Low hemoglobin and PSA kinetics are prognostic factors of overall survival in metastatic castration-resistant prostate cancer patients

Hakozaki, Yuji; Yamada, Yuta; Takeshima, Yuta; Taguchi, Satoru; Kawai, Taketo; Nakamura, Masaki; Iwaki, Takuya; Teshima, Teruki; Kinoshita, Yoshitaka; Akiyama, Yoshiyuki; Sato, Yusuke; Yamada, Daisuke; Suzuki, Motofumi; Kume, Haruki

doi:10.1038/s41598-023-29634-5

Cited by 8 publications

(5 citation statements)

References 37 publications

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“…IL-6 has also been shown to act as an autocrine growth factor that inhibits apoptosis in prostate cancer [29]. Finally, the signi cant reduction in blood haemoglobin concentration (Hb) in PCa group compared with BPH group is consistent with recent report by Kaya et al and Tanno et al [23,30]. The plausible ascribed mechanism(s) by which the presence of a tumour might leads to low blood Hb could be as result of the induction of the ironregulatory hormone, hepcidin, by in ammatory cytokines, especially IL-6 [31].…”

Section: Discussionsupporting

confidence: 82%

Ratios of Prostate-Specific Antigen to Albumin, C-reactive Protein, and Haemoglobin Concentration are Valuable Markers to Predict Patients with Either Prostate Cancer or Benign Prostate Hyperplasia

Mensah-Bonsu,

Appiah,

Dedjoe

et al. 2024

Preprint

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Prostate Cancer (PCa) diagnosis using PSA alone leads to unnecessary biopsy due to the non-specificity of PSA for PCa. Changes in systemic inflammation variables with the development and progression of PCa cancer have been widely acknowledged. This study evaluated the potential utility of ratios involving changes in serum PSA with changes in systemic inflammatory components: serum albumin, C-reactive protein, and full blood count differentials, to differentially predict PCa biopsy in a cohort of pre-biopsy patients. Methods: We prospectively analyzed data from 110 patients who underwent prostate biopsy between September 2022 and September 2023. Age, PSA, full blood count, serum albumin (ALB), serum C-reactive protein (CRP) and biopsy pathology results of the patients were analyzed. Based on biopsy findings, patients were grouped as benign prostatic hyperplasia (BPH) and PCa. Results: Analyses of ratios involving PSA and the selected inflammatory markers led to wider discriminating values between PCa and BPH. The mean PSA-to-ALB, PSA-to-Hb and PSA-to-CRP ratios were significantly lower in the BPH group compared with the PCa group. AUROC curves analysis at cut-off points of PSA-ALB˃1, PSA-CRP˃250 and PSA-Hb˃2.5 resulted in specificity and positive predictive values for PSA-to-ALB ratio of 93% and 91% respectively, PSA-to-Hb ratio of 86% and 80% respectively and PSA-to-CRP ratio of 78% and 77% respectively. Unconditional regression analysis showed that PSA-to-CRP, PSA-to-Hb and PSA-to-ALB ratios were independent predictors of positive PCa biopsy. Conclusion: This preliminary study suggests that, the combination of PSA with changes in serum inflammatory variables in ratios improved the diagnostic accuracy more than the use of PSA alone. These ratios may assist in the differential prediction of PCa and BPH, especially where biopsy services are not readily available in Low- and Middle-Income countries.

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Section: Discussionsupporting

confidence: 82%

Ratios of Prostate-Specific Antigen to Albumin, C-reactive Protein, and Haemoglobin Concentration are Valuable Markers to Predict Patients with Either Prostate Cancer or Benign Prostate Hyperplasia

Mensah-Bonsu,

Appiah,

Dedjoe

et al. 2024

Preprint

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“…Anemia that typically manifests as low Hb is an indicator of tumor load and the overall physiological response of patients. Hemoglobin is acknowledged as a prognostic factor in CRPC, particularly for patients treated with docetaxel [ 25 – 27 ]. While changes in other biomarkers after completing the entire course of therapy did not significantly differ regardless of flare, anemia progressed in 42 of 46 patients without flare.…”

Section: Discussionmentioning

confidence: 99%

Flare phenomenon visualized by 99mTc-bone scintigraphy has prognostic value for patients with metastatic castration-resistant prostate cancer

Zhang,

Nakajima,

Mizokami

et al. 2024

Ann Nucl Med

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Objective This study aimed to determine the prognostic value of the flare phenomenon in patients with metastatic castration-resistant prostate cancer (mCRPC) using the bone scan index (BSI) derived from 99mTc-methylenediphosphonate (MDP) bone scintigraphy images. Methods We categorized 72 patients from the PROSTAT-BSI registry with mCRPC who were followed-up for 2 years after starting docetaxel chemotherapy to groups based on pre-chemotherapy BSI values of < 1, 1–4, and > 4. We assessed the effects of the flare phenomenon (defined as a > 10% increase in the BSI within 3 months of starting chemotherapy, followed by > 10% improvement within the next 3 months) on survival using Kaplan–Meier curves and Cox proportional hazard analyses. Results The flare phenomenon was found in 26 (36%) of the 72 patients. Prostate-specific antigen (PSA), alkaline phosphatase (ALP), and hemoglobin (Hb) levels steadily increased, then deteriorated in patients with and without flare, respectively. Elevated BSI and PSA values at 3 months after starting therapy and the absence of abiraterone or/and enzalutamide therapy led to poor 2-year overall survival (OS) in the group without flare. In contrast, no influence was noticeable in the group with flare. The results of multivariable analyses that included only factors associated with PSA and BSI showed that increased baseline BSI (hazard ratio [HR], 1.39; 95% confidence interval [CI], 1.04–1.86; P = 0.023) and PSA (HR, 7.15; 95% CI 2.13–24.04; P = 0.0015) values could be independent risk factors for patients with mCRPC without flare. However, these factors lost significance during flare. The risk for all-cause death was significantly higher among patients with BSI > 4 without, than with flare. The results of univariable analyses indicated that flare positively impacted survival (HR, 0.24; 95% CI 0.06‒0.91; P = 0.035). Multivariable analysis did not identify any factors that could predict outcomes. Conclusion Favorable prognosis, with fewer disturbances from other factors such as the use of abiraterone or/and enzalutamide, PSA changes, and BSI, was attainable in cases when the mCRPC patient demonstrated flare phenomenon. Follow-up bone scintigraphy at least every 3 months could help to determine the prognosis of patients with bone metastasis of mCRPC.

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“…For instance, Taylor et al [ 18 ] demonstrated that preoperative anemia is linked to reduced overall survival in patients undergoing lung cancer surgery. Hakozaki et al [ 19 ] identified low HGB levels (< 11 g/dL) as a prognostic risk factor for PRCA patients. Regarding BLCA, individuals with higher HGB levels are less likely to develop the disease, with high HGB serving as a protective factor in patient prognosis [ 7 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…As previously mentioned, both earlier research and our retrospective analysis have indicated that fluctuations in HGB levels are associated with the risk of at least 10 malignant tumors. Notably, for PRCA, previous studies have reported the relationship between high HBG values and the favorable prognosis of this disease [ 19 , 22 , 23 ]. This is also verified in our analysis of the in-house data.…”

Section: Discussionmentioning

confidence: 99%

Correlation between hemoglobin and the risk of common malignant tumors: a 1999–2020 retrospective analysis and causal association analysis

Li,

Huang,

et al. 2024

BMC Cancer

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Background The role of hemoglobin (HGB) in common malignant tumors remains unclear. Methods A retrospective analysis was conducted to identify the correlation between HGB levels and risk of 15 malignant tumors using 50,085 samples from the National Health and Nutrition Examination Survey. Mendelian Randomization analyses (MRAs) were performed based on genome-wide association study data to assess the causal relationship between HGB levels and these malignant tumors using more than 700,000 samples. The robustness of the MRA results was confirmed through various analytical methods. Fifty-six in-house samples were used to investigate the correlation between HGB levels and the prognosis in prostate cancer (PRCA) using the Kaplan-Meier curve. Results High HGB levels were associated with a higher risk for patients with cervix cancer, melanoma, and non-melanoma skin cancer (OR > 1.000, p < 0.05). It served as a protective factor for colon cancer, esophagus cancer, stomach cancer, bone cancer, lung cancer, renal cancer, and PRCA (OR < 1.000, p < 0.05). Furthermore, MRAs suggested that elevated HGB levels were correlated with a reduced risk of PRCA (OR = 0.869, p < 0.05), with no significant association observed between this marker and the remaining 14 malignant tumors. No pleiotropy or heterogeneity was found in the ultimate results for MRAs (p-values > 0.05), suggesting the robustness of the results. The results derived from the in-house data revealed a relationship between higher HGB values and a more favorable prognosis in PRCA (p < 0.05). Conclusion High circulating HGB levels may play a protective prognostic role for PRCA and serve as a protective factor against the occurrence of PRCA.

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Low hemoglobin and PSA kinetics are prognostic factors of overall survival in metastatic castration-resistant prostate cancer patients

Cited by 8 publications

References 37 publications

Ratios of Prostate-Specific Antigen to Albumin, C-reactive Protein, and Haemoglobin Concentration are Valuable Markers to Predict Patients with Either Prostate Cancer or Benign Prostate Hyperplasia

Ratios of Prostate-Specific Antigen to Albumin, C-reactive Protein, and Haemoglobin Concentration are Valuable Markers to Predict Patients with Either Prostate Cancer or Benign Prostate Hyperplasia

Flare phenomenon visualized by 99mTc-bone scintigraphy has prognostic value for patients with metastatic castration-resistant prostate cancer

Correlation between hemoglobin and the risk of common malignant tumors: a 1999–2020 retrospective analysis and causal association analysis

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