Association between urinary arsenic, blood cadmium, blood lead, and blood mercury levels and serum prostate-specific antigen in a population-based cohort of men in the United States

A Case-Control Study of Association Between Serum Levels of 19 Trace Elements with Prostate Cancer in Southwest China

Prostate cancer (PCa) is the most prevalent urological malignancy, exhibiting the highest incidence and the second-highest mortality among all male cancers. The incidence of PCa in men in China is consistently rising. Studies have shown that elemental exposure levels are associated with the occurrence of PCa. However, epidemiological data are limited, and more researches on different regions and races are needed. To clarify the relationship between the occurrence of PCa and serum levels of 19 trace elements. Serum samples from 79 PCa patients and 74 male healthy controls were obtained, and the levels of 19 trace elements were measured using inductively coupled plasma mass spectrometry (ICP-MS). Baseline matching of key demographic characteristics was performed between the two groups. The relationship between serum trace elements levels and PCa, prostate-specific antigen (PSA), and PCa staging were evaluated using the Mann-Whitney U test, logistic regression, and Spearman's correlation analysis. Statistical analysis of the test results revealed that the low levels of Cu, Zn, and Se in serum may be associated with the development of PCa. Moreover, the changes in the interrelationship of trace elements may play a role in the development of PCa.

The Role of Trace Metals in the Development and Progression of Prostate Cancer

Over the years, prostate cancer (PCa) research has been of great interest, and trace metals have attracted a lot of attention due to their association with prostate cancer development and progression. PCa has a complex etiology, with genetic, environmental, and lifestyle factors being implicated. Trace metals such as zinc (Zn), mercury (Hg), selenium (Se), lead (Pb), cadmium (Cd), manganese (Mn), arsenic (As), and nickel (Ni) have garnered much attention in recent years, suspected of having direct links to the modulation of cancer risk and progression through their impacts on prostate cancer omics (genomics, epigenetics, proteomics, and transcriptomics). This has led to them being the subject of extensive research in this regard. In this review, we explored the influence of trace metals and offered a comprehensive analysis of the current knowledge on how trace metals affect the biology of prostate cancer at a molecular level by integrating findings from the recent literature to help suggest possible directions for future research.

Heavy metals in biological samples of cancer patients: a systematic literature review

The majority of the so-called heavy metals are suspected to be involved in a number of pathologies and play a role in human carcinogenesis. Some of them (i.e. arsenic (As), cadmium (Cd), chromium (Cr), lead (Pb), mercury (Hg) and nickel (Ni)) have been defined as carcinogens, increasing the susceptibility of tumor development and progression in humans. Moreover, Ni, Cr, Cd, Hg, and Pb together with zinc (Zn) and iron (Fe), may be capable of stimulating the progression of breast cancer and reducing a patient's sensitivity to treatment through alterations to DNA methylation. In patients with gastric cancers, levels of various heavy metals are augmented and hypothesized to amplify the expression of the human epidermal growth factor receptor type 2 gene. Cd may increase the risk of lung cancer development and have a negative impact on the overall survival of lung cancer patients. To investigate the relation between heavy metals in biological samples and risk, occurrence and survival cancer individuals, a comprehensive review work was performed, with a focus on breast, lung, prostate and gastric cancers. An extensive search strategy was devised to ensure relevant literature could be identified, with the PECO framework being adopted to facilitate this and identify key search terms. As evidenced in this review, there is substantial data to support the hypothesis that heavy metals influence tumor development and progression. Unluckily the number of papers dealing with the determination of metals directly in samples from cancer tissues is still rather limited, so we decided to expand the scope of this review also to analyses carried out on other biological samples, as urine, plasma, hair, nail, etc. The studies reviewed showed that several limitations and current knowledge gaps are present in the literature that require further investigation to improve our comprehension of the impact of different heavy metals on tumorigenesis.

CYP1A1 gene polymorphism and heavy metal analyses in benign prostatic hyperplasia and prostate cancer: An explorative case-control study

INTRODUCTION

The prostatic disorder is associated with benign prostatic hyperplasia (BPH) and prostate cancer (CaP). Evidently, prevalent transcription factors and signaling pathways define their relationship. The etiology of the prostatic disorder is multifactorial including heavy metal toxicity like lead (Pb), Cadmium (Cd), and genetic factors. This study elucidates the association between heavy metal toxicity Pb, Cd, and CYP1A1 gene polymorphism with BPH and CaP.

METHODS

a case-control study with (BPH, n = 104), (CaP, n = 58) and (controls, n =107) patients. Heavy metal Pb and Cd estimation by atomic absorption spectrophotometer. The polymorphism of the CYP1A1 T>C (rs4646903) gene was analyzed byPCR-RFLP.

RESULT

Higher levels of Pb and Cd were found in BPH and CaP followed by the control group (P-value: < 0.05). Pb and Cd show a significant correlation among prostate volume in CaP. Additionally, PSA, IPSS score, and pre void volume were positively co-related with Pb in BPH patients. The posthoc test defines the level of Pb and Cd as significantly elevated in the mutant genotype, highest among homozygous mutant genotype of CYP1A1gene among BPH. In CaP, Pb is significantly higher among the homozygous mutant type of CYP1A1 gene. The risk is also influenced by smoking, tobacco, and alcohol.

CONCLUSION

The heavy metal toxicity Pb and Cd were reported to raise the risk of BPH and CaP. However, a person with heavy metal toxicity especially in BPH has a high-risk genetic susceptibility to the CYP1A1 gene in the north Indian population.

Cadmium exposure and the risk of prostate cancer among Nigerian men: effect modification by zinc status

BACKGROUND

Prostate cancer (PCa) may result from an interplay between many factors including exposure to trace elements. This study examined the association between cadmium exposure and PCa among Nigerian men and evaluated possible modification of this effect by zinc status.

METHODS

This case-control study involved men with histologically confirmed PCa (n = 82), benign prostatic hyperplasia (BPH; n = 93) and controls (n = 98), aged between 40 and 80 years. Study participants were recruited from the main teaching hospital that draws clients from the entire Anambra State in South-Eastern Nigeria. Blood and urine samples were collected from these participants and were analyzed for trace elements using ICP-MS. Statistical models were used to assess the exposure risk for cadmium exposure as well as the mediating effect of zinc status.

RESULTS

Among men with prostatic disorders (case-case analysis), every 10-fold increase in urinary cadmium was associated with increased risk of PCa (adjusted odds ratios: 2.526; 95% CI: 1.096-5.821). Men in the highest blood zinc quartile had lower odds of PCa compared to the lowest quartile (AOR: 0.19; 95% CI, 0.06-0.54; p-for trend = 0.001). Zinc-specific effect was observed in this group: every 10-fold increase in urinary cadmium was associated with increased risk of PCa among men with creatinine-adjusted urinary zinc levels below the median value (AOR: 8.46; 95% CI: 1.97 -36.39) but not in those above the median value (AOR: 1.55; 95% CI: 0.45 - 5.39).

CONCLUSION

Higher exposure to cadmium may be associated with increased risk of PCa in Nigeria and probably other countries with high prevalence of Zn deficiency. These results point to the need to consider co-occurring trace metals in any effort to mitigate the toxicity of Cd in the environment.

Zinc in Prostate Health and Disease: A Mini Review

Introduction-With the high global prevalence of prostate cancer and associated mortalities, it is important to enhance current clinical practices for better prostate cancer outcomes. The current review is towards understanding the value of Zn towards this mission. Method-General information on Zn in biology and multiple aspects of Zn involvement in prostate health and disease were referred to in PubMed. Results-The most influential feature of Zn towards prostate health is its ability to retain sufficient citrate levels for a healthy prostate. Zn deficiencies were recorded in serum, hair, and prostate tissue of men with prostate cancer compared to non-cancer controls. Zn gut absorption, albumin binding, and storage compete with various factors. There are multiple associations of Zn cellular influx and efflux transporters, Zn finger proteins, matrix metalloproteinases, and Zn signaling with prostate cancer outcomes. Such Zn marker variations associated with prostate cancer recorded from biological matrices may improve algorithms for prostate cancer screening, prognosis, and management when coupled with standard clinical practices. Discussion-The influence of Zn in prostatic health and disease is multidimensional, therefore more personalized Zn requirements may be beneficial. Several opportunities exist to utilize and improve understanding of Zn associations with prostate health and disease.

Environmental Exposure to Metals, Parameters of Oxidative Stress in Blood and Prostate Cancer: Results from Two Cohorts

We studied the potential role of exposure to various metal(oid)s (As, Cd, Cr, Hg, Ni, and Pb) in prostate cancer. Two cohorts were established: the Croatian cohort, consisting of 62 cases and 30 controls, and the Serbian cohort, consisting of 41 cases and 61 controls. Blood/serum samples were collected. Levels of investigated metal(oid)s, various parameters of oxidative stress, and prostate-specific antigen (PSA) were determined in collected samples. A comparison of the measured parameters between 103 prostate cancer patients and 91 control men from both Croatian and Serbian cohorts showed significantly higher blood Hg, SOD, and GPx levels and significantly lower serum SH levels in prostate cancer patients than in controls. Correlation analyses revealed the significant relationship between certain parameters of oxidative stress and the concentrations of the measured metal(loid)s, pointing to the possible role of metal(oid)-induced oxidative stress imbalance. Furthermore, a significant inverse relationship was found between the blood Pb and the serum PSA in prostate cancer patients, but when the model was adjusted for the impacts of remaining parameters, no significant association between the serum PSA and the measured parameters was found. The results of the overall study indicate a substantial contribution of the measured metal(loid)s to the imbalance of the oxidant/antioxidant system. Although somewhat conflicting, the results of the present study point to the possible role of investigated metal(oid)s in prostate cancer, especially for Hg, since the obtained relationship was observed for both cohorts, followed by the disturbances in oxidative stress status, which were found to be correlated with Hg levels. Nevertheless, further studies in larger cohorts are warranted to explain and confirm the obtained results.

Assessing volatile organic compounds exposure and prostate-specific antigen: National Health and Nutrition Examination Survey, 2001-2010

Background

Volatile organic compounds (VOCs) are a large group of chemicals widely used in people's daily routines. Increasing evidence revealed the VOCs' accumulating toxicity. However, the VOCs toxicity in male prostate has not been reported previously. Thus, we comprehensively evaluated the association between VOCs and prostate-specific antigen (PSA).

Methods

A total of 2016 subjects were included in our study from the National Health and Nutrition Examination Survey with VOCs, PSA, and other variables among U.S. average population. We constructed XGBoost Algorithm Model, Regression Model, and Generalized linear Model (GAM) to analyze the potential association. Stratified analysis was used to identify high-risk populations.

Results

XGBoost Algorithm model identified blood chloroform as the most critical variable in the PSA concentration. Regression analysis suggested that blood chloroform was a positive association with PSA, which showed that environmental chloroform exposure is an independent risk factor that may cause prostate gland changes [β, (95% CI), P = 0.007, (0.003, 0.011), 0.00019]. GAM observed the linear relationship between blood chloroform and PSA concentration. Meanwhile, blood chloroform linear correlated with water chloroform in the lower dose range, indicating that the absorption of water may be the primary origin of chloroform. Stratified associations analysis identified the high-risk group on the chloroform exposures.

Conclusion

This study revealed that blood chloroform was positively and independently associated with total PSA level, suggesting that long-term environmental chloroform exposure may cause changes in the prostate gland.