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Reiss AB, Gulkarov S, Pinkhasov A, Sheehan KM, Srivastava A, De Leon J, Katz AE. Androgen Deprivation Therapy for Prostate Cancer: Focus on Cognitive Function and Mood. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:77. [PMID: 38256338 PMCID: PMC10819522 DOI: 10.3390/medicina60010077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/26/2023] [Accepted: 12/28/2023] [Indexed: 01/24/2024]
Abstract
Prostate cancer is the second leading cause of cancer death in men in the United States. Androgen deprivation therapy (ADT) is currently the primary treatment for metastatic prostate cancer, and some studies have shown that the use of anti-androgen drugs is related to a reduction in cognitive function, mood changes, diminished quality of life, dementia, and possibly Alzheimer's disease. ADT has potential physiological effects such as a reduction in white matter integrity and a negative impact on hypothalamic functions due to the lowering of testosterone levels or the blockade of downstream androgen receptor signaling by first- and second-generation anti-androgen drugs. A comparative analysis of prostate cancer patients undergoing ADT and Alzheimer patients identified over 30 shared genes, illustrating common ground for the mechanistic underpinning of the symptomatology. The purpose of this review was to investigate the effects of ADT on cognitive function, mood, and quality of life, as well as to analyze the relationship between ADT and Alzheimer's disease. The evaluation of prostate cancer patient cognitive ability via neurocognitive testing is described. Future studies should further explore the connection among cognitive deficits, mood disturbances, and the physiological changes that occur when hormonal balance is altered.
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Affiliation(s)
- Allison B. Reiss
- Department of Medicine and Biomedical Research Institute, NYU Grossman Long Island School of Medicine, Mineola, NY 11501, USA; (S.G.); (K.M.S.); (A.S.); (J.D.L.)
| | - Shelly Gulkarov
- Department of Medicine and Biomedical Research Institute, NYU Grossman Long Island School of Medicine, Mineola, NY 11501, USA; (S.G.); (K.M.S.); (A.S.); (J.D.L.)
| | - Aaron Pinkhasov
- Department of Psychiatry, NYU Grossman Long Island School of Medicine, Mineola, NY 11501, USA;
| | - Katie M. Sheehan
- Department of Medicine and Biomedical Research Institute, NYU Grossman Long Island School of Medicine, Mineola, NY 11501, USA; (S.G.); (K.M.S.); (A.S.); (J.D.L.)
| | - Ankita Srivastava
- Department of Medicine and Biomedical Research Institute, NYU Grossman Long Island School of Medicine, Mineola, NY 11501, USA; (S.G.); (K.M.S.); (A.S.); (J.D.L.)
| | - Joshua De Leon
- Department of Medicine and Biomedical Research Institute, NYU Grossman Long Island School of Medicine, Mineola, NY 11501, USA; (S.G.); (K.M.S.); (A.S.); (J.D.L.)
| | - Aaron E. Katz
- Department of Urology, NYU Grossman Long Island School of Medicine, Mineola, NY 11501, USA;
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Zimmerman Y, Frydenberg M, van Poppel H, van Moorselaar RJA, Roos EP, Somford DM, Roeleveld TA, de Haan TD, van Melick HH, Reisman Y, Krijgh J, Debruyne FM, Coelingh Bennink HJ. Estetrol Prevents Hot Flushes and Improves Quality of Life in Patients with Advanced Prostate Cancer Treated with Androgen Deprivation Therapy: The PCombi Study. EUR UROL SUPPL 2022; 45:59-67. [PMID: 36353657 PMCID: PMC9637725 DOI: 10.1016/j.euros.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 11/06/2022] Open
Abstract
Background Androgen deprivation therapy (ADT) for prostate cancer (PCa) is accompanied by side effects affecting health-related quality of life (HRQL). Objective To assess the effects of the fetal estrogen estetrol (E4) on symptoms related to estrogen and androgen deficiency, and on HRQL measured using the validated Functional Assessment of Cancer Therapy-Prostate (FACT-P) questionnaire. Design, setting, and participants This was a phase 2, double-blind, randomized, placebo-controlled study in patients with advanced PCa. Intervention Patients receiving ADT were randomly assigned at a 2:1 ratio to daily treatment with a high dose of E4 (HDE4; n = 41) or placebo (n = 21) for 24 wk. Outcome measurements and statistical analysis The primary outcome was the effect of HDE4 cotreatment on hot flushes (HFs). Secondary outcomes were the Q-Man questionnaire for evaluation of the effect on estrogen and androgen deficiency symptoms, and the FACT-P questionnaire for evaluating HRQL. Results and limitations At 24 wk, the number of patients experiencing HFs was significantly lower in the HDE4 group than in the placebo group (14.3% vs 60.0%; p < 0.001). HDE4 treatment was associated with lower incidence of night sweats, arthralgia, and fatigue, but more nipple tenderness and gynecomastia. At 24 wk, the mean HRQL score favored HDE4 over placebo for the FACT-P total score (122.2 ± 12.3 vs 118.7 ± 19.7) and for several other FACT subscales. Conclusions Daily HDE4 coadministration almost completely prevented HFs in patients with advanced PCa treated with ADT. HDE4 also had positive effects on HRQL and counteracted other estrogen deficiency symptoms caused by ADT. These data support the dual efficacy concept of ADT and HDE4 to improve HRQL and increase the antitumor effect of ADT. Patient summary For patients on androgen deprivation therapy for advanced prostate cancer, cotreatment with a high dose of estetrol almost completely prevents the occurrence of hot flushes and improves quality of life and well-being, but nipple sensitivity and an increase in breast size may occur.
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Effectiveness of Resistance Training on Fatigue in Patients Undergoing Cancer Treatment: A Meta-Analysis of Randomized Clinical Trials. Int J Breast Cancer 2022; 2022:9032534. [PMID: 35979509 PMCID: PMC9378000 DOI: 10.1155/2022/9032534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/21/2022] [Indexed: 11/17/2022] Open
Abstract
Objective. To assess the effectiveness of the resistance training to improve fatigue levels in people with cancer who are enrolled in adjuvant and/or neoadjuvant treatment. Methods. MEDLINE, Web of Science, Embase, SPORTDiscus, LILACS, CENTRAL, and CINAHL databases were searched from May to December 7, 2021. Randomized clinical trials (RCT) that evaluate the effects of resistance training on fatigue levels in people undergoing cancer treatment were included. The PEDro scale was considered to assess methodological quality of studies, and the evidence was summarized through the GRADE system. The standardized average differences, effect size, and inverse variance model for meta-analysis were calculated. Results. Fifteen RCT for qualitative synthesis and thirteen for meta-analysis were selected. A moderate to high level of evidence of resistance training was identified to improve fatigue in people undergoing cancer treatment. Meta-analysis showed a significant reduction in fatigue (
,
, -0.12,
) after 10 to 35 sessions of resistance training. Conclusion. The 10 to 35 sessions of resistance training are effective in reducing fatigue level in cancer patients who are undergoing cancer treatment and have a moderate level of quality evidence.
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Kakarla M, Ausaja Gambo M, Yousri Salama M, Haidar Ismail N, Tavalla P, Uppal P, Mohammed SA, Rajashekar S, Giri Ravindran S, Hamid P. Cardiovascular Effects of Androgen Deprivation Therapy in Prostate Cancer Patients: A Systematic Review. Cureus 2022; 14:e26209. [PMID: 35891816 PMCID: PMC9307258 DOI: 10.7759/cureus.26209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/22/2022] [Indexed: 12/24/2022] Open
Abstract
The purpose of this study was to investigate the relationship between androgen deprivation therapy (ADT) and cardiovascular events in men with prostate cancer. Cardiovascular disease (CVD) is a primary cause of noncancer mortality in men with prostate cancer. Surveillance, Epidemiology, and End Results (SEER) Medicare-linked data revealed that CVD was responsible for about a quarter of deaths among men with prostate cancer, with a focus on the role of ADT as a contributing cause. We performed a literature search in November 2021 utilizing search engines such as PubMed, Scopus, Science Direct, and Google Scholar. Original publications with data published between 2006 and 2020 were used in the investigation of men with prostate cancer undergoing ADT treatment with a CVD outcome. Two reviewers independently examined the content of the studies and extracted data from the final papers after they had been validated for quality using quality assessment tools.
A total of 14 observational studies and two randomized controlled trials are included in this systematic review. Sample sizes in the examined publications varied from 79 to 201,797 individuals. ADT was the intervention in all of the investigations. Seven of the included studies did not identify the type of ADT utilized; instead, they compared the outcomes of individuals who got ADT against those who did not. The specific type of ADT used is mentioned in the remaining nine studies included in the systematic review. Patients who got ADT, such as gonadotropin-releasing hormone (GnRH) agonists, combination androgen blockade, surgical castration, and oral anti-androgen, are compared to those who did not receive ADT to discover who had a better prognosis. In conclusion, even though ADT has several negative metabolic side effects that increase the risk of cardiovascular toxicity, published research utilizing a variety of designs has demonstrated inconsistency in the impact of ADT on cardiovascular outcomes. While the risk of CVD should be considered when prescribing ADT, the findings suggest that it should not be considered a contraindication if the expected benefit is substantial.
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de Pablos-Rodríguez P, la Rosa A, Rebez G, Mascarós Martínez JM, González Pérez V, Arribas Alpuente L, Rubio-Briones J, Ramírez-Backhaus M. Stereotactic body radiation therapy in patients with metachronous oligorecurrent prostate cancer: A single-center experience. ACTAS UROLÓGICAS ESPAÑOLAS (ENGLISH EDITION) 2022; 46:238-244. [PMID: 35321821 DOI: 10.1016/j.acuroe.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 12/11/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION AND OBJECTIVE Metachronous oligorecurrence in prostate cancer (PCa) occurs in patients with localized disease who, after failed radical treatment, develop oligometastases. Metastasis-directed stereotactic radiotherapy (SBRT) aims to delay androgen deprivation therapy. In this study, we report our experience to elucidate the role of SBRT in a selected population of patients with metachronous oligorecurrence. MATERIAL AND METHODS Retrospective analysis of patients treated with SBRT for oligorecurrent PCa between November 2015 and December 2020. We detailed clinicopathological characteristics at disease onset (age, PSA, stage, primary treatment), clinical scenario at diagnosis of oligorecurrence (PSA, PSA velocity, metastases characteristics), progression-free survival, castration resistance-free survival, dose, and toxicity of SBRT. RESULTS Thirty-eight SBRT treatments were applied to 13 lymph node and 25 bone metastases in a total of 28 patients. After a follow-up of 34.57 months (21.17-57.59), 17 patients had radiological progression of the disease and 11 presented castration resistant PCa. PFS and CRFS were 21.93 and 44.13 months, respectively. Only 2 patients presented grade 1 toxicity. CONCLUSIONS In patients with metachronous oligorecurrent PCa, SBRT constitutes a safe and effective treatment that allows delaying the onset of androgen deprivation therapy and the time to castration resistance, assuming low levels of toxicity.
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Affiliation(s)
- P de Pablos-Rodríguez
- Servicio de Urología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain.
| | - A la Rosa
- Servicio de Oncología Radioterápica, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - G Rebez
- Department of Urology, University of Trieste, Trieste, Italy
| | | | - V González Pérez
- Servicio de Radiofísica, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - L Arribas Alpuente
- Servicio de Oncología Radioterápica, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - J Rubio-Briones
- Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - M Ramírez-Backhaus
- Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain
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Liang H, Zhang F, Hong Y, Wu Y, Xie H, Zhang C, Wang Z, Lu Z, Yang H. Synergistic Silencing of Skp2 by siRNA Self-Assembled Nanoparticles as a Therapeutic Strategy for Advanced Prostate Cancer. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2022; 18:e2106046. [PMID: 35182014 DOI: 10.1002/smll.202106046] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/21/2022] [Indexed: 06/14/2023]
Abstract
Advanced prostate cancer, harboring multiple mutations of tumor suppressor genes, is refractory to conventional therapies. Knockout of the Skp2 gene blocks pRb/p53 doubly deficient prostate cancer in mice, which inspired the authors to develop an approach for delivering siRNA that would efficiently silence Skp2 (siSkp2) in vivo. Here, a facile strategy is reported to directly assemble siSkp2 with the natural compound quercetin (Que) into supramolecular nanoparticles (NPs). This carrier-free siSkp2 delivery system could effectively protect siSkp2 from degradation in serum and enhance its cellular internalization. Furthermore, the siSkp2/Que NPs exhibit synergistic effects in Skp2 silencing, because they can degrade the mRNA and protein of Skp2 simultaneously. Indeed, siSkp2/Que NPs remarkably diminish the Skp2 abundance and further inhibit the proliferation and migration of TMU cells (RB1/TP53/KRAS triple mutations) in vitro. The in vivo results further show that i.v. administration of siSkp2/Que NPs efficiently accumulates in tumor sites and strongly inhibits the growth of TMU tumors in nude mice. Importantly, the siSkp2/Que NPs do not induce any abnormality in the treated mice, which suggests satisfactory biocompatibility. Collectively, this study describes a tractable siRNA self-assembled strategy for Skp2 silencing, which might be a promising nanodrug to cure multitherapy-resistant advanced prostate cancer.
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Affiliation(s)
- Hong Liang
- College of Biological Science and Engineering, Fuzhou University, Fuzhou, 350108, P. R. China
- Fujian Key Laboratory of Functional Marine Sensing Materials, Fuzhou Institute of Oceanography, Minjiang University, Fuzhou, 350108, P. R. China
| | - Fangming Zhang
- College of Biological Science and Engineering, Fuzhou University, Fuzhou, 350108, P. R. China
| | - Yannv Hong
- College of Biological Science and Engineering, Fuzhou University, Fuzhou, 350108, P. R. China
| | - Yue Wu
- College of Biological Science and Engineering, Fuzhou University, Fuzhou, 350108, P. R. China
| | - Huanzhang Xie
- Fujian Key Laboratory of Functional Marine Sensing Materials, Fuzhou Institute of Oceanography, Minjiang University, Fuzhou, 350108, P. R. China
| | - Chen Zhang
- Fujian Key Laboratory of Functional Marine Sensing Materials, Fuzhou Institute of Oceanography, Minjiang University, Fuzhou, 350108, P. R. China
| | - Zonghua Wang
- Fujian Key Laboratory of Functional Marine Sensing Materials, Fuzhou Institute of Oceanography, Minjiang University, Fuzhou, 350108, P. R. China
| | - Zhonglei Lu
- College of Biological Science and Engineering, Fuzhou University, Fuzhou, 350108, P. R. China
| | - Huanghao Yang
- MOE Key Laboratory for Analytical Science of Food Safety and Biology, Fujian Provincial Key Laboratory of Analysis and Detection Technology for Food Safety, State Key Laboratory of Photocatalysis on Energy and Environment, College of Chemistry, Fuzhou University, Fuzhou, 350108, P. R. China
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Xia T, Liu S, Xu G, Zhou S, Luo Z. Dihydroartemisinin induces cell apoptosis through repression of UHRF1 in prostate cancer cells. Anticancer Drugs 2022; 33:e113-e124. [PMID: 34387595 DOI: 10.1097/cad.0000000000001156] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Prostate cancer (PCa) seriously jeopardizes men's health worldwide. Dihydroartemisinin, which is an effective antimalarial agent, has shown potential anticancer effects in various human cancer cell lines, including PCa cells. However, the mechanisms underlying the anticancer activity of dihydroartemisinin are not fully understood. Ubiquitin-like with plant homeodomain and ring finger domain 1 (UHRF1) is highly expressed in a variety of tumors and is negatively correlated with the prognosis of various tumors. We reported previously that UHRF1 is downregulated during apoptosis induced by dihydroartemisinin in PC-3 PCa cells. In this study, we transfected PC-3 cells with lentiviruses containing UHRF1 or shRNA-UHRF1. Then, the cells were treated with dihydroartemisinin at different concentrations. Our data showed that overexpression of UHRF1 promoted cell proliferation and migration in PC-3 cells, inhibited cell apoptosis, increased cell proportion in G2 phase, increased DNA methyltransferase 1 and decreased p16INK4A expression at mRNA and protein levels. Downregulation of UHRF1 produces the opposite results. Moreover, the phenomena caused by overexpression of UHRF1 were inhibited after dihydroartemisinin treatment. Compared with control cells, cells overexpressing UHRF1 can resist the proapoptotic and antiproliferative effects of dihydroartemisinin to a certain extent. The effects of UHRF1 knockdown were further aggravated by dihydroartemisinin treatment, but no statistically significant effect was observed with increasing drug concentration. Our results suggested that dihydroartemisinin decreases proliferation and migration but enhances apoptosis of PCa cells, likely by downregulating UHRF1 and upregulating p16INK4A.
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Affiliation(s)
- Tong Xia
- Laboratory of Medical Experiment Technology, Institute of Life Science, Chongqing Medical University, Chongqing, China
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de Pablos-Rodríguez P, la Rosa de los Ríos A, Rebez G, Mascarós Martínez J, González Pérez V, Arribas Alpuente L, Rubio-Briones J, Ramírez-Backhaus M. Terapia de radiación corporal estereotáctica en pacientes con cáncer de próstata oligorrecurrente metacrónico. Experiencia de un centro. Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Neuroprotection of dihydrotestosterone via suppression of the toll-like receptor 4/nuclear factor-kappa B signaling pathway in high glucose-induced BV-2 microglia inflammatory responses. Neuroreport 2021; 31:139-147. [PMID: 31876682 DOI: 10.1097/wnr.0000000000001385] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Hyperglycemia is considered to induce neuronal apoptosis via activating microglia inflammatory responses, thus involving in the development and progression of diabetic encephalopathy and neurodegenerative disorders. Increasing evidences suggest that androgen exerts neuroprotective functions including antiapoptosis, anti-inflammation and antioxidative stress. In this study, we investigate the anti-inflammatory role of dihydrotestosterone (DHT) in high glucose (HG)-induced neuroinflammatory response in BV-2 microglia. Our results revealed that DHT significantly inhibited HG-induced production of nitric oxide and prostaglandin E2 through suppressing the expression of corresponding regulatory enzymes - inducible NO synthase and cyclooxygenase-2. Also, DHT inhibited HG-induced expression of TNF-α and IL-1β. Moreover, DHT suppressed the toll-like receptor 4 (TLR4)/nuclear factor-kappa B (NF-κB) signaling pathway. Furthermore, when SH-SY5Y neurons were cultured in HG-treated BV-2 microglial supernatant, DHT pretreatment significantly increased neuronal survival, indicating the neuroprotective role of DHT. Collectively, these results suggest that DHT could protect SH-SY5Y neurons from HG-mediated BV-2 microglia inflammatory damage through inhibiting TLR4/NF-κB signaling, suggesting that maintenance of androgen level in brain might have potential benefit in neurodegenerative diseases, especially in diabetes patients combined with cognitive disorders.
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Liao KM, Wang YL, Chen CY. Medication utilization evaluation of androgen deprivation therapy for prostate cancer in Taiwan. Medicine (Baltimore) 2020; 99:e23644. [PMID: 33327345 PMCID: PMC7738133 DOI: 10.1097/md.0000000000023644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Prostate cancer is one of the most common cancer in males. Both the incidence and the mortality rates of prostate cancer show an increasing trend. Androgen deprivation therapy (ADT) is the standard treatment for metastatic prostate cancer. The aim of our study was to show the epidemiology of prostate cancer and the proportion of patients utilizing ADT.This study used Taiwan's National Health Insurance Research Database (NHIRD) and identified the patients who had been diagnosed with prostate cancer (International Classification of Disease (ICD)-10: C61) and followed up between Jan 1, 2008 and Dec 31, 2015. The ADT drugs used by prostate cancer patients were recorded: Gonadotropin-releasing hormone (GnRH) agonists; GnRH antagonist; estrogen analogs and androgen receptor antagonist.A total of 25,233 patients with newly diagnosed prostate cancer in 2008-2014 were enrolled. The utilization of ADT increased from more than 7,000 person-time in 2008 to more than 50,000 person-time in 2014. Cyproterone acetate was the most commonly used drug in 2008-2015, but its proportion of utilization, which was the highest in stage 2 cancer, dropped from 43% in 2008 to 15% in 2015. Bicalutamide was the second most used drug from 2008 to 2015, but its utilization was not different for different stages.The incidence rate of prostate cancer increased in the study period and medical expenditure also increased in ADT treatment. Health insurance benefits for various ADT drugs should be further evaluated.
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Affiliation(s)
- Kuang-Ming Liao
- Department of Internal Medicine, Chi Mei Medical Center, Chiali, Tainan
| | - Ya-Ling Wang
- Department of Pharmacy, Kaohsiung Medical University Hospital
| | - Chung-Yu Chen
- Department of Pharmacy, Kaohsiung Medical University Hospital
- Master Program in Clinical Pharmacy, School of Pharmacy, Kaohsiung Medical University
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Ryan C, Wefel JS, Morgans AK. A review of prostate cancer treatment impact on the CNS and cognitive function. Prostate Cancer Prostatic Dis 2020; 23:207-219. [PMID: 31844181 PMCID: PMC7237350 DOI: 10.1038/s41391-019-0195-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 11/07/2019] [Accepted: 11/18/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Androgen deprivation therapy (ADT) is the backbone of systemic therapy for men with prostate cancer (PC); almost one-half of patients receive treatment during their disease course. However, a range of cognitive and other central nervous system (CNS) changes have been associated with ADT. In this review, we discuss extant data describing these complications and the mechanisms through which medications used to deliver ADT may affect them. METHODS We performed a MEDLINE search for appropriate papers published between January 2000 and December 2018. Relevant papers were selected and reviewed; additional publications were identified by manually assessing references from included papers, and recent congress abstracts. RESULTS Of ~230 search outputs, 33 were selected for inclusion. Some studies suggested a clear association between ADT and CNS effects in men with PC, whereas others did not. Accurate assessment is limited by test instrument variability, inadequate sample sizes, short follow-up duration, and limited prospective longitudinal studies. The approved second-generation androgen receptor (AR) inhibitors enzalutamide and apalutamide were associated with some CNS-related adverse events (AEs) in clinical studies, including fatigue (which can interfere with cognitive function). The androgen synthesis inhibitor abiraterone acetate was associated with a low CNS AE profile when compared with enzalutamide. The AR antagonist darolutamide demonstrated a comparable incidence of cognitive disorder in clinical trials to that of ADT alone. CONCLUSIONS Adequately caring for men receiving ADT requires an understanding of the symptoms, incidence and magnitude of cognitive effects, and a feasible approach to cognitive assessment and management in clinical settings. Some CNS effects could relate to blood-brain barrier penetration and direct AR inhibitor activity; drug safety profiles may differ by the degree of blood-brain barrier penetration of particular agents. Ongoing clinical trials seek to define the CNS tolerability of newer AR pathway-targeted therapy options more clearly.
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Affiliation(s)
- Charles Ryan
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN, USA.
| | - Jeffrey S Wefel
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alicia K Morgans
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Chaplow ZL, Focht BC, Lucas AR, Grainger E, Simpson C, Buell J, Fairman CM, Thomas‐Ahner JM, Bowman J, DeScenza VR, Monk JP, Mortazavi A, Clinton SK. Effects of a lifestyle intervention on body composition in prostate cancer patients on androgen deprivation therapy. JCSM CLINICAL REPORTS 2020; 5:52-60. [PMID: 36051892 PMCID: PMC9432850 DOI: 10.1002/crt2.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Exercise and dietary (EX+D) interventions could represent an optimal treatment for attenuating or reversing adverse effects of androgen deprivation therapy (ADT) in prostate cancer (PCa) patients. The Individualized Diet and Exercise Adherence-Pilot (IDEA-P) trial compared the effects of an EX+D intervention relative to standard-of-care (SC) treatment among PCa patients undergoing ADT. The present study evaluated the effects of the EX+D intervention on body composition (BC) obtained via dual-energy X-ray absorptiometry (DXA) in a subsample of IDEA-P patients. A secondary objective was to explore the association of adiposity and lean mass with mobility performance and strength. Methods Complete DXA data were acquired from a subsample of 22 PCa patients (EX+D: n = 13; SC: n = 9) at baseline and 3 month follow-up. Intention-to-treat analysis included data from 30 participants (M age = 66.28; SD = 7.79) with baseline DXA assessments. Results Intention-to-treat analysis revealed EX+D resulted in significant improvements in fat mass (P = 0.022), per cent fat mass (P = 0.028), trunk fat mass (P = 0.017), fat mass/lean mass (P = 0.040), and per cent lean mass (P = 0.026) vs. SC. EX+D also resulted in more favourable changes in appendicular lean mass/body mass (d = 0.59). Select BC outcomes were also significantly correlated with mobility performance and strength (P < 0.05) at 3 month follow-up. Conclusions Findings suggest the EX+D intervention resulted in superior preservation of lean tissue and improvement in adiposity relative to SC treatment. Results underscore the utility of implementing EX+D interventions for preserving muscle mass and reducing adiposity in PCa patients undergoing ADT.
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Affiliation(s)
- Zachary L. Chaplow
- Kinesiology, Department of Human Sciences The Ohio State University 305 Annie and John Glenn Ave Columbus OH 43210 USA
| | - Brian C. Focht
- Kinesiology, Department of Human Sciences The Ohio State University 305 Annie and John Glenn Ave Columbus OH 43210 USA
- Comprehensive Cancer Center The Ohio State University Columbus OH 43210 USA
| | - Alexander R. Lucas
- Department of Health Behavior and Policy Virginia Commonwealth University Richmond VA USA
| | - Elizabeth Grainger
- Comprehensive Cancer Center The Ohio State University Columbus OH 43210 USA
- Department of Internal Medicine, Division of Medical Oncology The Ohio State University Columbus OH 43210 USA
| | - Christina Simpson
- Comprehensive Cancer Center The Ohio State University Columbus OH 43210 USA
- Department of Internal Medicine, Division of Medical Oncology The Ohio State University Columbus OH 43210 USA
| | - Jackie Buell
- Medical Dietetics, School of Health and Rehabilitation Sciences The Ohio State University Columbus OH 43210 USA
| | - Ciaran M. Fairman
- Exercise Medicine Research Institute Edith Cowan University Joondalup WA Australia
| | - Jennifer M. Thomas‐Ahner
- Comprehensive Cancer Center The Ohio State University Columbus OH 43210 USA
- Department of Internal Medicine, Division of Medical Oncology The Ohio State University Columbus OH 43210 USA
| | - Jessica Bowman
- Kinesiology, Department of Human Sciences The Ohio State University 305 Annie and John Glenn Ave Columbus OH 43210 USA
| | - Victoria R. DeScenza
- Kinesiology, Department of Human Sciences The Ohio State University 305 Annie and John Glenn Ave Columbus OH 43210 USA
| | - J. Paul Monk
- Comprehensive Cancer Center The Ohio State University Columbus OH 43210 USA
- Department of Internal Medicine, Division of Medical Oncology The Ohio State University Columbus OH 43210 USA
| | - Amir Mortazavi
- Comprehensive Cancer Center The Ohio State University Columbus OH 43210 USA
- Department of Internal Medicine, Division of Medical Oncology The Ohio State University Columbus OH 43210 USA
| | - Steven K. Clinton
- Comprehensive Cancer Center The Ohio State University Columbus OH 43210 USA
- Department of Internal Medicine, Division of Medical Oncology The Ohio State University Columbus OH 43210 USA
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Firat F, Erdemir F, Günaydın B, Parlaktas BS, Markoç F, Yaşar A. Evaluation of effectiveness of antiandrogen treatments on cavernosal tissues in rats. Andrologia 2020; 52:e13567. [PMID: 32189380 DOI: 10.1111/and.13567] [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: 01/29/2020] [Revised: 02/18/2020] [Accepted: 02/21/2020] [Indexed: 11/29/2022] Open
Abstract
In this study, we aimed to compare changes in cavernosal tissues in rats with antiandrogen treatment and orchiectomy. A total of 42 Wistar albino rats were divided into four groups. Group I, control group, Group II, LH-RH was given for 1 month, Group III-LH-RH + Bicalutamide was given for 1 month, and Group IV was defined as orchiectomy and followed up for 1 month. Measurements of intracavernosal pressure with different electrical stimuli and pathological findings of smooth muscle collagen in cavernosal tissues were examined. While the cavernosal pressure response in all the different electrical stimuli given in the control group and in all other groups was significantly lower than that in the other groups, it was statistically significant at 7.5 and 10 V (p = .005, p < 0001). According to the pathologic evaluation, the density of tissue collagen increased significantly in the other groups according to the control group. In groups 3 and 4, the density of 4+ collagen was found to be increased according to Groups 1 and 2. In the LH-RH alone group, it appears that there are no 4+ colloid density and less damage. According to these findings, the negative effect of LH-RH treatment on cavernosal tissues appears to be less.
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Affiliation(s)
- Fatih Firat
- Department of Urology, Tokat State Hospital, Tokat, Turkey
| | - Fikret Erdemir
- Department of Urology, Gaziosmanpasa University, Tokat, Turkey
| | - Bilal Günaydın
- Department of Urology, Niğde Ömer Halisdemir University, Niğde, Turkey
| | | | - Fatma Markoç
- Department of Pathology, Gaziosmanpasa University, Tokat, Turkey
| | - Adem Yaşar
- Department of Urology, Amasya Training and Research Hospital, Amasya, Turkey
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14
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Abstract
Cancer remains a common disease with approximately 40% of Americans diagnosed with cancer in their lifetime. Medical advances in the field of oncology have led to an increased life expectancy and a decreased mortality rate. Antineoplastic agents such as taxanes and targeted therapies are indicated in the treatment of many cancers, and their use can be associated with various musculoskeletal complaints and adverse effects. Orthopaedic Surgeons are trained to identify primary bone tumors and metastasis to bones. It is also important for them to have an understanding of the profile of musculoskeletal adverse effects associated with the treatment of the more common neoplasms. This article reviews the current literature on the commonly used chemotherapeutic agents and their associated musculoskeletal effects.
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15
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Bravi CA, Tin A, Vertosick E, Mazzone E, Bandini M, Dell'Oglio P, Stabile A, Gandaglia G, Fossati N, Sjoberg D, Touijer K, Cozzarini C, Briganti A, Montorsi F, Eastham J, Vickers A. Androgen deprivation therapy in men with node-positive prostate cancer treated with postoperative radiotherapy. Urol Oncol 2019; 38:204-209. [PMID: 31653565 DOI: 10.1016/j.urolonc.2019.09.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/19/2019] [Accepted: 09/22/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND In men with node-positive prostate cancer after radical prostatectomy there are limited data on the value of adding androgen deprivation therapy (ADT) to postoperative radiotherapy. OBJECTIVE To determine whether there is a clear oncologic benefit to ADT in the setting of node-positive prostate cancer treated with postoperative radiotherapy. METHODS We analyzed data for 372 prostate cancer patients treated at San Raffaele Hospital with postoperative radiotherapy for node-positive disease after radical prostatectomy, 272 received both ADT and radiotherapy. Eighty-six men were followed without an event for more than 10 years. RESULTS Patients who received postoperative radiotherapy + ADT had more aggressive disease, with higher preoperative PSA level, higher rate of ISUP grade 5, pT3b-T4 tumors and ≥3 positive nodes. At multivariable Cox regression, the comparison between men treated by postoperative radiotherapy + ADT vs. radiotherapy alone did not show a significant difference for overall (hazards ratio: 0.91; 95% confidence interval: 0.45, 1.84; P = 0.8) and cancer-specific survival (hazards ratio: 5.39; 95% confidence intervalI: 0.70, 41.39; P = 0.11). These results remained consistent in a number of sensitivity analyses, including propensity score matching. Consideration of 95% CIs suggests that a clinically significant benefit of ADT in node-positive patients receiving radiotherapy after surgery is unlikely. CONCLUSIONS We can exclude the sort of large survival benefit that would be required to justify the risks and toxicities of ADT in men with node-positive disease receiving postoperative radiotherapy. Awaiting larger and more powered studies on this topic, men with pN+ prostate cancer treated with postoperative radiotherapy should not receive ADT outside well-controlled clinical trials.
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Affiliation(s)
- Carlo Andrea Bravi
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy; Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Amy Tin
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Emily Vertosick
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Elio Mazzone
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Bandini
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Dell'Oglio
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Armando Stabile
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Giorgio Gandaglia
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Nicola Fossati
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Daniel Sjoberg
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Karim Touijer
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Cesare Cozzarini
- Department of Radiotherapy, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - James Eastham
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew Vickers
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
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16
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Coelingh Bennink HJT, Zimmerman Y, Verhoeven C, Dutman AE, Mensinga T, Kluft C, Reisman Y, Debruyne FMJ. A Dose-Escalating Study With the Fetal Estrogen Estetrol in Healthy Men. J Clin Endocrinol Metab 2018; 103:3239-3249. [PMID: 29931320 DOI: 10.1210/jc.2018-00147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 06/15/2018] [Indexed: 12/28/2022]
Abstract
CONTEXT Luteinizing hormone-releasing hormone (LHRH) agonists have replaced estrogens for endocrine treatment of advanced prostate cancer (PC) because of cardiovascular side effects. The fetal estrogen estetrol (E4) may be safer for PC treatment and is expected to decrease testosterone (T) and prevent estrogen deficiency. OBJECTIVE To investigate the safety and T-suppressive effect of E4 in healthy men. DESIGN Double-blind, randomized, placebo-controlled, dose-escalating study. SETTING The study was conducted at a phase I clinical unit (QPS, Netherlands). PARTICIPANTS Healthy male volunteers aged 40 to 70 years. INTERVENTION(S) Three treatment cohorts of 15 volunteers with placebo (n = 5) and E4 (n = 10). Estetrol doses tested were 20, 40, and 60 mg/d. Subjects were treated for 4 weeks. MAIN OUTCOME MEASURES Subjective side effects, pharmacodynamic effects on hemostatic variables, lipids, glucose, bone parameters, and endocrine parameters related to T metabolism. RESULTS Total and free T decreased dose-dependently and significantly. Nipple tenderness occurred in 40% and decrease of libido occurred in 30% of E4-treated men. The unwanted estrogenic effects on hemostasis were small, dose dependent, and in some cases significant. Lipid and bone parameters showed a favorable trend. CONCLUSION The effect of E4 on testosterone levels is insufficient for standalone PC treatment. Taking all clinical and pharmacodynamic variables into consideration, a daily dose of 40 mg E4 seems safe for further evaluation of endocrine PC treatment in combination with LHRH analogs.
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Affiliation(s)
| | | | | | | | | | | | - Yacov Reisman
- Department of Urology, Amstelland Hospital, AM Amstelveen, Netherlands
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17
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Bradley MC, Zhou Y, Freedman AN, Yood MU, Quesenbery CP, Haque R, Van Den Eeden SK, Cassidy-Bushrow AE, Aaronson D, Potosky AL. Risk of diabetes complications among those with diabetes receiving androgen deprivation therapy for localized prostate cancer. Cancer Causes Control 2018; 29:785-791. [PMID: 29959604 PMCID: PMC6660131 DOI: 10.1007/s10552-018-1050-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 06/13/2018] [Indexed: 01/03/2023]
Abstract
PURPOSE Androgen deprivation therapy (ADT), used increasingly in the treatment of localized prostate cancer, is associated with substantial long-term adverse consequences, including incident diabetes. While previous studies have suggested that ADT negatively influences glycemic control in existing diabetes, its association with diabetes complications has not been investigated. In this study, we examined the association between ADT use and diabetes complications in prostate cancer patients. METHODS A retrospective cohort study was conducted among men with newly diagnosed localized prostate cancer between 1995 and 2008, enrolled in three integrated health care systems. Men had radical prostatectomy or radiotherapy (curative intent therapy), existing type II diabetes mellitus (T2DM), and were followed through December 2010 (n = 5,336). Cox proportional hazards models were used to examine associations between ADT use and diabetes complications (any complication), and individual complications (diabetic neuropathy, diabetic retinopathy, diabetic amputation or diabetic cataract) after prostate cancer diagnosis. RESULTS ADT use was associated with an increased risk of any diabetes complication after prostate cancer diagnosis (adjusted hazard ratio, AHR, 1.12, 95% CI 1.03-1.23) as well as an increased risk of each individual complication compared to non-use. CONCLUSION ADT use in men with T2DM, who received curative intent therapy for prostate cancer, was associated with an increased risk of diabetes complications. These findings support those of previous studies, which showed that ADT worsened diabetes control. Additional, larger studies are required to confirm these findings and to potentially inform the development of a risk-benefit assessment for men with existing T2DM, before initiating ADT.
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Affiliation(s)
- Marie C Bradley
- Clinical and Translational Epidemiology Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA.
| | - Yingjun Zhou
- Georgetown University Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Andrew N Freedman
- Clinical and Translational Epidemiology Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | | | | | - Reina Haque
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | | | | | - David Aaronson
- Kaiser Permanente, Oakland Medical Center, 3600 Broadway, Oakland, CA, USA
| | - Arnold L Potosky
- Georgetown University Lombardi Comprehensive Cancer Center, Washington, DC, USA
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18
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Zabegalina NS, Henderickx MMEL, Lamotte V, Segers B, Stassijns G, De Wachter S, Hoekx L. Effects of a six-month supervised physical exercise program on physical and cardio-metabolic profile and quality of life in patients with prostate cancer on androgen deprivation therapy: a pilot and feasibility study. Cent European J Urol 2018; 71:234-241. [PMID: 30038816 PMCID: PMC6051362 DOI: 10.5173/ceju.2018.1652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 04/15/2018] [Accepted: 05/04/2018] [Indexed: 11/22/2022] Open
Abstract
Introduction To evaluate the effect of a six-month supervised physical exercise program on the physical and cardio-metabolic profile and quality of life in patients with prostate cancer on androgen deprivation therapy. Material and methods Twenty-seven patients with prostate cancer on androgen deprivation therapy were included in a physical exercise program. The program consisted of supervised physical exercises during a six-month period (two hours, twice a week). The exercise program contained moderate to high intensity aerobic and resistance exercises: cycling, walking or jogging for 45 minutes at an intensity of ±80% of the individual maximum heart rate, followed by resistance exercises targeting the major lower and upper body muscles. All patients were assessed prior to the exercise program, including anthropometrical parameters, blood analysis, quality of life and physical fitness. Blood analysis was repeated at a three-month follow-up. Anthropometrical parameters, physical fitness and quality of life were recorded at a three-, six- and nine-month follow-up. Results A positive effect on physical performance, muscular strength and quality of life was seen. The applied physical exercise program was well tolerated and characterized by a high satisfaction rate. An alarming issue of remarkably unfavorable baseline cardio-metabolic profile was revealed within our study population. Conclusions Our data indicates that a six-month supervised physical exercise program can be beneficial in preventing androgen deprivation therapy-related side effects in patients with prostate cancer. We emphasize the importance of screening for cardio-metabolic risk factors in patients who are treated with androgen deprivation therapy.
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Affiliation(s)
| | - Michaël M E L Henderickx
- Department of Urology, Antwerp University Hospital, Edegem, Belgium.,Department of Urology, Academic Medical Center, Amsterdam, The Netherlands
| | - Veerle Lamotte
- Department of Urology, Antwerp University Hospital, Edegem, Belgium.,Multidisciplinary Oncological Center of Antwerp (MOCA), Antwerp, Belgium
| | - Bart Segers
- Department of Physical Medicine and Rehabilitation, Antwerp University Hospital, Edegem, Belgium
| | - Gaetane Stassijns
- Department of Physical Medicine and Rehabilitation, Antwerp University Hospital, Edegem, Belgium
| | | | - Lucien Hoekx
- Department of Urology, Antwerp University Hospital, Edegem, Belgium.,Multidisciplinary Oncological Center of Antwerp (MOCA), Antwerp, Belgium
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19
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Bae HJ, Mian O, Vaidya D, DeWeese TL, Song DY. Use of 5-alpha-reductase inhibitors as alternatives to luteinizing-hormone releasing hormone (LHRH) analogs or anti-androgens for prostate downsizing before brachytherapy. Pract Radiat Oncol 2018; 8:e159-e165. [PMID: 29153901 PMCID: PMC5893440 DOI: 10.1016/j.prro.2017.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 09/20/2017] [Accepted: 10/05/2017] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Prostate hypertrophy, median lobe hypertrophy, and pubic arch interference (PAI) are relative contraindications to brachytherapy because of potential morbidity and technical considerations. GnRH analogs or non-steroidal anti-androgens are currently utilized to achieve prostatic downsizing prior to brachytherapy. However, such agents have been associated with effects on body habitus, metabolism, and quality of life. In contrast, 5-alpha reductase inhibitors (5-ARI) are far less frequently associated with these morbidities. METHODS AND MATERIALS Patients with large gland size, median lobe hypertrophy, or PAI were offered 5-ARI therapy. Repeat transrectal ultrasound was performed at 3 or 4 months, followed by brachytherapy if resolution was achieved. If downsizing was inadequate, patients were offered continuation of 5-ARI for additional 3 months, gonadotropin-releasing hormone analog (GnRH) agonist or antiandrogen therapy, or other curative treatment. RESULTS Of 59 patients with follow-up available, 42 (71%) were deemed to have adequate downsizing; 37 (63%) after 3 to 4 months of 5-ARI and 5 (8%) after 7 to 8 months. Seventeen patients (29%) received other treatments because of inadequate effect. Median volume reduction was 20%. Of 41 patients undergoing brachytherapy, 4 (9.7%) required temporary catheterization because of obstruction. Median follow-up after implantation was 25 months (range, 1-64). Median time for return to International Prostate Symptom Score ≤5 of baseline score was 7 months (interquartile ratio, 6-13). All but 1 patient who received brachytherapy remain biochemically controlled. CONCLUSION 5-ARI monotherapy is an alternative for downsizing in patients with hypertrophy or PAI, with more than 70% achieving adequate downsizing without use of GnRH analogs or antiandrogens. Patients who received brachytherapy experienced typical rates of postimplant urinary morbidity.
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Affiliation(s)
- Hee Joon Bae
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Omar Mian
- Department of Translational Hematology and Oncology Research, Cleveland Clinic, Cleveland, OH, USA
| | - Dhananjay Vaidya
- Department of Oncology - Biostatistics and Bioinformatics Division, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Theodore L. DeWeese
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Daniel Y. Song
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
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20
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Effect of dihydroartemisinin on UHRF1 gene expression in human prostate cancer PC-3 cells. Anticancer Drugs 2017; 28:384-391. [PMID: 28059831 DOI: 10.1097/cad.0000000000000469] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
As the second most common cancer in men around the world, prostate cancer is increasingly gaining more attention. Dihydroartemisinin (DHA) has been proven to be a promising anticancer agent in vitro as well as in vivo in accumulating data. However, the detailed mechanisms of how DHA action in human prostate cancer PC-3 cells remain elusive. This study aimed to investigate the effects of DHA, a novel anticancer agent, by inhibiting the expression of ubiquitin like containing PHD and ring finger 1 (UHRF1) in PC-3 cells. The apoptosis and cell-cycle distribution were detected by flow cytometry. Quantitative real-time PCR was performed to examine both UHRF1 and DNA methyltransferase 1 (DNMT1) expressions at mRNA levels, whereas the expressions of UHRF1, DNMT1, and p16 proteins at protein levels were detected by Western blotting. Methylation levels of p16 CpG islands were determined by bisulfite genomic sequencing. We showed that DHA induced the downregulation of UHRF1 and DNMT1, accompanied by an upregulation of p16 in PC-3 cells. Decreased p16 promoter methylation levels in DHA-treated groups were also observed in PC-3 cells. Furthermore, DHA significantly induced apoptosis and G1/S cell-cycle arrest in PC-3 cells. Our results suggested that downregulation of UHRF1/DNMT1 is upstream to many cellular events, including G1 cell arrest, demethylation of p16, and apoptosis. Together, our study provides new evidence that DHA may serve as a potential therapeutic agent in the treatment of prostate cancer.
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21
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Díaz Convalía EJ, Cano-García MDC, Miján-Ortiz JL, Arrabal-Martín M, Arrabal-Polo MÁ, Cózar-Olmo JM. Androgen deprivation therapy in prostate cancer and risk of developing renal calculi: Results of a case-control study. Med Clin (Barc) 2017; 148:495-497. [PMID: 28256207 DOI: 10.1016/j.medcli.2017.01.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 01/09/2017] [Accepted: 01/12/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND OBJECTIVE Androgenic deprivation therapy in prostate cancer is associated with the onset of different adverse effects, including osteoporosis and metabolic syndrome. Both are related to the onset of nephrolithiasis. The objective of this article is to study the incidence of renal stones in patients undergoing androgen deprivation therapy with LHRH analogue. PATIENTS AND METHODS Case-control study including a total of 85 patients divided into 2 groups: group 1, with 41 patients on androgen deprivation therapy, and group 2, with 44 patients not receiving androgen deprivation therapy. RESULTS New-onset lithiasis was observed in 12 cases (29.3%) in group 1 compared to 2 cases (4.5%) in group 2 (P=.0001), 4.4 years after starting the androgen deprivation therapy. The estimated odds ratio was 8.69 (95% CI 1.81-41.76). CONCLUSION The incidence of renal stones could be increased in patients receiving treatment with analogue LHRH. However, long-term prospective studies with a metabolic control are required to be able to establish the causes explaining the development of this phenomenon in patients undergoing treatment with androgen deprivation therapy.
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Affiliation(s)
| | | | - José Luis Miján-Ortiz
- Unidad de Gestión Clínica de Urología, Complejo Hospitalario Universitario de Granada, Granada, España
| | - Miguel Arrabal-Martín
- Unidad de Gestión Clínica de Urología, Complejo Hospitalario Universitario de Granada, Granada, España
| | - Miguel Ángel Arrabal-Polo
- Unidad de Gestión Clínica de Urología, Complejo Hospitalario Universitario de Granada, Granada, España.
| | - José Manuel Cózar-Olmo
- Unidad de Gestión Clínica de Urología, Complejo Hospitalario Universitario de Granada, Granada, España
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22
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Scailteux LM, Vincendeau S, Balusson F, Leclercq C, Happe A, Le Nautout B, Polard E, Nowak E, Oger E. Androgen deprivation therapy and cardiovascular risk: No meaningful difference between GnRH antagonist and agonists—a nationwide population-based cohort study based on 2010–2013 French Health Insurance data. Eur J Cancer 2017; 77:99-108. [DOI: 10.1016/j.ejca.2017.03.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 02/23/2017] [Accepted: 03/02/2017] [Indexed: 12/11/2022]
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23
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Tang X, Li F, Jia J, Yang C, Liu W, Jin B, Wang X, Gao R, He D, Guo P. Synthesis of magnetic molecularly imprinted polymers with excellent biocompatibility for the selective separation and inhibition of testosterone in prostate cancer cells. Int J Nanomedicine 2017; 12:2979-2993. [PMID: 28442907 PMCID: PMC5396939 DOI: 10.2147/ijn.s133009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Androgen plays an important role in the progression of prostate cancer. In the present study, novel magnetic molecularly imprinted polymers (MMIPs) with good biocompatibility were produced for the selective separation and inhibition of testosterone in prostate cancer cells. MATERIALS AND METHODS MMIPs were prepared by using magnetic nanospheres, gelatin, and testosterone as the supporting materials, functional monomer, and the template molecule, respectively. The characterization of the resultant products was investigated by transmission electron microscopy, X-ray diffraction, and vibrating sample magnetometry. To test whether MMIPs can remove testosterone in biologic samples, human LNCaP (androgen-dependent) and C4-2 (androgen-independent) prostate cancer cells were selected as cell models. The translocation of androgen receptor (AR) was detected by immunofluorescence assay, and the expression of PSA mRNA was detected by real-time quantitative polymerase chain reaction analysis. Cell flow cytometry analysis was performed to detect cell cycle arrest. RESULTS The synthesized nanomaterials (MMIPs) possessed high crystallinity, satisfactory superparamagnetic properties, and uniform imprinted shell, and exhibited high adsorption capacity, fast kinetics, and high selectivity for testosterone. Moreover, the obtained imprinted nanomaterials could selectively enrich and detect testosterone in the LNCaP cell samples as a solid-phase extractant coupled with high-performance liquid chromatography. In addition, the MMIPs could freely enter prostate cancer cells and suppress the translocation of AR into the cell nucleus. We further found that MMIPs inhibited upregulation of AR downstream target genes in LNCaP and C4-2 cells; also, MMIPs inhibited cell growth and induced obvious cell cycle arrest in androgen-dependent LNCaP cells, but had no obvious effect on androgen-independent C4-2 cells. CONCLUSION Our results indicate that the obtained imprinted nanomaterials can specifically and effectively bind testosterone and recover it from prostate cancer cells. Moreover, the MMIPs can freely enter prostate cancer cells and block the activation of testosterone-AR pathway. Thus, the MMIPs may be a new option for antiandrogen therapy in prostate cancer.
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Affiliation(s)
- Xiaoshuang Tang
- Department of Urology, The First Affiliated Hospital of Xi’an Jiaotong University
- Department of Urology, The Second Affiliated Hospital of Xi’an Jiaotong University
| | - Feng Li
- Department of Urology, The First Affiliated Hospital of Xi’an Jiaotong University
| | - Jing Jia
- Department of Urology, The First Affiliated Hospital of Xi’an Jiaotong University
| | - Chao Yang
- Department of Urology, The First Affiliated Hospital of Xi’an Jiaotong University
| | - Wei Liu
- Department of Urology, The First Affiliated Hospital of Xi’an Jiaotong University
| | - Ben Jin
- Department of Urology, The First Affiliated Hospital of Xi’an Jiaotong University
| | - Xinyang Wang
- Department of Urology, The First Affiliated Hospital of Xi’an Jiaotong University
| | - Ruixia Gao
- Institute of Analytical Science, School of Science, Xi’an Jiaotong University
| | - Dalin He
- Department of Urology, The First Affiliated Hospital of Xi’an Jiaotong University
- Key laboratory for Tumor Precision Medicine of Shaanxi Province, Xi’an, Shaanxi, People’s Republic of China
| | - Peng Guo
- Department of Urology, The First Affiliated Hospital of Xi’an Jiaotong University
- Key laboratory for Tumor Precision Medicine of Shaanxi Province, Xi’an, Shaanxi, People’s Republic of China
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24
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Kiwata JL, Dorff TB, Schroeder ET, Gross ME, Dieli-Conwright CM. A review of clinical effects associated with metabolic syndrome and exercise in prostate cancer patients. Prostate Cancer Prostatic Dis 2016; 19:323-332. [PMID: 27349496 PMCID: PMC5099103 DOI: 10.1038/pcan.2016.25] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 04/19/2016] [Accepted: 05/17/2016] [Indexed: 12/17/2022]
Abstract
Androgen deprivation therapy (ADT), a primary treatment for locally advanced or metastatic prostate cancer, is associated with the adverse effects on numerous physiologic parameters, including alterations in cardiometabolic variables that overlap with components of the metabolic syndrome (MetS). As MetS is an established risk factor for cardiovascular mortality and treatment for prostate cancer has been associated with the development of MetS, interventions targeting cardiometabolic factors have been investigated in prostate cancer patients to attenuate the detrimental effects of ADT. Much support exists for exercise interventions in improving MetS variables in insulin-resistant adults, but less evidence is available in men with prostate cancer. Regular exercise, when performed at appropriate intensities and volumes, can elicit improvements in ADT-related adverse effects, including MetS, and contributes to the growing body of literature supporting the role of exercise in cancer survivorship. This review (1) discusses the biologic inter-relationship between prostate cancer, ADT and MetS, (2) evaluates the current literature in support of exercise in targeting MetS and (3) describes the physiological mechanisms by which exercise may favorably alter MetS risk factors in prostate cancer patients on ADT.
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Affiliation(s)
- J L Kiwata
- Division of Biokinesiology and Physical Therapy, Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - T B Dorff
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - E T Schroeder
- Division of Biokinesiology and Physical Therapy, Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - M E Gross
- Center for Applied Molecular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - C M Dieli-Conwright
- Division of Biokinesiology and Physical Therapy, Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
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Khan O, Mashru A. The efficacy, safety and ethics of the use of testosterone-suppressing agents in the management of sex offending. Curr Opin Endocrinol Diabetes Obes 2016; 23:271-8. [PMID: 27032060 DOI: 10.1097/med.0000000000000257] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW The use of endocrine medications to reduce sexual offending recidivism is established and may involve clinicians from diverse specialities. The present review aims to outline relevant background information and note a Medical Ethics framework upon which to facilitate decision-making. RECENT FINDINGS There have been several systematic reviews in recent years. A number of problems with research in the area of the medical treatment of sex offenders have been highlighted. There remains scope for improvement in the research to answer a number of relevant clinical issues. Nonetheless, some very useful indicators of relevance to clinical practice have emerged. SUMMARY The use of medication to manage the risk of sex offending in males is appropriate under the right circumstances. These include, for example, hypersexuality with sexual deviance and psychological-treatment interfering sexual preoccupation.
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Affiliation(s)
- Omer Khan
- aChadwick Lodge, Milton Keynes bThe Wells Road Center, Nottingham, UK
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Scailteux LM, Naudet F, Alimi Q, Vincendeau S, Oger E. Mortality, cardiovascular risk, and androgen deprivation therapy for prostate cancer: A systematic review with direct and network meta-analyses of randomized controlled trials and observational studies. Medicine (Baltimore) 2016; 95:e3873. [PMID: 27310974 PMCID: PMC4998460 DOI: 10.1097/md.0000000000003873] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
UNLABELLED Androgen deprivation therapy (ADT) is a cornerstone therapy for advanced prostate cancer (PCa). We hypothesized that cardiovascular (CV) risk is different across the various ADT modalities to compare their effects on CV morbidity and mortality, and all-cause mortality in patients with PCa. To investigate more in depth potential CV risk heterogeneity focusing on coronary (main outcome) and cerebrovascular risk, CV, and overall mortality. We performed a Medline and Embase query, without language restriction, since 1950 up to July 2014. We included randomized controlled trials (RCTs) and observational studies providing that they compared at least 1 ADT modality to another one or to placebo and they gave data on CV event or all-cause mortality. Sixty-eight studies out of 3419 met our eligibility criteria. Eleven observational studies were analyzed. Direct meta-analyses showed that antiandrogen was associated with a 30% decrease risk for myocardial infarction (MI) compared to GnRH agonists (RR, 0.70 [0.54-0.91]); combined androgen blockade (CAB) was associated with a 10% increase risk for stroke when compared to antiandrogen (RR, 1.10 [1.02-1.19]). With regard to RCTs, 57 were included: direct meta-analyses suggested that CAB was associated with a 10% decrease of all-cause mortality when compared to GnRH agonist (RR, 0.90 [0.82-1.00]). Network analysis could only be performed for all-cause mortality and it remains difficult to disentangle benefit (positive impact on cancer survival) and risk (including CV risk). The impact of the ADT modalities on CV morbidity remains difficult to quantify and more detailed prospective collection is required. REGISTRATION PROSPERO, CRD42014010598.
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Affiliation(s)
- Lucie-Marie Scailteux
- Pharmacovigilance, Pharmacoepidemiology and Drug Information Center, Rennes University Hospital, Rennes, France
| | - Florian Naudet
- Clinical Investigation Center, INSERM 1414, Rennes University Hospital and University of Rennes 1, Rennes, France
| | - Quentin Alimi
- Urology Department, Rennes University Hospital, Rennes, France
| | | | - Emmanuel Oger
- Pharmacovigilance, Pharmacoepidemiology and Drug Information Center, Rennes University Hospital, Rennes, France
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Falchook AD, Basak R, Mohiuddin JJ, Chen RC. Evaluation of the effectiveness of adding androgen deprivation to modern dose-escalated radiotherapy for men with favorable intermediate-risk prostate cancer. Cancer 2016; 122:2341-9. [DOI: 10.1002/cncr.30049] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 02/18/2016] [Accepted: 02/23/2016] [Indexed: 12/23/2022]
Affiliation(s)
- Aaron D. Falchook
- Department of Radiation Oncology; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Ramsankar Basak
- Department of Radiation Oncology; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Jahan J. Mohiuddin
- Department of Radiation Oncology; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Ronald C. Chen
- Department of Radiation Oncology; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
- University of North Carolina Lineberger Comprehensive Cancer Center; Chapel Hill North Carolina
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Rot I, Wassersug RJ, Walker LM. What do urologists think patients need to know when starting on androgen deprivation therapy? The perspective from Canada versus countries with lower gross domestic product. Transl Androl Urol 2016; 5:235-47. [PMID: 27141453 PMCID: PMC4837317 DOI: 10.21037/tau.2016.03.06] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Androgen deprivation therapy (ADT) side effects are numerous and negatively impact prostate cancer patients’ quality of life. There is considerable discrepancy though among Canadian urologists regarding what ADT side effects and side effect management strategies. Little is known about global differences in ADT patient education. Methods International respondents were recruited via online posting and at an international urology conference. Hypotheses suggest that economic and cultural differences influence patient education practices; therefore, international respondents were divided into 3 categories (high, medium, and low gross domestic product). Results No differences were found between responses from Canadian urologists and high GDP countries. Compared to responses from low GDP countries, Canadian urologists are more likely to endorse informing patients about: osteoporosis, loss of muscle mass, weight gain, fatigue/sleep disturbance, relationship changes, cognitive changes, and loss of body hair. Infertility was the only side effect more often disclosed by urologists in low GDP counties. Recommended management strategies for hot flashes are more likely to be pharmaceutical in Canada, and behavioral in low GDP countries. Management strategies for gynecomastia are emphasized more in low GDP countries. Physical exercise is endorsed consistently more often by Canadian urologists. Conclusions ADT educational practices vary greatly between Canada and lower GDP countries. Factors that could contribute to differences include economics (e.g., ADT drug costs), differences in side effect presentation due to different ADT drugs used, racial differences in perceived side effect burden, disease status at ADT commencement, and cultural differences in patient-physician shared-decision making.
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Affiliation(s)
- Irena Rot
- 1 Department of Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada ; 2 Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada ; 3 Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia ; 4 Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Richard J Wassersug
- 1 Department of Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada ; 2 Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada ; 3 Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia ; 4 Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Lauren M Walker
- 1 Department of Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada ; 2 Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada ; 3 Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia ; 4 Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Alberta, Canada
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Dubois V, Laurent MR, Jardi F, Antonio L, Lemaire K, Goyvaerts L, Deldicque L, Carmeliet G, Decallonne B, Vanderschueren D, Claessens F. Androgen Deficiency Exacerbates High-Fat Diet-Induced Metabolic Alterations in Male Mice. Endocrinology 2016; 157:648-65. [PMID: 26562264 DOI: 10.1210/en.2015-1713] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Androgen deficiency is associated with obesity, metabolic syndrome, and type 2 diabetes mellitus in men, but the mechanisms behind these associations remain unclear. In this study, we investigated the combined effects of androgen deficiency and high-fat diet (HFD) on body composition and glucose homeostasis in C57BL/6J male mice. Two models of androgen deficiency were used: orchidectomy (ORX) and androgen receptor knockout mice. Both models displayed higher adiposity and serum leptin levels upon HFD, whereas no differences were seen on a regular diet. Fat accumulation in HFD ORX animals was accompanied by increased sedentary behavior and occurred in spite of reduced food intake. HFD ORX mice showed white adipocyte hypertrophy, correlated with decreased mitochondrial content but not function as well as increased lipogenesis and decreased lipolysis suggested by the up-regulation of fatty acid synthase and the down-regulation of hormone-sensitive lipase. Both ORX and androgen receptor knockout exacerbated HFD-induced glucose intolerance by impairing insulin action in liver and skeletal muscle, as evidenced by the increased triglyceride and decreased glycogen content in these tissues. In addition, serum IL-1β levels were elevated, and pancreatic insulin secretion was impaired after ORX. Testosterone but not dihydrotestosterone supplementation restored the castration effects on body composition and glucose homeostasis. We conclude that sex steroid deficiency in combination with HFD exacerbates adiposity, insulin resistance, and β-cell failure in 2 preclinical male mouse models. Our findings stress the importance of a healthy diet in a clinical context of androgen deficiency and may have implications for the prevention of metabolic alterations in hypogonadal men.
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Affiliation(s)
- Vanessa Dubois
- Molecular Endocrinology Laboratory (V.D., M.R.L., L.A., F.C.), Department of Cellular and Molecular Medicine, KU Leuven, 3000 Leuven, Belgium; Gerontology and Geriatrics (M.R.L.), KU Leuven, 3000 Leuven, Belgium; Clinical and Experimental Endocrinology (F.J., L.A., G.C., B.D., D.V.), Department of Clinical and Experimental Medicine, KU Leuven, 3000 Leuven, Belgium; Gene Expression Unit (K.L., L.G.), Department of Cellular and Molecular Medicine, KU Leuven, 3000 Leuven, Belgium; Exercise Physiology Research Group (L.D.), Department of Kinesiology, KU Leuven, 3000 Leuven, Belgium; and Institute of Neuroscience (L.D.), Université Catholique de Louvain, 1348 Louvain-la-Neuve, Belgium
| | - Michaël R Laurent
- Molecular Endocrinology Laboratory (V.D., M.R.L., L.A., F.C.), Department of Cellular and Molecular Medicine, KU Leuven, 3000 Leuven, Belgium; Gerontology and Geriatrics (M.R.L.), KU Leuven, 3000 Leuven, Belgium; Clinical and Experimental Endocrinology (F.J., L.A., G.C., B.D., D.V.), Department of Clinical and Experimental Medicine, KU Leuven, 3000 Leuven, Belgium; Gene Expression Unit (K.L., L.G.), Department of Cellular and Molecular Medicine, KU Leuven, 3000 Leuven, Belgium; Exercise Physiology Research Group (L.D.), Department of Kinesiology, KU Leuven, 3000 Leuven, Belgium; and Institute of Neuroscience (L.D.), Université Catholique de Louvain, 1348 Louvain-la-Neuve, Belgium
| | - Ferran Jardi
- Molecular Endocrinology Laboratory (V.D., M.R.L., L.A., F.C.), Department of Cellular and Molecular Medicine, KU Leuven, 3000 Leuven, Belgium; Gerontology and Geriatrics (M.R.L.), KU Leuven, 3000 Leuven, Belgium; Clinical and Experimental Endocrinology (F.J., L.A., G.C., B.D., D.V.), Department of Clinical and Experimental Medicine, KU Leuven, 3000 Leuven, Belgium; Gene Expression Unit (K.L., L.G.), Department of Cellular and Molecular Medicine, KU Leuven, 3000 Leuven, Belgium; Exercise Physiology Research Group (L.D.), Department of Kinesiology, KU Leuven, 3000 Leuven, Belgium; and Institute of Neuroscience (L.D.), Université Catholique de Louvain, 1348 Louvain-la-Neuve, Belgium
| | - Leen Antonio
- Molecular Endocrinology Laboratory (V.D., M.R.L., L.A., F.C.), Department of Cellular and Molecular Medicine, KU Leuven, 3000 Leuven, Belgium; Gerontology and Geriatrics (M.R.L.), KU Leuven, 3000 Leuven, Belgium; Clinical and Experimental Endocrinology (F.J., L.A., G.C., B.D., D.V.), Department of Clinical and Experimental Medicine, KU Leuven, 3000 Leuven, Belgium; Gene Expression Unit (K.L., L.G.), Department of Cellular and Molecular Medicine, KU Leuven, 3000 Leuven, Belgium; Exercise Physiology Research Group (L.D.), Department of Kinesiology, KU Leuven, 3000 Leuven, Belgium; and Institute of Neuroscience (L.D.), Université Catholique de Louvain, 1348 Louvain-la-Neuve, Belgium
| | - Katleen Lemaire
- Molecular Endocrinology Laboratory (V.D., M.R.L., L.A., F.C.), Department of Cellular and Molecular Medicine, KU Leuven, 3000 Leuven, Belgium; Gerontology and Geriatrics (M.R.L.), KU Leuven, 3000 Leuven, Belgium; Clinical and Experimental Endocrinology (F.J., L.A., G.C., B.D., D.V.), Department of Clinical and Experimental Medicine, KU Leuven, 3000 Leuven, Belgium; Gene Expression Unit (K.L., L.G.), Department of Cellular and Molecular Medicine, KU Leuven, 3000 Leuven, Belgium; Exercise Physiology Research Group (L.D.), Department of Kinesiology, KU Leuven, 3000 Leuven, Belgium; and Institute of Neuroscience (L.D.), Université Catholique de Louvain, 1348 Louvain-la-Neuve, Belgium
| | - Lotte Goyvaerts
- Molecular Endocrinology Laboratory (V.D., M.R.L., L.A., F.C.), Department of Cellular and Molecular Medicine, KU Leuven, 3000 Leuven, Belgium; Gerontology and Geriatrics (M.R.L.), KU Leuven, 3000 Leuven, Belgium; Clinical and Experimental Endocrinology (F.J., L.A., G.C., B.D., D.V.), Department of Clinical and Experimental Medicine, KU Leuven, 3000 Leuven, Belgium; Gene Expression Unit (K.L., L.G.), Department of Cellular and Molecular Medicine, KU Leuven, 3000 Leuven, Belgium; Exercise Physiology Research Group (L.D.), Department of Kinesiology, KU Leuven, 3000 Leuven, Belgium; and Institute of Neuroscience (L.D.), Université Catholique de Louvain, 1348 Louvain-la-Neuve, Belgium
| | - Louise Deldicque
- Molecular Endocrinology Laboratory (V.D., M.R.L., L.A., F.C.), Department of Cellular and Molecular Medicine, KU Leuven, 3000 Leuven, Belgium; Gerontology and Geriatrics (M.R.L.), KU Leuven, 3000 Leuven, Belgium; Clinical and Experimental Endocrinology (F.J., L.A., G.C., B.D., D.V.), Department of Clinical and Experimental Medicine, KU Leuven, 3000 Leuven, Belgium; Gene Expression Unit (K.L., L.G.), Department of Cellular and Molecular Medicine, KU Leuven, 3000 Leuven, Belgium; Exercise Physiology Research Group (L.D.), Department of Kinesiology, KU Leuven, 3000 Leuven, Belgium; and Institute of Neuroscience (L.D.), Université Catholique de Louvain, 1348 Louvain-la-Neuve, Belgium
| | - Geert Carmeliet
- Molecular Endocrinology Laboratory (V.D., M.R.L., L.A., F.C.), Department of Cellular and Molecular Medicine, KU Leuven, 3000 Leuven, Belgium; Gerontology and Geriatrics (M.R.L.), KU Leuven, 3000 Leuven, Belgium; Clinical and Experimental Endocrinology (F.J., L.A., G.C., B.D., D.V.), Department of Clinical and Experimental Medicine, KU Leuven, 3000 Leuven, Belgium; Gene Expression Unit (K.L., L.G.), Department of Cellular and Molecular Medicine, KU Leuven, 3000 Leuven, Belgium; Exercise Physiology Research Group (L.D.), Department of Kinesiology, KU Leuven, 3000 Leuven, Belgium; and Institute of Neuroscience (L.D.), Université Catholique de Louvain, 1348 Louvain-la-Neuve, Belgium
| | - Brigitte Decallonne
- Molecular Endocrinology Laboratory (V.D., M.R.L., L.A., F.C.), Department of Cellular and Molecular Medicine, KU Leuven, 3000 Leuven, Belgium; Gerontology and Geriatrics (M.R.L.), KU Leuven, 3000 Leuven, Belgium; Clinical and Experimental Endocrinology (F.J., L.A., G.C., B.D., D.V.), Department of Clinical and Experimental Medicine, KU Leuven, 3000 Leuven, Belgium; Gene Expression Unit (K.L., L.G.), Department of Cellular and Molecular Medicine, KU Leuven, 3000 Leuven, Belgium; Exercise Physiology Research Group (L.D.), Department of Kinesiology, KU Leuven, 3000 Leuven, Belgium; and Institute of Neuroscience (L.D.), Université Catholique de Louvain, 1348 Louvain-la-Neuve, Belgium
| | - Dirk Vanderschueren
- Molecular Endocrinology Laboratory (V.D., M.R.L., L.A., F.C.), Department of Cellular and Molecular Medicine, KU Leuven, 3000 Leuven, Belgium; Gerontology and Geriatrics (M.R.L.), KU Leuven, 3000 Leuven, Belgium; Clinical and Experimental Endocrinology (F.J., L.A., G.C., B.D., D.V.), Department of Clinical and Experimental Medicine, KU Leuven, 3000 Leuven, Belgium; Gene Expression Unit (K.L., L.G.), Department of Cellular and Molecular Medicine, KU Leuven, 3000 Leuven, Belgium; Exercise Physiology Research Group (L.D.), Department of Kinesiology, KU Leuven, 3000 Leuven, Belgium; and Institute of Neuroscience (L.D.), Université Catholique de Louvain, 1348 Louvain-la-Neuve, Belgium
| | - Frank Claessens
- Molecular Endocrinology Laboratory (V.D., M.R.L., L.A., F.C.), Department of Cellular and Molecular Medicine, KU Leuven, 3000 Leuven, Belgium; Gerontology and Geriatrics (M.R.L.), KU Leuven, 3000 Leuven, Belgium; Clinical and Experimental Endocrinology (F.J., L.A., G.C., B.D., D.V.), Department of Clinical and Experimental Medicine, KU Leuven, 3000 Leuven, Belgium; Gene Expression Unit (K.L., L.G.), Department of Cellular and Molecular Medicine, KU Leuven, 3000 Leuven, Belgium; Exercise Physiology Research Group (L.D.), Department of Kinesiology, KU Leuven, 3000 Leuven, Belgium; and Institute of Neuroscience (L.D.), Université Catholique de Louvain, 1348 Louvain-la-Neuve, Belgium
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Effect of androgen deprivation therapy on arterial stiffness and serum lipid profile changes in patients with prostate cancer: a prospective study of initial 6-month follow-up. Int J Clin Oncol 2015; 21:389-396. [DOI: 10.1007/s10147-015-0891-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 08/11/2015] [Indexed: 11/26/2022]
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Ali Shah SI. Emerging potential of parenteral estrogen as androgen deprivation therapy for prostate cancer. South Asian J Cancer 2015; 4:95-7. [PMID: 25992351 PMCID: PMC4418092 DOI: 10.4103/2278-330x.155699] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Androgen deprivation therapy (ADT) is a key management strategy for prostate cancer (PC), achieved commonly by administration of luteinizing hormone-releasing hormone agonist (LHRHa), ADT markedly suppresses both male and female sex hormones which results in "castration syndrome", a constellation of adverse events such as muscle weakness, impairment of glucose and lipid metabolism, impotence, osteoporosis, and fractures. Recent evidence suggests that estrogen, in the parenteral form, may emerge as an alternative to LHRHa as it offers potential benefits of arresting PC growth as well as avoiding some of the estrogen deficiency related toxicities of LHRHa by maintaining endogenous levels of estrogen.
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Affiliation(s)
- Syed Imran Ali Shah
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London W12 ONN, United Kingdom
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Azzam G, Lanciano R, Arrigo S, Lamond J, Ding W, Yang J, Hanlon A, Good M, Brady L. SBRT: An Opportunity to Improve Quality of Life for Oligometastatic Prostate Cancer. Front Oncol 2015; 5:101. [PMID: 26000249 PMCID: PMC4419680 DOI: 10.3389/fonc.2015.00101] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 04/14/2015] [Indexed: 11/18/2022] Open
Abstract
Objective Oligometastatic prostate cancer is a limited metastatic disease state in which potential long-term control is still possible with the use of targeted therapies such as surgery or stereotactic body radiation therapy (SBRT). SBRT may as well potentially prolong the time before the initiation of androgen deprivation therapy (ADT) and docetaxel chemotherapy for oligometastatic prostate cancer. The goal of this study is to outline prognostic factors associated with improved outcome with SBRT for metastatic prostate cancer and to quantify the effect of prior systemic treatments such as ADT and docetaxel on survival after SBRT. Methods Twenty-four prostate cancer patients were treated with SBRT at the Philadelphia CyberKnife Center between August 2007 and April 2014. Retrospective data collection and analysis were performed for these patients on this Institutional Review Board approved study. Kaplan–Meier methodology was utilized to estimate and visually assess overall survival (OS) at the patient level, with comparisons accomplished using the log-rank test. Unadjusted hazard ratios were estimated using Cox proportional hazards regression modeling. Results An improved median survival was noted for patients with oligometastatic disease defined as ≤4 lesions with median survival of >3 years compared with 11 months for polymetastases (p = 0.02). The use of docetaxel at some time in follow-up either before or after SBRT was associated with decreased survival with median survival of 9 months vs. >3 years (p = 0.01). Conclusion Prognosis was better for men with recurrent prostate cancer treated with SBRT if they had ≤4 metastases (oligometastases) or if docetaxel was not necessary for salvage treatment. The prolonged median OS for men with oligometastases in this population of heavily pretreated prostate cancer patients following SBRT may allow for improved quality of life because of a delay of more toxic salvage therapies.
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Affiliation(s)
- Gregory Azzam
- Department of Radiation Oncology, Drexel University College of Medicine , Philadelphia, PA , USA
| | - Rachelle Lanciano
- Department of Radiation Oncology, Drexel University College of Medicine , Philadelphia, PA , USA ; Philadelphia CyberKnife Center, Delaware County Memorial Hospital , Havertown, PA , USA
| | - Steve Arrigo
- Department of Radiation Oncology, Drexel University College of Medicine , Philadelphia, PA , USA ; Philadelphia CyberKnife Center, Delaware County Memorial Hospital , Havertown, PA , USA
| | - John Lamond
- Department of Radiation Oncology, Drexel University College of Medicine , Philadelphia, PA , USA ; Philadelphia CyberKnife Center, Delaware County Memorial Hospital , Havertown, PA , USA
| | - William Ding
- Philadelphia CyberKnife Center, Delaware County Memorial Hospital , Havertown, PA , USA
| | - Jun Yang
- Department of Radiation Oncology, Drexel University College of Medicine , Philadelphia, PA , USA ; Philadelphia CyberKnife Center, Delaware County Memorial Hospital , Havertown, PA , USA
| | - Alexandra Hanlon
- Office of Nursing Research, School of Nursing, University of Pennsylvania , Philadelphia, PA , USA
| | - Michael Good
- Philadelphia CyberKnife Center, Delaware County Memorial Hospital , Havertown, PA , USA
| | - Luther Brady
- Department of Radiation Oncology, Drexel University College of Medicine , Philadelphia, PA , USA ; Philadelphia CyberKnife Center, Delaware County Memorial Hospital , Havertown, PA , USA
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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.
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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
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Affiliation(s)
- Frank Claessens
- Molecular Endocrinology LaboratoryDepartment of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, Campus GHB ON1, PO Box 901, 3000 Leuven, BelgiumDame Roma Mitchell Cancer Research LaboratoriesSchool of Medicine, University of Adelaide, Adelaide, South Australia 5000, Australia
| | - Wayne Tilley
- Molecular Endocrinology LaboratoryDepartment of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, Campus GHB ON1, PO Box 901, 3000 Leuven, BelgiumDame Roma Mitchell Cancer Research LaboratoriesSchool of Medicine, University of Adelaide, Adelaide, South Australia 5000, Australia
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