Serum lipid profiles and aggressive prostate cancer.

The introduction of widespread prostate specific antigen (PSA) screening in western countries led to a sharp increase in prostate biopsies and the subsequent diagnosis of prostate cancer. This phenomenon appears to be repeating itself in countries such as China where economic development in recent decades has resulted in increased access to healthcare and more frequent screening tests. It is now recognized that the majority of prostate cancers diagnosed in PSA-screened men is of the indolent nature that does not impact patients’ quality of life or life expectancy. Unfortunately, due to our inability to image prostate cancer accurately, biopsies have been performed largely in a blind, un-targeted fashion. Some cancers, particularly those located in the anterior prostate, can be missed with this biopsy technique. On the other hand, if biopsies contain low-grade cancer (e.g. combined Gleason score 6) of limited quantity, it can cause serious difficulties in clinical management. Many such patients have indolent cancers that do not require radical treatments such as prostatectomy or radiation that carry potentially serious side effects. However, a small fraction of these patients actually harbor aggressive cancers that were not adequately sampled by the biopsy. Such uncertainties have resulted in over-treatment as well as under-treatment of patients. Currently, prediction of the aggressiveness of prostate cancer relies mostly on certain clinical (e.g. preoperative PSA) and pathologic (e.g. Gleason grade and tumor quantities on biopsy) parameters, which is obviously inadequate for certain patients. It is, therefore, important to develop new modalities, particularly noninvasive biomarkers, for better patient management. A study by Zhang et al. 1 represents a step forward in this direction. The authors analyzed serum lipid profiles in 322 consecutive patients who received prostatectomy and extended pelvic lymphadenectomy at their institution. Their analysis reveals that total cholesterol, triglyceride, and low-density lipoprotein levels are significant predictors of the pathologic parameters of the tumor after prostatectomy. Specifically, high levels of total cholesterol were associated with increased risk of lymph node metastasis; elevated levels of triglyceride were associated with a more than twofold increased risk of pT3–4 disease, and high levels of low-density lipoprotein were an independent predictor of high Gleason grade (≥8). Importantly, with the increase of the number of abnormal lipid components, a higher probability of pT3–4 disease and lymph node metastasis was observed. This study thus demonstrates the potential value of serum lipid profile in predicting the aggressiveness of prostate cancer once it is diagnosed by biopsy. Addition of the lipid profile to existing clinical 1Department of Pathology and Urology, Jonsson Comprehensive Cancer Center and Broad Center for Regenerative Medicine and Stem Cell Biology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; 2Department of Urology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China. Correspondence: Dr. J Huang ([email protected]) Open Access