Assessment of Thyroid Function and Metabolic Disorders in Management of Prostate Cancer with Agonists of LH Releasing Hormone
Study Objective: to assess thyroid function and metabolic disorders in patients with local prostate cancer (pT3N0M0) or biochemical relapse after total prostatectomy for local prostate cancer, who were treated with agonists of luteinizing hormone-releasing hormone (aLHRH).
Study Design: follow-up study.
Materials and Methods. 102 patients were enrolled to the study, 99 subjects were followed up till the study completion. The mean age was 69 years old (95% confidence range: 61.5-79.2 years old). To assess thyroid function, thyroid-stimulating hormone (TSH) and free T4 were measured prior to and in 12 months after androgen depriving therapy (ADT). To see metabolic disorders, waist circumference (WC), body mass index (BMI), and total cholesterol (TH) were measured prior to and 3, 6 and 12 months after ADT initiation.
Study Results. The following changes were noted in test parameters: thyroid hormones (basic and 12 months later, respectively): TSH (mU/L): 1.67506 and 1.90684 (p < 0.001), free T4 — 11.6266 and 11.0555 (p < 0.001). Metabolic parameters (basic, 3, 6 and 12 months, respectively): WC (cm): 91.5, 95.4 (+4.2%), 96.1 (+5.0%), 96.4 (+5.4%) (for all differences p ≤ 0.017); BMI (kg/m2): 27.4, 28.2 (+2.9%), 28.4 (+3.6%), 28.4 (+3.6%) (p ≤ 0.004 for all differences, save for differences between values in 6 and 12 months — p = 0.995); TC (mmol/L): 5.2, 5.6 (+7.7%), 5.8 (+11.5%), 5.9 (+13.5%) (for all differences p ≤ 0.001). Statistically significant positive correlation was recorded between TSH and TC dynamics (R = 0.285, p = 0.004), statistically significant negative correlation — between TSH and free T4 (R = –0.315, p = 0.001).
Conclusion. aLHRH monotherapy led to the trend of increase in WC, body mass, TSH raise and free T4 reduction one year after ADT, though mean hormone values were within acceptable range; TH demonstrated an increase. The highest increase in WC, BMI, TH was recorded within first 3 months of therapy, then the rate of increase diminished. Further study of metabolic and hormonal complications from ADT and evidence base enhancement are required in order to check the data and develop measures to prevent complications.
Contribution: Gritskevich, E.Yu. — subjects selection, sampling, thematic publications reviewing, statistical processing, data analysis and interpretation, manuscript preparation; Demidova, T.Yu. — study design, review of critically important material, approval of the manuscript for publication; Maturov, M.R., Bystrov, A.A. — subjects selection, database generation; Gritskevich, A.A. — participation in manuscript preparation, article reviewing; Neudakhina, V.O. — partial data analysis, participation in manuscript preparation.
Conflict of interest: The authors declare that they do not have any conflict of interests.
E.Yu. Gritskevich (Corresponding author) — N.I. Pirogov Russian National Research Medical University (a Federal State Autonomous Educational Institution of Higher Education), Russian Ministry of Health; 4 Shkulev St., Bldg. 1, Moscow, Russian Federation 109263. eLIBRARY.RU SPIN: 4125-2055. ORCID: https://orcid.org/0000-0002-0086-869X. E-mail: firstname.lastname@example.org
T.Yu. Demidova — N.I. Pirogov Russian National Research Medical University (a Federal State Autonomous Educational Institution of Higher Education), Russian Ministry of Health; 4 Shkulev St., Bldg. 1, Moscow, Russian Federation 109263. eLIBRARY.RU SPIN: 9600-9796. ORCID: https://orcid.org/0000-0001-6385-540X. Scopus Author ID: 7003771623. E-mail: email@example.com
M.R. Maturov — Outpatient Cancer Care Centre at Pletnev Municipal Clinical Hospital at Moscow Healthcare Department; 29 Verkhyaya Pervomayskaya, Moscow, Russian Federation 105264. E-mail: firstname.lastname@example.org
A.A. Bystrov — Moscow Municipal Oncology Hospital No.62 of Moscow Healthcare Department (outpatient unit); 6/2 Staropetrovskiy Proezd, Moscow, Russian Federation 125130. Е-mail: email@example.com
A.A. Gritskevich — Vishnevskiy National Medical Scientific Centre of Surgery of the Ministry of Health of the Russian Federation; 27 Bolshaya Serpukhovskaya Str., Moscow, Russian Federation 117997. eLIBRARY.RU SPIN: 2128-7536. ORCID: https://orcid.org/0000-0002-5160-925X. Е-mail: firstname.lastname@example.org
V.O. Neudakhina — N.I. Pirogov Russian National Research Medical University (a Federal State Autonomous Educational Institution of Higher Education), Russian Ministry of Health; 4 Shkulev St., Bldg. 1, Moscow, Russian Federation 109263. ORCID: https://orcid.org/0000-0003-0809-0429. E-mail: NeudakhinaVeronika@yandex.ru
Dynamics of mean thyroid-stimulating hormone (TSH) and free T4 values
Fig. 1. Dynamics of mean thyroid-stimulating hormone (TSH) values
Fig. 2. Dynamics of free T4 values
Comparison of thyroid-stimulating hormone and free T4 prior to and 12 months after hormone therapy initiation (t-test for paired samples)
Dynamics of mean body mass index (BMI), kg/m2
* Statistically significant differences from basic parameter (p ≤ 0.004).
Fig. 3. Diagram of changes in mean body mass index (BMI) over time.
* Statistically significant differences from basic parameter (p ≤ 0.004)
Dynamics of mean waist circumference (WC) value, cm
* Statistically significant differences from basic parameter (p ≤ 0,017).
Fig. 4. Diagram of changes in mean waist circumference (WC) over time.
* Statistically significant differences from basic parameter (p ≤ 0.017)
Changes in mean total cholesterol (TC) over time, mmol/L
* Statistically significant differences from basic parameter (p < 0,001). Fig. 5. Diagram of changes in mean total cholesterol (TC) over time.
* Statistically significant differences from basic parameter (p < 0.001)
Correlation of changes in thyroid-stimulating hormone (TSH) and free T4 values with other parameters
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