Abstract
Introduction: Prostate cancer (PCa) is the commonest male malignancy worldwide with African descent and age greater than 50 years as important risk factors. Men (75%) with PCa undergo bilateral orchidectomy (BO) as preferred mode of treatment due to late presentation. Reports show poor management outcome with rapid progression to key features of metabolic syndrome (MS) and increased mortality rate of 64% within 2 years. This study was aimed at identifying pre-existing metabolic changes in blacks with PCa before BO.
Methods: 100 participants were recruited by convenience sampling. Demographic, clinical history and life style measures were obtained from pre-test questionnaire. Anthropometric indices and blood pressure readings were obtained by standard methods. Serum testosterone and prostate specific antigen (PSA) were estimated by enzyme immunoassay. Fasting plasma glucose (FPG), total cholesterol (TC), triglycerides and high density lipoprotein (HDLC) were determined by enzymatic methods while low density lipoprotein was calculated. pÂ0.05 was considered significant.
Results: The mean PSA level in PCa group was higher than BPH and control groups. On the other hand, the mean serum testosterone levels in PCa and BPH were significantly lower than the corresponding value in the control group. 25.8%, 30.6%, 30.0% of PCa, BPH and control groups respectively had MS. Elevated BP, FPG and reduced HDLC were the most prevalent MS components while elevated WC and elevated triglyceride were the least MS components in all groups.
Conclusion: Testosterone is reduced in prostatic diseases. Preexisting MS in males with PCa before BO may inform the high mortality observed after BO.
Keywords: Metabolic syndrome, testosterone, benign prostatic hyperplasia, bilateral orchidectomy, prostate specific antigen, prostate cancer.
Résumé
Introduction: Le cancer de la prostate (CaP) est la malignité masculine la plus fréquente dans le monde avec une descendance africaine et l’âge de plus de 50 ans comme facteurs de risque importants. Les hommes (75%) atteints de CaP subissent une orchidectomie bilatérale (OB) en tant que mode de traitement préféré en raison d’une présentation tardive. Les rapports montrent des résultats de gestion médiocres avec une progression rapide vers les principales caractéristiques du syndrome métabolique (SM) et une augmentation du taux de mortalité de 64% dans 2 ans. Cette étude visait à identifier les changements métaboliques préexistants chez les Noirs avec CaP avant OB.
Méthodes: 100 participants ont été recrutés par échantillonnage de commodité.Des données démographiques, d’histoire clinique et de style de vie ont été obtenues à partir d’un questionnaire pré-test.Les indices anthropométriques et les lectures de pression sanguine ont été obtenus par des méthodes standard.La testostérone sérique et l’antigène prostatique spécifique (APS) ont été estimés par essai-immunitaire enzymatique.La glycémie à jeun (FPG), le cholestérol total (TC), les triglycérides et les lipoprotéines de haute densité (HDLC) ont été déterminés par des méthodes enzymatiques tandis que les lipoprotéines de basse densité ont été calculées. pÂ0,05 était considéré comme significatif.
Résultats: Le taux moyen d’APS dans le groupe CaP était supérieur à celui du BPH et du groupe témoin. D’autre part, les taux moyens de testostérone sérique dans CaP et BPH étaient significativement plus bas que la valeur correspondante dans le groupe témoin. 25,8% ; 30,6% ; 30,0% des groupes CaP, BPH et témoin avaient respectivement SM. La PA élevée, la glycémie à jeun et les HDLC réduites étaient les composantes les plus fréquentes du SM, tandis que les valeurs élevées de WC et les triglycérides élevés étaient les composantes les moins importantes du SM dans tous les groupes.
Conclusion: La testostérone est réduite dans les maladies prostatiques. Un SM préexistant chez les mâles atteints de CaP avant l’OB peut renseigner sur la mortalité élevée observée après OB.
Mots-clés: Syndrome métabolique, testostérone, hyperplasie bénigne de la prostate, orchidectomie bilatérale, antigène prostatique spécifique, cancer de la prostate. Paper presented at 5th Unibadan Conference Biomedical Research, held from 12-15 July , 2016 at the Conference Centre, University of Ibadan, Ibadan, Nigeria.
Correspondence: Dr. Mabel A Charles-Davies, Department of Chemical Pathology, College of Medicine, University of Ibadan, Ibadan, Nigeria. E-mail: mcharlesdavies@yahoo.com.
References
Globocan, Cancer fact sheet 2008.International Agency for research on cancer.http://globocan.iarc.fr
Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. “Global cancer statistics”.CA Cancer J Clin. 2011;61(2):69–90.
Okolo CA, Akinosun OM, Shittu OB, et al. Correlation of serum PSA and Gleason Score in Nigerian Men with Prostate Cancer. Afr. J. Urol. 2008;14:15-22.
Akinremi TO, Adeniyi A, Olutunde A, Oduniyi, A and Ogo CN. Need for and relevance of prostate cancer screening in Nigeria. Ecance. Rmedical science 2014;8:457. doi:10.3332/ecancer.2014.457.
Mohammed AZ, Edino ST, Ochicha O, Gwarzo Ak, Samaila AA .Cancer in Nigeria: a 10 year analysis of the kano cancer registry. Niger J. Med 2008;17(3) 280-284.
Akinremi OT, Chidiebere NO and Ayodeji OO. Review of prostate cancer research in Nigeria. Infect Agent cancer 2011;6(Suppl 2):s8.doi:10.1186/1750-9378-6-s2-s8
Anunobi CC, Akinde OR, Elesha SO, et al. Prostate Diseases in Lagos, Nigeria: A Histologic Study with PSA correlation. Niger Postgrad Med J. 2011;18(2):98-104.
Langlois M and Blaton V. PSA and other Biomarkers for Early Detection, Diagnosis and Monitoring of Prostate Cancer 2005.http://www.ifcc.org/ejifcc/vol16no2/160206200510.htm
Lee RJ and Smith MR. Hormone Therapy for Prostate Cancer. In: Chabner BA, Longo DL, eds. Cancer Chemotherapy and Biotherapy: Principles and Practice. 5th ed: Wolters Kluwer: Lippincott Williams and Wilkins; 2011. ISBN: 13:978-1-60547-431-1 and 10:1-60547-431-2.
Olapade-Olaopa EO, Obamuyide HA and Tisa GT. Management of advanced prostate cancer in Africa. Can J Urol 2008;15 (1):3890-3898.
Olapade-Olaopa EO, Popoola AA, Ukachukwu AK, et al. Histology of orchidectomy specimens in Nigerian patients with prostate cancer. Infect Agent Cancer 2011;6 (suppl 1)A3.doi:10.1186/1750-9378-6-S1-A3.
Gunter HJ, Lubik AA, Mckenzie L, Pollak M and Nelson CC. The interaction between insulin, androgens in progression to castrate–resistant prostate cancer. Advances in urology 2012; (2012): 11pages. http://dx.doi.org/10.1155/2012/248607
Leon CG, Locke JA, Adomat HH et al. Alterations in cholesterol regulation contribute to the production of the intratumoral androgens during progression to castration –resistant prostate cancer in a mouse xenograft model. Prostrate. 2010;70 (4):390-400.
Fabian UA, Charles-Davies MA, Fasanmade AA et al.Male Sexual Dysfunction, Leptin, Pituitary and Gonadal Hormones in Nigerian Males with Metabolic Syndrome and Type 2 Diabetes Mellitus. J Reprod Infertil 2016;17(1):17-25.
Charles-Davies MA, Fasanmade AA, Olaniyi JA, et al. Metabolic Alterations in Different Stages of Hypertension in an Apparently Healthy Nigerian Population. International Journal of Hypertension; 2014(2013): 6 pages, http://dx.doi.org/10.1155/2013/351357.
Adekola S, Charles-Davies MA, Onifade AA and Okoli SU. Oxidative Stress Biomarkers and their Relationship with Testosterone in Male Automechanics in Ibadan, Nigeria. BJMMR 2016; 12(9):1-11.
Umoh U, Charles-Davies MA and Adeleye J. Serum testosterone and lipids in relation to sexual dysfunction in males with Metabolic Syndrome and type 2 Diabetes Mellitus. Int. J Med. Med Sci. 2010; 2(12):402-412.
Osegbe DN. Prostate Cancer in Nigerians facts and non- facts.J. urol. 1997; 157(40):1340-1343.
Alberti KG, Eckel RH, Grundy SM et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009; 120 (16):1640-1645.
Charles-Davies MA, Arinola OG, Fasanmade AA et al. Indices of Metabolic Syndrome in 534 Traders. Journal of the US-China Medical Science 2012 ;9(2):91-100.
Fabian UA, Charles-Davies MA, Adebusuyi JR et al. Leptin Concentrations in African Blacks with Metabolic Syndrome and Type 2 diabetes Mellitus. Journal of the US-China Medical Science 2011; 8(8):493-500.
Petterway CA, Lamerato LE, Eaddy MT, et al. Benign Prostatic Hyperplasia: Racial Differences in Treatment Patterns and Prostate Cancer Prevalence. BJU Int 2011;108(8):1302-1308.
Pope HG, Wood RI, Rogol A , et al. Adverse Health Consequences of Performance–Enhancing Drugs: An Endocrine Society Scientific Statement. Endocr Rev. 2014 Jun; 35(3):341-375.
Lassed S, Deus CM, Lourenco N, et al. Diet, Lifestyles, Family History and Prostate Cancer Incidence in an East Algerian patient group. Biomed Res Int.; 2016; 2016 :5730569 doi: 10.1155/2016/5730569.
Kolonel LN. Fat, Meat and Prostate Cancer. Epidemiologic Reviews 2001; 23(1):72-81.
Bouvard V, Loomis D, Guyton K, et al. Carcinogenicity of consumption of red and processed meat. 2015. http://dx.doi.org/10. 1016/s1470-2045(15) 00444-1.
Grundy SM, Brewer HB, Cleeman JI, et al. Definition of metabolic syndrome: report of the national heart, lung and blood institution/ American heart association conference on scientific issues related to definition. Circulation 2004;109 (3):438.
Ogbera AO. Prevalence and gender distribution of the metabolic syndrome. Diabetol Metab Syndr. 2010; 2:1.doi: 10:1186/1758-5996-2-1.
Garg S, Vinutha S, Karthiyanee K and Nachal A. Relation between anthropometric measurement and serum lipid profile among cardio-metabolically healthy subjects: A pilot study. Indian J Endocr Metab 2012; 16 (5):857-858.
Okafor C. The metabolic syndrome in Africa: Current trends. Indian J EndocrinolMetab 2012.; 16(1):56-66.
Redig AJ and Munshi HG. “Care of the cancer survivor: metabolic syndrome after hormone-modifying therapy,” Am J Med 2010; 123(1):87.e1–87.e6.
Hoffman MA, DeWolf WC and Morgentaler A. Is low serum free testosterone a marker for high grade prostate cancer? J Urol. 2000; 163:824-827.
Chiles K and Honig S. Relationship of testosterone and prostate cancer: A 2011 perspective. Renal and urology news 2011; CME article.
Hoffman RM, Gilliland FG, Eley JW,et al.Racial and ethnic differences in advanced – stage prostate cancer: The prostate cancer outcomes study. J. Natl. Cancer Inst. 2001; 93(5):388-395.
Imamoto T, Suzuki H, Yano M,et al. Does presence of prostate cancer affects serum testosterone levels in clinically localized prostate cancer patients? Prostate Cancer and Prostatic Dis. 2009; 12:78-82.
Chodak GW, Vogelzang NJ, Caplan RJ, et al. Independent prognostic factors in patients with metastatic (stage D2) prostate cancer. The Zoladex Study Group. JAMA 1991; 265:618-621.