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Alyamani M, Michael P, Hettel D, Thomas L, Lundy SD, Berk M, Patel M, Li J, Rashidi H, McKenney JK, Klein EA, Sharifi N. Elevated periprostatic venous testosterone correlates with prostate cancer progression after radical prostatectomy. J Clin Invest 2023; 133:e171117. [PMID: 37655657 PMCID: PMC10471166 DOI: 10.1172/jci171117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/11/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUNDGenerally, clinical assessment of gonadal testosterone (T) in human physiology is determined using concentrations measured in peripheral blood. Prostatic T exposure is similarly thought to be determined from peripheral T exposure. Despite the fact that androgens drive prostate cancer, peripheral T has had no role in the clinical evaluation or treatment of men with localized prostate cancer.METHODSTo assess the role of local androgen delivery in prostate cancer, we obtained blood from the (periprostatic) prostatic dorsal venous complex in 266 men undergoing radical prostatectomy from July 2014 to August 2021 and compared dorsal T (DT) levels with those in circulating peripheral blood (PT) and prostatic tissue. Comprehensive targeted steroid analysis and unbiased metabolomics analyses were performed. The association between the DT/PT ratio and progression-free survival after prostatectomy was assessed.RESULTSSurprisingly, in some men, DT levels were enriched several-fold compared with PT levels. For example, 20% of men had local T concentrations that were at least 2-fold higher than peripheral T concentrations. Isocaproic acid, a byproduct of androgen biosynthesis, and 17-OH-progesterone, a marker of intratesticular T, were also enriched in the dorsal vein of these men, consistent with testicular shunting. Men with enriched DT had higher rates of prostate cancer recurrence. DT/PT concentration ratios predicted worse outcomes even when accounting for known clinical predictors.CONCLUSIONSThese data suggest that a large proportion of men have a previously unappreciated exposure to an undiluted and highly concentrated T supply. Elevated periprostatic T exposure was associated with worse clinical outcomes after radical prostatectomy.FUNDINGNational Cancer Institute (NCI), NIH grants R01CA172382, R01CA236780, R01CA261995, R01CA249279, and R50CA251961; US Army Medical Research and Development Command grants W81XWH2010137 and W81XWH-22-1-0082.
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Affiliation(s)
- Mohammad Alyamani
- Genitourinary Malignancies Research Center, Lerner Research Institute
| | - Patrick Michael
- Genitourinary Malignancies Research Center, Lerner Research Institute
- Department of Urology, Glickman Urological and Kidney Institute
| | - Daniel Hettel
- Genitourinary Malignancies Research Center, Lerner Research Institute
- Department of Urology, Glickman Urological and Kidney Institute
| | - Lewis Thomas
- Genitourinary Malignancies Research Center, Lerner Research Institute
- Department of Urology, Glickman Urological and Kidney Institute
| | - Scott D. Lundy
- Department of Urology, Glickman Urological and Kidney Institute
| | - Mike Berk
- Genitourinary Malignancies Research Center, Lerner Research Institute
| | - Mona Patel
- Genitourinary Malignancies Research Center, Lerner Research Institute
| | - Jianbo Li
- Department of Quantitative Health Sciences, Lerner Research Institute
| | - Hooman Rashidi
- Department of Pathology, Pathology and Laboratory Medicine Institute, and
| | - Jesse K. McKenney
- Department of Pathology, Pathology and Laboratory Medicine Institute, and
| | - Eric A. Klein
- Genitourinary Malignancies Research Center, Lerner Research Institute
- Department of Urology, Glickman Urological and Kidney Institute
| | - Nima Sharifi
- Genitourinary Malignancies Research Center, Lerner Research Institute
- Department of Urology, Glickman Urological and Kidney Institute
- Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Werneburg GT, Lundy SD, Hettel D, Bajic P, Gill BC, Adler A, Mukherjee SD, Wood HM, Angermeier KW, Shoskes DA, Miller AW. Microbe-metabolite interaction networks, antibiotic resistance, and in vitro reconstitution of the penile prosthesis biofilm support a paradigm shift from infection to colonization. Sci Rep 2023; 13:11522. [PMID: 37460611 PMCID: PMC10352235 DOI: 10.1038/s41598-023-38750-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 07/14/2023] [Indexed: 07/20/2023] Open
Abstract
To understand differences between asymptomatic colonized and infected states of indwelling medical devices, we sought to determine penile prosthesis biofilm composition, microbe-metabolite interaction networks, and association with clinical factors. Patients scheduled for penile prosthesis removal/revision were included. Samples from swabbed devices and controls underwent next-generation sequencing, metabolomics, and culture-based assessments. Biofilm formation from device isolates was reconstituted in a continuous-flow stir tank bioreactor. 93% of 27 analyzed devices harbored demonstrable biofilm. Seven genera including Faecalibaculum and Jeotgalicoccus were more abundant in infected than uninfected device biofilms (p < 0.001). Smokers and those with diabetes mellitus or cardiac disease had lower total normalized microbial counts than those without the conditions (p < 0.001). We identified microbe-metabolite interaction networks enriched in devices explanted for infection and pain. Biofilm formation was recapitulated on medical device materials including silicone, PTFE, polyurethane, and titanium in vitro to facilitate further mechanistic studies. Nearly all penile prosthesis devices harbor biofilms. Staphylococcus and Escherichia, the most common causative organisms of prosthesis infection, had similar abundance irrespective of infection status. A series of other uncommon genera and metabolites were differentially abundant, suggesting a complex microbe-metabolite pattern-rather than a single organism-is responsible for the transition from asymptomatic to infected or painful states.
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Affiliation(s)
- Glenn T Werneburg
- Department of Urology, Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Cleveland, OH, 44195, USA.
| | - Scott D Lundy
- Department of Urology, Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Cleveland, OH, 44195, USA
| | - Daniel Hettel
- Department of Urology, Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Cleveland, OH, 44195, USA
| | - Petar Bajic
- Department of Urology, Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Cleveland, OH, 44195, USA
| | - Bradley C Gill
- Department of Urology, Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Cleveland, OH, 44195, USA
| | - Ava Adler
- Department of Urology, Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Cleveland, OH, 44195, USA
| | - Sromona D Mukherjee
- Department of Urology, Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Cleveland, OH, 44195, USA
| | - Hadley M Wood
- Department of Urology, Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Cleveland, OH, 44195, USA
| | - Kenneth W Angermeier
- Department of Urology, Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Cleveland, OH, 44195, USA
| | - Daniel A Shoskes
- Department of Urology, Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Cleveland, OH, 44195, USA
| | - Aaron W Miller
- Department of Urology, Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Cleveland, OH, 44195, USA
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Zillioux J, Lewis KC, Hettel D, Goldman HB, Vasavada SP, Gill BC. Cognitive impairment does not impact sacral neuromodulation implant rates for overactive bladder. Neurourol Urodyn 2023; 42:623-630. [PMID: 36701189 DOI: 10.1002/nau.25138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/02/2023] [Accepted: 01/16/2023] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To evaluate the impact of cognitive impairment (CI) diagnoses on sacral neuromodulation (SNM) outcomes in older patients. MATERIALS AND METHODS We completed a retrospective review of all patients aged ≥55 years who underwent test-phase SNM (peripheral nerve evaluation (PNE) or stage 1) for overactive bladder (OAB) between 2014 and 2021 within a large multi-regional health system. Patient demographics, relevant comorbidities, CI diagnoses (dementia or mild CI), and SNM procedures were recorded. Logistic regression modeling was performed to evaluate the impact of CI on SNM implantation rates. RESULTS Five-hundred and ten patients underwent SNM test phase (161 PNE, 349 Stage 1) during the study period. The mean age was 71.0(8.5) years, and most (80.6%) were female. Overall, 52(10.1%) patients had a CI diagnosis at the time of SNM, and 30 (5.8%) were diagnosed at a median of 18.5 [9.25, 39.5] months after SNM. Patients with CI diagnoses were older, with more comorbidities, and were more likely to undergo PNE. Univariable comparison found no difference in implantation rate based on pre-SNM CI (85.4% vs. 76.9%, p = 0.16). Multivariable analysis identified PNE (OR 0.43, 95% CI 0.26-0.71), age (OR 0.96, 95%CI 0.93-0.98), and prior beta-3 agonist use (OR 0.60, 95% CI 0.37-0.99) but not CI or dementia as independent negative predictors of implantation. Implanted patients had a median follow-up of 25 [12.0, 55.0] months. Explant and revision rates did not differ according to CI. CONCLUSION Patients with OAB and CI diagnoses proceed to SNM implant at rates similar to patients without CI diagnoses. A diagnosis of CI should not necessarily exclude patients from SNM therapy for refractory OAB.
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Affiliation(s)
- Jacqueline Zillioux
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kevin C Lewis
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Daniel Hettel
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Howard B Goldman
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
| | - Sandip P Vasavada
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
| | - Bradley C Gill
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
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Werneburg GT, Hettel D, Adler A, Mukherjee SD, Lundy SD, Angermeier KW, Wood HM, Gill BC, Vasavada SP, Goldman HB, Rackley RR, Shoskes DA, Miller AW. Biofilms on Indwelling Artificial Urinary Sphincter Devices Harbor Complex Microbe-Metabolite Interaction Networks and Reconstitute Differentially In Vitro by Material Type. Biomedicines 2023; 11:biomedicines11010215. [PMID: 36672723 PMCID: PMC9855829 DOI: 10.3390/biomedicines11010215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/12/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
The artificial urinary sphincter (AUS) is an effective treatment option for incontinence due to intrinsic sphincteric deficiency in the context of neurogenic lower urinary tract dysfunction, or stress urinary incontinence following radical prostatectomy. A subset of AUS devices develops infection and requires explant. We sought to characterize biofilm composition of the AUS device to inform prevention and treatment strategies. Indwelling AUS devices were swabbed for biofilm at surgical removal or revision. Samples and controls were subjected to next-generation sequencing and metabolomics. Biofilm formation of microbial strains isolated from AUS devices was reconstituted in a bioreactor mimicking subcutaneous tissue with a medical device present. Mean patient age was 73 (SD 10.2). All eighteen artificial urinary sphincter devices harbored microbial biofilms. Central genera in the overall microbe−metabolite interaction network were Staphylococcus (2620 metabolites), Escherichia/Shigella (2101), and Methylobacterium-Methylorubrum (674). An rpoB mutation associated with rifampin resistance was detected in 8 of 15 (53%) biofilms. Staphylococcus warneri formed greater biofilm on polyurethane than on any other material type (p < 0.01). The results of this investigation, wherein we comprehensively characterized the composition of AUS device biofilms, provide the framework for future identification and rational development of inhibitors and preventive strategies against device-associated infection.
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Scovell JM, Hettel D, Abouassaly R, Almassi N, Berglund R, Breaux T, Weight C, Isac W, Zampini A, Stark E, Rochelle R, Kestranek A, Stovsky M, Klein EA. IsoPSA ® Reduces Provider Recommendations for Biopsy and Magnetic Resonance Imaging in Men with Total Prostate Specific Antigen ≥4 ng/ml: A Real-World Observational Clinical Utility Study. Urol Pract 2022; 9:173-180. [PMID: 37145695 DOI: 10.1097/upj.0000000000000291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION We assessed the impact of the IsoPSA® test for prostate cancer risk assessment on provider patient management decisions in a real-world clinical setting. METHODS A total of 38 providers, including advanced practice providers, fellowship trained oncologists and general urologists in the Cleveland Clinic health system including both community-based practices and academic locations, enrolled 900 men being evaluated for prostate cancer; 734 met inclusion criteria (age ≥50 years, total serum prostate specific antigen [PSA] ≥4 and <100 ng/ml and no history of prostate cancer) and IsoPSA indication for use. A standard template was used to document biopsy recommendation prior to and after receiving IsoPSA results. The primary outcome was the number of biopsy and magnetic resonance imaging recommendation changes occurring after IsoPSA testing. RESULTS IsoPSA testing resulted in a 55% (284 vs 638) net reduction in recommendations for prostate biopsy for men with total PSA ≥4 ng/ml. Additionally, a 9% reduction in recommendations for magnetic resonance imaging was observed. There was strong concordance between IsoPSA results and provider recommendations for prostate biopsy, with 87% of patients with an IsoPSA index above the threshold recommended for biopsy and 92% of patients with an IsoPSA index below the threshold not recommended for biopsy. CONCLUSIONS In a real-world clinical setting, providers from diverse training backgrounds and practice settings readily adopted IsoPSA with substantial reductions in the rate of recommended prostate biopsies in patients with elevated PSA values (≥4 ng/ml). There was a high concordance between recommendation for or against prostate biopsy and the IsoPSA result.
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Affiliation(s)
- Jason M Scovell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Daniel Hettel
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Robert Abouassaly
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Nima Almassi
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ryan Berglund
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Todd Breaux
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Christopher Weight
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Wahib Isac
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Anna Zampini
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Elizabeth Stark
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | | | | | | | - Eric A Klein
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
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Dai C, Ganesan V, Nyame YA, Almassi N, Greene DJ, Hettel D, Magi-Galluzzi C, Gong M, Jones JS, Stephenson AJ, Berglund RK, Klein EA. Older Age at Diagnosis and Initial Disease Volume Predict Grade Reclassification Risk on Confirmatory Biopsy in Patients Considered for Active Surveillance. Urology 2019; 130:106-112. [PMID: 31071349 DOI: 10.1016/j.urology.2019.02.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 02/02/2019] [Accepted: 02/06/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To identify which active surveillance candidates benefit most from confirmatory biopsies to exclude grade underclassification. MATERIALS AND METHODS This observational study includes 556 men diagnosed between 2002 and 2015 with Gleason 3 + 3 (GG1) disease on initial diagnostic biopsy, of whom 406 received a confirmatory biopsy within 12 months for active surveillance. Multivariable logistic regression analysis was performed to determine clinicopathologic features associated with Gleason 7 or higher (GG2+) on a confirmatory biopsy. Regression tree analysis was employed to stratify patients into select risk groups. RESULTS Eighty-five of 406 patients (20.9%) with initially GG1 disease were reclassified to GG2+ on a confirmatory biopsy. On multivariable analysis, increasing age (per year odds ratio 1.07; 95% confidence interval 1.02-1.12; P <.01) and more positive cores at diagnosis (per core, odds ratio 1.37, 95% confidence interval 1.09-1.72; P <.01) were significantly associated with reclassification, independent of prostate volume, clinical stage, initial PSA, or confirmatory biopsy type (including magnetic resonance imaging-targeted approaches or transrectal saturation random sampling). Recursive partitioning demonstrated that age over 73 and 5 or more positive cores were factors associated with the greatest reclassification risk. CONCLUSION In our cohort, both advancing age and additional positive cores were associated with increased odds of reclassification to GG2+ on confirmatory biopsy. In men over age 73 or with 5 or more positive cores, a repeat biopsy within 12 months may be particularly beneficial to minimize tumor grade underclassification.
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Affiliation(s)
- Charles Dai
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH
| | - Vishnu Ganesan
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH; Department of Urology, UT Southwestern Medical Center, Dallas, TX
| | - Yaw A Nyame
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH; Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Nima Almassi
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH; Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Daniel J Greene
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH; Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Daniel Hettel
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH
| | | | - Michael Gong
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH; Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | - Andrew J Stephenson
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH; Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Ryan K Berglund
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH; Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Eric A Klein
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH; Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
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Thomas L, Nyame YA, El-Shafei A, Dai C, Ganesan V, Zampini A, Arora H, Crane A, Hettel D, Fareed K, Stein R, Gong MC, Klein EA, Stephenson AJ. Outcomes of active surveillance for African-American men with prostate cancer: Results of a matched analysis. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
89 Background: Prior work has questioned the safety of active surveillance (AS) for African-American (AA) men with prostate cancer. However, studies of AA men on AS are rare, and some show contradictory results as more AA men may undergo definitive therapy leaving a well-selected AS population. To overcome these limitations we performed a retrospective matched cohort study of AA men on AS. Methods: We queried our AS database (2000-2016) for all AA patients. AA men were matched to non-AA men using a 1:1 algorithm based on National Comprehensive Cancer Network (NCCN) risk, age at diagnosis, and year of diagnosis. Cohorts were compared on outcomes of NCCN risk reclassification, receipt of treatment, post-treatment recurrence, development of metastases, and prostate cancer specific mortality. Results: Fifty-nine AA patients were identified and matched, including 18 very low risk (31%), 24 low risk (41%), and 17 intermediate risk patients (29%). Groups were equally matched by NCCN risk and year of diagnosis, and had similar ages at diagnosis (65.6 years AA, 65.9 years non-AA, p=0.97). Initial PSA values were similar between groups (5.2 AA versus 5.1 non-AA, p=0.77). Rates of risk reclassification during AS were higher among AA patients (54% versus 39% p=0.09), though treatment (46% vs 44%) and post-treatment recurrence (11% vs 19%) rates were similar. While AA patients were more often reclassified, many were due to PSA rise (40% AA, 8% non-AA upgraded by PSA alone) rather than pathologic upgrading. AA patients had a longer time to reclassification and treatment than non-AA patients (2.9 and 2.8 years vs 0.9 and 1.0 years, p=0.14). Similar follow-up time was noted (AA 6.0 years versus non-AA 6.4 years, p=0.91). One patient in each group developed metastases. No cancer specific mortalities occurred. Conclusions: In a matched analysis of AA versus non-AA patients on AS, rates of risk reclassification were higher among AA patients, though receipt of treatment and treatment outcomes were similar between groups. Metastatic progression and prostate cancer mortality were rare in both groups. AS appears to be a reasonable option for AA patients with long treatment free periods and reasonable post-treatment outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Hans Arora
- Cleveland Clinic Foundation, Cleveland, OH
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Zhang JJH, Nicolas M, Hardaway A, Bohn K, Hettel D, Klein EA, Sharifi N. 3βHSD1 immunohistochemistry and HSD3B1 genotype in prostate cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
277 Background: 3β-hydroxysteroid dehydrogenase (3βHSD1), encoded by HSD3B1, catalyzes intratumoral androgen synthesis from adrenal precursors. The HSD3B1(1245A>C) germline variant encodes a more stable enzyme that promotes increased DHT synthesis and more rapid clinical progression in men treated with androgen deprivation therapy (ADT). 3βHSD1 localization and expression in prostate tissue has not been rigorously characterized. We hypothesized that HSD3B1 homozygous variant genotype is associated with elevated 3βHSD1 immunoreactivity compared with wild-type (WT) genotype. Methods: In a pilot study, HSD3B1 genotypes were obtained from prostatectomy tissues of 30 patients with prostate cancer (10 WT, 10 heterozygous, and 10 homozygous variant). Following prostatectomy, tumor tissue with adjacent benign prostate was formalin-fixed and paraffin-embedded. Immunostaining for 3βHSD1 using a validated mouse monoclonal antibody was performed. Human placenta was used as a positive control. Immunostaining patterns and histology was qualitatively assessed by a GU pathologist. Immunoreactivity was quantitatively assessed using ImagePro7. Results: Qualitative IHC scoring localizes 3βHSD1 to epithelial cells in prostatic glands and urothelium, with faint muscle and stromal staining. 3βHSD1 was immunoreactive in 100% of prostates in both benign and malignant regions. When stratified by HSD3B1 genotype, the mean density/intensity was significantly greater for HSD3B1 homozygous variant prostate (670.10u) compared to heterozygous (174.69u) and WT (176.19u) (p=0.044). (Density/Intensity) per square micron demonstrated higher mean values for homozygous variant (35.79)> heterozygous (28.67) >WT (22.56) (p=0.52). Conclusions: These pilot data demonstrate differential tissue expression of 3βHSD1 according to HSD3B1 genotype: importantly, homozygous variant HSD3B1 (1245A>C) specimen showed the most robust 3βHSD1 expression compared to heterozygous and WT prostates. These results explore the potential for 3βHSD1 as a prostate biomarker to predict aggressive disease.
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Affiliation(s)
| | | | | | | | - Daniel Hettel
- Cleveland Clinic Lerner Research Institute, Cleveland, OH
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Hettel D, Zhang A, Alyamani M, Berk M, Sharifi N. AR Signaling in Prostate Cancer Regulates a Feed-Forward Mechanism of Androgen Synthesis by Way of HSD3B1 Upregulation. Endocrinology 2018; 159:2884-2890. [PMID: 29850791 PMCID: PMC6456955 DOI: 10.1210/en.2018-00283] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 05/23/2018] [Indexed: 11/19/2022]
Abstract
3βHSD1 enzymatic activity is essential for synthesis of potent androgens from adrenal precursor steroids in prostate cancer. A germline variant in HSD3B1, the gene that encodes 3βHSD1, encodes for a stable enzyme, regulates adrenal androgen dependence, and is a predictive biomarker of poor clinical outcomes after gonadal testosterone deprivation therapy. However, little is known about HSD3B1 transcriptional regulation. Generally, it is thought that intratumoral androgen synthesis is upregulated after gonadal testosterone deprivation, enabling development of castration-resistant prostate cancer. Given its critical role in extragonadal androgen synthesis, we sought to directly interrogate the transcriptional regulation of HSD3B1 in multiple metastatic prostate cancer cell models. Surprisingly, we found that VCaP, CWR22Rv1, LNCaP, and LAPC4 models demonstrate induction of HSD3B1 upon androgen stimulation for approximately 72 hours, followed by attenuation around 120 hours. 3βHSD1 protein levels mirrored transcriptional changes in models harboring variant (LNCaP) and wild-type (LAPC4) HSD3B1, and in these models androgen induction of HSD3B1 is abrogated via enzalutamide treatment. Androgen treatment increased flux from [3H]-dehydroepiandrosterone to androstenedione and other downstream metabolites. HSD3B1 expression was reduced 72 hours after castration in the VCaP xenograft mouse model, suggesting androgen receptor (AR) regulation of HSD3B1 also occurs in vivo. Overall, these data suggest that HSD3B1 is unexpectedly positively regulated by androgens and ARs. These data may have implications for the development of treatment strategies tailored to HSD3B1 genotype status.
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Affiliation(s)
- Daniel Hettel
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ao Zhang
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Michael Berk
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Nima Sharifi
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
- Correspondence: Nima Sharifi, MD, Department of Cancer Biology, Lerner Research Institute, 9500 Euclid Avenue, Cleveland, Ohio 44195. E-mail:
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Gill B, Zampini A, Khanna A, Hettel D, Faris A, Wood H, Sabanegh E. MP32-04 ASSOCIATIONS BETWEEN PREOPERATIVE PREPAREDNESS FOR RADICAL PROSTATECTOMY AND PATIENT-REPORTED SEXUAL FUNCTION OUTCOMES. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hettel D, Faris A, Agrawal S, Naelitz B, Fareed K, Ulchaker J, Stephenson A, Gong M, Klein E. PD20-11 17-GENE GENOMIC PROSTATE SCORE CAN ACCURATELY DETERMINE THE NEED FOR CONFIRMATORY BIOPSY IN PATIENTS ELECTING ACTIVE SURVEILLANCE. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dai C, Ganesan V, Zabell J, Nyame YA, Almassi N, Greene DJ, Hettel D, Reichard C, Haywood SC, Arora H, Zampini A, Crane A, Li J, Elshafei A, Magi-Galluzzi C, Stein RJ, Fareed K, Gong M, Jones JS, Klein EA, Stephenson AJ. Impact of 5α-Reductase Inhibitors on Disease Reclassification among Men on Active Surveillance for Localized Prostate Cancer with Favorable Features. J Urol 2018; 199:445-452. [DOI: 10.1016/j.juro.2017.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Charles Dai
- Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Vishnu Ganesan
- Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Joseph Zabell
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Yaw A. Nyame
- Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Nima Almassi
- Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Daniel J. Greene
- Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Daniel Hettel
- Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Chad Reichard
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Samuel C. Haywood
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Hans Arora
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Anna Zampini
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Alice Crane
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jianbo Li
- Quantitative Health Services, Cleveland Clinic, Cleveland, Ohio
| | - Ahmed Elshafei
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
- Urology Department, Al Kasr Al Aini Hospital, Cairo University, Cairo, Egypt
| | - Cristina Magi-Galluzzi
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Robert J. Stein
- Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Khaled Fareed
- Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Michael Gong
- Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - J. Stephen Jones
- Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eric A. Klein
- Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Andrew J. Stephenson
- Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
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Ganesan V, Dai C, Nyame YA, Greene DJ, Almassi N, Hettel D, Zabell J, Arora H, Haywood S, Crane A, Reichard C, Zampini A, Elshafei A, Stein RJ, Fareed K, Jones JS, Gong M, Stephenson AJ, Klein EA, Berglund RK. Prognostic Significance of a Negative Confirmatory Biopsy on Reclassification Among Men on Active Surveillance. Urology 2017. [PMID: 28625591 DOI: 10.1016/j.urology.2017.06.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To examine the association between absence of disease on confirmatory biopsy and risk of pathologic reclassification in men on active surveillance (AS). MATERIALS AND METHODS Men with grade groups 1 and 2 disease on AS between 2002 and 2015 were identified who received a confirmatory biopsy within 1 year of diagnosis and ≥3 biopsies overall. The primary outcomes were pathologic reclassification by grade (any increase in primary Gleason pattern or Gleason score) or volume (>33% of sampled cores involved or increase in the number of cores with >50% involvement). The effect of a negative confirmatory biopsy survival was evaluated using Kaplan-Meier analysis and a Cox proportional hazards modeling. RESULTS Out of 635 men, 224 met inclusion criteria (median follow-up: 55.8 months). A total of 111 men (49.6%) had a negative confirmatory biopsy. Decreased grade reclassification (69.7% vs 83.9%; P = .01) and volume reclassification (66.3% vs 87.4%; P = .004) was seen at 5 years for men with a negative confirmatory biopsy compared with those with a positive biopsy. On adjusted analysis, a negative confirmatory biopsy was associated with a decreased risk of grade reclassification (hazard ratio, 0.51; 95% confidence interval, 0.28-0.94; P = .03) and volume reclassification (hazard ratio, 0.32; 95% confidence interval, 0.17-0.61; P = .0006) at a median of 4.7 years. CONCLUSION Absence of cancer on the confirmatory biopsy is associated with a significant decrease in rate of grade and volume reclassification among men on AS. This information may be used to better counsel men on AS.
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Affiliation(s)
- Vishnu Ganesan
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH
| | - Charles Dai
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH
| | - Yaw A Nyame
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH; Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Daniel J Greene
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH; Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Nima Almassi
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH; Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Daniel Hettel
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH
| | - Joseph Zabell
- Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Hans Arora
- Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Samuel Haywood
- Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Alice Crane
- Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Chad Reichard
- Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Anna Zampini
- Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Ahmed Elshafei
- Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Robert J Stein
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH; Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Khaled Fareed
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH; Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - J Stephen Jones
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH; Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Michael Gong
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH; Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Andrew J Stephenson
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH; Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Eric A Klein
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH; Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Ryan K Berglund
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH; Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH.
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Nyame YA, Almassi N, Greene D, Ganesan V, Dai C, Zabell J, Haywood S, Reichard C, Arora H, Hettel D, Zampini A, Crane A, El-Shafei A, Stein R, Fareed K, Gong M, Jones JS, Stephenson AJ, Klein EA. MP15-15 A RETROSPECTIVE REVIEW OF A LARGE ACTIVE SURVEILLANCE COHORT IN PATIENTS WITH PROSTATE CANCER AT THE CLEVELAND CLINIC. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.2539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ganesan V, Dai C, Nyame Y, Greene D, Almassi N, Zabell J, Arora H, Haywood S, Crane A, Reichard C, Hettel D, Zampini A, El-Shafei A, Stein R, Fareed K, Gong M, Jones JS, Stephenson A, Klein E. MP15-10 THE PROGNOSTIC SIGNIFICANCE OF A NEGATIVE CONFIRMATORY PROSTATE BIOPSY ON PROGRESSION FOR PATIENTS ON ACTIVE SURVEILLANCE. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.2534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dai C, Ganesan V, Zabell J, Nyame Y, Hettel D, Almassi N, Greene D, Haywood S, Reichard C, Zampini A, Crane A, Arora H, El-Shafei A, Stein R, Fareed K, Gong M, Jones JS, Stephenson A, Klein E. PD08-03 5-ALPHA-REDUCTASE INHIBITORS IN MEN ON ACTIVE SURVEILLANCE FOR PROSTATE CANCER. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.2819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Almassi N, Nyame Y, Greene D, Ganesan V, Dai C, Zabell J, Haywood S, Reichard C, Zampini A, Arora H, Crane A, Hettel D, El-Shafei A, Stein R, Fareed K, Gong M, Jones JS, Stephenson A, Klein E. PD03-11 PATHOLOGIC OUTCOMES AMONG MEN WITH EARLY VERSUS DELAYED PROGRESSION TO RADICAL PROSTATECTOMY AFTER INITIAL ACTIVE SURVEILLANCE. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.2099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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