
32
|
Crowe H, Pillay B, Howard N, Crowe J, Rutherford M, Wootten A, Corcoran N, Costello A. Evaluation of a multidisciplinary allied health prostate cancer clinic. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2017. [DOI: 10.1111/ijun.12147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Helen Crowe
- Epworth Prostate Centre Epworth HealthCare; Australian Prostate Cancer Research; Melbourne Australia
| | - Brindha Pillay
- Epworth Prostate Centre Epworth HealthCare; Australian Prostate Cancer Research; Melbourne Australia
| | - Nicholas Howard
- Epworth Prostate Centre Epworth HealthCare; Australian Prostate Cancer Research; Melbourne Australia
| | - Jane Crowe
- Epworth Prostate Centre Epworth HealthCare; Australian Prostate Cancer Research; Melbourne Australia
| | - Max Rutherford
- Epworth Prostate Centre Epworth HealthCare; Australian Prostate Cancer Research; Melbourne Australia
| | - Addie Wootten
- Epworth Prostate Centre Epworth HealthCare; Australian Prostate Cancer Research; Melbourne Australia
| | - Niall Corcoran
- Epworth Prostate Centre Epworth HealthCare; Royal Melbourne Hospital, Australian Prostate Cancer Research; Melbourne Australia
| | - Anthony Costello
- Proffesor, Epworth Prostate Centre Epworth HealthCare; Royal Melbourne Hospital, Australian Prostate Cancer Research; Melbourne Australia
| |
Collapse
|
33
|
Affiliation(s)
- Ji Cheol Bae
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
| |
Collapse
|
34
|
von Klot CA, Kuczyk MA, Boeker A, Reuter C, Imkamp F, Herrmann TRW, Tezval H, Kramer MW, Perner S, Merseburger AS. Role of free testosterone levels in patients with metastatic castration-resistant prostate cancer receiving second-line therapy. Oncol Lett 2016; 13:22-28. [PMID: 28123517 PMCID: PMC5244876 DOI: 10.3892/ol.2016.5392] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 07/07/2016] [Indexed: 12/20/2022] Open
Abstract
A range of new treatment options has recently become available for patients with advanced metastatic castration-resistant prostate cancer (mCRPC). Androgen deprivation therapy (ADT) with luteinizing hormone-releasing hormone is continued when performing chemotherapy or androgen deprivation with new second-generation therapeutic agents such as enzalutamide or abiraterone acetate. Despite the fact that free testosterone (FT) is the biologically active form, it is common practice that androgen suppression is monitored via total testosterone levels only. The aim of the present study was to evaluate the role of FT as a prognostic biomarker for cancer-specific survival (CSS) and its feasibility as an ADT monitoring biomarker in patients with mCRPC for the first time. The requirement for continued ADT in mCRPC patients is discussed within the basis of the current literature. A total of 34 patients with continuous measurements of FT levels and mCRPC status underwent therapy with docetaxel, abiraterone acetate, enzalutamide, cabozantinib, carboplatin or cabazitaxel. Data were obtained from the Departments of Urology and Urological Oncology, Hannover Medical School (Hannover, Germany) between March 2009 and April 2014. A cutoff point of 0.5 pg/ml was used to discriminate between patients according to FT levels. Statistical evaluation of CSS was performed by applying Kaplan Meier survival estimates, multivariate Cox regression analyses and log-rank tests. The median age of all 34 patients was 72 years (range, 51–86 years). The mean follow-up interval was 16.1 months (range, 0.7–55.6 months). Despite the fact that all patients were undergoing androgen deprivation, the mean serum FT levels for each patient varied; the mean FT concentration in the cohort was 0.328 pg/ml, ranging from 0.01–9.1 pg/ml. A notable difference with regard to CSS was observed for patients with regard to serum FT concentration; CSS was significantly longer for patients with a serum FT level below the cutoff level (43.6 vs. 17.3 months, respectively, P=0.0063). Upon multivariate Cox regression analysis, the mean FT concentration during treatment remained a significant prognostic factor for CSS (hazard ratio, 1.22; 95% confidence interval, 1.03–1.43; P=0.0182). In conclusion, in patients with mCRPC, the serum FT level is a strong predictor of CSS in patients under therapy with second-line anti-hormonal therapeutic medication and chemotherapy. It may be concluded that FT levels should be included into the routine control of androgen suppression while under treatment with ADT and second-generation hormonal therapy.
Collapse
Affiliation(s)
- Christoph A von Klot
- Department of Urology and Urological Oncology, Hannover Medical School, D-30625 Hannover, Germany
| | - Markus A Kuczyk
- Department of Urology and Urological Oncology, Hannover Medical School, D-30625 Hannover, Germany
| | - Alena Boeker
- Department of Urology and Urological Oncology, Hannover Medical School, D-30625 Hannover, Germany
| | - Christoph Reuter
- Department of Hematology and Oncology, Hannover Medical School, D-30625 Hannover, Germany
| | - Florian Imkamp
- Department of Urology and Urological Oncology, Hannover Medical School, D-30625 Hannover, Germany
| | - Thomas R W Herrmann
- Department of Urology and Urological Oncology, Hannover Medical School, D-30625 Hannover, Germany
| | - Hossein Tezval
- Department of Urology and Urological Oncology, Hannover Medical School, D-30625 Hannover, Germany
| | - Mario W Kramer
- Department of Urology, Campus Luebeck, University Hospital Schleswig-Holstein, D-24105 Luebeck, Germany
| | - Sven Perner
- Pathology Network of the University Hospital of Luebeck and Leibniz Research Center, D-23528 Borstel, Germany
| | - Axel S Merseburger
- Department of Urology, Campus Luebeck, University Hospital Schleswig-Holstein, D-24105 Luebeck, Germany
| |
Collapse
|
35
|
Cornford P, Bellmunt J, Bolla M, Briers E, De Santis M, Gross T, Henry AM, Joniau S, Lam TB, Mason MD, van der Poel HG, van der Kwast TH, Rouvière O, Wiegel T, Mottet N. EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part II: Treatment of Relapsing, Metastatic, and Castration-Resistant Prostate Cancer. Eur Urol 2016; 71:630-642. [PMID: 27591931 DOI: 10.1016/j.eururo.2016.08.002] [Citation(s) in RCA: 1082] [Impact Index Per Article: 135.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 08/02/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To present a summary of the 2016 version of the European Association of Urology (EAU) - European Society for Radiotherapy & Oncology (ESTRO) - International Society of Geriatric Oncology (SIOG) Guidelines on the treatment of relapsing, metastatic, and castration-resistant prostate cancer (CRPC). EVIDENCE ACQUISITION The working panel performed a literature review of the new data (2013-2015). The guidelines were updated, and the levels of evidence and/or grades of recommendation were added based on a systematic review of the literature. EVIDENCE SYNTHESIS Relapse after local therapy is defined by a rising prostate-specific antigen (PSA) level >0.2ng/ml following radical prostatectomy (RP) and >2ng/ml above the nadir after radiation therapy (RT). 11C-choline positron emission tomography/computed tomography is of limited importance if PSA is <1.0ng/ml; bone scans and computed tomography can be omitted unless PSA is >10ng/ml. Multiparametric magnetic resonance imaging and biopsy are important to assess biochemical failure following RT. Therapy for PSA relapse after RP includes salvage RT at PSA levels <0.5ng/ml and salvage RP, high-intensity focused ultrasound, cryosurgical ablation or salvage brachytherapy of the prostate in radiation failures. Androgen deprivation therapy (ADT) remains the basis for treatment of men with metastatic prostate cancer (PCa). However, docetaxel combined with ADT should be considered the standard of care for men with metastases at first presentation, provided they are fit enough to receive the drug. Follow-up of ADT should include analysis of PSA, testosterone levels, and screening for cardiovascular disease and metabolic syndrome. Level 1 evidence for the treatment of metastatic CRPC (mCRPC) includes, abiraterone acetate plus prednisone (AA/P), enzalutamide, radium 223 (Ra 223), docetaxel at 75 mg/m2 every 3 wk and sipuleucel-T. Cabazitaxel, AA/P, enzalutamide, and radium are approved for second-line treatment of CRPC following docetaxel. Zoledronic acid and denosumab can be used in men with mCRPC and osseous metastases to prevent skeletal-related complications. CONCLUSIONS The knowledge in the field of advanced and metastatic PCa and CRPC is changing rapidly. The 2016 EAU-ESTRO-SIOG Guidelines on PCa summarise the most recent findings and advice for use in clinical practice. These PCa guidelines are the first endorsed by the European Society for Therapeutic Radiology and Oncology and the International Society of Geriatric Oncology and reflect the multidisciplinary nature of PCa management. A full version is available from the EAU office or online (http://uroweb.org/guideline/prostate-cancer/). PATIENT SUMMARY In men with a rise in their PSA levels after prior local treatment for prostate cancer only, it is important to balance overtreatment against further progression of the disease since survival and quality of life may never be affected in many of these patients. For patients diagnosed with metastatic castrate-resistant prostate cancer, several new drugs have become available which may provide a clear survival benefit but the optimal choice will have to be made on an individual basis.
Collapse
Affiliation(s)
- Philip Cornford
- Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK.
| | - Joaquim Bellmunt
- Bladder Cancer Center, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Michel Bolla
- Department of Radiation Therapy, CHU Grenoble, Grenoble, France
| | | | | | - Tobias Gross
- Department of Urology, University of Bern, Inselspital, Bern, Switzerland
| | - Ann M Henry
- Leeds Cancer Centre, St. James's University Hospital, Leeds, UK
| | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Thomas B Lam
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | | | - Henk G van der Poel
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Olivier Rouvière
- Hospices Civils de Lyon, Radiology Department, Edouard Herriot Hospital, Lyon, France
| | - Thomas Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | - Nicolas Mottet
- Department of Urology, University Hospital, St. Etienne, France
| |
Collapse
|
36
|
Khera M, Broderick GA, Carson CC, Dobs AS, Faraday MM, Goldstein I, Hakim LS, Hellstrom WJG, Kacker R, Köhler TS, Mills JN, Miner M, Sadeghi-Nejad H, Seftel AD, Sharlip ID, Winters SJ, Burnett AL. Adult-Onset Hypogonadism. Mayo Clin Proc 2016; 91:908-26. [PMID: 27343020 DOI: 10.1016/j.mayocp.2016.04.022] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 04/12/2016] [Accepted: 04/18/2016] [Indexed: 10/21/2022]
Abstract
In August 2015, an expert colloquium commissioned by the Sexual Medicine Society of North America (SMSNA) convened in Washington, DC, to discuss the common clinical scenario of men who present with low testosterone (T) and associated signs and symptoms accompanied by low or normal gonadotropin levels. This syndrome is not classical primary (testicular failure) or secondary (pituitary or hypothalamic failure) hypogonadism because it may have elements of both presentations. The panel designated this syndrome adult-onset hypogonadism (AOH) because it occurs commonly in middle-age and older men. The SMSNA is a not-for-profit society established in 1994 to promote, encourage, and support the highest standards of practice, research, education, and ethics in the study of human sexual function and dysfunction. The panel consisted of 17 experts in men's health, sexual medicine, urology, endocrinology, and methodology. Participants declared potential conflicts of interest and were SMSNA members and nonmembers. The panel deliberated regarding a diagnostic process to document signs and symptoms of AOH, the rationale for T therapy, and a monitoring protocol for T-treated patients. The evaluation and management of hypogonadal syndromes have been addressed in recent publications (ie, the Endocrine Society, the American Urological Association, and the International Society for Sexual Medicine). The primary purpose of this document was to support health care professionals in the development of a deeper understanding of AOH, particularly in how it differs from classical primary and secondary hypogonadism, and to provide a conceptual framework to guide its diagnosis, treatment, and follow-up.
Collapse
Affiliation(s)
| | - Gregory A Broderick
- Mayo Clinic College of Medicine, Department of Urology, Mayo Clinic Florida, Jacksonville, FL
| | | | - Adrian S Dobs
- Department of Medicine, Division of Endocrinology and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | | | - Wayne J G Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, LA; Section of Andrology, Tulane University School of Medicine, New Orleans, LA; Tulane Medical Center, University Medical Center, and the Veteran's Affairs Medical Center, New Orleans, LA
| | - Ravi Kacker
- Men's Health Boston, Boston, MA; Harvard Medical School, Boston, MA
| | - Tobias S Köhler
- Division of Urology, Southern Illinois University School of Medicine, Springfield, IL
| | - Jesse N Mills
- David Geffen School of Medicine at UCLA, Los Angeles, CA; The Men's Clinic at UCLA, Los Angeles, CA
| | - Martin Miner
- Men's Health Center, Providence, RI; Miriam Hospital, Providence, RI; Warren Alpert School of Medicine, Brown University, Providence, RI
| | - Hossein Sadeghi-Nejad
- Rutgers New Jersey Medical School and Hackensack University Medical Center, Hackensack, NJ
| | - Allen D Seftel
- Division of Urology, Cooper University Hospital, Camden, NJ; Cooper Medical School of Rowan University, Camden, NJ; MD Anderson Cancer Center, Houston, TX
| | - Ira D Sharlip
- Department of Urology, University of California, San Francisco, CA
| | - Stephen J Winters
- Division of Endocrinology, Metabolism and Diabetes, University of Louisville, Louisville, KY
| | - Arthur L Burnett
- Department of Urology, Oncology, Johns Hopkins Medical Institutions, Baltimore, MD.
| |
Collapse
|
37
|
Mauvais-Jarvis F. Androgen-deprivation therapy and pancreatic β-cell dysfunction in men. J Diabetes Complications 2016; 30:389-90. [PMID: 26861947 DOI: 10.1016/j.jdiacomp.2016.01.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 01/07/2016] [Indexed: 11/21/2022]
Affiliation(s)
- Franck Mauvais-Jarvis
- Section of Endocrinology & Metabolism, Department of Medicine, Tulane University Health Sciences Center, New Orleans, LA 70112, USA.
| |
Collapse
|
38
|
Conteduca V, Caffo O, Derosa L, Veccia A, Petracci E, Chiuri VE, Santoni M, Santini D, Fratino L, Maines F, Testoni S, De Giorgi U. Metabolic syndrome in castration-resistant prostate cancer patients treated with abiraterone. Prostate 2015; 75:1329-38. [PMID: 25982919 DOI: 10.1002/pros.23014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 04/16/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Metabolic syndrome (MS) has not yet been studied in castration-resistant prostate cancer (CRPC) men treated with novel hormonal therapies. The study aims to assess the impact of MS on outcome from time starting abiraterone. PATIENTS AND METHODS We retrospectively evaluated a consecutive series of metastatic CRPC patients treated with abiraterone after docetaxel failure. MS, as defined by modified Adult Treatment Panel (ATP) III criteria, was assessed at the time of initiation of abiraterone, during treatment and follow-up. RESULTS Sixty-seven of 178 patients evaluated (37.6%) met MS criteria at baseline, before abiraterone initiation, whereas for 11 (9.9%) without MS before treatment with abiraterone this occurred during treatment. Median PFS was equal to 4.7 months for patients with MS versus 9 months for those without MS. Patients with MS had an increased risk of 71% of progression or death for all causes than patients without MS (HR = 1.7, 95% CI [1.2-2.4], P = 0.03). Median OS was 14.7 months and 22.3 months in patients with and without MS, respectively. After adjusting for covariates, MS resulted not significantly associated to OS (HR = 1.42, 95% CI [0.91-2.22], P = 0.073). CONCLUSIONS The presence of MS is a significant risk factor for shorter PFS in CRPC patients treated with abiraterone, even if it does not show a significant impact on OS. A prospective evaluation is warranted.
Collapse
Affiliation(s)
- Vincenza Conteduca
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Orazio Caffo
- Medical Oncology Department, Santa Chiara Hospital, Trento, Italy
| | - Lisa Derosa
- Medical Oncology Department, Santa Chiara Hospital, Pisa, Italy
| | - Antonello Veccia
- Medical Oncology Department, Santa Chiara Hospital, Trento, Italy
| | - Elisabetta Petracci
- Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | - Matteo Santoni
- Medical Oncology Department, AOU Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Daniele Santini
- Medical Oncology Department, Campus Bio-Medico, University of Rome, Rome, Italy
| | - Lucia Fratino
- Medical Oncology Department, National Cancer Institute, Aviano, Italy
| | - Francesca Maines
- Medical Oncology Department, Santa Chiara Hospital, Trento, Italy
| | - Sara Testoni
- Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Ugo De Giorgi
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| |
Collapse
|
39
|
Abstract
Testosterone is a key hormone in the pathology of metabolic diseases such as obesity. Low testosterone levels are associated with increased fat mass (particularly central adiposity) and reduced lean mass in males. These morphological features are linked to metabolic dysfunction, and testosterone deficiency is associated with energy imbalance, impaired glucose control, reduced insulin sensitivity and dyslipidaemia. A bidirectional relationship between testosterone and obesity underpins this association indicated by the hypogonadal-obesity cycle and evidence weight loss can lead to increased testosterone levels. Androgenic effects on enzymatic pathways of fatty acid metabolism, glucose control and energy utilization are apparent and often tissue specific with differential effects noted in different regional fat depots, muscle and liver to potentially explain the mechanisms of testosterone action. Testosterone replacement therapy demonstrates beneficial effects on measures of obesity that are partially explained by both direct metabolic actions on adipose and muscle and also potentially by increasing motivation, vigour and energy allowing obese individuals to engage in more active lifestyles. The degree of these beneficial effects may be dependent on the treatment modality with longer term administration often achieving greater improvements. Testosterone replacement may therefore potentially be an effective adjunctive treatment for weight management in obese men with concomitant hypogonadism.
Collapse
Affiliation(s)
- D M Kelly
- Department of Human Metabolism, Medical School, The University of Sheffield, Sheffield, UK
| | - T H Jones
- Department of Human Metabolism, Medical School, The University of Sheffield, Sheffield, UK.,Centre for Diabetes and Endocrinology, Barnsley Hospital NHS Foundation Trust, Barnsley, UK
| |
Collapse
|
40
|
Bosco C, Crawley D, Adolfsson J, Rudman S, Van Hemelrijck M. Quantifying the evidence for the risk of metabolic syndrome and its components following androgen deprivation therapy for prostate cancer: a meta-analysis. PLoS One 2015; 10:e0117344. [PMID: 25794005 PMCID: PMC4368630 DOI: 10.1371/journal.pone.0117344] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 12/23/2014] [Indexed: 11/18/2022] Open
Abstract
Background No meta-analysis is yet available for the risk of metabolic syndrome (MetS) following androgen deprivation therapy (ADT) for men with prostate cancer. To summarize the evidence for the link between ADT and MetS or its components quantitatively with a meta-analysis including all studies published to date. Methods PubMed and Embase were searched using predefined inclusion criteria to perform meta-analyses on the association between metabolic syndrome, hyperglycemia, diabetes, hypertension, dyslipidemia or obesity and androgen deprivation therapy in patients with prostate cancer. Random effects methods were used to estimate pooled relative risks (RRs) and 95% confidence intervals (CI). Results A total of nine studies was included. There was a positive association between ADT and risk of MetS (RR: 1.75 (95% CI: 1.27–2.41)). Diabetes was the only MetS component present in more than 3 studies, and also showed an increased risk following ADT (RR: 1.36 (95% CI: 1.17–1.58)). Conclusion This is the first quantitative summary addressing the potential risk of MetS following ADT in men with PCa. The positive RRs indicate that there is a need to further elucidate how type and duration of ADT affect these increased risks of MetS and diabetes as the number of men with PCa treated with ADT is increasing.
Collapse
Affiliation(s)
- Cecilia Bosco
- King’s College London, School of Medicine, Division of Cancer Studies, Cancer Epidemiology Group, London, United Kingdom
| | - Danielle Crawley
- King’s College London, School of Medicine, Division of Cancer Studies, Cancer Epidemiology Group, London, United Kingdom
- Department of Oncology, Guy’s & St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Jan Adolfsson
- Karolinska Institute, CLINTEC Department, Stockholm, Sweden
| | - Sarah Rudman
- Department of Oncology, Guy’s & St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Mieke Van Hemelrijck
- King’s College London, School of Medicine, Division of Cancer Studies, Cancer Epidemiology Group, London, United Kingdom
- * E-mail:
| |
Collapse
|
41
|
Mason MD, Parulekar WR, Sydes MR, Brundage M, Kirkbride P, Gospodarowicz M, Cowan R, Kostashuk EC, Anderson J, Swanson G, Parmar MKB, Hayter C, Jovic G, Hiltz A, Hetherington J, Sathya J, Barber JBP, McKenzie M, El-Sharkawi S, Souhami L, Hardman PDJ, Chen BE, Warde P. Final Report of the Intergroup Randomized Study of Combined Androgen-Deprivation Therapy Plus Radiotherapy Versus Androgen-Deprivation Therapy Alone in Locally Advanced Prostate Cancer. J Clin Oncol 2015; 33:2143-50. [PMID: 25691677 PMCID: PMC4477786 DOI: 10.1200/jco.2014.57.7510] [Citation(s) in RCA: 173] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose We have previously reported that radiotherapy (RT) added to androgen-deprivation therapy (ADT) improves survival in men with locally advanced prostate cancer. Here, we report the prespecified final analysis of this randomized trial. Patients and Methods NCIC Clinical Trials Group PR.3/Medical Research Council PR07/Intergroup T94-0110 was a randomized controlled trial of patients with locally advanced prostate cancer. Patients with T3-4, N0/Nx, M0 prostate cancer or T1-2 disease with either prostate-specific antigen (PSA) of more than 40 μg/L or PSA of 20 to 40 μg/L plus Gleason score of 8 to 10 were randomly assigned to lifelong ADT alone or to ADT+RT. The RT dose was 64 to 69 Gy in 35 to 39 fractions to the prostate and pelvis or prostate alone. Overall survival was compared using a log-rank test stratified for prespecified variables. Results One thousand two hundred five patients were randomly assigned between 1995 and 2005, 602 to ADT alone and 603 to ADT+RT. At a median follow-up time of 8 years, 465 patients had died, including 199 patients from prostate cancer. Overall survival was significantly improved in the patients allocated to ADT+RT (hazard ratio [HR], 0.70; 95% CI, 0.57 to 0.85; P < .001). Deaths from prostate cancer were significantly reduced by the addition of RT to ADT (HR, 0.46; 95% CI, 0.34 to 0.61; P < .001). Patients on ADT+RT reported a higher frequency of adverse events related to bowel toxicity, but only two of 589 patients had grade 3 or greater diarrhea at 24 months after RT. Conclusion This analysis demonstrates that the previously reported benefit in survival is maintained at a median follow-up of 8 years and firmly establishes the role of RT in the treatment of men with locally advanced prostate cancer.
Collapse
Affiliation(s)
- Malcolm D Mason
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; James B.P. Barber, Velindre Hospital, Cardiff; Matthew R. Sydes, Mahesh K.B. Parmar, Gordana Jovic, Medical Research Council Clinical Trials Unit at University College London, London; Peter Kirkbride, The Clatterbridge Cancer Centre National Health Service Foundation Trust, Wirral; Richard Cowan, Christie Hospital, University of Manchester, Manchester; John Anderson, Sheffield Teaching Hospitals, National Health Service Foundation Trust, Sheffield; John Hetherington, Castle Hill Hospital, Hull; Salah El-Sharkawi, South West Wales Cancer Centre, Swansea; P.D. John Hardman, The James Cook University Hospital, Middlesbrough, United Kingdom; Wendy R. Parulekar, Andrea Hiltz, and Bingshu E. Chen, NCIC Clinical Trials Group, Queen's University; Michael Brundage, Cancer Centre of Southeastern Ontario, Kingston; Mary Gospodarowicz and Padraig Warde, University of Toronto, Princess Margaret Cancer Centre; Charles Hayter, University of Toronto, Carlo Fidani Peel Regional Cancer Center, Toronto, Ontario; Edmund C. Kostashuk, Fraser Valley Cancer Centre, Surrey; Michael McKenzie, Vancouver Cancer Centre, Vancouver, British Columbia; Jinka Sathya, Memorial University of Newfoundland, St Johns, Newfoundland and Labrador, Canada; Luis Souhami, McGill University, Montreal, Quebec, Canada; and Gregory Swanson, University of Texas Health Science Center, San Antonio, TX.
| | - Wendy R Parulekar
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; James B.P. Barber, Velindre Hospital, Cardiff; Matthew R. Sydes, Mahesh K.B. Parmar, Gordana Jovic, Medical Research Council Clinical Trials Unit at University College London, London; Peter Kirkbride, The Clatterbridge Cancer Centre National Health Service Foundation Trust, Wirral; Richard Cowan, Christie Hospital, University of Manchester, Manchester; John Anderson, Sheffield Teaching Hospitals, National Health Service Foundation Trust, Sheffield; John Hetherington, Castle Hill Hospital, Hull; Salah El-Sharkawi, South West Wales Cancer Centre, Swansea; P.D. John Hardman, The James Cook University Hospital, Middlesbrough, United Kingdom; Wendy R. Parulekar, Andrea Hiltz, and Bingshu E. Chen, NCIC Clinical Trials Group, Queen's University; Michael Brundage, Cancer Centre of Southeastern Ontario, Kingston; Mary Gospodarowicz and Padraig Warde, University of Toronto, Princess Margaret Cancer Centre; Charles Hayter, University of Toronto, Carlo Fidani Peel Regional Cancer Center, Toronto, Ontario; Edmund C. Kostashuk, Fraser Valley Cancer Centre, Surrey; Michael McKenzie, Vancouver Cancer Centre, Vancouver, British Columbia; Jinka Sathya, Memorial University of Newfoundland, St Johns, Newfoundland and Labrador, Canada; Luis Souhami, McGill University, Montreal, Quebec, Canada; and Gregory Swanson, University of Texas Health Science Center, San Antonio, TX
| | - Matthew R Sydes
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; James B.P. Barber, Velindre Hospital, Cardiff; Matthew R. Sydes, Mahesh K.B. Parmar, Gordana Jovic, Medical Research Council Clinical Trials Unit at University College London, London; Peter Kirkbride, The Clatterbridge Cancer Centre National Health Service Foundation Trust, Wirral; Richard Cowan, Christie Hospital, University of Manchester, Manchester; John Anderson, Sheffield Teaching Hospitals, National Health Service Foundation Trust, Sheffield; John Hetherington, Castle Hill Hospital, Hull; Salah El-Sharkawi, South West Wales Cancer Centre, Swansea; P.D. John Hardman, The James Cook University Hospital, Middlesbrough, United Kingdom; Wendy R. Parulekar, Andrea Hiltz, and Bingshu E. Chen, NCIC Clinical Trials Group, Queen's University; Michael Brundage, Cancer Centre of Southeastern Ontario, Kingston; Mary Gospodarowicz and Padraig Warde, University of Toronto, Princess Margaret Cancer Centre; Charles Hayter, University of Toronto, Carlo Fidani Peel Regional Cancer Center, Toronto, Ontario; Edmund C. Kostashuk, Fraser Valley Cancer Centre, Surrey; Michael McKenzie, Vancouver Cancer Centre, Vancouver, British Columbia; Jinka Sathya, Memorial University of Newfoundland, St Johns, Newfoundland and Labrador, Canada; Luis Souhami, McGill University, Montreal, Quebec, Canada; and Gregory Swanson, University of Texas Health Science Center, San Antonio, TX
| | - Michael Brundage
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; James B.P. Barber, Velindre Hospital, Cardiff; Matthew R. Sydes, Mahesh K.B. Parmar, Gordana Jovic, Medical Research Council Clinical Trials Unit at University College London, London; Peter Kirkbride, The Clatterbridge Cancer Centre National Health Service Foundation Trust, Wirral; Richard Cowan, Christie Hospital, University of Manchester, Manchester; John Anderson, Sheffield Teaching Hospitals, National Health Service Foundation Trust, Sheffield; John Hetherington, Castle Hill Hospital, Hull; Salah El-Sharkawi, South West Wales Cancer Centre, Swansea; P.D. John Hardman, The James Cook University Hospital, Middlesbrough, United Kingdom; Wendy R. Parulekar, Andrea Hiltz, and Bingshu E. Chen, NCIC Clinical Trials Group, Queen's University; Michael Brundage, Cancer Centre of Southeastern Ontario, Kingston; Mary Gospodarowicz and Padraig Warde, University of Toronto, Princess Margaret Cancer Centre; Charles Hayter, University of Toronto, Carlo Fidani Peel Regional Cancer Center, Toronto, Ontario; Edmund C. Kostashuk, Fraser Valley Cancer Centre, Surrey; Michael McKenzie, Vancouver Cancer Centre, Vancouver, British Columbia; Jinka Sathya, Memorial University of Newfoundland, St Johns, Newfoundland and Labrador, Canada; Luis Souhami, McGill University, Montreal, Quebec, Canada; and Gregory Swanson, University of Texas Health Science Center, San Antonio, TX
| | - Peter Kirkbride
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; James B.P. Barber, Velindre Hospital, Cardiff; Matthew R. Sydes, Mahesh K.B. Parmar, Gordana Jovic, Medical Research Council Clinical Trials Unit at University College London, London; Peter Kirkbride, The Clatterbridge Cancer Centre National Health Service Foundation Trust, Wirral; Richard Cowan, Christie Hospital, University of Manchester, Manchester; John Anderson, Sheffield Teaching Hospitals, National Health Service Foundation Trust, Sheffield; John Hetherington, Castle Hill Hospital, Hull; Salah El-Sharkawi, South West Wales Cancer Centre, Swansea; P.D. John Hardman, The James Cook University Hospital, Middlesbrough, United Kingdom; Wendy R. Parulekar, Andrea Hiltz, and Bingshu E. Chen, NCIC Clinical Trials Group, Queen's University; Michael Brundage, Cancer Centre of Southeastern Ontario, Kingston; Mary Gospodarowicz and Padraig Warde, University of Toronto, Princess Margaret Cancer Centre; Charles Hayter, University of Toronto, Carlo Fidani Peel Regional Cancer Center, Toronto, Ontario; Edmund C. Kostashuk, Fraser Valley Cancer Centre, Surrey; Michael McKenzie, Vancouver Cancer Centre, Vancouver, British Columbia; Jinka Sathya, Memorial University of Newfoundland, St Johns, Newfoundland and Labrador, Canada; Luis Souhami, McGill University, Montreal, Quebec, Canada; and Gregory Swanson, University of Texas Health Science Center, San Antonio, TX
| | - Mary Gospodarowicz
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; James B.P. Barber, Velindre Hospital, Cardiff; Matthew R. Sydes, Mahesh K.B. Parmar, Gordana Jovic, Medical Research Council Clinical Trials Unit at University College London, London; Peter Kirkbride, The Clatterbridge Cancer Centre National Health Service Foundation Trust, Wirral; Richard Cowan, Christie Hospital, University of Manchester, Manchester; John Anderson, Sheffield Teaching Hospitals, National Health Service Foundation Trust, Sheffield; John Hetherington, Castle Hill Hospital, Hull; Salah El-Sharkawi, South West Wales Cancer Centre, Swansea; P.D. John Hardman, The James Cook University Hospital, Middlesbrough, United Kingdom; Wendy R. Parulekar, Andrea Hiltz, and Bingshu E. Chen, NCIC Clinical Trials Group, Queen's University; Michael Brundage, Cancer Centre of Southeastern Ontario, Kingston; Mary Gospodarowicz and Padraig Warde, University of Toronto, Princess Margaret Cancer Centre; Charles Hayter, University of Toronto, Carlo Fidani Peel Regional Cancer Center, Toronto, Ontario; Edmund C. Kostashuk, Fraser Valley Cancer Centre, Surrey; Michael McKenzie, Vancouver Cancer Centre, Vancouver, British Columbia; Jinka Sathya, Memorial University of Newfoundland, St Johns, Newfoundland and Labrador, Canada; Luis Souhami, McGill University, Montreal, Quebec, Canada; and Gregory Swanson, University of Texas Health Science Center, San Antonio, TX
| | - Richard Cowan
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; James B.P. Barber, Velindre Hospital, Cardiff; Matthew R. Sydes, Mahesh K.B. Parmar, Gordana Jovic, Medical Research Council Clinical Trials Unit at University College London, London; Peter Kirkbride, The Clatterbridge Cancer Centre National Health Service Foundation Trust, Wirral; Richard Cowan, Christie Hospital, University of Manchester, Manchester; John Anderson, Sheffield Teaching Hospitals, National Health Service Foundation Trust, Sheffield; John Hetherington, Castle Hill Hospital, Hull; Salah El-Sharkawi, South West Wales Cancer Centre, Swansea; P.D. John Hardman, The James Cook University Hospital, Middlesbrough, United Kingdom; Wendy R. Parulekar, Andrea Hiltz, and Bingshu E. Chen, NCIC Clinical Trials Group, Queen's University; Michael Brundage, Cancer Centre of Southeastern Ontario, Kingston; Mary Gospodarowicz and Padraig Warde, University of Toronto, Princess Margaret Cancer Centre; Charles Hayter, University of Toronto, Carlo Fidani Peel Regional Cancer Center, Toronto, Ontario; Edmund C. Kostashuk, Fraser Valley Cancer Centre, Surrey; Michael McKenzie, Vancouver Cancer Centre, Vancouver, British Columbia; Jinka Sathya, Memorial University of Newfoundland, St Johns, Newfoundland and Labrador, Canada; Luis Souhami, McGill University, Montreal, Quebec, Canada; and Gregory Swanson, University of Texas Health Science Center, San Antonio, TX
| | - Edmund C Kostashuk
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; James B.P. Barber, Velindre Hospital, Cardiff; Matthew R. Sydes, Mahesh K.B. Parmar, Gordana Jovic, Medical Research Council Clinical Trials Unit at University College London, London; Peter Kirkbride, The Clatterbridge Cancer Centre National Health Service Foundation Trust, Wirral; Richard Cowan, Christie Hospital, University of Manchester, Manchester; John Anderson, Sheffield Teaching Hospitals, National Health Service Foundation Trust, Sheffield; John Hetherington, Castle Hill Hospital, Hull; Salah El-Sharkawi, South West Wales Cancer Centre, Swansea; P.D. John Hardman, The James Cook University Hospital, Middlesbrough, United Kingdom; Wendy R. Parulekar, Andrea Hiltz, and Bingshu E. Chen, NCIC Clinical Trials Group, Queen's University; Michael Brundage, Cancer Centre of Southeastern Ontario, Kingston; Mary Gospodarowicz and Padraig Warde, University of Toronto, Princess Margaret Cancer Centre; Charles Hayter, University of Toronto, Carlo Fidani Peel Regional Cancer Center, Toronto, Ontario; Edmund C. Kostashuk, Fraser Valley Cancer Centre, Surrey; Michael McKenzie, Vancouver Cancer Centre, Vancouver, British Columbia; Jinka Sathya, Memorial University of Newfoundland, St Johns, Newfoundland and Labrador, Canada; Luis Souhami, McGill University, Montreal, Quebec, Canada; and Gregory Swanson, University of Texas Health Science Center, San Antonio, TX
| | - John Anderson
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; James B.P. Barber, Velindre Hospital, Cardiff; Matthew R. Sydes, Mahesh K.B. Parmar, Gordana Jovic, Medical Research Council Clinical Trials Unit at University College London, London; Peter Kirkbride, The Clatterbridge Cancer Centre National Health Service Foundation Trust, Wirral; Richard Cowan, Christie Hospital, University of Manchester, Manchester; John Anderson, Sheffield Teaching Hospitals, National Health Service Foundation Trust, Sheffield; John Hetherington, Castle Hill Hospital, Hull; Salah El-Sharkawi, South West Wales Cancer Centre, Swansea; P.D. John Hardman, The James Cook University Hospital, Middlesbrough, United Kingdom; Wendy R. Parulekar, Andrea Hiltz, and Bingshu E. Chen, NCIC Clinical Trials Group, Queen's University; Michael Brundage, Cancer Centre of Southeastern Ontario, Kingston; Mary Gospodarowicz and Padraig Warde, University of Toronto, Princess Margaret Cancer Centre; Charles Hayter, University of Toronto, Carlo Fidani Peel Regional Cancer Center, Toronto, Ontario; Edmund C. Kostashuk, Fraser Valley Cancer Centre, Surrey; Michael McKenzie, Vancouver Cancer Centre, Vancouver, British Columbia; Jinka Sathya, Memorial University of Newfoundland, St Johns, Newfoundland and Labrador, Canada; Luis Souhami, McGill University, Montreal, Quebec, Canada; and Gregory Swanson, University of Texas Health Science Center, San Antonio, TX
| | - Gregory Swanson
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; James B.P. Barber, Velindre Hospital, Cardiff; Matthew R. Sydes, Mahesh K.B. Parmar, Gordana Jovic, Medical Research Council Clinical Trials Unit at University College London, London; Peter Kirkbride, The Clatterbridge Cancer Centre National Health Service Foundation Trust, Wirral; Richard Cowan, Christie Hospital, University of Manchester, Manchester; John Anderson, Sheffield Teaching Hospitals, National Health Service Foundation Trust, Sheffield; John Hetherington, Castle Hill Hospital, Hull; Salah El-Sharkawi, South West Wales Cancer Centre, Swansea; P.D. John Hardman, The James Cook University Hospital, Middlesbrough, United Kingdom; Wendy R. Parulekar, Andrea Hiltz, and Bingshu E. Chen, NCIC Clinical Trials Group, Queen's University; Michael Brundage, Cancer Centre of Southeastern Ontario, Kingston; Mary Gospodarowicz and Padraig Warde, University of Toronto, Princess Margaret Cancer Centre; Charles Hayter, University of Toronto, Carlo Fidani Peel Regional Cancer Center, Toronto, Ontario; Edmund C. Kostashuk, Fraser Valley Cancer Centre, Surrey; Michael McKenzie, Vancouver Cancer Centre, Vancouver, British Columbia; Jinka Sathya, Memorial University of Newfoundland, St Johns, Newfoundland and Labrador, Canada; Luis Souhami, McGill University, Montreal, Quebec, Canada; and Gregory Swanson, University of Texas Health Science Center, San Antonio, TX
| | - Mahesh K B Parmar
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; James B.P. Barber, Velindre Hospital, Cardiff; Matthew R. Sydes, Mahesh K.B. Parmar, Gordana Jovic, Medical Research Council Clinical Trials Unit at University College London, London; Peter Kirkbride, The Clatterbridge Cancer Centre National Health Service Foundation Trust, Wirral; Richard Cowan, Christie Hospital, University of Manchester, Manchester; John Anderson, Sheffield Teaching Hospitals, National Health Service Foundation Trust, Sheffield; John Hetherington, Castle Hill Hospital, Hull; Salah El-Sharkawi, South West Wales Cancer Centre, Swansea; P.D. John Hardman, The James Cook University Hospital, Middlesbrough, United Kingdom; Wendy R. Parulekar, Andrea Hiltz, and Bingshu E. Chen, NCIC Clinical Trials Group, Queen's University; Michael Brundage, Cancer Centre of Southeastern Ontario, Kingston; Mary Gospodarowicz and Padraig Warde, University of Toronto, Princess Margaret Cancer Centre; Charles Hayter, University of Toronto, Carlo Fidani Peel Regional Cancer Center, Toronto, Ontario; Edmund C. Kostashuk, Fraser Valley Cancer Centre, Surrey; Michael McKenzie, Vancouver Cancer Centre, Vancouver, British Columbia; Jinka Sathya, Memorial University of Newfoundland, St Johns, Newfoundland and Labrador, Canada; Luis Souhami, McGill University, Montreal, Quebec, Canada; and Gregory Swanson, University of Texas Health Science Center, San Antonio, TX
| | - Charles Hayter
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; James B.P. Barber, Velindre Hospital, Cardiff; Matthew R. Sydes, Mahesh K.B. Parmar, Gordana Jovic, Medical Research Council Clinical Trials Unit at University College London, London; Peter Kirkbride, The Clatterbridge Cancer Centre National Health Service Foundation Trust, Wirral; Richard Cowan, Christie Hospital, University of Manchester, Manchester; John Anderson, Sheffield Teaching Hospitals, National Health Service Foundation Trust, Sheffield; John Hetherington, Castle Hill Hospital, Hull; Salah El-Sharkawi, South West Wales Cancer Centre, Swansea; P.D. John Hardman, The James Cook University Hospital, Middlesbrough, United Kingdom; Wendy R. Parulekar, Andrea Hiltz, and Bingshu E. Chen, NCIC Clinical Trials Group, Queen's University; Michael Brundage, Cancer Centre of Southeastern Ontario, Kingston; Mary Gospodarowicz and Padraig Warde, University of Toronto, Princess Margaret Cancer Centre; Charles Hayter, University of Toronto, Carlo Fidani Peel Regional Cancer Center, Toronto, Ontario; Edmund C. Kostashuk, Fraser Valley Cancer Centre, Surrey; Michael McKenzie, Vancouver Cancer Centre, Vancouver, British Columbia; Jinka Sathya, Memorial University of Newfoundland, St Johns, Newfoundland and Labrador, Canada; Luis Souhami, McGill University, Montreal, Quebec, Canada; and Gregory Swanson, University of Texas Health Science Center, San Antonio, TX
| | - Gordana Jovic
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; James B.P. Barber, Velindre Hospital, Cardiff; Matthew R. Sydes, Mahesh K.B. Parmar, Gordana Jovic, Medical Research Council Clinical Trials Unit at University College London, London; Peter Kirkbride, The Clatterbridge Cancer Centre National Health Service Foundation Trust, Wirral; Richard Cowan, Christie Hospital, University of Manchester, Manchester; John Anderson, Sheffield Teaching Hospitals, National Health Service Foundation Trust, Sheffield; John Hetherington, Castle Hill Hospital, Hull; Salah El-Sharkawi, South West Wales Cancer Centre, Swansea; P.D. John Hardman, The James Cook University Hospital, Middlesbrough, United Kingdom; Wendy R. Parulekar, Andrea Hiltz, and Bingshu E. Chen, NCIC Clinical Trials Group, Queen's University; Michael Brundage, Cancer Centre of Southeastern Ontario, Kingston; Mary Gospodarowicz and Padraig Warde, University of Toronto, Princess Margaret Cancer Centre; Charles Hayter, University of Toronto, Carlo Fidani Peel Regional Cancer Center, Toronto, Ontario; Edmund C. Kostashuk, Fraser Valley Cancer Centre, Surrey; Michael McKenzie, Vancouver Cancer Centre, Vancouver, British Columbia; Jinka Sathya, Memorial University of Newfoundland, St Johns, Newfoundland and Labrador, Canada; Luis Souhami, McGill University, Montreal, Quebec, Canada; and Gregory Swanson, University of Texas Health Science Center, San Antonio, TX
| | - Andrea Hiltz
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; James B.P. Barber, Velindre Hospital, Cardiff; Matthew R. Sydes, Mahesh K.B. Parmar, Gordana Jovic, Medical Research Council Clinical Trials Unit at University College London, London; Peter Kirkbride, The Clatterbridge Cancer Centre National Health Service Foundation Trust, Wirral; Richard Cowan, Christie Hospital, University of Manchester, Manchester; John Anderson, Sheffield Teaching Hospitals, National Health Service Foundation Trust, Sheffield; John Hetherington, Castle Hill Hospital, Hull; Salah El-Sharkawi, South West Wales Cancer Centre, Swansea; P.D. John Hardman, The James Cook University Hospital, Middlesbrough, United Kingdom; Wendy R. Parulekar, Andrea Hiltz, and Bingshu E. Chen, NCIC Clinical Trials Group, Queen's University; Michael Brundage, Cancer Centre of Southeastern Ontario, Kingston; Mary Gospodarowicz and Padraig Warde, University of Toronto, Princess Margaret Cancer Centre; Charles Hayter, University of Toronto, Carlo Fidani Peel Regional Cancer Center, Toronto, Ontario; Edmund C. Kostashuk, Fraser Valley Cancer Centre, Surrey; Michael McKenzie, Vancouver Cancer Centre, Vancouver, British Columbia; Jinka Sathya, Memorial University of Newfoundland, St Johns, Newfoundland and Labrador, Canada; Luis Souhami, McGill University, Montreal, Quebec, Canada; and Gregory Swanson, University of Texas Health Science Center, San Antonio, TX
| | - John Hetherington
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; James B.P. Barber, Velindre Hospital, Cardiff; Matthew R. Sydes, Mahesh K.B. Parmar, Gordana Jovic, Medical Research Council Clinical Trials Unit at University College London, London; Peter Kirkbride, The Clatterbridge Cancer Centre National Health Service Foundation Trust, Wirral; Richard Cowan, Christie Hospital, University of Manchester, Manchester; John Anderson, Sheffield Teaching Hospitals, National Health Service Foundation Trust, Sheffield; John Hetherington, Castle Hill Hospital, Hull; Salah El-Sharkawi, South West Wales Cancer Centre, Swansea; P.D. John Hardman, The James Cook University Hospital, Middlesbrough, United Kingdom; Wendy R. Parulekar, Andrea Hiltz, and Bingshu E. Chen, NCIC Clinical Trials Group, Queen's University; Michael Brundage, Cancer Centre of Southeastern Ontario, Kingston; Mary Gospodarowicz and Padraig Warde, University of Toronto, Princess Margaret Cancer Centre; Charles Hayter, University of Toronto, Carlo Fidani Peel Regional Cancer Center, Toronto, Ontario; Edmund C. Kostashuk, Fraser Valley Cancer Centre, Surrey; Michael McKenzie, Vancouver Cancer Centre, Vancouver, British Columbia; Jinka Sathya, Memorial University of Newfoundland, St Johns, Newfoundland and Labrador, Canada; Luis Souhami, McGill University, Montreal, Quebec, Canada; and Gregory Swanson, University of Texas Health Science Center, San Antonio, TX
| | - Jinka Sathya
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; James B.P. Barber, Velindre Hospital, Cardiff; Matthew R. Sydes, Mahesh K.B. Parmar, Gordana Jovic, Medical Research Council Clinical Trials Unit at University College London, London; Peter Kirkbride, The Clatterbridge Cancer Centre National Health Service Foundation Trust, Wirral; Richard Cowan, Christie Hospital, University of Manchester, Manchester; John Anderson, Sheffield Teaching Hospitals, National Health Service Foundation Trust, Sheffield; John Hetherington, Castle Hill Hospital, Hull; Salah El-Sharkawi, South West Wales Cancer Centre, Swansea; P.D. John Hardman, The James Cook University Hospital, Middlesbrough, United Kingdom; Wendy R. Parulekar, Andrea Hiltz, and Bingshu E. Chen, NCIC Clinical Trials Group, Queen's University; Michael Brundage, Cancer Centre of Southeastern Ontario, Kingston; Mary Gospodarowicz and Padraig Warde, University of Toronto, Princess Margaret Cancer Centre; Charles Hayter, University of Toronto, Carlo Fidani Peel Regional Cancer Center, Toronto, Ontario; Edmund C. Kostashuk, Fraser Valley Cancer Centre, Surrey; Michael McKenzie, Vancouver Cancer Centre, Vancouver, British Columbia; Jinka Sathya, Memorial University of Newfoundland, St Johns, Newfoundland and Labrador, Canada; Luis Souhami, McGill University, Montreal, Quebec, Canada; and Gregory Swanson, University of Texas Health Science Center, San Antonio, TX
| | - James B P Barber
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; James B.P. Barber, Velindre Hospital, Cardiff; Matthew R. Sydes, Mahesh K.B. Parmar, Gordana Jovic, Medical Research Council Clinical Trials Unit at University College London, London; Peter Kirkbride, The Clatterbridge Cancer Centre National Health Service Foundation Trust, Wirral; Richard Cowan, Christie Hospital, University of Manchester, Manchester; John Anderson, Sheffield Teaching Hospitals, National Health Service Foundation Trust, Sheffield; John Hetherington, Castle Hill Hospital, Hull; Salah El-Sharkawi, South West Wales Cancer Centre, Swansea; P.D. John Hardman, The James Cook University Hospital, Middlesbrough, United Kingdom; Wendy R. Parulekar, Andrea Hiltz, and Bingshu E. Chen, NCIC Clinical Trials Group, Queen's University; Michael Brundage, Cancer Centre of Southeastern Ontario, Kingston; Mary Gospodarowicz and Padraig Warde, University of Toronto, Princess Margaret Cancer Centre; Charles Hayter, University of Toronto, Carlo Fidani Peel Regional Cancer Center, Toronto, Ontario; Edmund C. Kostashuk, Fraser Valley Cancer Centre, Surrey; Michael McKenzie, Vancouver Cancer Centre, Vancouver, British Columbia; Jinka Sathya, Memorial University of Newfoundland, St Johns, Newfoundland and Labrador, Canada; Luis Souhami, McGill University, Montreal, Quebec, Canada; and Gregory Swanson, University of Texas Health Science Center, San Antonio, TX
| | - Michael McKenzie
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; James B.P. Barber, Velindre Hospital, Cardiff; Matthew R. Sydes, Mahesh K.B. Parmar, Gordana Jovic, Medical Research Council Clinical Trials Unit at University College London, London; Peter Kirkbride, The Clatterbridge Cancer Centre National Health Service Foundation Trust, Wirral; Richard Cowan, Christie Hospital, University of Manchester, Manchester; John Anderson, Sheffield Teaching Hospitals, National Health Service Foundation Trust, Sheffield; John Hetherington, Castle Hill Hospital, Hull; Salah El-Sharkawi, South West Wales Cancer Centre, Swansea; P.D. John Hardman, The James Cook University Hospital, Middlesbrough, United Kingdom; Wendy R. Parulekar, Andrea Hiltz, and Bingshu E. Chen, NCIC Clinical Trials Group, Queen's University; Michael Brundage, Cancer Centre of Southeastern Ontario, Kingston; Mary Gospodarowicz and Padraig Warde, University of Toronto, Princess Margaret Cancer Centre; Charles Hayter, University of Toronto, Carlo Fidani Peel Regional Cancer Center, Toronto, Ontario; Edmund C. Kostashuk, Fraser Valley Cancer Centre, Surrey; Michael McKenzie, Vancouver Cancer Centre, Vancouver, British Columbia; Jinka Sathya, Memorial University of Newfoundland, St Johns, Newfoundland and Labrador, Canada; Luis Souhami, McGill University, Montreal, Quebec, Canada; and Gregory Swanson, University of Texas Health Science Center, San Antonio, TX
| | - Salah El-Sharkawi
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; James B.P. Barber, Velindre Hospital, Cardiff; Matthew R. Sydes, Mahesh K.B. Parmar, Gordana Jovic, Medical Research Council Clinical Trials Unit at University College London, London; Peter Kirkbride, The Clatterbridge Cancer Centre National Health Service Foundation Trust, Wirral; Richard Cowan, Christie Hospital, University of Manchester, Manchester; John Anderson, Sheffield Teaching Hospitals, National Health Service Foundation Trust, Sheffield; John Hetherington, Castle Hill Hospital, Hull; Salah El-Sharkawi, South West Wales Cancer Centre, Swansea; P.D. John Hardman, The James Cook University Hospital, Middlesbrough, United Kingdom; Wendy R. Parulekar, Andrea Hiltz, and Bingshu E. Chen, NCIC Clinical Trials Group, Queen's University; Michael Brundage, Cancer Centre of Southeastern Ontario, Kingston; Mary Gospodarowicz and Padraig Warde, University of Toronto, Princess Margaret Cancer Centre; Charles Hayter, University of Toronto, Carlo Fidani Peel Regional Cancer Center, Toronto, Ontario; Edmund C. Kostashuk, Fraser Valley Cancer Centre, Surrey; Michael McKenzie, Vancouver Cancer Centre, Vancouver, British Columbia; Jinka Sathya, Memorial University of Newfoundland, St Johns, Newfoundland and Labrador, Canada; Luis Souhami, McGill University, Montreal, Quebec, Canada; and Gregory Swanson, University of Texas Health Science Center, San Antonio, TX
| | - Luis Souhami
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; James B.P. Barber, Velindre Hospital, Cardiff; Matthew R. Sydes, Mahesh K.B. Parmar, Gordana Jovic, Medical Research Council Clinical Trials Unit at University College London, London; Peter Kirkbride, The Clatterbridge Cancer Centre National Health Service Foundation Trust, Wirral; Richard Cowan, Christie Hospital, University of Manchester, Manchester; John Anderson, Sheffield Teaching Hospitals, National Health Service Foundation Trust, Sheffield; John Hetherington, Castle Hill Hospital, Hull; Salah El-Sharkawi, South West Wales Cancer Centre, Swansea; P.D. John Hardman, The James Cook University Hospital, Middlesbrough, United Kingdom; Wendy R. Parulekar, Andrea Hiltz, and Bingshu E. Chen, NCIC Clinical Trials Group, Queen's University; Michael Brundage, Cancer Centre of Southeastern Ontario, Kingston; Mary Gospodarowicz and Padraig Warde, University of Toronto, Princess Margaret Cancer Centre; Charles Hayter, University of Toronto, Carlo Fidani Peel Regional Cancer Center, Toronto, Ontario; Edmund C. Kostashuk, Fraser Valley Cancer Centre, Surrey; Michael McKenzie, Vancouver Cancer Centre, Vancouver, British Columbia; Jinka Sathya, Memorial University of Newfoundland, St Johns, Newfoundland and Labrador, Canada; Luis Souhami, McGill University, Montreal, Quebec, Canada; and Gregory Swanson, University of Texas Health Science Center, San Antonio, TX
| | - P D John Hardman
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; James B.P. Barber, Velindre Hospital, Cardiff; Matthew R. Sydes, Mahesh K.B. Parmar, Gordana Jovic, Medical Research Council Clinical Trials Unit at University College London, London; Peter Kirkbride, The Clatterbridge Cancer Centre National Health Service Foundation Trust, Wirral; Richard Cowan, Christie Hospital, University of Manchester, Manchester; John Anderson, Sheffield Teaching Hospitals, National Health Service Foundation Trust, Sheffield; John Hetherington, Castle Hill Hospital, Hull; Salah El-Sharkawi, South West Wales Cancer Centre, Swansea; P.D. John Hardman, The James Cook University Hospital, Middlesbrough, United Kingdom; Wendy R. Parulekar, Andrea Hiltz, and Bingshu E. Chen, NCIC Clinical Trials Group, Queen's University; Michael Brundage, Cancer Centre of Southeastern Ontario, Kingston; Mary Gospodarowicz and Padraig Warde, University of Toronto, Princess Margaret Cancer Centre; Charles Hayter, University of Toronto, Carlo Fidani Peel Regional Cancer Center, Toronto, Ontario; Edmund C. Kostashuk, Fraser Valley Cancer Centre, Surrey; Michael McKenzie, Vancouver Cancer Centre, Vancouver, British Columbia; Jinka Sathya, Memorial University of Newfoundland, St Johns, Newfoundland and Labrador, Canada; Luis Souhami, McGill University, Montreal, Quebec, Canada; and Gregory Swanson, University of Texas Health Science Center, San Antonio, TX
| | - Bingshu E Chen
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; James B.P. Barber, Velindre Hospital, Cardiff; Matthew R. Sydes, Mahesh K.B. Parmar, Gordana Jovic, Medical Research Council Clinical Trials Unit at University College London, London; Peter Kirkbride, The Clatterbridge Cancer Centre National Health Service Foundation Trust, Wirral; Richard Cowan, Christie Hospital, University of Manchester, Manchester; John Anderson, Sheffield Teaching Hospitals, National Health Service Foundation Trust, Sheffield; John Hetherington, Castle Hill Hospital, Hull; Salah El-Sharkawi, South West Wales Cancer Centre, Swansea; P.D. John Hardman, The James Cook University Hospital, Middlesbrough, United Kingdom; Wendy R. Parulekar, Andrea Hiltz, and Bingshu E. Chen, NCIC Clinical Trials Group, Queen's University; Michael Brundage, Cancer Centre of Southeastern Ontario, Kingston; Mary Gospodarowicz and Padraig Warde, University of Toronto, Princess Margaret Cancer Centre; Charles Hayter, University of Toronto, Carlo Fidani Peel Regional Cancer Center, Toronto, Ontario; Edmund C. Kostashuk, Fraser Valley Cancer Centre, Surrey; Michael McKenzie, Vancouver Cancer Centre, Vancouver, British Columbia; Jinka Sathya, Memorial University of Newfoundland, St Johns, Newfoundland and Labrador, Canada; Luis Souhami, McGill University, Montreal, Quebec, Canada; and Gregory Swanson, University of Texas Health Science Center, San Antonio, TX
| | - Padraig Warde
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; James B.P. Barber, Velindre Hospital, Cardiff; Matthew R. Sydes, Mahesh K.B. Parmar, Gordana Jovic, Medical Research Council Clinical Trials Unit at University College London, London; Peter Kirkbride, The Clatterbridge Cancer Centre National Health Service Foundation Trust, Wirral; Richard Cowan, Christie Hospital, University of Manchester, Manchester; John Anderson, Sheffield Teaching Hospitals, National Health Service Foundation Trust, Sheffield; John Hetherington, Castle Hill Hospital, Hull; Salah El-Sharkawi, South West Wales Cancer Centre, Swansea; P.D. John Hardman, The James Cook University Hospital, Middlesbrough, United Kingdom; Wendy R. Parulekar, Andrea Hiltz, and Bingshu E. Chen, NCIC Clinical Trials Group, Queen's University; Michael Brundage, Cancer Centre of Southeastern Ontario, Kingston; Mary Gospodarowicz and Padraig Warde, University of Toronto, Princess Margaret Cancer Centre; Charles Hayter, University of Toronto, Carlo Fidani Peel Regional Cancer Center, Toronto, Ontario; Edmund C. Kostashuk, Fraser Valley Cancer Centre, Surrey; Michael McKenzie, Vancouver Cancer Centre, Vancouver, British Columbia; Jinka Sathya, Memorial University of Newfoundland, St Johns, Newfoundland and Labrador, Canada; Luis Souhami, McGill University, Montreal, Quebec, Canada; and Gregory Swanson, University of Texas Health Science Center, San Antonio, TX
| |
Collapse
|
42
|
Tsai HT, Keating NL, Van Den Eeden SK, Haque R, Cassidy-Bushrow AE, Ulcickas Yood M, Smith MR, Potosky AL. Risk of diabetes among patients receiving primary androgen deprivation therapy for clinically localized prostate cancer. J Urol 2014; 193:1956-62. [PMID: 25524243 DOI: 10.1016/j.juro.2014.12.027] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Androgen deprivation therapy may increase diabetes risk. As the benefits of primary androgen deprivation therapy for localized prostate cancer are controversial, and most prostate cancer survivors are of advanced age with comorbidities, it is important to determine if primary androgen deprivation therapy increases the risk of diabetes and to determine the susceptibility factors. MATERIALS AND METHODS We conducted a retrospective cohort study of 12,191 men diagnosed with incident localized prostate cancer during 1995 to 2008, age 35 to 100 years, and without diabetes or receipt of prostatectomy or radiation 1 year after diagnosis. Patients were enrolled in 1 of 3 managed health plans and followed through 2010. Primary androgen deprivation therapy was defined as androgen deprivation therapy within 1 year after diagnosis. Incident diabetes was ascertained using inpatient and outpatient diagnosis codes, diabetes medications and hemoglobin A1c values. We estimated primary androgen deprivation therapy associated diabetes risk using Cox proportional hazard models in conventional and propensity score analyses. RESULTS Diabetes developed in 1,203 (9.9%) patients during followup (median 4.8 years) with incidence rates of 2.5 and 1.6 events per 100 person-years in the primary androgen deprivation therapy and nonprimary androgen deprivation therapy groups, respectively. Primary androgen deprivation therapy was associated with a 1.61-fold increased diabetes risk (95% CI 1.38-1.88). The number needed to harm was 29. The association was stronger in men age 70 or younger than in older men (HR 2.25 vs 1.40, p value for interaction=0.008). CONCLUSIONS Primary androgen deprivation therapy may increase diabetes risk by 60% and should be used with caution when managing localized prostate cancer. Because of the consistent association between androgen deprivation therapy and greater diabetes risk across disease states, we recommend routine screening and lifestyle interventions to reduce the risk of diabetes in men receiving androgen deprivation therapy.
Collapse
Affiliation(s)
- Huei-Ting Tsai
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC.
| | - Nancy L Keating
- Division of General Internal Medicine, Brigham and Women's Hospital and Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | | | - Reina Haque
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | | | - Marianne Ulcickas Yood
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Matthew R Smith
- Genitourinary Oncology Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Arnold L Potosky
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| |
Collapse
|
43
|
Yu IC, Lin HY, Sparks JD, Yeh S, Chang C. Androgen receptor roles in insulin resistance and obesity in males: the linkage of androgen-deprivation therapy to metabolic syndrome. Diabetes 2014; 63:3180-8. [PMID: 25249645 PMCID: PMC4171661 DOI: 10.2337/db13-1505] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Prostate cancer (PCa) is one of the most frequently diagnosed malignancies in men. Androgen-deprivation therapy (ADT) is the first-line treatment and fundamental management for men with advanced PCa to suppress functions of androgen/androgen receptor (AR) signaling. ADT is effective at improving cancer symptoms and prolonging survival. However, epidemiological and clinical studies support the notion that testosterone deficiency in men leads to the development of metabolic syndrome that increases cardiovascular disease risk. The underlying mechanisms by which androgen/AR signaling regulates metabolic homeostasis in men are complex, and in this review, we discuss molecular mechanisms mediated by AR signaling that link ADT to metabolic syndrome. Results derived from various AR knockout mouse models reveal tissue-specific AR signaling that is involved in regulation of metabolism. These data suggest that steps be taken early to manage metabolic complications associated with PCa patients receiving ADT, which could be accomplished using tissue-selective modulation of AR signaling and by treatment with insulin-sensitizing agents.
Collapse
Affiliation(s)
- I-Chen Yu
- Department of Pathology, George Whipple Laboratory for Cancer Research, University of Rochester Medical Center, Rochester, NY Department of Urology, George Whipple Laboratory for Cancer Research, University of Rochester Medical Center, Rochester, NY Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY
| | - Hung-Yun Lin
- Department of Pathology, George Whipple Laboratory for Cancer Research, University of Rochester Medical Center, Rochester, NY Department of Urology, George Whipple Laboratory for Cancer Research, University of Rochester Medical Center, Rochester, NY Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY
| | - Janet D Sparks
- Department of Pathology, George Whipple Laboratory for Cancer Research, University of Rochester Medical Center, Rochester, NY Department of Urology, George Whipple Laboratory for Cancer Research, University of Rochester Medical Center, Rochester, NY Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY
| | - Shuyuan Yeh
- Department of Pathology, George Whipple Laboratory for Cancer Research, University of Rochester Medical Center, Rochester, NY Department of Urology, George Whipple Laboratory for Cancer Research, University of Rochester Medical Center, Rochester, NY Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY
| | - Chawnshang Chang
- Department of Pathology, George Whipple Laboratory for Cancer Research, University of Rochester Medical Center, Rochester, NY Department of Urology, George Whipple Laboratory for Cancer Research, University of Rochester Medical Center, Rochester, NY Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY Sex Hormone Research Center, China Medical University/Hospital, Taichung, Taiwan
| |
Collapse
|
44
|
Abstract
Men who undergo long-term androgen deprivation therapy (ADT) may experience systemic side effects similar to the classical metabolic syndrome. Exercise is a potential strategy for offsetting the adverse effects of ADT among patients with prostate cancer, resulting in improved muscular resistance and positive outcomes on body size and composition. Fitness (aerobic capacity), fatigue and certain quality of life (QOL) outcomes may also improve in response to a regular exercise regimen. Caution and cardiovascular screening are merited given the elderly population with this disease.
Collapse
Affiliation(s)
- Roanne Segal
- Medical Oncologist, Regional Cancer Center, Medical Lead, Breast Disease Site, Head Survivorship Program, Associate Professor of Medicine, University of Ottawa, The Ottawa Hospital Regional Cancer Program, Ottawa, ON
| |
Collapse
|
45
|
Tran H, Kwok J, Pickles T, Tyldesley S, Black PC. Underutilization of local salvage therapy after radiation therapy for prostate cancer. Urol Oncol 2014; 32:701-6. [PMID: 24629499 DOI: 10.1016/j.urolonc.2013.12.014] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 12/09/2013] [Accepted: 12/30/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the rates at which patients are offered and receive local salvage therapy (LST) after failure of primary radiotherapy for localized prostate cancer, as it is the only potentially curative treatment for localized recurrence but appears to be underutilized when compared with androgen-deprivation therapy (ADT) or observation. MATERIALS AND METHODS Patients with localized prostate cancer who received primary radiotherapy with curative intent between 1999 and 2000 were identified in the British Columbia Tumour Registry. Exclusion criteria included patient age >72 years, prostate-specific antigen>40 ng/ml, and clinical stage T4 at diagnosis. Data on clinicopathologic features, primary therapy, prostate-specific antigen kinetics, and salvage therapy were collected retrospectively. Radiation failure was defined as biochemical recurrence according to the Phoenix criteria or by initiation of salvage therapy. RESULTS Of 1,782 patients treated in the study period, 1,067 met inclusion criteria. Of these, 257 failed radiation therapy. Radiation therapy failure was managed with observation (>12 mo) in 126 patients and ADT in 119. Of the observed patients, 66 subsequently received ADT. Five patients (1.8%) received LST (3 radical prostatectomy and 2 brachytherapy). CONCLUSIONS Only 2% of patients relapsing after radiation therapy for localized prostate cancer received LST. Although the benefits of LST are unproven, these findings reveal a possible underutilization of LST and indicate a need for enhanced collaboration between specialties to optimize care of this challenging cohort.
Collapse
Affiliation(s)
- Henry Tran
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - Jaime Kwok
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - Tom Pickles
- Department of Radiation Oncology, Vancouver Cancer Center, BC Cancer Agency, Vancouver, Canada
| | - Scott Tyldesley
- Department of Radiation Oncology, Vancouver Cancer Center, BC Cancer Agency, Vancouver, Canada
| | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada.
| |
Collapse
|
46
|
Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, Mason M, Matveev V, Wiegel T, Zattoni F, Mottet N. EAU guidelines on prostate cancer. Part II: Treatment of advanced, relapsing, and castration-resistant prostate cancer. Eur Urol 2013; 65:467-79. [PMID: 24321502 DOI: 10.1016/j.eururo.2013.11.002] [Citation(s) in RCA: 1016] [Impact Index Per Article: 92.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Accepted: 11/01/2013] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To present a summary of the 2013 version of the European Association of Urology (EAU) guidelines on the treatment of advanced, relapsing, and castration-resistant prostate cancer (CRPC). EVIDENCE ACQUISITION The working panel performed a literature review of the new data (2011-2013). The guidelines were updated, and levels of evidence and/or grades of recommendation were added to the text based on a systematic review of the literature that included a search of online databases and bibliographic reviews. EVIDENCE SYNTHESIS Luteinising hormone-releasing hormone (LHRH) agonists are the standard of care in metastatic prostate cancer (PCa). LHRH antagonists decrease testosterone without any testosterone surge, and they may be associated with an oncologic benefit compared with LHRH analogues. Complete androgen blockade has a small survival benefit of about 5%. Intermittent androgen deprivation results in noninferior oncologic efficacy when compared with continuous androgen-deprivation therapy (ADT) in well-selected populations. In locally advanced and metastatic PCa, early ADT does not result in a significant survival advantage when compared with delayed ADT. Relapse after local therapy is defined by prostate-specific antigen (PSA) values >0.2 ng/ml following radical prostatectomy (RP) and >2 ng/ml above the nadir and after radiation therapy (RT). Therapy for PSA relapse after RP includes salvage RT (SRT) at PSA levels <0.5 ng/ml and SRP or cryosurgical ablation of the prostate in radiation failures. Endorectal magnetic resonance imaging and 11C-choline positron emission tomography/computed tomography (PET/CT) are of limited importance if the PSA is <1.0 ng/ml; bone scans and CT can be omitted unless PSA is >20 ng/ml. Follow-up after ADT should include analysis of PSA and testosterone levels, and screening for cardiovascular disease and metabolic syndrome. Treatment of CRPC includes sipuleucel-T, abiraterone acetate plus prednisone (AA/P), or chemotherapy with docetaxel at 75mg/m(2) every 3 wk. Cabazitaxel, AA/P, enzalutamide, and radium-223 are available for second-line treatment of CRPC following docetaxel. Zoledronic acid and denosumab can be used in men with CRPC and osseous metastases to prevent skeletal-related complications. CONCLUSIONS The knowledge in the field of advanced, metastatic, and castration-resistant PCa is rapidly changing. These EAU guidelines on PCa summarise the most recent findings and put them into clinical practice. A full version is available at the EAU office or at www.uroweb.org. PATIENT SUMMARY We present a summary of the 2013 version of the European Association of Urology guidelines on treatment of advanced, relapsing, and castration-resistant prostate cancer (CRPC). Luteinising hormone-releasing hormone (LHRH) agonists are the standard of care in metastatic prostate cancer (PCa). LHRH antagonists decrease testosterone without any testosterone surge, and they might be associated with an oncologic benefit compared with LHRH analogues. Complete androgen blockade has a small survival benefit of about 5%. Intermittent androgen deprivation results in noninferior oncologic efficacy when compared with continuous androgen-deprivation therapy (ADT) in well-selected populations. In locally advanced and metastatic PCa, early ADT does not result in a significant survival advantage when compared with delayed ADT. Relapse after local therapy is defined by prostate-specific antigen (PSA) values >0.2 ng/ml following radical prostatectomy (RP) and >2 ng/ml above the nadir and after radiation therapy. Therapy for PSA relapse after RP includes salvage radiation therapy at PSA levels <0.5 ng/ml and salvage RP or cryosurgical ablation of the prostate in radiation failures. Multiparametric magnetic resonance imaging and 11C-choline positron emission tomography/computed tomography (PET/CT) are of limited importance if the PSA is <1.0 ng/ml; bone scans, and CT can be omitted unless PSA is >20 ng/ml. Follow-up after ADT should include analysis of PSA and testosterone levels, and screening for cardiovascular disease and metabolic syndrome. Treatment of castration-resistant CRPC includes sipuleucel-T, abiraterone acetate plus prednisone (AA/P), or chemotherapy with docetaxel 75 mg/m(2) every 3 wk. Cabazitaxel, AA/P, enzalutamide, and radium-223 are available for second-line treatment of CRPC following docetaxel. Zoledronic acid and denosumab can be used in men with CRPC and osseous metastases to prevent skeletal-related complications. The guidelines reported should be adhered to in daily routine to improve the quality of care in PCa patients. As we have shown recently, guideline compliance is only in the area of 30-40%.
Collapse
Affiliation(s)
| | | | - Joaquim Bellmunt
- Department of Medical Oncology, University Hospital Del Mar, Barcelona, Spain
| | - Michel Bolla
- Department of Radiation Therapy, CHU Grenoble, Grenoble, France
| | - Steven Joniau
- Department of Urology, University Hospital, Leuven, Belgium
| | | | - Malcolm Mason
- Department of Oncology and Palliative Medicine, Velindre Hospital, Cardiff, UK
| | - Vsevolod Matveev
- Department of Urology, Russian Academy of Medical Science, Cancer Research Center, Moscow, Russia
| | - Thomas Wiegel
- Department of Radiation Oncology, University Hospital, Ulm, Germany
| | - Filiberto Zattoni
- Department of Urology, Santa Maria Della Misericordia Hospital, Udine, Italy
| | - Nicolas Mottet
- Department of Urology, University Hospital St Etienne, France
| | | |
Collapse
|
47
|
Walker LM, Tran S, Wassersug RJ, Thomas B, Robinson JW. Patients and partners lack knowledge of androgen deprivation therapy side effects. Urol Oncol 2013; 31:1098-105. [DOI: 10.1016/j.urolonc.2011.12.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 11/23/2011] [Accepted: 12/20/2011] [Indexed: 10/14/2022]
|
48
|
Hvid T, Winding K, Rinnov A, Dejgaard T, Thomsen C, Iversen P, Brasso K, Mikines KJ, van Hall G, Lindegaard B, Solomon TPJ, Pedersen BK. Endurance training improves insulin sensitivity and body composition in prostate cancer patients treated with androgen deprivation therapy. Endocr Relat Cancer 2013; 20:621-32. [PMID: 23744766 DOI: 10.1530/erc-12-0393] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Insulin resistance and changes in body composition are side effects of androgen deprivation therapy (ADT) given to prostate cancer patients. The present study investigated whether endurance training improves insulin sensitivity and body composition in ADT-treated prostate cancer patients. Nine men undergoing ADT for prostate cancer and ten healthy men with normal testosterone levels underwent 12 weeks of endurance training. Primary endpoints were insulin sensitivity (euglycemic-hyperinsulinemic clamps with concomitant glucose-tracer infusion) and body composition (dual-energy X-ray absorptiometry and magnetic resonance imaging). The secondary endpoint was systemic inflammation. Statistical analysis was carried out using two-way ANOVA. Endurance training increased VO2max (ml(O2)/min per kg) by 11 and 13% in the patients and controls respectively (P<0.0001). The patients and controls demonstrated an increase in peripheral tissue insulin sensitivity of 14 and 11% respectively (P<0.05), with no effect on hepatic insulin sensitivity (P=0.32). Muscle protein content of GLUT4 (SLC2A4) and total AKT (AKT1) was also increased in response to the training (P<0.05 and P<0.01 respectively). Body weight (P<0.0001) and whole-body fat mass (FM) (P<0.01) were reduced, while lean body mass (P=0.99) was unchanged. Additionally, reductions were observed in abdominal (P<0.01), subcutaneous (P<0.05), and visceral (P<0.01) FM amounts. The concentrations of plasma markers of systemic inflammation were unchanged in response to the training. No group × time interactions were observed, except for thigh intermuscular adipose tissue (IMAT) (P=0.01), reflecting a significant reduction in the amount of IMAT in the controls (P<0.05) not observed in the patients (P=0.64). In response to endurance training, ADT-treated prostate cancer patients exhibited improved insulin sensitivity and body composition to a similar degree as eugonadal men.
Collapse
Affiliation(s)
- Thine Hvid
- The Centre of Inflammation and Metabolism, Department of Infectious Diseases, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Denmark.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Wibowo E, Wassersug RJ. The effect of estrogen on the sexual interest of castrated males: Implications to prostate cancer patients on androgen-deprivation therapy. Crit Rev Oncol Hematol 2013; 87:224-38. [DOI: 10.1016/j.critrevonc.2013.01.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 12/09/2012] [Accepted: 01/16/2013] [Indexed: 11/30/2022] Open
|
50
|
Roayaei M, Ghasemi S. Effect of androgen deprivation therapy on cardiovascular risk factors in prostate cancer. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2013; 18:580-2. [PMID: 24516490 PMCID: PMC3897025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 08/05/2012] [Accepted: 12/30/2012] [Indexed: 11/13/2022]
Abstract
BACKGROUND Androgen deprivation is the basis of treatment for advanced stages of prostate cancer. Cardiovascular disease may be a risk factor for mortality in prostate cancer. Therefore, we decided to evaluate the effect of androgen deprivation therapy (ADT) on the cardiovascular risk factors in patients with prostate cancer. MATERIALS AND METHODS In a cross-sectional study on 2011, 35 patients suffering from metastatic prostate cancer as candidates for ADT were enrolled. Serum levels of fasting blood sugar (FBS), triglyceride (TG) and total cholesterol (TC) were measured at the beginning and after the 5(th) month of ADT. RESULTS The mean level of TG increased significantly from 130.82 ± 41.57 mg/dl to 150.05 ± 48.29 mg/dl (P < 0.012). Furthermore, serum level of TC increased from 197.62 ± 40.71 mg/dl to 212.54 ± 38.25 mg/dl, which is statistically significant (P < 0.001). A non-significant increase in the serum level of FBS from 96.74 ± 14.04 mg/dl to 99.17 ± 15.23 mg/dl was also seen (P = 0.27). CONCLUSION ADT in prostate cancer may lead to an increase in TG and TC levels. In patients with a high risk of cardiovascular disease patient's lipid profile should be considered during ADT.
Collapse
Affiliation(s)
- Mahnaz Roayaei
- Department of Radiation Oncology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sedighe Ghasemi
- Department of Radiation Oncology, Isfahan University of Medical Sciences, Isfahan, Iran,Address for correspondence: Dr. Sedighe Ghasemi, Department of Radiation Oncology, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail:
| |
Collapse
|