INTRODUCTION: Prostate cancer is one of the most common cancers in men. Despite the sharp rise in incidence, mortality is decreasing. ARTA preparations are preferred options for asymptomatic or mildly symptomatic patients with mCRPC. The use of enzalutamide in elderly patients with mCRPC is risky and depends on a number of factors. An increased risk of falls and fractures has been shown. CASE PRESENTATION: We present a case report of an elderly patient with mCRPC treated with enzalutamide with very good long-term tolerance and efficacy. CONCLUSION: Despite the older age, no reduction of therapy was necessary in the patient due to good tolerance. Administration of enzalutamide in full doses resulted in a very good effect of therapy.

• Klíčová slova
• Aged 75 and over, Comorbidity, Enzalutamide, Metastatic castration-resistant prostate cancer,
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Prostate cancer is a very common disease, which is, unfortunately, often the cause of many male deaths. This is underlined by the fact that the early stages of prostate cancer are often asymptomatic. Therefore, the disease is usually detected and diagnosed at late advanced or even metastasized stages, which are already difficult to treat. Hence, it is important to pursue research and development not only in terms of novel diagnostic methods but also of therapeutic ones, as well as to increase the effectiveness of the treatment by combinational medicinal approach. Therefore, in this review article, we focus on recent approaches and novel potential tools for the treatment of advanced prostate cancer; these include not only androgen deprivation therapy, antiandrogen therapy, photodynamic therapy, photothermal therapy, immunotherapy, multimodal therapy, but also poly(ADP-ribose) polymerase, Akt and cyclin-dependent kinase inhibitors.

• Klíčová slova
• advanced prostate cancer treatment, androgen deprivation therapy, antiandrogen therapy, cancer diagnostics, immunotherapy, multimodal therapy, photodynamic therapy, phototherapy, specific drug targeting,
• MeSH
• fototerapie MeSH
• hormonální protinádorové látky chemie   farmakologie   terapeutické užití   MeSH
• imunoterapie MeSH
• klinické zkoušky jako téma MeSH
• kombinovaná terapie MeSH
• lidé MeSH
• nádory prostaty farmakoterapie   imunologie   terapie   MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• hormonální protinádorové látky MeSH

Management of non-metastatic castration-resistant prostate cancer (nmCRPC) has undergone a paradigm shift with next-generation androgen receptor inhibitors. However, direct comparative data are not available to inform treatment decisions and/or guideline recommendations. Therefore, we performed network meta-analysis to indirectly compare the efficacy and safety of currently available treatments. Multiple databases were searched for articles published before June 2020. Studies that compared overall and/or metastasis-free and/or prostate-specific antigen (PSA) progression-free survival (OS/MFS/PSA-PFS) and/or adverse events (AEs) in nmCRPC patients were considered eligible. Three studies (n = 4117) met our eligibility criteria. Formal network meta-analyses were conducted. For MFS, apalutamide, darolutamide, and enzalutamide were significantly more effective than placebo, and apalutamide emerged as the best option (P score: 0.8809). Apalutamide [hazard ratio (HR): 0.85, 95% credible interval (CrI): 0.77-0.94] and enzalutamide (HR: 0.86, 95% CrI: 0.78-0.95) were both significantly more effective than darolutamide. For PSA-PFS, all three agents were statistically superior to placebo, and apalutamide emerged as the likely preferred option (P score: 1.000). Apalutamide (HR: 0.71, 95% CrI: 0.69-0.74) and enzalutamide (HR: 0.76, 95% CrI: 0.74-0.79) were both significantly more effective than darolutamide. For AEs (including all AEs, grade 3 or grade 4 AEs, grade 5 AEs, and discontinuation rates), darolutamide was the likely best option. Apalutamide and enzalutamide appear to be more efficacious agents for therapy of nmCRPC, while darolutamide appears to have the most favorable tolerability profile. These findings may facilitate individualized treatment strategies and inform future direct comparative trials.

• Klíčová slova
• Apalutamide, Darolutamide, Enzalutamide, Network meta-analysis, Non-metastatic castration-resistant prostate cancer,
• MeSH
• antagonisté androgenních receptorů terapeutické užití   MeSH
• benzamidy MeSH
• doba přežití bez progrese choroby MeSH
• fenylthiohydantoin analogy a deriváty   terapeutické užití   MeSH
• kalikreiny metabolismus   MeSH
• lidé MeSH
• nádory prostaty rezistentní na kastraci farmakoterapie   mortalita   patologie   MeSH
• nitrily MeSH
• proporcionální rizikové modely MeSH
• prostatický specifický antigen metabolismus   MeSH
• protinádorové látky terapeutické užití   MeSH
• pyrazoly terapeutické užití   MeSH
• thiohydantoiny terapeutické užití   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• síťová metaanalýza MeSH
• systematický přehled MeSH
• Názvy látek
• antagonisté androgenních receptorů MeSH
• apalutamide MeSH Prohlížeč
• benzamidy MeSH
• darolutamide MeSH Prohlížeč
• enzalutamide MeSH Prohlížeč
• fenylthiohydantoin MeSH
• kalikreiny MeSH
• KLK3 protein, human MeSH Prohlížeč
• nitrily MeSH
• prostatický specifický antigen MeSH
• protinádorové látky MeSH
• pyrazoly MeSH
• thiohydantoiny MeSH

BACKGROUND: Androgen receptor targeted therapies have emerged as an effective tool to manage advanced prostate cancer (PCa). Nevertheless, frequent occurrence of therapy resistance represents a major challenge in the clinical management of patients, also because the molecular mechanisms behind therapy resistance are not yet fully understood. In the present study, we therefore aimed to identify novel targets to intervene with therapy resistance using gene expression analysis of PCa co-culture spheroids where PCa cells are grown in the presence of cancer-associated fibroblasts (CAFs) and which have been previously shown to be a reliable model for antiandrogen resistance. METHODS: Gene expression changes of co-culture spheroids (LNCaP and DuCaP seeded together with CAFs) were identified by Illumina microarray profiling. Real-time PCR, Western blotting, immunohistochemistry and cell viability assays in 2D and 3D culture were performed to validate the expression of selected targets in vitro and in vivo. Cytokine profiling was conducted to analyze CAF-conditioned medium. RESULTS: Gene expression analysis of co-culture spheroids revealed that CAFs induced a significant upregulation of cholesterol and steroid biosynthesis pathways in PCa cells. Cytokine profiling revealed high amounts of pro-inflammatory, pro-migratory and pro-angiogenic factors in the CAF supernatant. In particular, two genes, 3-hydroxy-3-methylglutaryl-Coenzyme A synthase 2 (HMGCS2) and aldo-keto reductase family 1 member C3 (AKR1C3), were significantly upregulated in PCa cells upon co-culture with CAFs. Both enzymes were also significantly increased in human PCa compared to benign tissue with AKR1C3 expression even being associated with Gleason score and metastatic status. Inhibiting HMGCS2 and AKR1C3 resulted in significant growth retardation of co-culture spheroids as well as of various castration and enzalutamide resistant cell lines in 2D and 3D culture, underscoring their putative role in PCa. Importantly, dual targeting of cholesterol and steroid biosynthesis with simvastatin, a commonly prescribed cholesterol synthesis inhibitor, and an inhibitor against AKR1C3 had the strongest growth inhibitory effect. CONCLUSIONS: From our results we conclude that CAFs induce an upregulation of cholesterol and steroid biosynthesis in PCa cells, driving them into AR targeted therapy resistance. Blocking both pathways with simvastatin and an AKR1C3 inhibitor may therefore be a promising approach to overcome resistances to AR targeted therapies in PCa. Video abstract.

• Klíčová slova
• AKR1C3, Antiandrogens, Castration resistance, Cholesterol, HMGCS2, Prostate cancer, Simvastatin, Steroid metabolism,
• MeSH
• androgenní receptory metabolismus   MeSH
• anotace sekvence MeSH
• benzamidy farmakologie   MeSH
• biologické modely MeSH
• biosyntetické dráhy genetika   MeSH
• buněčné sféroidy metabolismus   patologie   MeSH
• buněčný cyklus genetika   MeSH
• chemorezistence účinky léků   genetika   MeSH
• cholesterol biosyntéza   MeSH
• extracelulární matrix metabolismus   MeSH
• fenotyp MeSH
• fenylthiohydantoin farmakologie   MeSH
• fibroblasty asociované s nádorem metabolismus   patologie   MeSH
• kultivační média speciální farmakologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádorové buněčné linie MeSH
• nádory prostaty rezistentní na kastraci genetika   patologie   MeSH
• nádory prostaty genetika   metabolismus   patologie   MeSH
• nitrily farmakologie   MeSH
• progrese nemoci * MeSH
• proliferace buněk genetika   MeSH
• regulace genové exprese u nádorů účinky léků   MeSH
• senioři MeSH
• simvastatin farmakologie   MeSH
• stanovení celkové genové exprese MeSH
• upregulace * MeSH
• viabilita buněk účinky léků   genetika   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• androgenní receptory MeSH
• AR protein, human MeSH Prohlížeč
• benzamidy MeSH
• cholesterol MeSH
• enzalutamide MeSH Prohlížeč
• fenylthiohydantoin MeSH
• kultivační média speciální MeSH
• nitrily MeSH
• simvastatin MeSH

A number of prostate cancer (PCa)-specific genomic aberrations (denominated BRCAness genes) have been discovered implicating sensitivity to PARP inhibition within the concept of synthetic lethality. Recent clinical studies show favorable results for the PARP inhibitor olaparib used as single agent for treatment of metastatic castration-resistant PCa. Using 2D and 3D cell culture models mimicking the different treatment and progression stages of PCa, we evaluated a potential use for olaparib in combination with first-line endocrine treatments, androgen deprivation, and complete androgen blockade, and as a maintenance therapy following on from endocrine therapy. We demonstrate that the LNCaP cell line, possessing multiple aberrations in BRCAness genes, is sensitive to olaparib. Additive effects of olaparib combined with endocrine treatments in LNCaP are noted. In contrast, we find that the TMPRSS2:ERG fusion-positive cell lines VCaP and DuCaP do not show signs of synthetic lethality, but are sensitive to cytotoxic effects caused by olaparib. In consequence, additive effects of olaparib with endocrine therapy were not observable in these cell lines, showing the need for synthetic lethality in combination treatment regimens. Additionally, we show that PCa cells remain sensitive to olaparib treatment after initial androgen deprivation implicating a possible use of olaparib as maintenance therapy. In sum, our preclinical data recommend olaparib as a synthetic lethal treatment option in combination or sequenced to first-line endocrine therapy for PCa patients with diagnosed BRCAness.

• Klíčová slova
• PARP inhibition, combination therapy, endocrine therapy, maintenance therapy, olaparib, prostate cancer,
• MeSH
• androgeny metabolismus   MeSH
• biologické modely * MeSH
• ftalaziny farmakologie   MeSH
• lidé MeSH
• nádorové buněčné linie MeSH
• nádory prostaty rezistentní na kastraci * metabolismus   patologie   terapie   MeSH
• piperaziny farmakologie   MeSH
• udržovací chemoterapie metody   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• androgeny MeSH
• ftalaziny MeSH
• olaparib MeSH Prohlížeč
• piperaziny MeSH

Enzalutamide is an androgen receptor (AR) inhibitor approved for therapy of metastatic castration resistant prostate cancer. However, clinical application revealed that 30 to 40% of patients acquire resistance after a short period of treatment. Currently, the molecular mechanisms underlying such resistances are not completely understood, partly due to a lack of model systems. In the present study we established three different cellular models of enzalutamide resistance including a cell line with wild type AR (LAPC4), DuCaP cells which overexpress wild-type AR, as well as a cell which has been adapted to long term androgen ablation (LNCaP Abl) and harbors the AR T878A mutation. After 10 months of cultivation, sustained growth in the presence of enzalutamide was achieved. When compared to controls, resistant cells exhibit significantly decreased sensitivity to enzalutamide as measured with 3[H]thymidine incorporation and WST assay. Moreover, these cell models exhibit partly re-activated AR signaling despite presence of enzalutamide. In addition, we show that enzalutamide resistant cells are insensitive to bicalutamide but retain considerable sensitivity to abiraterone. Mechanistically, enzalutamide resistance was accompanied by increased AR and AR-V7 mRNA and protein expression as well as AR gene amplification, while no additional AR mutations have been identified.

• Klíčová slova
• AR gene amplification, AR-V7, androgen receptor, enzalutamide resistance, prostate cancer,
• MeSH
• androgenní receptory genetika   metabolismus   MeSH
• androsteny farmakologie   MeSH
• anilidy farmakologie   MeSH
• benzamidy MeSH
• chemorezistence účinky léků   genetika   MeSH
• fenylthiohydantoin analogy a deriváty   farmakologie   MeSH
• lidé MeSH
• mutace MeSH
• nádorové buněčné linie MeSH
• nádory prostaty genetika   metabolismus   patologie   MeSH
• nitrily farmakologie   MeSH
• proliferace buněk účinky léků   genetika   MeSH
• regulace genové exprese u nádorů účinky léků   MeSH
• signální transdukce účinky léků   genetika   MeSH
• tosylové sloučeniny farmakologie   MeSH
• viabilita buněk účinky léků   genetika   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• abiraterone MeSH Prohlížeč
• androgenní receptory MeSH
• androsteny MeSH
• anilidy MeSH
• benzamidy MeSH
• bicalutamide MeSH Prohlížeč
• enzalutamide MeSH Prohlížeč
• fenylthiohydantoin MeSH
• nitrily MeSH
• tosylové sloučeniny MeSH