Correlates of thrombin generation in patients with advanced prostate cancer

Role of the Coagulation System in Genitourinary Cancers: Review

Tumor progression is associated with aberrant hemostasis, and patients with malignant diseases have an elevated risk of developing thrombosis. A crosstalk among the vascular endothelium, components of the coagulation cascade, and cancer cells transforms the intravascular milieu to a prothrombotic, proinflammatory, and cell-adhesive state. We review the existing evidence on activation of the coagulation system and its implication in genitourinary malignancies and discuss the potential therapeutic benefit of antithrombotic agents. A literature review was performed searching the Medline database and the Cochrane Library for original articles and reviews. A second search identified studies reporting on oncological benefit of anticoagulants in genitourinary cancer. An elevated expression of procoagulatory tissue factor on tumor cells and tumor-derived microparticles seems to stimulate cancer development and progression. Several components of the hemostatic system, including D-dimers, von Willebrand Factor, thrombin, fibrin-/ogen, soluble P-selectin, and prothrombin fragments 1 + 2 were either overexpressed or overactive in genitourinary cancers. Hypercoagulation was in general associated with a poorer prognosis. Experimental models and small trials in humans showed reduced cancer progression after treatment with anticoagulants. Main limitations of these studies were heterogeneous experimental methodology, small patient numbers, and a lack of prospective validation. In conclusion, experimental and clinical evidence suggests procoagulatory activity of genitourinary neoplasms, particularly in prostate, bladder and kidney cancer. This may promote the risk of vascular thrombosis but also metastatic progression. Clinical studies linked elevated biomarkers of hemostasis with poor prognosis in patients with genitourinary cancers. Thus, anticoagulation may have a therapeutic role beyond prevention of thromboembolism.

Thromboelastography identifies hypercoagulablilty and predicts thromboembolic complications in patients with prostate cancer

Cancer patients are at higher risk for thromboembolism compared to the normal population. This may be related to tumour burden and/or enhanced by systemic therapy. While there is ample evidence regarding venous thromboembolism, systematic studies investigating arterial thrombotic events are scarce. Conventional coagulation tests have limited capacity in evaluating the coagulability or the need for anticoagulant prophylaxis. In this pilot study, we investigated whether assessment of global haemostasis using thromboelastography (TEG) and quantification of plasma pro-coagulant microparticles can help determine the risk of adverse thrombotic events in patients with prostate cancer (PCa). Thirty two patients were recruited a priori into three groups: 11 men on 'watchful waiting' following recurrent disease after definitive treatment (Group A); 10 patients with metastatic disease on Androgen deprivation therapy (ADT) (Group B); and 11 with castration resistant cancer (Group C) and followed up over a period of 12months. These patients were compared to a control group composed of 8 men with negative prostate biopsy. Whole blood TEG and plasma tissue factor-carrying microparticles (TF-MPs) in addition to basic coagulation testing, plasma fibrinogen and d-dimer were performed. 22/32 (68.8%) of the patients demonstrated hypercoagulable TEG traces. Hypercoagulability was marked in group B compared to the control. Plasma MPs were significantly elevated in patients compared to the controls with significant increase in group B. All other coagulation tests were normal. Seven of the 22 hypercoagulable patients (31.8%) developed one or more thromboembolic events over 12months follow up period. The data in this pilot study show that PCa patients are hypercoagulable, particularly those with advanced disease on ADT and that this hypercoagulability can be identified by TEG. While this needs to be verified in a larger study, the data indicate TEG may aid in thrombosis risk stratification and determining the subsequent need for anticoagulant prophylaxis in PCa patients.

Effect of thrombin tube on PSA determination, a clue for false negative in screening for prostate cancer

Prostate cancer is an important male carcinoma. Laboratory screening for tumor marker is the routine preventive strategy for control of this cancer. For screening, prostate specific antigen (PSA) has been proposed as a marker in the serum. In this article, the author assesses the effect of new blood collection tube, thrombin tube, on the analysis of the PSA by bioinformatics technique. Using GoFigure server, the molecular functions of thrombin, PSA and thrombin-PSA were predicted. A significant change of molecular function due to the interaction between thrombin and PSA can be found. Increased of coagulation due to the synergistic clot activation can be expected. If this occurs, the false negative can be expected and it can bring the underdiagnosis of early prostate cancer. Therefore, the recommendation for usage of thrombin tube for PSA test should be modified from general usage. Shortening of the period between blood collection and sample analysis than general case must be done.

PAR1-mediated RhoA activation facilitates CCL2-induced chemotaxis in PC-3 cells

Patients with advanced prostate cancer often exhibit increased activation of the coagulation system. The key activator of the coagulation cascade is the serine protease thrombin which is capable of eliciting numerous cellular responses. We previously reported that the thrombin receptor PAR1 is overexpressed in prostate cancer. To investigate further the role of PAR1 in prostate cancer metastasis, we examined the effects of thrombin activation on cell adhesion and motility in PC-3 prostate cancer cells. Activation of PAR1-induced dynamic cytoskeletal reorganization and reduced PC-3 binding to collagen I, collagen IV, and laminin (P < 0.01) but not fibronectin. Expression of the cell surface integrin receptors did not change as assessed by flow cytometry. Immunofluorescence microscopy revealed that PAR1 stimulation caused reorganization of the focal adhesions, suggesting that PAR1 activation in PC-3 cells may be modulating cell adhesion through integrin function but not expression. Furthermore, RhoA was activated upon stimulation with thrombin with subsequent cell contraction, decreased cell adhesion, and induced migration towards monocyte chemoattractant protein 1 (MCP-1; CCL2). Thus, it appears that thrombin stimulation plays a role in prostate cancer metastasis by decreasing cell adhesion to the extracellular matrix and positioning the cell in a "ready state" for migration in response to a chemotactic signal. Further exploration is needed to determine whether PAR1 activation affects other signaling pathways involved in prostate cancer.

PAR1-mediated NFkappaB activation promotes survival of prostate cancer cells through a Bcl-xL-dependent mechanism

We have previously reported that protease-activated receptor 1 (PAR1 or thrombin receptor) is over-expressed in metastatic prostate cancer cell lines compared to prostate epithelial cells. In this study, we examined 1,074 prostate biopsies by tissue microarray analysis and demonstrated that PAR1 expression is significantly increased in prostate cancer compared to normal prostate epithelial cells and benign prostatic hyperplasia. We hypothesized that PAR1 activation contributed to prostate cancer cell progression. We demonstrated that stimulation of PAR1 by thrombin or thrombin receptor activating peptide (TRAP6), in androgen-independent DU145 and PC-3 cells resulted in increased DNA binding activity of the NFkappaB p65 subunit. IL-6 and IL-8 levels were also elevated in conditioned media by at least two-fold within 4-6 h of PAR1 activation. This induction of cytokine production was abrogated by pretreatment of cells with the NFkappaB inhibitor caffeic acid phorbol ester. The p38 and ERK1/2 MAPK signaling cascades were also activated by PAR1 stimulation, whereas the SAPK/JNK pathway was unaffected. Inhibition of p38 and ERK1/2 by SB-203589 and PD-098059, respectively, did not abrogate NFkappaB activity, suggesting an independent induction of NFkappaB by PAR1 stimulation. Furthermore, TUNEL assay showed that activation of PAR1 attenuated docetaxel induced apoptosis through the upregulation of the Bcl-2 family protein Bcl-xL. Akt activation was not observed, suggesting that drug resistance induced by PAR1 was independent of PI3K signaling pathway. Because thrombin and PAR1 are over-expressed in prostate cancer patients, targeting the inhibition of their interaction may attenuate NFkappaB signaling transduction resulting in decreased drug resistance and subsequent survival of prostate cancer cells.