Influence of family history on psychosocial distress and perceived need for treatment in prostate cancer survivors

[What causes prostate cancer: patient-perceived causes]

BACKGROUND

 Psychosocial distress caused by prostate cancer (PCa) can persist in patients for years after treatment. A possible factor in this context is the subjectively perceived cause of the disease, which can have a significant influence on the experience of distress, therapy adherence and preventive behaviour. The aim of this study was to record subjective reasons for PCa in long-term survivors and to investigate associated factors.

MATERIAL AND METHODS

 PCa survivors from the national research project "Familial Prostate Cancer" were included in the study. As part of the annual postal follow-up questionnaire, PCa survivors were asked about subjectively perceived causes of their PCa. Responses were assigned to 18 possible categories. In addition, the association between the subjectively perceived causes of PCa and secondary tumours, a positive family history of tumour diseases and sociodemographic factors was investigated.

RESULTS

 Of the 9 047 PCa survivors surveyed, 4 054 (44.8 %) provided information on the subjectively perceived causes of their PCa and were included in this analysis. The mean time since diagnosis was 10.1 years with a mean age of 63.1 years at diagnosis. The most frequent responses were "don't know" (31.8 %), genetics (30.1 %) and stress (18.5 %). Age, the most important risk factor for PCa, was rarely mentioned (2.5 %). In addition to these responses, unusual non-evidence-based reasons were also reported. Men with a positive family history of PCa cited genetics as the cause of their disease about 4 times more frequently than sporadic cases. This proportion increased with the number of affected family members. PCa survivors aged ≤ 65 years at diagnosis indicated stress as the cause of their PCa approximately 2 times more often than men who were older than 65 years at PCa diagnosis.

CONCLUSION

 Most men surveyed reported non-evidence-based causes of their PCa. Preventive programs should address the evidence-based causes more distinctly and with a high visibility. Due to the significance of lay illness beliefs for the experience of distress and the adherence to treatment, the patient's subjective cause of disease should be surveyed and considered by the urologist in charge.

Benefit finding in long-term prostate cancer survivors

Purpose

Benefit finding (BF) represents possible positive changes that people may experience after cancer diagnosis and treatment and has proven to be valuable to the psychological outcome. Knowledge of such beneficial consequences of prostate cancer (PCa) is limited in long-term survivors (> 5 years). Thus, the present study investigated the occurrence of benefit finding (BF) and its determinants in a large sample of (very-) long-term PCa survivors.

Methods

BF was assessed in 4252 PCa survivors from the German database “Familial Prostate Cancer” using the German version of the Benefit Finding Scale (BFS). Associations between BF and sociodemographic, clinical, and psychosocial (e.g., depressive and anxiety symptoms and perceived severity of the disease experience) variables were analyzed using hierarchical multiple linear regression analysis.

Results

Mean age at survey was 77.4 years (SD = 6.2) after a mean follow-up of 14.8 years (SD = 3.8). Mean BFS score was 3.14 (SD = 1.0); the prevalence of moderate-to-high BF (score ≥ 3) was 59.7%. Younger age at diagnosis, lower educational level, and higher perceived severity of the disease experience were predictive of BF. Objective disease severity or family history of PCa was not uniquely associated with BF.

Conclusions

BF occurs in older, (very-) long-term PCa survivors. Our findings suggest that the self-asserted severity of the disease experience in a patient’s biography is linked to BF in the survivorship course above all tangible sociodemographic and clinical factors.

Implications for cancer survivors

PCa survivors may express BF regardless of clinical disease severity. Treating urologists should consider inquiring BF to enrich a patient’s cancer narrative.

Bloom Syndrome Protein Activates AKT and PRAS40 in Prostate Cancer Cells

Purpose

Prostate cancer (PC) is a common malignant tumor and a leading cause of cancer-related death in men worldwide. In order to design new therapeutic interventions for PC, an understanding of the molecular events underlying PC tumorigenesis is required. Bloom syndrome protein (BLM) is a RecQ-like helicase, which helps maintain genetic stability. BLM dysfunction has been implicated in tumor development, most recently during PC tumorigenesis. However, the molecular basis for BLM-induced PC progression remains poorly characterized. In this study, we investigated whether BLM modulates the phosphorylation of an array of prooncogenic signaling pathways to promote PC progression.

Methods

We analyzed differentially expressed proteins (DEPs) using iTRAQ technology. Site-directed knockout of BLM in PC-3 prostate cancer cells was performed using CRISPR/Cas9-mediated homologous recombination gene editing to confirm the effects of BLM on DEPs. PathScan® Antibody Array Kits were used to analyze the phosphorylation of nodal proteins in PC tissue. Immunohistochemistry and automated western blot (WES) analyses were used to validate these findings.

Results

We found that silencing BLM in PC-3 cells significantly reduced their proliferative capacity. In addition, BLM downregulation significantly reduced levels of phosphorylated protein kinase B (AKT (Ser473)) and proline-rich AKT substrate of 40 kDa (PRAS40 (Thr246)), and this was accompanied by enhanced ROS (reactive oxygen species) levels. In addition, we found that AKT and PRAS40 inhibition reduced BLM, increased ROS levels, and induced PC cell apoptosis.

Conclusions

We demonstrated that BLM activates AKT and PRAS40 to promote PC cell proliferation and survival. We further propose that ROS act in concert with BLM to facilitate PC oncogenesis, potentially via further enhancing AKT signaling and downregulating PTEN expression. Importantly, inhibiting the BLM-AKT-PRAS40 axis induced PC cell apoptosis. Thus, we highlight new avenues for novel anti-PC treatments.

Genome-wide haplotype association study identifies BLM as a risk gene for prostate cancer in Chinese population

Prostate cancer (PC) is a common malignant tumor that occurs in the prostate epithelial cells. It is generally considered to be caused by both genetic and environmental factors. To identify the genetic risk factors of PC in Chinese population, we carried out a genome-wide haplotype-based association study. The 33 Chinese PC cases were from the public GEO database (GSE18333), and the 139 Chinese controls (CHB) were from the HapMap project. Our analysis included three stages: (1) identifying the linkage disequilibrium (LD) blocks and performing genome-wide haplotype association scan, (2) mapping PC-risk haplotypes to PC candidate genes, and (3) prioritizing PC candidate genes based on their similarity to known PC susceptibility genes. The results showed that (1) 749 haplotypes were significantly associated with PC (P < 1E-5). (2) Then, we mapped these significant haplotypes to genes and got 454 PC candidate genes. (3) After prioritizing the candidate genes based on their similarity to known PC susceptibility genes, we found that seven novel PC susceptibility genes including BLM, RPS6KA2, FRK, ERBB4, RBL1, PAK7, and ERBB2IP. Among the seven genes, BLM gene ranked first (P = 1.89E-04). A haplotype GGTTACCCCTC (rs2270131, rs2073919, rs11073953, rs12592875, rs16944863, rs2238337, rs414634, rs401549, rs17183344, rs16944884, and rs16944888) on chromosome 15q26.1 had significant association with PC (P = 2.37E-11). To our knowledge, this is the first genetic association study to show the significant association between BLM gene and PC susceptibility in Chinese population.