1
|
Dias A, Brook MN, Bancroft EK, Page EC, Chamberlain A, Saya S, Amin J, Mikropoulos C, Taylor N, Myhill K, Thomas S, Saunders E, Dadaev T, Leongamornlert D, Dyrsø Jensen T, Evans DG, Cybulski C, Liljegren A, Teo SH, Side L, Kote‐Jarai Z, Eeles RA. Serum testosterone and prostate cancer in men with germline BRCA1/2 pathogenic variants. BJUI COMPASS 2023; 4:361-373. [PMID: 37025481 PMCID: PMC10071088 DOI: 10.1002/bco2.156] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/10/2022] [Accepted: 04/12/2022] [Indexed: 01/11/2023] Open
Abstract
Objectives The relation of serum androgens and the development of prostate cancer (PCa) is subject of debate. Lower total testosterone (TT) levels have been associated with increased PCa detection and worse pathological features after treatment. However, data from the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) and Prostate Cancer Prevention (PCPT) trial groups indicate no association. The aim of this study is to investigate the association of serum androgen levels and PCa detection in a prospective screening study of men at higher genetic risk of aggressive PCa due to BRCA1/2 pathogenic variants (PVs), the IMPACT study. Methods Men enrolled in the IMPACT study provided serum samples during regular visits. Hormonal levels were calculated using immunoassays. Free testosterone (FT) was calculated from TT and sex hormone binding globulin (SHBG) using the Sodergard mass equation. Age, body mass index (BMI), prostate-specific antigen (PSA) and hormonal concentrations were compared between genetic cohorts. We also explored associations between age and TT, SHBG, FT and PCa, in the whole subset and stratified by BRCA1/2 PVs status. Results A total of 777 participants in the IMPACT study had TT and SHBG measurements in serum samples at annual visits, giving 3940 prospective androgen levels, from 266 BRCA1 PVs carriers, 313 BRCA2 PVs carriers and 198 non-carriers. The median number of visits per patient was 5. There was no difference in TT, SHBG and FT between carriers and non-carriers. In a univariate analysis, androgen levels were not associated with PCa. In the analysis stratified by carrier status, no significant association was found between hormonal levels and PCa in non-carriers, BRCA1 or BRCA2 PVs carriers. Conclusions Male BRCA1/2 PVs carriers have a similar androgen profile to non-carriers. Hormonal levels were not associated with PCa in men with and without BRCA1/2 PVs. Mechanisms related to the particularly aggressive phenotype of PCa in BRCA2 PVs carriers may therefore not be linked with circulating hormonal levels.
Collapse
Affiliation(s)
- Alexander Dias
- Oncogenetics TeamThe Institute of Cancer ResearchLondonUK
- Instituto Nacional de Cancer Jose de Alencar Gomes da Silva INCARio de JaneiroBrazil
| | - Mark N. Brook
- Oncogenetics TeamThe Institute of Cancer ResearchLondonUK
| | - Elizabeth K. Bancroft
- Oncogenetics TeamThe Institute of Cancer ResearchLondonUK
- Academic Urology UnitRoyal Marsden NHS Foundation TrustLondonUK
| | | | | | - Sibel Saya
- Oncogenetics TeamThe Institute of Cancer ResearchLondonUK
| | - Jan Amin
- Clinical Biochemistry SectionRoyal Marsden NHS Foundation TrustLondonUK
| | - Christos Mikropoulos
- Oncogenetics TeamThe Institute of Cancer ResearchLondonUK
- Academic Urology UnitRoyal Marsden NHS Foundation TrustLondonUK
| | - Natalie Taylor
- Oncogenetics TeamThe Institute of Cancer ResearchLondonUK
- Academic Urology UnitRoyal Marsden NHS Foundation TrustLondonUK
| | - Kathryn Myhill
- Oncogenetics TeamThe Institute of Cancer ResearchLondonUK
- Academic Urology UnitRoyal Marsden NHS Foundation TrustLondonUK
| | - Sarah Thomas
- Oncogenetics TeamThe Institute of Cancer ResearchLondonUK
| | | | - Tokhir Dadaev
- Oncogenetics TeamThe Institute of Cancer ResearchLondonUK
| | | | | | - D. Gareth Evans
- Genetic Medicine, Manchester Academic Health Sciences CentreCentral Manchester University Hospitals NHS Foundation TrustManchesterUK
| | - Cezary Cybulski
- International Hereditary Cancer Center, Department of Genetics and PathologyPomeranian Medical University in SzczecinSzczecinPoland
| | - Annelie Liljegren
- Karolinska University Hospital and Karolinska InstitutetStockholmSweden
| | - Soo H. Teo
- Cancer Research Initiatives FoundationSubang Jaya Medical CentreSelangorDarul EhsanMalaysia
| | - Lucy Side
- Wessex Clinical Genetics ServicePrincess Anne HospitalSouthamptonUK
| | | | | | - Rosalind A. Eeles
- Oncogenetics TeamThe Institute of Cancer ResearchLondonUK
- Academic Urology UnitRoyal Marsden NHS Foundation TrustLondonUK
| |
Collapse
|
2
|
Naiyila X, Li J, Huang Y, Chen B, Zhu M, Li J, Chen Z, Yang L, Ai J, Wei Q, Liu L, Cao D. A Novel Insight into the Immune-Related Interaction of Inflammatory Cytokines in Benign Prostatic Hyperplasia. J Clin Med 2023; 12:jcm12051821. [PMID: 36902608 PMCID: PMC10003138 DOI: 10.3390/jcm12051821] [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: 11/23/2022] [Revised: 01/25/2023] [Accepted: 02/02/2023] [Indexed: 02/26/2023] Open
Abstract
Benign prostatic hyperplasia (BPH) is a common male condition that impacts many men's quality of life by generating lower urinary tract symptoms (LUTS). In recent years, inflammation has become very common in the prostate, and BPH with inflammation has a higher International Prostate Symptom Score (IPSS) score and an enlarged prostate. Chronic inflammation leads to tissue damage and the release of pro-inflammatory cytokines, which play an important role in the pathogenesis of BPH. We will focus on current advancements in pro-inflammatory cytokines in BPH, as well as the future of pro-inflammatory cytokine research.
Collapse
Affiliation(s)
- Xiaokaiti Naiyila
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
- West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Jinze Li
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
- West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Yin Huang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
- West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Bo Chen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
- West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Mengli Zhu
- Research Core Facility, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jin Li
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
- West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Zeyu Chen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
- West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Lu Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jianzhong Ai
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Liangren Liu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
- Correspondence: (L.L.); (D.C.); Tel./Fax: +86-28-8542-2451 (L.L. & D.C.)
| | - Dehong Cao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
- Correspondence: (L.L.); (D.C.); Tel./Fax: +86-28-8542-2451 (L.L. & D.C.)
| |
Collapse
|
3
|
Abstract
Due to late onset hypogonadism (LOH), there is an increased usage of testosterone replacement therapy (TRT) in the aging male population. Since prostate is a target organ for androgens and anti-androgenic strategies are used to treat and palliate benign prostate hyperplasia (BPH) and prostate cancer (PC), the prevalence of both increases with age, the possible influence of TRT on prostate health becomes highly relevant. The present review summarizes existing data on the associations between endogenous hormone concentrations and prostate growth and concludes that circulating concentrations of androgens do not appear to be associated with the risks of development of BPH or initiation or progression of PC. The explanation for these findings relates to an apparent insensitivity of prostatic tissue to changes of testosterone concentrations within the physiological range.
Collapse
Affiliation(s)
- Karin Welén
- grid.8761.80000 0000 9919 9582Department of Urology, Institute of Clinical Sciences, Sahlgrenska Center for Cancer Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jan-Erik Damber
- grid.8761.80000 0000 9919 9582Department of Urology, Institute of Clinical Sciences, Sahlgrenska Center for Cancer Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
4
|
Zeng B, Qiu S, Xiong X, Su X, Zhang Z, Wei Q, Yang L. The effect of different administrations of testosterone therapy on adverse prostate events: A Bayesian network meta-analysis. Front Endocrinol (Lausanne) 2022; 13:1009900. [PMID: 36419763 PMCID: PMC9678341 DOI: 10.3389/fendo.2022.1009900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Hypogonadism has become a major cause endangering men's health and quality of life all over the world. Testosterone Therapy (TT) is a widely accepted treatment for relieving hypogonadal symptoms. However, the effect of different administrations of TT on prostate safety is still unclear. METHODS We did a thorough search of PubMed, Embase and Cochrane Library to identify eligible studies up to January 2022. Randomized controlled trials (RCTs) and Cohort studies evaluating the impacts of using different formulations of TT on prostate parameters were included. Changes of prostate-specific antigen (PSA) level and prostate cancer (Pca) cases were used as the primary outcomes. Quality of individual studies was estimated by RoB2 (Cochrane tool for assessing the risk of bias in randomized trials) and the Newcastle-Ottawa scale (Tool for assessing non-RCTs). Certainty of evidence for each study was evaluated according to the evidence assessment criteria of the Oxford Evidence-based Medicine Center. Random-effect network meta-analysis(NMA)was performed based on the Bayesian model. RESULTS Thirty-five studies (30 RCTs and 5 Cohort studies) with 7,740 participants were included. TT administration led to fewer Pca patients (RR=0.62, 95%CI [0.39,0.99], I2=0%), while little decreasing in PSA level (MD=-0.05, 95%CI [-0.08, -0.02], I2=0%). The NMA revealed that compared with other formulations, the intramuscular injection was the most likely to rank first in decreasing Pca cases. The TT also resulted in more biopsy cases (RR=2.38, 95%CI [1.01,5.60], I2=0%). As for NMA, intramuscular injection also performed relatively better in fewer prostate biopsy cases compared with transdermal group. CONCLUSION TT does not lead to abnormal PSA changes and increased risk of Pca in patients with hypogonadism or low testosterone level. Compared with other preparations of TT, intramuscular injection proved better in minimizing Pca cases and was more likely to result in fewer prostate biopsy cases.
Collapse
Affiliation(s)
- Bin Zeng
- Department of Urology, Institute of Urology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Shi Qiu
- Department of Urology, Institute of Urology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- Center of Biomedical Big Data, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xingyu Xiong
- Department of Urology, Institute of Urology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Xingyang Su
- Department of Urology, Institute of Urology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Zilong Zhang
- Department of Urology, Institute of Urology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Wei
- Department of Urology, Institute of Urology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Qiang Wei, ; Lu Yang,
| | - Lu Yang
- Department of Urology, Institute of Urology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Qiang Wei, ; Lu Yang,
| |
Collapse
|
5
|
Determination of Intraprostatic and Intratesticular Androgens. Int J Mol Sci 2021; 22:ijms22010466. [PMID: 33466491 PMCID: PMC7796479 DOI: 10.3390/ijms22010466] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/25/2020] [Accepted: 12/31/2020] [Indexed: 12/19/2022] Open
Abstract
Androgens represent the main hormones responsible for maintaining hormonal balance and function in the prostate and testis. As they are involved in prostate and testicular carcinogenesis, more detailed information of their active concentration at the site of action is required. Since the introduction of the term intracrinology as the local formation of active steroid hormones from inactive precursors of the adrenal gland, mainly dehydroepiandrosterone (DHEA) and DHEA-S, it is evident that blood circulating levels of sex steroid hormones need not reflect their actual concentrations in the tissue. Here, we review and critically evaluate available methods for the analysis of human intraprostatic and intratesticular steroid concentrations. Since analytical approaches have much in common in both tissues, we discuss them together. Preanalytical steps, including various techniques for separation of the analytes, are compared, followed by the end-point measurement. Advantages and disadvantages of chromatography-mass spectrometry (LC-MS, GC-MS), immunoanalytical methods (IA), and hybrid (LC-IA) are discussed. Finally, the clinical information value of the determined steroid hormones is evaluated concerning differentiating between patients with cancer or benign hyperplasia and between patients with different degrees of infertility. Adrenal-derived 11-oxygenated androgens are mentioned as perspective prognostic markers for these purposes.
Collapse
|
6
|
Review of the Roles and Interaction of Androgen and Inflammation in Benign Prostatic Hyperplasia. Mediators Inflamm 2020; 2020:7958316. [PMID: 33192175 PMCID: PMC7641707 DOI: 10.1155/2020/7958316] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/16/2020] [Accepted: 10/19/2020] [Indexed: 11/17/2022] Open
Abstract
The lower urinary tract symptoms (LUTSs) and acute urinary retention (AUR) caused by benign prostatic hyperplasia (BPH) can seriously affect the quality of life of elderly men. Studies suggest that both androgens and inflammation greatly influence the occurrence and development of BPH in most patients. These two factors combined can also affect each other, leading to pathological changes in the stromal and epithelial tissue of the prostate transition zone in BPH patients. DHT in the prostate tissue of BPH patients may activate a chronic inflammatory response in the prostate, amplifying the expression of inflammatory factors and upregulating the proliferation ability of prostate tissue.
Collapse
|
7
|
García-Cruz E, Alcaraz A. Testosterone deficiency syndrome: Diagnosis and treatment. Actas Urol Esp 2020; 44:294-300. [PMID: 32423612 DOI: 10.1016/j.acuro.2019.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 10/28/2019] [Indexed: 11/18/2022]
Abstract
The testosterone deficiency syndrome (TDS) is a very common clinical and biochemical condition that affects approximately 2-5% men over the age of 40. From a clinical point of view, it is usually associated with decreased sexual desire and activity, erectile dysfunction, low energy and mood swings, along with T<8-12 nmol/l levels. Questionnaires are not useful in screening but may be useful for diagnosis and follow-up. Its diagnosis requires the presentation of multiple hypogonadism symptoms together with two morning T tests below the acceptable limits. LH and SHBG levels can be useful to determine the cause and the free T level, respectively. Contraindications for treatment are active prostate cancer, stage IV heart failure, breast cancer, desired fertility and hematocrit values over 54%. Treatment is based on the cause of TDS, if any, along with testosterone supplementation. The objective is to achieve normal testosterone levels. Follow-up includes clinical history, analysis (PSA, T+SHBG, hematocrit, glucose and lipid profile) and rectal examination, 3, 6 and 12 months after beginning treatment.
Collapse
Affiliation(s)
- Eduard García-Cruz
- Servicio de Urología, Hospital Clínic de Barcelona, Barcelona, España; Vigora, Barcelona, España.
| | - Antonio Alcaraz
- Servicio de Urología, Hospital Clínic de Barcelona, Barcelona, España
| |
Collapse
|
8
|
Thomas L, Baratchian M, Sharifi N. Supraphysiologic Testosterone Solutions for Enzalutamide-resistant Prostate Cancer. Eur Urol 2019; 77:156-157. [PMID: 31377027 DOI: 10.1016/j.eururo.2019.07.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 07/19/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Lewis Thomas
- Genitourinary Malignancies Research Center, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mehdi Baratchian
- Genitourinary Malignancies Research Center, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nima Sharifi
- Genitourinary Malignancies Research Center, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
| |
Collapse
|
9
|
Late-onset Hypogonadism and Testosterone Therapy – A Summary of Guidelines from the American Urological Association and the European Association of Urology. Eur Urol Focus 2019; 5:539-544. [DOI: 10.1016/j.euf.2019.02.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 02/05/2019] [Accepted: 02/25/2019] [Indexed: 11/23/2022]
|
10
|
Yeap BB, Page ST, Grossmann M. Testosterone treatment in older men: clinical implications and unresolved questions from the Testosterone Trials. Lancet Diabetes Endocrinol 2018; 6:659-672. [PMID: 30017800 DOI: 10.1016/s2213-8587(17)30416-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/02/2017] [Accepted: 11/06/2017] [Indexed: 10/28/2022]
Abstract
A decrease in the concentration of circulating testosterone in many older men is a biomarker and possibly a rectifiable contributing factor to ill health. Low circulating testosterone concentration has been associated with cardiovascular disease, reduced cognition, fracture risk, and anaemia. However, randomised placebo-controlled trials are essential to clarify the benefits and possible risks of testosterone treatment in men without hypothalamic, pituitary, or testicular disease. The Testosterone Trials (T-Trials) were a coordinated set of trials that, following a screening-to-enrolment ratio of 65:1, randomly assigned 790 men aged 65 years or older who had a baseline testosterone concentration of less than 9·54 nmol/L and symptoms consistent with hypogonadism, but no recognisable hypothalamic-pituitary-testicular axis pathology, to daily transdermal testosterone or placebo for 12 months. In the main trial, testosterone treatment resulted in a modest benefit for sexual function, whereas the other primary outcomes of vitality and physical function were not met. Data from concomitant substudies raised a possible concern over changes in coronary plaque volume, showed a neutral effect on memory and other cognitive functions, and revealed improvements in volumetric bone mineral density and anaemia. Although insufficient to alter the existing clinical equipoise, the T-Trials provided substantial new data on organ-specific outcomes for testosterone treatment in older men. Further clinical trials are necessary to determine whether testosterone treatment will translate into patient-valued health outcomes and to clarify effects on the cardiovascular system.
Collapse
Affiliation(s)
- Bu B Yeap
- School of Medicine, University of Western Australia, Perth, WA, Australia; Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, WA, Australia
| | - Stephanie T Page
- Division of Metabolism and Endocrinology, University of Washington, Seattle, WA, USA.
| | - Mathis Grossmann
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia; Department of Endocrinology, Austin Health, Melbourne, VIC, Australia
| |
Collapse
|
11
|
Boibessot C, Toren P. Sex steroids in the tumor microenvironment and prostate cancer progression. Endocr Relat Cancer 2018; 25:R179-R196. [PMID: 29317479 DOI: 10.1530/erc-17-0493] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/08/2018] [Indexed: 12/30/2022]
Abstract
Prostate cancer is uniquely dependent on androgens. Despite years of research on the relationship between androgens and prostate cancer, many questions remain as to the biological effects of androgens and other sex steroids during prostate cancer progression. This article reviews the clinical and basic research on the influence of sex steroids such as androgens, estrogens and progesterone within the prostate tumor microenvironment on the progression of prostate cancer. We review clinical studies to date evaluating serum sex steroids as prognostic biomarkers and discuss their respective biological effects within the prostate tumor microenvironment. We also review the link between genomic alterations and sex steroid levels within prostate tumors. Finally, we highlight the links between sex steroid levels and the function of the immune system within the tumor microenvironment. As the context of treatment of lethal prostate cancer evolves over time, an understanding of this underlying biology remains central to developing optimal treatment approaches.
Collapse
Affiliation(s)
- Clovis Boibessot
- Department of SurgeryLaval University, Quebec City, Quebec, Canada
| | - Paul Toren
- Department of SurgeryLaval University, Quebec City, Quebec, Canada
| |
Collapse
|
12
|
Gravina GL, Marampon F, Sanità P, Festuccia C, Forcella C, Scarsella L, Jitariuc A, Vetuschi A, Sferra R, Colapietro A, Carosa E, Dolci S, Lenzi A, Jannini EA. Episode-like pulse testosterone supplementation induces tumor senescence and growth arrest down-modulating androgen receptor through modulation of p-ERK1/2, pAR ser81 and CDK1 signaling: biological implications for men treated with testosterone replacement therapy. Oncotarget 2017; 8:113792-113806. [PMID: 29371946 PMCID: PMC5768363 DOI: 10.18632/oncotarget.22776] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 11/01/2017] [Indexed: 12/21/2022] Open
Abstract
Despite the growing body of knowledge showing that testosterone (T) may not significantly affect tumor progression in hypogonadal patients treated for prostate cancer (Pca), the use of this hormone in this population still remains controversial. The effects of continuous or pulsed T stimulation were tested in vitro and in vivo on androgen-sensitive Pca cell lines in order to assess the differential biological properties of these two treatment modalities. Pulsed T treatment resulted in a greater inhibition than continuous T supplementation of tumor growth in vitro and in vivo. The effects of pulsed T treatment on tumor growth inhibition, G0/G1 cell cycle arrest, and tumor senescence was more pronounced than those obtained upon continuous T treatments. Mechanistic studies revealed that G0/G1 arrest and tumor senescence upon pulsed T treatment were associated with a marked decrease in cyclin D1, c-Myc and SKp2, CDK4 and p-Rb levels and upregulation of p27 and p-ERK1/2. Pulsed, but not continuous, T supplementation decreased the expression levels of AR, p-ARser81 and CDK1 in both cellular models. The in vitro results were confirmed in an in vivo xenografts, providing evidence of a greater inhibitory activity of pulsed supraphysiological T supplementation than continuous treatment, both in terms of tumor volume and decreased AR, p-ARser81, PSA and CDK1 staining. The rapid cycling from hypogonadal to physiological or supra-physiological T intraprostatic concentrations results in cytostatic and senescence effects in preclinical models of androgen-sensitive Pca. Our preclinical evidence provides relevant new insights in the biology of Pca response to pulsed T supplementation.
Collapse
Affiliation(s)
- Giovanni Luca Gravina
- Department of Biotechnological and Applied Clinical Sciences, Laboratory of Prostate Onco-pathology and Experimental Endocrinology, University of L'Aquila, 67100 L'Aquila, Italy
| | - Francesco Marampon
- Department of Biotechnological and Applied Clinical Sciences, Laboratory of Prostate Onco-pathology and Experimental Endocrinology, University of L'Aquila, 67100 L'Aquila, Italy
| | - Patrizia Sanità
- Department of Biotechnological and Applied Clinical Sciences, Laboratory of Prostate Onco-pathology and Experimental Endocrinology, University of L'Aquila, 67100 L'Aquila, Italy
| | - Claudio Festuccia
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100 L'Aquila, Italy
| | - Chiara Forcella
- Department of Biotechnological and Applied Clinical Sciences, Laboratory of Prostate Onco-pathology and Experimental Endocrinology, University of L'Aquila, 67100 L'Aquila, Italy
| | - Luca Scarsella
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100 L'Aquila, Italy
| | - Anna Jitariuc
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100 L'Aquila, Italy
| | - Antonella Vetuschi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100 L'Aquila, Italy
| | - Roberta Sferra
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100 L'Aquila, Italy
| | - Alessandro Colapietro
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100 L'Aquila, Italy
| | - Eleonora Carosa
- Department of Biotechnological and Applied Clinical Sciences, Laboratory of Prostate Onco-pathology and Experimental Endocrinology, University of L'Aquila, 67100 L'Aquila, Italy
| | - Susanna Dolci
- Department of Biomedicine and Prevention, Section of Anatomy, Tor Vergata University of Rome, 00133 Rome, Italy
| | - Andrea Lenzi
- Department of Experimental Medicine, Chair of Endocrinology, Sapienza University of Rome, 00161 Rome, Italy
| | - Emmanuele A Jannini
- Department of Systems Medicine, Chair of Endocrinology and Medical Sexology (ENDOSEX), Tor Vergata University of Rome, 00133 Rome, Italy
| |
Collapse
|
13
|
Rubinow KB, Chao JH, Hagman D, Kratz M, Van Yserloo B, Gaikwad NW, Amory JK, Page ST. Circulating sex steroids coregulate adipose tissue immune cell populations in healthy men. Am J Physiol Endocrinol Metab 2017; 313:E528-E539. [PMID: 28698282 PMCID: PMC5792144 DOI: 10.1152/ajpendo.00075.2017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 06/06/2017] [Accepted: 07/06/2017] [Indexed: 12/11/2022]
Abstract
Male hypogonadism results in changes in body composition characterized by increases in fat mass. Resident immune cells influence energy metabolism in adipose tissue and could promote increased adiposity through paracrine effects. We hypothesized that manipulation of circulating sex steroid levels in healthy men would alter adipose tissue immune cell populations. Subjects (n = 44 men, 19-55 yr of age) received 4 wk of treatment with the gonadotropin-releasing hormone receptor antagonist acyline with daily administration of 1) placebo gel, 2) 1.25 g testosterone gel (1.62%), 3) 5 g testosterone gel, or 4) 5 g testosterone gel with an aromatase inhibitor. Subcutaneous adipose tissue biopsies were performed at baseline and end-of-treatment, and adipose tissue immune cells, gene expression, and intra-adipose estrogen levels were quantified. Change in serum total testosterone level correlated inversely with change in the number of CD3+ (β = -0.36, P = 0.04), CD4+ (β = -0.34, P = 0.04), and CD8+ (β = -0.33, P = 0.05) T cells within adipose tissue. Change in serum 17β-estradiol level correlated inversely with change in the number of adipose tissue macrophages (ATMs) (β = -0.34, P = 0.05). A negative association also was found between change in serum testosterone and change in CD11c+ ATMs (β = -0.41, P = 0.01). Overall, sex steroid deprivation was associated with increases in adipose tissue T cells and ATMs. No associations were found between changes in serum sex steroid levels and changes in adipose tissue gene expression. Circulating sex steroid levels may regulate adipose tissue immune cell populations. These exploratory findings highlight a possible novel mechanism that could contribute to increased metabolic risk in hypogonadal men.
Collapse
Affiliation(s)
- Katya B Rubinow
- Center for Research in Reproduction and Contraception, Department of Medicine, University of Washington School of Medicine, Seattle, Washington;
- Diabetes Institute, Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Jing H Chao
- Center for Research in Reproduction and Contraception, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Derek Hagman
- The Fred Hutchinson Cancer Research Center, Seattle, Washington; and
| | - Mario Kratz
- Department of Nutrition and Department of Environmental Toxicology, University of California-Davis, Davis, California
| | - Brian Van Yserloo
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Nilesh W Gaikwad
- Department of Nutrition and Department of Environmental Toxicology, University of California-Davis, Davis, California
| | - John K Amory
- Center for Research in Reproduction and Contraception, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Stephanie T Page
- Center for Research in Reproduction and Contraception, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
- Diabetes Institute, Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| |
Collapse
|
14
|
Abstract
The androgen-signaling axis plays a pivotal role in the pathogenesis of prostate cancer. Since the landmark discovery by Huggins and Hodges, gonadal depletion of androgens has remained a mainstay of therapy for advanced disease. However, progression to castration-resistant prostate cancer (CRPC) typically follows and is largely the result of restored androgen signaling. Efforts to understand the mechanisms behind CRPC have revealed new insights into dysregulated androgen signaling and intratumoral androgen synthesis, which has ultimately led to the development of several novel androgen receptor (AR)-directed therapies for CRPC. However, emergence of resistance to these newer agents has also galvanized new directions in investigations of prereceptor and postreceptor AR regulation. Here, we review our current understanding of AR signaling as it pertains to the biology and natural history of prostate cancer.
Collapse
Affiliation(s)
- Charles Dai
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio 44195
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio 44195
| | - Hannelore Heemers
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio 44195
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio 44195
- Hematology & Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio 44195
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195
| | - Nima Sharifi
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio 44195
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio 44195
- Hematology & Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio 44195
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195
| |
Collapse
|
15
|
Thirumalai A, Rubinow KB, Cooper LA, Amory JK, Marck BT, Matsumoto AM, Page ST. Dose-response effects of sex hormone concentrations on body composition and adipokines in medically castrated healthy men administered graded doses of testosterone gel. Clin Endocrinol (Oxf) 2017; 87:59-67. [PMID: 28370068 PMCID: PMC5521203 DOI: 10.1111/cen.13342] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 03/26/2017] [Accepted: 03/27/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Serum sex steroid concentrations may alter body composition and glucose homoeostasis in men in a dose-response manner. We evaluated these end-points in healthy men rendered medically castrate through use of a gonadotrophin-releasing hormone antagonist (acyline) with incremental doses of exogenous testosterone (T) gel. DESIGN Subjects (n=6-9 per group) were randomly assigned to injections of acyline every 2 weeks plus transdermal T gel (1.25 g, 2.5 g, 5.0 g, 10 g or 15 g) daily or double placebo (injections and gel) for 12 weeks. PATIENTS Healthy men, ages 25-55 years, with normal serum total T concentrations. MEASUREMENTS Serum T, dihydrotestosterone (DHT) and oestradiol (E2) were measured at baseline and every 2 weeks. Body composition was analysed by dual-energy X-ray absorptiometry at baseline and week 12. Fasting serum adiponectin, leptin, glucose and insulin concentrations were measured at baseline and week 10. RESULTS Forty-eight men completed the study. A significant treatment effect was observed for change in lean mass (ANOVAP=.01) but not fat mass (P=.14). Lean mass increased in the 15 g T group relative to all lower dose groups, except the 10 g T group. When all subjects were analysed together, changes in lean mass correlated directly and changes in fat mass correlated inversely with serum T, E2 and DHT. No changes were noted in serum glucose, insulin or adipokine levels. CONCLUSIONS In healthy men, higher serum concentrations of T, DHT and E2 were associated with greater increases in lean mass and decreases in fat mass but not with changes in serum glucose, insulin or adipokines.
Collapse
Affiliation(s)
- Arthi Thirumalai
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Katya B Rubinow
- Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - John K Amory
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Brett T Marck
- Geriatric Research, Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Alvin M Matsumoto
- Geriatric Research, Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, USA
- Division of Gerontology & Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Stephanie T Page
- Department of Medicine, University of Washington, Seattle, WA, USA
| |
Collapse
|
16
|
Pejčić T, Tosti T, Tešić Ž, Milković B, Dragičević D, Kozomara M, Čekerevac M, Džamić Z. Testosterone and dihydrotestosterone levels in the transition zone correlate with prostate volume. Prostate 2017; 77:1082-1092. [PMID: 28594074 DOI: 10.1002/pros.23365] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 04/21/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND There is still no consensus regarding intraprostatic androgen levels and the accumulation of androgens in the hyperplastic prostatic tissue. The current opinion is that intraprostatic dihydrotestosterone (DHT) concentrations are maintained but not elevated in benign prostatic hyperplasia (BPH), while there is no similar data concerning intraprostatic testosterone (T). METHODS Tissue T (tT) and tissue DHT (tDHT) concentration were determined in 93 patients scheduled for initial prostate biopsy. The criteria for biopsy were abnormal DRE and/or PSA > 4 ng/mL. Total prostate volume (TPV) was determined by transrectal ultrasound (TRUS). During TRUS- guided prostate biopsy, 10-12 samples were collected from the peripheral zone (PZ) and two additional samples were collected from the transition zone (TZ). The samples from the TZ were immediately frozen in liquid nitrogen at -70°C, and transported for tissue androgen determination, using liquid chromatography mass spectrometry (LC-MS). RESULTS Pathological analysis revealed that prostate cancer (PCa) was present in 45 and absent in 48 patients. In the whole group, there were 42 men with small prostate (TPV < 30 mL) and 51 with enlarged prostate (TPV ≥ 31 mL). The overall average tT level was 0.79 ± 0.66 ng/g, while the average tDHT level was 10.27 ± 7.15 ng/g. There were no differences in tT and tDHT level in prostates with and without PCa. However, tT and tDHT levels were significantly higher in larger, than in smaller prostates (tT: 1.05 ± 0.75 and 0.46 ± 0.29 ng/g, and tDHT: 15.0 ± 6.09 and 4.51 ± 2.75 ng/g, respectively). There were strong correlations between tT and TPV (r = 0.71), and tDHT and TPV (r = 0.74). CONCLUSIONS The present study confirmed that both T and DHT accumulated in the stroma of enlarged prostates; the degree of accumulation correlated with prostate volume.
Collapse
Affiliation(s)
- Tomislav Pejčić
- Clinic of Urology, Clinical Center of Serbia, Belgrade, Serbia
| | - Tomislav Tosti
- Faculty of Chemistry, University of Belgrade, Belgrade, Serbia
| | - Živoslav Tešić
- Faculty of Chemistry, University of Belgrade, Belgrade, Serbia
| | | | | | | | - Milica Čekerevac
- Institute of Pathology, Clinical Center of Serbia, Belgrade, Serbia
| | - Zoran Džamić
- Clinic of Urology, Clinical Center of Serbia, Belgrade, Serbia
| |
Collapse
|
17
|
Anawalt BD. Is Dihydrotestosterone a Classic Hormone? Endocr Rev 2017; 38:170-172. [PMID: 28582536 DOI: 10.1210/er.2017-00091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 04/24/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Bradley D Anawalt
- Department of Medicine, University of Washington, Seattle, Washington 98195
| |
Collapse
|
18
|
Herati AS, Kohn TP, Butler PR, Lipshultz LI. Effects of Testosterone on Benign and Malignant Conditions of the Prostate. CURRENT SEXUAL HEALTH REPORTS 2017; 9:65-73. [PMID: 29056882 DOI: 10.1007/s11930-017-0104-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF THE REVIEW This review summarizes the current literature regarding the effects of testosterone therapy (TTh) on common disorders of the prostate. RECENT FINDINGS Testosterone therapy has gained credibility over the last several decades as a potentially safe co-treatment modality for men with benign and malignant prostatic conditions. Our understanding of the effects of testosterone on the prostate continues to evolve with ongoing clinical and basic science research. Findings of these studies have reinvigorated the debate over the effects of testosterone on benign and malignant disorders of the prostate, including BPH, chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), and prostate cancer. SUMMARY Despite the burgeoning body of data claiming the safety and efficacy of TTh in common prostatic conditions (including BPH, CP/CPPS, and prostate cancer), diligent monitoring, appropriate patient selection, and informed consent are critical until more definitive studies are performed.
Collapse
Affiliation(s)
- Amin S Herati
- Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX 77030.,Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030
| | - Taylor P Kohn
- Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030
| | - Peter R Butler
- Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX 77030.,Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030
| | - Larry I Lipshultz
- Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX 77030.,Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030
| |
Collapse
|
19
|
Iyer R, Mok SF, Savkovic S, Turner L, Fraser G, Desai R, Jayadev V, Conway AJ, Handelsman DJ. Pharmacokinetics of testosterone cream applied to scrotal skin. Andrology 2017; 5:725-731. [DOI: 10.1111/andr.12357] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 02/06/2017] [Accepted: 02/10/2017] [Indexed: 11/27/2022]
Affiliation(s)
- R. Iyer
- Andrology Department; Concord Hospital and ANZAC Research Institute; University of Sydney; Sydney NSW Australia
| | - S. F. Mok
- Andrology Department; Concord Hospital and ANZAC Research Institute; University of Sydney; Sydney NSW Australia
| | - S. Savkovic
- Andrology Department; Concord Hospital and ANZAC Research Institute; University of Sydney; Sydney NSW Australia
| | - L. Turner
- Andrology Department; Concord Hospital and ANZAC Research Institute; University of Sydney; Sydney NSW Australia
| | - G. Fraser
- Andrology Department; Concord Hospital and ANZAC Research Institute; University of Sydney; Sydney NSW Australia
| | - R. Desai
- Andrology Department; Concord Hospital and ANZAC Research Institute; University of Sydney; Sydney NSW Australia
| | - V. Jayadev
- Andrology Department; Concord Hospital and ANZAC Research Institute; University of Sydney; Sydney NSW Australia
| | - A. J. Conway
- Andrology Department; Concord Hospital and ANZAC Research Institute; University of Sydney; Sydney NSW Australia
| | - D. J. Handelsman
- Andrology Department; Concord Hospital and ANZAC Research Institute; University of Sydney; Sydney NSW Australia
| |
Collapse
|
20
|
Marcucci G, Della Pepa G, Brandi ML. Natpara for the treatment of hypoparathyroidism. Expert Opin Biol Ther 2016; 16:1417-1424. [DOI: 10.1080/14712598.2016.1238455] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
|