دراسة بعض الدلائل والمتغيرات الكيمياحيوية لمرضى سرطان البروستات المنتشر الى العظم

Study of Some Biochemical Markers and Biochemical Variables in Prostate Cancer Patients with Advanced Bone Metastasis

Prostate cancer is the most common cancer in the world specifically in Iraq, compared to other cancers, that affects men of old ages of 50 years and more, but it rarely affects men that lesser than this age category. The cancer, often metastasis, reaches in advanced stages even up to the bone, which causes an increase in metabolism products (catabolism) of collagen, like Deoxypyridinoline (DPD) level, and an increase of the level of alkaline phosphatase (ALP), and other elements in the bone structure such as calcium (Ca²⁺) and phosphate (PO4³⁻).

This study deals with the verification of cancerous metastasis whether it reaches to the bone or not, through the marker of DPD, as well as to explain the relationship between DPD and other clinical indicators in patients with metastatic prostate cancer, under study. Fifty patients with prostate tumor were selected from AL-Hussein Teaching Hospital of Kerbala and 30 healthy subjects represented as the control group, their ages were identical with the ages of patients.

The clinical characteristics of patients were documented, which included age, smoking, family history, obesity, and chemotherapy drug. Statistical analysis of the results showed that 60% of patients were aged (66-80) year and 40% were between the ages of (50-65) year. The concentrations of PSA, total-alkaline phosphatase (T-ALP), calcium, and phosphate were measured in the sera of both patients with prostate cancer and the healthy group. As well as, the concentrations of deoxypyridinoline, and creatinine were measured in the urine of same patients and healthy group.

The statistical results, by using student`s t-test, showed a highly significant (P˂0.000) increase in the level of PSA, DPD/Creat., calcium, and phosphate. There also was a highly significant (P˂0.01) increase in the activity of serum total-alkaline phosphatase (T-ALP), compared with the healthy group.

In this study, fifty patients with prostate tumor were clinically classified into three groups; benign prostate hyperplasia (B.P.H), localized prostate cancer (L.P.C), and metastasis prostate cancer (M.P.C). The results appeared that urinary excretion of deoxypyridinoline (DPD) showed a highly significant (P˂0.000) increase in the patients with bone metastasis than in those with B.P.H and those with localized prostate cancer (L.P.C), whereas DPD levels did not show a significant variation between B.P.H and L.P.C groups. In addition, the results of other parameters under study which included PSA, T-ALP, Ca²⁺, and PO4³⁻, showed a significant (P˂0.01) increase in the concentration of PSA, and a highly significant (P˂0.000) increase in the concentrations of Ca²⁺ and PO4³⁻ in M.P.C group, compared with B.P.H and L.P.C groups.

By using Pearson’s correlation coefficient between parameters under study in prostate cancer patients with bone metastasis group (M.P.C), the results showed a significant positive correlation between PSA and T-ALP (P=0.003, r=0.577), DPD and calcium (P=0.009, r=0.520), DPD and phosphate (P=0.01, r=0.499), calcium and phosphate (P˂0.000, r=0.721).

The demographic study of patients which included age, smoking, chemotherapy drug, family history, and obesity demonstrated a significant (P˂0.05) decrease in the level of PSA in smoker patients, when compared with non-smoker patients, whereas there wasn’t noticed any significant (P˃0.05) in the other parameters under study in smoker patients with prostate tumor. In addition, it is shown that a highly significant (P˂0.000) increase in the levels of PSA and DPD, and significant (P˂0.01) increase in the levels of calcium and phosphate, in patients who were treated with chemotherapy drug, when compared with patients who were untreated with chemotherapy drug. The results didn`t show any significant variation (P˃0.05) in levels of all parameters that used in the present research, with another clinical characteristics (age, family history, obesity) in patients of prostate tumor.

The results indicate to that Deoxypyridinoline is a good clinical marker. We can monitor through DPD, the stage of cancerous metastasis and for treatment monitoring to the bone, in prostate cancer and all types of cancers. In addition, the results showed a correlation between DPD with other clinical indicators in metastasis prostatic cancer patients. The results also demonstrated a decrease in a therapeutic effect of chemotherapy drug in prostate cancer patients; and increase the progression of cancer, because of the toxicity of bone marrow by chemotherapy drug. Therefore, we recommend using the dependent-dose of radiotherapy with chemotherapy to save the bone.