Studies Of Some Renal Parameters And Testosterone Levels In Prostate Cancer Patients At Federal University Teaching Hospital, Owerri.

ABSTRACT

Prostate cancer is one of the most common malignancies affecting men worldwide and is often associated with alterations in hormonal and renal function. This study aims to evaluate the renal parameters and testosterone levels in prostate cancer patients at the Federal University Teaching Hospital, Owerri. Specifically, the levels of creatinine, urea, sodium, potassium, chloride, and bicarbonate in prostate cancer patients were assessed and then compared to apparently healthy individuals. Additionally, testosterone levels were measured to investigate possible correlations between testosterone and renal function in the affected population. A total of thirty prostate cancer patients and thirty healthy controls were included in the study. Blood samples were collected and analyzed using standard biochemical methods to determine renal function parameters, while testosterone levels were measured using enzyme-linked immunosorbent assay (ELISA). The findings revealed that the mean value Serum Creatinine (1.36±0.67 mg/dL) of test subject did not increase significantly when compared with mean value of Serum Creatinine (1.35±0.74 mg/dL) in apparently healthy individuals (Control), and there was significant increase in Serum Urea (3.54±0.86 mmol/L), Sodium (138.10±5.85 mmol/L), and Chloride (100.97±3.54 mmol/L) of test subject compared to Serum Urea (3.12±0.73 mmol/L), Sodium (129.17±3.06 mmol/L), and chloride (94.87±3.95 mmol/L) respectively of apparently healthy individuals (Control). The mean value of potassium (3.87±0.57 mmol/L), and Bicarbonate (28.04±1.98 mmol/L), recorded a slight insignificant decrease compared to that of apparently healthy individuals (Control), (4.23±0.56 mmol/L) (29.12±2.28 mmol/L) at P < 0.05. There was also significant decrease in the Mean level of Testosterone in Patients with Prostate cancer (291.50-133.63 ng/dL), (Test), when compared with apparently healthy individuals at Mean (419.03-188.55 ng/dL), (Control). These results highlight the potential impact of prostate cancer on renal function and hormonal balance, providing insight into disease progression and possible therapeutic targets. Further studies are recommended to explore the long-term effects of these alterations in prostate cancer patients.

CHAPTER ONE

INTRODUCTION

1.1   Background of Study

Prostate cancer, also known as carcinoma of the prostate, is the development of cancer in the prostate, a gland in the male reproductive system (WHO, 2021).

Prostate cancer is one amongst the most common medical diseases affecting senior men. Carcinoma of the prostate is the most common non-cutaneous cancer diagnosed in Nigeria male population. The lifetime risk of prostatic carcinoma is 16.7% and the risk of death during the entire lifetime is around 2.6% for men in the Nigeria but the overall lifetime risk of death due to prostate malignancy is low about the lifetime risk of diagnosis (Yamamoto et al., 2022).

In developed countries, carcinoma of the prostate gland is more prevalent in the elderly male population compared with younger men. Around 15% of men diagnosed to have cancer of the prostate in the developed world when compared to only about 4% of men in emerging nations (Hoffman et al., 2023). While, many men present with localized and potentially curable disease, a large number of deaths from prostate cancer is due to the development of metastatic disease. Therefore, more accurate prognosis and predictive markers should be applied for prostate cancer to guide therapy and monitor disease progress in individual patients (Schatz et al., 2011).

Creatinine is a waste product produced by muscles from the breakdown of a compound called creatine (Baxmann et al., 2023). Creatinine is removed from the body by the kidneys, which filter almost all of it from the blood and release it into the urine.

Urea is major nitrogenous end product of protein and amino acid catabolism, produced by liver and distributed throughout intracellular and extracellular fluid. In kidneys urea is filtered out of blood by glomerulli and is partially being reabsorbed with water (Corbett, 2023).

Conventionally used laboratory markers for the diagnosis of prostate disorders are acid phosphatase and PSA, a glycoprotein produced in the benign and malignant prostate cells. However, the latter has replaced the former with regard to sensitivity and specificity. It was earlier reported that serum creatinine and urea is associated with a high risk of prostate cancer, more so in advanced cases where the chances of survival were low (Lalitha et al., 2012).

Electrolytes in the body including sodium (Na+), calcium (Ca2+), potassium (K+), chlorine (Cl-) and magnesium (Mg2+) play important physiological roles in the body such as enhancing enzyme activities, creating electrical gradients, promoting several metabolic and cellular activities, and ensuring normal homeostasis (Lindner and Funk, 2021). However, distortion or imbalance of the normal electrolyte level may lead to clinical abnormalities or disorders which are frequently associated with increased morbidity and mortality (Liamis et al., 2022). Electrolyte imbalance is frequently observed in clinical subjects and usually caused by several factors including gastrointestinal absorption capacity, nutritional deficiencies, acid-base abnormalities, pharmacological agents, renal disease, acute illness or diseases which can act alone or in combination (Liamis et al., 2022).

Testosterone is the primary male sex hormone and an anabolic steroid. It is a steroid from the androsterone class containing a keto and hydroxyl groups at the three and seventeen positions respectively (Veldhuis et al., 2019).

The relationship of prostate cancer and serum testosterone is known for the past few decades. The benefits of surgical castration and the role of estrogen treatment in the management of metastatic cancer prostate was evaluated since olden days by Huggins and Hodges (Yamamoto et al., 2022). They earlier demonstrated the beneficial clinical effects of androgen suppression therapy in the management of metastatic (advanced) cancer of the prostate. The androgen suppression benefits are recently extended in the management of even in non-metastatic prostate cancer patients and recurrent prostate cancer after definitive management (Schatzl et al., 2011). Again there is a role for hormonal therapy in neoadjuvant settings like before radical prostatectomy which resulted in the decrease in serum PSA, Shrinkage of prostate tumor volume and reduction in the rate of positive surgical margins. The reduction in prostate volume following neoadjuvant hormonal therapy is more in peripheral zone compared to the central zone. Prostate cancer is hormonedependent cancer, and the clinical course of prostate cancer varies with the individual, and again it varies within the individual in relationship to serum testosterone levels (Massengill et al., 2013).

1.2     Justification

In developed countries, carcinoma of the prostate gland is more prevalent in the elderly male population compared with younger men. Around 15% of men diagnosed to have cancer of the prostate in the developed world when compared to only about 4% of men in emerging nations (Hoffman et al., 2016).

Studies among prostate cancer patients have shown that serum creatinine and urea is associated with more advanced disease and with decreased survival, although this relationship is not supported by some studies (Lalitha et al., 2016). Since prostate disorders have an association with end stage renal disease and is also age related, this study focuses on the of blood levels of urea and creatinine, as a possible aid in the diagnosis of prostate cancer.

Report by Huggins and Hodges in 1941 shows that prostate cancer cells rely on androgens to grow and survive, castration has been the standard therapeutic approach for patients with advanced prostate cancer but recently, Androgen-deprivation therapy (ADT) is a standard of care in the treatment of advanced prostate cancer; however, testosterone monitoring practices for men undergoing ADT vary across Nigeria. Despite several researches been carried out on the level of testosterone and renal parameters in males with prostate cancer the authenticity of the information reported by the researchers have still not been confirmed, these study is therefore slated to evaluate the testosterone level and renal function parameters in prostate cancer patients.

1.3    Significance of the Study

Cancer is a leading cause of mortality and the burden of disease (WHO, 2021). Lifestyle constituents, such as smoking, poor diet, and physical inactivity account for a significant relationship of cases, but sex hormones are thought to have a role in the etiology of some cancers and several studies have it that prostate cancer might have an effect on the kidney. Reports on the high incidence of prostate cancer in humans and their influence on the quality of life of patients have made a search for the most reliable diagnostic tool to aid their treatment a priority for public health (Nutting et al., 2022). This study is designed to evaluate renal function parameters and testosterone level in prostate cancer patients, the result will aid the clinician in the diagnosis, treatment and management of the disease.

1.4   Aim and Objectives

Aim

To evaluate renal function parameters and testosterone level in prostate cancer patient visiting Federal University Teaching Hospital, Owerri, Imo State.

Specific Objectives

1. To evaluate the level of creatinine, urea, sodium, potassium, chloride and bicarbonate in prostate cancer patient compared to apparently healthy individuals.
2. To evaluate testosterone level in prostate cancer patient compared to apparently healthy individuals.
3. To correlate the level of testosterone with renal function parameters in prostate cancer patient.

1.5      Research Question

1. What are the levels of creatinine, urea, sodium, potassium, chloride, and bicarbonate in prostate cancer patients compared to apparently healthy individuals?
2. What is the level of testosterone in prostate cancer patients compared to apparently healthy individuals?
3. What is the correlation between testosterone levels and renal function parameters (creatinine, urea, sodium, potassium, chloride, and bicarbonate) in prostate cancer patients?

1.6   Hypothesis

– Hypothesis 1 (Null): There are no significant differences in the levels of creatinine, urea, sodium, potassium, chloride, and bicarbonate between prostate cancer patients and apparently healthy individuals.

– Hypothesis 1 (Alternative): There are significant differences in the levels of creatinine, urea, sodium, potassium, chloride, and bicarbonate between prostate cancer patients and apparently healthy individuals.

– Hypothesis 2 (Null): There is no significant difference in testosterone levels between prostate cancer patients and apparently healthy individuals.

– Hypothesis 2 (Alternative): There is a significant difference in testosterone levels between prostate cancer patients and apparently healthy individuals.

– Hypothesis 3 (Null): There is no significant correlation between testosterone levels and renal function parameters (creatinine, urea, sodium, potassium, chloride, and bicarbonate) in prostate cancer patients.

– Hypothesis 3 (Alternative): There is a significant correlation between testosterone levels and renal function parameters (creatinine, urea, sodium, potassium, chloride, and bicarbonate) in prostate cancer patients.

CHAPTER ONE

INTRODUCTION

1.1   Background of Study

Prostate cancer, also known as carcinoma of the prostate, is the development of cancer in the prostate, a gland in the male reproductive system (WHO, 2021).

Prostate cancer is one amongst the most common medical diseases affecting senior men. Carcinoma of the prostate is the most common non-cutaneous cancer diagnosed in Nigeria male population. The lifetime risk of prostatic carcinoma is 16.7% and the risk of death during the entire lifetime is around 2.6% for men in the Nigeria but the overall lifetime risk of death due to prostate malignancy is low about the lifetime risk of diagnosis (Yamamoto et al., 2022).

In developed countries, carcinoma of the prostate gland is more prevalent in the elderly male population compared with younger men. Around 15% of men diagnosed to have cancer of the prostate in the developed world when compared to only about 4% of men in emerging nations (Hoffman et al., 2023). While, many men present with localized and potentially curable disease, a large number of deaths from prostate cancer is due to the development of metastatic disease. Therefore, more accurate prognosis and predictive markers should be applied for prostate cancer to guide therapy and monitor disease progress in individual patients (Schatz et al., 2011).

Creatinine is a waste product produced by muscles from the breakdown of a compound called creatine (Baxmann et al., 2023). Creatinine is removed from the body by the kidneys, which filter almost all of it from the blood and release it into the urine.

Urea is major nitrogenous end product of protein and amino acid catabolism, produced by liver and distributed throughout intracellular and extracellular fluid. In kidneys urea is filtered out of blood by glomerulli and is partially being reabsorbed with water (Corbett, 2023).

Conventionally used laboratory markers for the diagnosis of prostate disorders are acid phosphatase and PSA, a glycoprotein produced in the benign and malignant prostate cells. However, the latter has replaced the former with regard to sensitivity and specificity. It was earlier reported that serum creatinine and urea is associated with a high risk of prostate cancer, more so in advanced cases where the chances of survival were low (Lalitha et al., 2012).

Electrolytes in the body including sodium (Na+), calcium (Ca2+), potassium (K+), chlorine (Cl-) and magnesium (Mg2+) play important physiological roles in the body such as enhancing enzyme activities, creating electrical gradients, promoting several metabolic and cellular activities, and ensuring normal homeostasis (Lindner and Funk, 2021). However, distortion or imbalance of the normal electrolyte level may lead to clinical abnormalities or disorders which are frequently associated with increased morbidity and mortality (Liamis et al., 2022). Electrolyte imbalance is frequently observed in clinical subjects and usually caused by several factors including gastrointestinal absorption capacity, nutritional deficiencies, acid-base abnormalities, pharmacological agents, renal disease, acute illness or diseases which can act alone or in combination (Liamis et al., 2022).

Testosterone is the primary male sex hormone and an anabolic steroid. It is a steroid from the androsterone class containing a keto and hydroxyl groups at the three and seventeen positions respectively (Veldhuis et al., 2019).

The relationship of prostate cancer and serum testosterone is known for the past few decades. The benefits of surgical castration and the role of estrogen treatment in the management of metastatic cancer prostate was evaluated since olden days by Huggins and Hodges (Yamamoto et al., 2022). They earlier demonstrated the beneficial clinical effects of androgen suppression therapy in the management of metastatic (advanced) cancer of the prostate. The androgen suppression benefits are recently extended in the management of even in non-metastatic prostate cancer patients and recurrent prostate cancer after definitive management (Schatzl et al., 2011). Again there is a role for hormonal therapy in neoadjuvant settings like before radical prostatectomy which resulted in the decrease in serum PSA, Shrinkage of prostate tumor volume and reduction in the rate of positive surgical margins. The reduction in prostate volume following neoadjuvant hormonal therapy is more in peripheral zone compared to the central zone. Prostate cancer is hormonedependent cancer, and the clinical course of prostate cancer varies with the individual, and again it varies within the individual in relationship to serum testosterone levels (Massengill et al., 2013).

1.2     Justification

In developed countries, carcinoma of the prostate gland is more prevalent in the elderly male population compared with younger men. Around 15% of men diagnosed to have cancer of the prostate in the developed world when compared to only about 4% of men in emerging nations (Hoffman et al., 2016).

Studies among prostate cancer patients have shown that serum creatinine and urea is associated with more advanced disease and with decreased survival, although this relationship is not supported by some studies (Lalitha et al., 2016). Since prostate disorders have an association with end stage renal disease and is also age related, this study focuses on the of blood levels of urea and creatinine, as a possible aid in the diagnosis of prostate cancer.

Report by Huggins and Hodges in 1941 shows that prostate cancer cells rely on androgens to grow and survive, castration has been the standard therapeutic approach for patients with advanced prostate cancer but recently, Androgen-deprivation therapy (ADT) is a standard of care in the treatment of advanced prostate cancer; however, testosterone monitoring practices for men undergoing ADT vary across Nigeria. Despite several researches been carried out on the level of testosterone and renal parameters in males with prostate cancer the authenticity of the information reported by the researchers have still not been confirmed, these study is therefore slated to evaluate the testosterone level and renal function parameters in prostate cancer patients.

1.3    Significance of the Study

Cancer is a leading cause of mortality and the burden of disease (WHO, 2021). Lifestyle constituents, such as smoking, poor diet, and physical inactivity account for a significant relationship of cases, but sex hormones are thought to have a role in the etiology of some cancers and several studies have it that prostate cancer might have an effect on the kidney. Reports on the high incidence of prostate cancer in humans and their influence on the quality of life of patients have made a search for the most reliable diagnostic tool to aid their treatment a priority for public health (Nutting et al., 2022). This study is designed to evaluate renal function parameters and testosterone level in prostate cancer patients, the result will aid the clinician in the diagnosis, treatment and management of the disease.

1.4   Aim and Objectives

Aim

To evaluate renal function parameters and testosterone level in prostate cancer patient visiting Federal University Teaching Hospital, Owerri, Imo State.

Specific Objectives

1. To evaluate the level of creatinine, urea, sodium, potassium, chloride and bicarbonate in prostate cancer patient compared to apparently healthy individuals.
2. To evaluate testosterone level in prostate cancer patient compared to apparently healthy individuals.
3. To correlate the level of testosterone with renal function parameters in prostate cancer patient.

1.5      Research Question

1. What are the levels of creatinine, urea, sodium, potassium, chloride, and bicarbonate in prostate cancer patients compared to apparently healthy individuals?
2. What is the level of testosterone in prostate cancer patients compared to apparently healthy individuals?
3. What is the correlation between testosterone levels and renal function parameters (creatinine, urea, sodium, potassium, chloride, and bicarbonate) in prostate cancer patients?

1.6   Hypothesis

– Hypothesis 1 (Null): There are no significant differences in the levels of creatinine, urea, sodium, potassium, chloride, and bicarbonate between prostate cancer patients and apparently healthy individuals.

– Hypothesis 1 (Alternative): There are significant differences in the levels of creatinine, urea, sodium, potassium, chloride, and bicarbonate between prostate cancer patients and apparently healthy individuals.

– Hypothesis 2 (Null): There is no significant difference in testosterone levels between prostate cancer patients and apparently healthy individuals.

– Hypothesis 2 (Alternative): There is a significant difference in testosterone levels between prostate cancer patients and apparently healthy individuals.

– Hypothesis 3 (Null): There is no significant correlation between testosterone levels and renal function parameters (creatinine, urea, sodium, potassium, chloride, and bicarbonate) in prostate cancer patients.

– Hypothesis 3 (Alternative): There is a significant correlation between testosterone levels and renal function parameters (creatinine, urea, sodium, potassium, chloride, and bicarbonate) in prostate cancer patients.

Pages:  85

Category: Project

Format:  Word & PDF               

Chapters: 1-5                                          

Source: Imsuinfo                            

Material contains Table of Content, Abstract and References.