Departamento de Matemáticas, Universidade da Coruña, 15071 A Coruña, Spain;
Department of Civil Engineering and Architecture, University of Pavia, 27100 Pavia, Italy.
Proc Natl Acad Sci U S A. 2019 Jan 22;116(4):1152-1161. doi: 10.1073/pnas.1815735116. Epub 2019 Jan 7.
Prostate cancer and benign prostatic hyperplasia are common genitourinary diseases in aging men. Both pathologies may coexist and share numerous similarities, which have suggested several connections or some interplay between them. However, solid evidence confirming their existence is lacking. Recent studies on extensive series of prostatectomy specimens have shown that tumors originating in larger prostates present favorable pathological features. Hence, large prostates may exert a protective effect against prostate cancer. In this work, we propose a mechanical explanation for this phenomenon. The mechanical stress fields that originate as tumors enlarge have been shown to slow down their dynamics. Benign prostatic hyperplasia contributes to these mechanical stress fields, hence further restraining prostate cancer growth. We derived a tissue-scale, patient-specific mechanically coupled mathematical model to qualitatively investigate the mechanical interaction of prostate cancer and benign prostatic hyperplasia. This model was calibrated by studying the deformation caused by each disease independently. Our simulations show that a history of benign prostatic hyperplasia creates mechanical stress fields in the prostate that impede prostatic tumor growth and limit its invasiveness. The technology presented herein may assist physicians in the clinical management of benign prostate hyperplasia and prostate cancer by predicting pathological outcomes on a tissue-scale, patient-specific basis.
前列腺癌和良性前列腺增生是老年男性常见的泌尿生殖系统疾病。这两种病理可能同时存在,并具有许多相似之处,这表明它们之间存在一些联系或相互作用。然而,缺乏证实它们存在的确凿证据。最近对大量前列腺切除术标本的研究表明,起源于较大前列腺的肿瘤具有较好的病理特征。因此,较大的前列腺可能对前列腺癌具有保护作用。在这项工作中,我们提出了一种对此现象的力学解释。研究表明,随着肿瘤的增大而产生的力学应力场会减缓其动力学过程。良性前列腺增生会导致这些力学应力场的产生,从而进一步抑制前列腺癌的生长。我们推导了一个组织尺度、患者特异性的力学耦合数学模型,定性地研究了前列腺癌和良性前列腺增生的力学相互作用。该模型通过分别研究每种疾病引起的变形来进行校准。我们的模拟表明,良性前列腺增生的病史会在前列腺中产生力学应力场,从而阻碍前列腺肿瘤的生长并限制其侵袭性。本文所介绍的技术可以通过预测组织水平、患者特异性的病理结果,帮助医生对良性前列腺增生和前列腺癌进行临床管理。