Prostate Cancer

Antiandrogens that block androgen action through the androgen receptor, often in conjunction with chemical or surgical castration, have been widely used for the treatment of advanced prostate cancer. Although this treatment produces a significant clinical response in most of the patients, the majority of the responders eventually develop recurrences termed castration-resistant prostate cancer. In addition, clinically available androgen receptor antagonists have been shown to possess agonist activity, resulting in an increase in serum prostate-specific antigen levels, which is known as the antiandrogen withdrawal syndrome. Recent studies have demonstrated that new types of androgen receptor signaling inhibitors improve survival in men with castration-resistant prostate cancer. Moreover, other drugs may have the potential of not inducing androgen withdrawal response. This article reviews the characteristics of classical and recent androgen receptor antagonists as well as their clinical efficacy in prostate cancer patients. Novel experimental compounds that may more specifically and effectively target androgens and/or androgen receptor signals in hormone-naive and possibly castration- resistant prostate cancer cells are also discussed.

Sixteen years in the making, this monumental revision of the first edition of this text is a ground-breaking new work highlighting the role of natural medicine in urology and men’s health. With massively expanded content, and the benefit of Dr. Yarnell’s focused practice and study in these areas for the past 20 years, this text will help both the student approaching the content for the first time, and the busy clinician looking to improve their outcomes in these areas.
This text covers the extremely common conditions of benign prostatic hyperplasia, chronic prostatitis, and the various forms of prostate cancer, as well as acute prostatitis. The text provides quick, effective clinical guidance on these problems and in-depth discussion of controversies related to each. Learn to properly recognize and manage all these conditions and more, with handy quick summary guides starting off each chapter and then diving into deep discussions of each topic. Extensive coverage of herbal treatment for patients with these conditions is particularly notable.

Prostate cancer characteristically induces osteoblastic bone metastasis, for which no therapies are available. A dual kinase inhibitor of c-Met and VEGFR-2 (cabozantinib) was shown to reduce prostate cancer growth in bone, with evidence for suppressing osteoblastic activity. However, c-Met and VEGFR2 signaling in osteoblasts in the context of bone metastasis remain unclear. Here we show using cultured osteoblasts that hepatocyte growth factor (HGF) and VEGF-A increased receptor activator of NFkB ligand (RANKL) and M-CSF, two essential factors for osteoclastogenesis. Insulin-like growth factor-1 (IGF1) also increased RANKL and M-CSF via c-Met transactivation. The conditioned media from IGF1-, HGF-, or VEGFA-treated osteoblasts promoted osteoclastogenesis that was reversed by inhibiting c-Met and/or VEGFR2 in osteoblasts. In vivo experiments used cabozantinib-resistant prostate cancer cells (PC-3 and C4-2B) to test the effects of c-Met/VEGFR2 inhibition specifically in osteoblasts. Cabozantinib (60 mg/kg, 3 weeks) suppressed tumor growth in bone and reduced expression of RANKL and M-CSF and subsequent tumor-induced osteolysis. Collectively, inhibition of c-Met and VEGFR2 in osteoblasts reduced RANKL and M-CSF expression, and associated with reduction of tumor-induced osteolysis, suggesting that c-Met and VEGFR2 are promising therapeutic targets in bone metastasis.

Troxacitabine (Troxatyl; BCH-4556; (-)-2'-deoxy-3'-oxacytidine), a deoxycytidine analogue with an unusual dioxolane structure and nonnatural L-configuration, has potent antitumor activity in animal models and is in clinical trials against human malignancies. The current work ...

Locally recurrent prostate cancer can lead to significant morbidity, metastasis, and even death. The objective of this study was to evaluate the efficacy of an injectable polymeric paste formulation containing paclitaxel against orthotopic prostate tumor in rats. The Dunning R-3327 rat prostate adenocarcinoma is experimental tumor model used to study tumor progression. The polymer loaded with paclitaxel was injected into the tumor bearing prostate glands of the rats 3 days after tumor cell inoculation. In control untreated rats, tumor volume reached 14 cm3 after 25 days, while in rats treated with intratumoral injection of polymer/paclitaxel formulation the prostate volume with the tumor was only 0.9 cm3, 35 days posttumor cells inoculation. In the group treated with intratumoral injection of paclitaxel suspension, the tumor volume was 6.6 cm3, and in the group treated with intraperitonial (IP) paclitaxel formulation, the tumor volume reached 13.9 cm3 25 days posttumor cells inoculation. No metastases were found in rats treated intratumorally with 200 µL of polymer/paclitaxel formulation, while rats in other treatment groups developed metastases in the lungs and lymph nodes. The results of this study indicated that a site-directed, injectable, controlled release formulation of paclitaxel is effective against localized prostate tumors and metastasis. © 2008 Wiley-Liss, Inc. and the American Pharmacists Association J Pharm Sci 98:1005–1014, 2009

The cell-cell adhesion molecule 1 (C-CAM1) plays an important role as a tumor suppressor for prostate cancer. Decreased expression of C-CAM1 was detected in prostate, breast, and colon carcinoma. Reexpression of C-CAM1 in prostate and breast cancer cell lines was able to suppress tumorigenicity in vivo. These observations suggest that C-CAM1 may be used as a marker for cancer detection or diagnosis. To generate monoclonal antibodies specific to C-CAM1, we have overexpressed full-length human C-CAM1 in Sf9 cells using a baculovirus expression system. The protein was purified 104-fold using nickel affinity chromatography. About 0.4 mg purified C-CAM1 was obtained from 200 mg of infected cells. When the purified protein was digested with peptidyl-N-glycosidase, the apparent mobility of the protein on SDS-PAGE changed from 90 to 58 kDa, which is close to the molecular weight predicted from the cloned cDNA sequence. This observation suggests that C-CAM1 was glycosylated on asparagine residues when expressed in Sf9 cells. Western blotting and internal protein sequencing analysis confirmed that the purified protein is human C-CAM1. Biochemical and functional assays indicate that this protein expressed in Sf9 cells displays characteristics similar to those of native protein, including adhesion function and glycosylation modification. Using this protocol, sufficient quantity of this protein can be produced with purity suitable for monoclonal antibody generation and biochemical study.

BACKGROUNDProstate cancer (PCa) is the second leading cause of cancer-related death in men in the United States. Many men have implemented purported chemopreventive agents into their daily diet in an attempt to delay the early onset of a PCa. Green tea polyphenols, one such agent, has been shown to be chemopreventive in skin, breast, and prostate cancers. We hypothesized that Epigallocatechin-3-Gallate (EGCG), the major polyphenol found in green tea, will exert its chemopreventive effect in the prostate via regulation of sex steroid receptor, growth factor-signaling, and inflammatory pathways.Prostate cancer (PCa) is the second leading cause of cancer-related death in men in the United States. Many men have implemented purported chemopreventive agents into their daily diet in an attempt to delay the early onset of a PCa. Green tea polyphenols, one such agent, has been shown to be chemopreventive in skin, breast, and prostate cancers. We hypothesized that Epigallocatechin-3-Gallate (EGCG), the major polyphenol found in green tea, will exert its chemopreventive effect in the prostate via regulation of sex steroid receptor, growth factor-signaling, and inflammatory pathways.METHODSFive-week-old male TRAMP (Transgenic Adenocarcinoma Mouse Prostate) offspring were fed AIN-76A diet and 0.06% EGCG in tap water. Animals were sacrificed at 28 weeks of age and the entire prostates were scored histopathologically. In addition, animals were sacrificed at 12 weeks of age and ventral (VP) and dorsolateral (DLP) prostates were removed for histopathological evaluation and immunoblot analyses or ELISA.Five-week-old male TRAMP (Transgenic Adenocarcinoma Mouse Prostate) offspring were fed AIN-76A diet and 0.06% EGCG in tap water. Animals were sacrificed at 28 weeks of age and the entire prostates were scored histopathologically. In addition, animals were sacrificed at 12 weeks of age and ventral (VP) and dorsolateral (DLP) prostates were removed for histopathological evaluation and immunoblot analyses or ELISA.RESULTSEGCG, inhibited early but not late stage PCa in the current study. In the VP, EGCG significantly reduced cell proliferation, induced apoptosis, and decreased androgen receptor (AR), insulin-like growth factor-1 (IGF-1), IGF-1 receptor (IGF-1R), phospho-extracellular signal-regulated kinases 1 and 2 (phospho-ERKs 1 and 2), cyclooxygenase-2 (COX-2), and inducible nitric oxide synthase (iNOS).EGCG, inhibited early but not late stage PCa in the current study. In the VP, EGCG significantly reduced cell proliferation, induced apoptosis, and decreased androgen receptor (AR), insulin-like growth factor-1 (IGF-1), IGF-1 receptor (IGF-1R), phospho-extracellular signal-regulated kinases 1 and 2 (phospho-ERKs 1 and 2), cyclooxygenase-2 (COX-2), and inducible nitric oxide synthase (iNOS).CONCLUSIONSThe attenuation of the AR, the down-regulation of potent growth factor IGF-1, modulation of inflammation biomarkers, and decrease in the MAPK signaling may contribute to the reduction in cell proliferation and induction of apoptosis and hence provide a biochemical basis for EGCG suppressing PCa without toxicity. Prostate 67: 1576–1589, 2007. © 2007 Wiley-Liss, Inc.The attenuation of the AR, the down-regulation of potent growth factor IGF-1, modulation of inflammation biomarkers, and decrease in the MAPK signaling may contribute to the reduction in cell proliferation and induction of apoptosis and hence provide a biochemical basis for EGCG suppressing PCa without toxicity. Prostate 67: 1576–1589, 2007. © 2007 Wiley-Liss, Inc.

NKX3.1, a member of the NK class of homeodomain proteins, is expressed primarily in the adult prostate and has growth suppression and differentiating effects in prostate epithelial cells. A C-->T polymorphism at nucleotide 154 (NKX3.1 C154T) is present in approximately 11% of healthy men with equal distribution among whites and blacks. In a cohort of 1253 prostate cancer patients and age-matched controls, the presence of the polymorphism was associated with a 1.8-fold risk of having stage C or D prostate cancer or Gleason score > or =7 (confidence interval, 1.01-3.22). The NKX3.1 C154T polymorphism codes for a variant protein that contains an arginine-to-cysteine substitution at amino acid 52 (R52C) adjacent to a protein kinase C phosphorylation site at serine 48. Substitution of cysteine for arginine 52 or of alanine for serine 48 (S48A) reduced phosphorylation at serine 48 in vitro and in vivo. Phosphorylation of wild-type NKX3.1, but not of NKX3.1 R52C or NKX3.1 S48A, dimin...

Significant inhibition of proliferative activity in PC3 human prostate cancer cells by estradiol is reported, accompanied by experimental evidence for a specific estrogen receptor (ER). Radioligand-binding assays revealed the presence of high affinity sites of estrogen binding in the nuclear compartment of PC3 cells. In addition, using a reverse transcriptase-polymerase chain reaction system, we obtained evidence of either normal or a variant ER mRNA; the latter, which lacks the entire exon 4, is coexpressed with normal ER mRNA and has been recently characterized in our laboratories. The likelihood that the inhibitory effect exerted by estradiol could be mediated by an increase of transforming growth factor beta (TGF beta) production was also investigated. Use of monoclonal antibodies against TGF beta 1 produced a 3-fold increase of growth rate in PC3 cells; this clearly speaks for high levels of endogenous TGF beta 1. This effect was almost completely abolished after addition of 10...

Hydrogen sulfide (H2S) was originally considered toxic at elevated levels; however just in the past decade H2S has been proposed to be an important gasotransmitter with various physiological and pathophysiological roles in the body. H2S can be generated endogenously from L-cysteine by multiple enzymes, including cystathionine gamma-lyase, cystathionine beta-synthase, and 3-mercaptopyruvate sulfurtransferase in combination with cysteine aminotransferase. Prostate cancer is a major health concern and no effective treatment for prostate cancers is available. H2S has been shown to inhibit cell survival of androgen-independent, androgen-dependent, and antiandrogen-resistant prostate cancer cells through different mechanisms. Various H2S-releasing compounds, including sulfide salts, diallyl disulfide, diallyl trisulfide, sulforaphane, and other polysulfides, also have been shown to inhibit prostate cancer growth and metastasis. The expression of H2S-producing enzyme was reduced in both hu...

The Cooperative Prostate Cancer Tissue Resource (CPCTR) is a consortium of four geographically dispersed institutions that are funded by the U.S. National Cancer Institute (NCI) to provide clinically annotated prostate cancer tissue samples to researchers. To facilitate this effort, it was critical to arrive at agreed upon common data elements (CDEs) that could be used to collect demographic, pathologic, treatment and clinical outcome data. The CPCTR investigators convened a CDE curation subcommittee to develop and implement CDEs for the annotation of collected prostate tissues. The draft CDEs were refined and progressively annotated to make them ISO 11179 compliant. The CDEs were implemented in the CPCTR database and tested using software query tools developed by the investigators. By collaborative consensus the CPCTR CDE subcommittee developed 145 data elements to annotate the tissue samples collected. These included for each case: 1) demographic data, 2) clinical history, 3) path...

Genes regulated by androgenic hormones are of critical importance for the normal physiological function of the human prostate gland, and they contribute to the development and progression of prostate carcinoma. We used cDNA microarrays containing 1500 cDNAs to profile transcripts regulated by androgens in prostate cancer cells and identified the serine protease TMPRSS2 as a gene exhibiting increased expression upon exposure to androgens. The TMPRSS2 gene is located on chromosome 21 and contains four distinct domains, including a transmembrane region, indicating that it is expressed on the cell surface. Northern analysis demonstrated that TMPRSS2 is highly expressed in prostate epithelium relative to other normal human tissues. In situ hybridization of normal and malignant prostate tissues localizes TMMPRSS2 expression to prostate basal cells and to prostate carcinoma. These results suggest that TMPRSS2 may play a role in prostate carcinogenesis and should be investigated as a diagno...

Roel A. M. Heesakkers, MD Gerrit J. Jager, MD, PhD Anke M. Hövels, MSc Bartjan de Hoop, MD Harrie C. M. van den Bosch, MD Frank Raat, MD J. Alfred Witjes, MD, PhD Peter F. A. Mulders, MD, PhD Christina Hulsbergen van der Kaa, MD, PhD Jelle O. Barentsz, MD, PhD Purpose: To prospectively evaluate the feasibility of magnetic resonance (MR) imaging with ferumoxtran-10 in patients with prostate cancer to depict lymph node metastases outside the routine pelvic lymph node dissection (PLND) area.

Poor understanding of the clinicopathological features of prostate cancer (CaP) in Black men (BM) is one of the major challenges implicated in the management and prevention of the disease. The development of CaP involves an accumulation of multiple oncogenic events with associated increase in prostate specific antigen (PSA) and stress related hormones such as Cortisol. This research aims to examine the role of Cortisol and health-related quality of life (HRQoL) in CaP development. Data was collected as part of a large CaPTC Familial CaP Cohort Study. The HRQoL indicators were measured and salivary Cortisol levels evaluated by enzyme immunoassay. CaP tissue expression patterns of cortisol and Annexin V were also studied by immunohistochemistry. The HRQoL indicators showed a significant difference between participants with and without physical activity (P = 0.025), stress (P = 0.008) and self-care (P = 0.005). There was significant increase in salivary cortisol levels in the CaP patients compared to CaP-free participants (P = 0.003). The salivary cortisol level for the CaP patients ranged from 1.029 μg/dL to 0.037 μg/dL while the range for the CaP-free participants was from 0.139 μg/dL to 0.026 μg/dL. In addition, we found increased expression of the cortisol protein in CaP patients with Gleason score 8 compared to those with lower scores and the CaP tissues showed overexpression of Annexin V protein. Salivary and tissue cortisol levels with an accompanying Annexin V expression may serve as important biomarkers for CaP diagnosis and prognosis in West African Black men.

Abstract
Introduction: Prolonged urethral catheterization can cause retained catheter
Key Words: Retained catheter; bladder stone; prostate
Case: 70 years old with BPH, with retained catheter due to huge stone, he had extraction of the stone and prostatectomy.
Discussion: our patient presented with six months prolonged catheterization and Argarwal et al reported 3 months.
Conclusion: retained catheter can be caused by stone around the tip of the catheter.