Department of Gynecology-Obstetrics & Urology, Sapienza University of Rome, Rome, Italy.
Department of Internal Medicine and Medical Disciplines, Sapienza University of Rome, Rome, Italy.
Endocrine. 2018 Feb;59(2):338-343. doi: 10.1007/s12020-017-1351-0. Epub 2017 Jun 28.
Prostate cancer is the most common tumor in men. To the best of our knowledge a systematic assessment of bone and mineral abnormalities has not been performed in prostatic cancer patients consecutively enrolled.
This study was therefore carried out to investigate changes of skeletal and mineral metabolism in patients with prostate cancer (n = 69). A population of patients with cancer of various origin was also investigated as a control group (n = 53), since a comparison with non-prostate cancer patients has not been previously reported.
In the prostatic cancer group, one patient had extremely high values of C-terminal Fibroblast Growth Factor 23, low values of tubular reabsorption of phosphate and very high values of bone alkaline phosphatase, suggesting the diagnosis of oncogenic osteomalacia. We found nine patients with primary hyperparathyroidism in the group of prostate cancer vs. only one in cancer patients group (p < 0.026). We stratified the population on the basis of Gleason score, prostate specific antigen and hormonal therapy. Using a generalized linear model with a logit link to predict the probability of developing primary hyperparathyroidism, only Gleason score, C-terminal fibroblast growth factor 23 and hormonal therapy had a significant effect (p < 0.05). Controlling for other covariates, a rise in fibroblast growth factor 23 increases the odds of developing primary hyperparathyroidism by 2% (p = 0.017), while patients with higher values of Gleason score have a much greater probability of developing primary hyperparathyroidism (log-odds = 3.6, p < 0.01). The probability decreases with higher values of Gleason score while on hormonal therapy; a further decrease was observed in patients on hormonal treatment and lower values of GS. Finally, lower grade of Gleason score without hormonal therapy have a significant protective factor (p < 0.01) decreasing the odds of developing primary hyperparathyroidism by 8%.
We showed a remarkable prevalence of primary hyperparathyroidism in men with prostate cancer; the multivariate analysis demonstrates that higher aggressiveness of prostate cancer, as determined by Gleason score, is a significant predictor of increased risk of developing primary hyperparathyroidism.
前列腺癌是男性最常见的肿瘤。据我们所知，尚未对连续入组的前列腺癌患者进行系统性骨矿物质异常评估。
因此，本研究旨在调查前列腺癌患者（n=69）骨骼和矿物质代谢的变化。还调查了一组来自不同癌症来源的患者作为对照组（n=53），因为之前没有报告过与非前列腺癌患者的比较。
在前列腺癌组中，一名患者的 C 端成纤维细胞生长因子 23 极高，肾小管磷酸盐重吸收值低，骨碱性磷酸酶极高，提示诊断为癌性骨软化症。我们发现前列腺癌组中有 9 例原发性甲状旁腺功能亢进症患者，而癌症组中只有 1 例（p<0.026）。我们根据 Gleason 评分、前列腺特异抗原和激素治疗对人群进行分层。使用对数链接的广义线性模型预测发生原发性甲状旁腺功能亢进症的概率，只有 Gleason 评分、C 端成纤维细胞生长因子 23 和激素治疗有显著影响（p<0.05）。在控制其他协变量的情况下，成纤维细胞生长因子 23 的升高使发生原发性甲状旁腺功能亢进症的几率增加 2%（p=0.017），而 Gleason 评分较高的患者发生原发性甲状旁腺功能亢进症的可能性更大（对数优势比=3.6，p<0.01）。随着 Gleason 评分的升高，概率降低；在接受激素治疗的患者中观察到进一步降低，而 GS 值较低。最后，没有接受激素治疗的 Gleason 评分较低的患者具有显著的保护因素（p<0.01），使发生原发性甲状旁腺功能亢进症的几率降低 8%。
我们显示了前列腺癌患者中原发性甲状旁腺功能亢进症的显著患病率；多变量分析表明，Gleason 评分确定的前列腺癌侵袭性更高是发生原发性甲状旁腺功能亢进症风险增加的显著预测因素。
