Lipid Status During Combined Treatment in Prostate Cancer Patients

Adipose Tissues Have Been Overlooked as Players in Prostate Cancer Progression

Obesity is a common risk factor in multiple tumor types, including prostate cancer. Obesity has been associated with driving metastasis, therapeutic resistance, and increased mortality. The effect of adipose tissue on the tumor microenvironment is still poorly understood. This review aims to highlight the work conducted in the field of obesity and prostate cancer and bring attention to areas where more research is needed. In this review, we have described key differences between healthy adipose tissues and obese adipose tissues, as they relate to the tumor microenvironment, focusing on mechanisms related to metabolic changes, abnormal adipokine secretion, altered immune cell presence, and heightened oxidative stress as drivers of prostate cancer formation and progression. Interestingly, common treatment options for prostate cancer ignore the adipose tissue located near the site of the tumor. Because of this, we have outlined how excess adipose tissue potentially affects therapeutics' efficacy, such as androgen deprivation, chemotherapy, and radiation treatment, and identified possible drug targets to increase prostate cancer responsiveness to clinical treatments. Understanding how obesity affects the tumor microenvironment will pave the way for understanding why some prostate cancers become metastatic or treatment-resistant, and why patients experience recurrence.

GnRH antagonist monotherapy versus a GnRH agonist plus bicalutamide for advanced hormone-sensitive prostate cancer; KYUCOG-1401

OBJECTIVES

To compare the effectiveness and safety of gonadotropin-releasing hormone (GnRH) antagonist monotherapy to combined androgen blockade (CAB) with a GnRH agonist and bicalutamide in patients with advanced hormone-sensitive prostate cancer (HSPC).

METHODS

The study was conducted as KYUCOG-1401 trial (UMIN000014243) and enrolled 200 patients who were randomly assigned to either group A (GnRH antagonist monotherapy followed by the addition of bicalutamide) or group B (CAB by a GnRH agonist and bicalutamide). The primary endpoint was PSA progression-free survival. The secondary endpoints were the time to CAB treatment failure, radiographic progression-free survival, overall survival, changes in serum parameters, including PSA, hormones, and bone and lipid metabolic markers, and adverse events.

RESULTS

PSA progression-free survival was significantly longer in group B (hazard ratio [HR], 95% confidence interval [CI]; 1.40, 1.01-1.95, p = 0.041). The time to CAB treatment failure was slightly longer in group A (HR, 95% CI; 0.80, 0.59-1.08, p = 0.146). No significant differences were observed in radiographic progression-free survival or overall survival. The percentage of patients with serum testosterone that did not reach the castration level was higher at 60 weeks (p = 0.046) in group A. No significant differences were noted in the serum levels of bone metabolic or lipid markers between the two groups. An injection site reaction was more frequent in group A.

CONCLUSIONS

The present results support the potential of CAB using a GnRH agonist and bicalutamide as a more effective treatment for advanced HSPC than GnRH antagonist monotherapy.

Altered amino and fatty acids metabolism in Sudanese prostate cancer patients: insights from metabolic analysis

Introduction

Prostate cancer (PCa) management presents a multifaceted clinical challenge, intricately linking oncological considerations with cardiovascular health. Despite the recognized importance of lipid metabolism and hypertension in this interwoven relationship, their involvement in PCa development remains partially understood. This study aimed to explore variations in plasma metabolome among Sudanese PCa patients and their associated comorbidities.

Methods

Plasma samples were collected from 50 patients across four hospitals in Sudan and profiled by nuclear magnetic resonance (NMR) spectroscopy. One-dimensional proton NMR spectra were acquired for each sample using standard nuclear Overhauser effect spectroscopy pulse sequence presat on a 500 MHz Bruker Avance III HD NMR spectrometer. Metabolite concentrations were quantified using R scripts developed in-house. Univariate and multivariate analyses were generated in the R software.

Results

Patients were categorized into four distinct metabotypes based on their metabolic profiles, and statistical analyses were conducted to evaluate the significance of observed differences. Our findings revealed high levels of fatty acids, phospholipids, cholesterol, valine, leucine, and isoleucine associated with non-hypertensive patients. In contrast, hypertensive patients were associated with high GlycA and GlycB levels and altered amino acid metabolism.

Conclusion

These findings underscore the intricate interplay between metabolic dysregulation and hypertension in PCa patients. Further research is warranted to elucidate the precise molecular pathways underlying lipid metabolism in PCa and to explore the therapeutic potential of targeting these pathways. In conclusion, our study contributes to a deeper understanding of the metabolic landscape of PCa in Sudanese patients, emphasizing the importance of personalized approaches in cancer management.

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

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.

The central role of Sphingosine kinase 1 in the development of neuroendocrine prostate cancer (NEPC): A new targeted therapy of NEPC

BACKGROUND

Neuroendocrine prostate cancer (NEPC) is often diagnosed as a sub-type from the castration-resistant prostate cancer (CRPC) recurred from the second generation of anti-androgen treatment and is a rapidly progressive fatal disease. The molecular mechanisms underlying the trans-differentiation from CRPC to NEPC are not fully characterized, which hampers the development of effective targeted therapy.

METHODS

Bioinformatic analyses were conducted to determine the clinical correlation of sphingosine kinase 1 (SphK1) in CRPC progression. To investigate the transcriptional regulation SphK1 and neuroendocrine (NE) transcription factor genes, both chromosome immunoprecipitation and luciferase reporter gene assays were performed. To demonstrate the role of SphK1 in NEPC development, neurosphere assay was carried out along with several biomarkers determined by quantitative PCR and western blot. Furthermore, in vivo NEPC xenograft models and patient-derived xenograft (PDX) model were employed to determine the effect of SphK1 inhibitors and target validation.

RESULTS

Significant prevalence of SphK1 in NEPC development is observed from clinical datasets. SphK1 is transcriptionally repressed by androgen receptor-RE1-silencing transcription factor (REST) complex. Furthermore, sphingosine 1-phosphate produced by SphK1 can modulate REST protein turnover via MAPK signaling pathway. Also, decreased REST protein levels enhance the expression of NE markers in CRPC, enabling the transition to NEPC. Finally, specific SphK1 inhibitors can effectively inhibit the growth of NEPC tumors and block the REST protein degradation in PDX.

CONCLUSIONS

SphK1 plays a central role in NEPC development, which offers a new target for this lethal cancer using clinically approved SphK1 inhibitors.

[ADVERSE EFFECTS OF ANDROGEN DEPRIVATION THERAPY ON PATIENTS WITH PROSTATE CANCER AND ITS EFFECT ON OVERALL SURVIVAL]

(Background) Patients with prostate cancer, which progresses slowly compared with other cancers, are generally older, and not a few are solely treated with androgen-deprivation therapy (ADT). The physical effects of ADT on bone health, body composition, and hematological parameters must be carefully considered. (Methods) We collected the clinical records of 185 men with pathologically diagnosed prostate cancer who were treated with ADT at our hospital. The primary aim of the study was to determine the prevalence and severity of adverse effects caused by ADT. The second aim was to analyze the effect of fluctuation in the rate of these adverse effects on overall survival (OS). (Results) The median age of patients was 75 years. After ADT for 1 or 2 years, evaluation of bone mineral density revealed median losses of 3% and 6%, respectively. After ADT for 1 year, body mass index was significantly increased by a median 2.1%, and total cholesterol and hemoglobin levels were significantly increased and decreased, respectively. The local and systemic symptoms of subcutaneous granuloma and hot flashes were experienced by 39% and 21.6% patients, respectively. Mono- and multivariate analysis revealed that significant fluctuation in the rate of adverse events after 1-year ADT did not affect OS. (Conclusion) Prevalence and severity of adverse effects caused by ADT were acceptable and almost all patients could be treated in the outpatient clinic, and significant fluctuation in the rate of adverse effects had no effect on OS.