published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Bakgrund: Prostatacancer är den vanligaste typen av cancer i världen och antalet drabbade ökar för varje år i Sverige. Diagnosticeringsprocessen av cancer är ett känsligt ämne för männen då det väcker existentiella frågor som leder till en förändrad kroppsuppfattning. Cancer kan också innebära en störning av hälsan och leda till ett lidande. Syfte: Syftet med studien var att belysa mäns erfarenheter av att diagnosticeras med prostatacancer. Metod: Litteraturbaserad studie baserad på tolv vetenskapliga artiklar med kvalitativ ansats. Resultat: Ur analysen framkom tre kategorier; diagnosen ett livsomvälvande besked, hantera sjukdomen är en krävande process samt kunskapsbrist skapar otrygghet med nio underkategorier. Diskussion: Det är viktigt att sjuksköterskan har kunskap om de känslor och informationsbehov männen upplever i samband med diagnosen och hur de kan möta detta genom en god kommunikation och stöd. Sjuksköterskan blir medveten om dessa erfarenheter och kan då främja hälsa och lindra lidande för männen. Slutsats: Männen upplever en omvälvande period fram tills ett behandlingsbeslut ska tas. De behöver egentid för initial hantering av diagnos följt av information och stöd. De upplever också en bristfällig sjukvårdspersonal under denna period. / Background: Prostate cancer is the most common form of cancer in the world and the amount of people affected in Sweden increasing every year. The diagnosing process of cancer is a sensitive subject and it leads to existential questions followed by a perceived change in the body image. Cancer could also lead to a disturbance in health and lead to suffering. Aim: The aim of this study was to illuminate men’s experiences of being diagnosed with prostate cancer. Method: A qualitative literature study based on twelve research articles with a qualitative approach. Results: Three categories emerged from the analysis; diagnosis a life-changing result, handle the disease is a demanding period and lack of knowledge creates insecurity followed by nine subcategories. Discussion: It is important that the nurse has knowledge about the emotions and informational needs the men experience associated to the diagnosis and how they can meet these needs through good communication and support. The nurse becomes aware of these experiences and can then promote health and ease suffering for the men. Conclusion: Men experience a life-changing period from diagnosis to the treatment decision. They need time alone in order to cope with the diagnosis followed by information and support. They also experience a deficient medical staff during this period.

Prostate cancer is the second leading cause of cancer deaths among men. Targeted analyses of DNA from prostate cancers have identified recurrent somatic alterations that promote tumor growth and survival. Only recently, however, has the comprehensive analysis of cancer genomes become possible due to rapid advances in DNA sequencing technology.

The recently resurrected cancer stem cell (CSC) theory sheds new light on understanding tumor biology. Most solid tumors have now been shown to contain CSCs, i.e., stem cell-like cancer cells. These cells, although generally rare, appear to be highly tumorigenic and may be the cells that drive tumor formation, maintain tumor homeostasis, and mediate tumor metastasis. In order to test whether any given human tumor cell population has CSC properties, the relatively enriched single tumor cells have to be put into a foreign microenvironment in a recipient animal to test their tumorigenic potential. Furthermore, various in vitro assays can be performed to demonstrate that the presumed CSCs have certain biological properties normally associated with the stem cells (SCs). Herein, I first present a comprehensive review of the experimental methodologies that our lab has been using in assaying putative prostate cancer (PCa) SCs in culture, xenograft tumors, and primary tumor samples. Clonal morphology is one of the critical properties of cultured cancer cells that has been largely ignored. Interestingly, long term-cultured human epithelial cancer cells form holoclones, meroclones, and paraclones, and tumor cell holoclones have been hypothesized to harbor stem-like cells. Using PC3 human prostate carcinoma cells as a model, we provide direct experimental evidence that tumor cell holoclones contain stem-like cells that can initiate serially transplantable tumors. Importantly, holoclones derived from either cultured PC3 cells or holoclone-initiated tumors can be serially passaged and regenerate all three types of clones. In contrast, meroclones and paraclones cannot be continuously propagated and fail to initiate tumor development. Phenotypic characterizations reveal high levels of CD44, [alpha]2[beta]1 integrin, and [beta]-catenin expression in holoclones, whereas meroclones and paraclones show markedly reduced expression of these markers. These observations have important implications in understanding morphologic heterogeneities and tumorigenic hierarchies in human epithelial cancer cells. PCa metastasis represents the worst outcome, and, if unchecked, will eventually kill the patient. Although many PCa cell-intrinsic molecules and end-organ factors have been implicated in the metastatic dissemination of PCa cells, the role of primary tumor microenvironment and the nature of the metastatic PCa cells remain poorly defined. By establishing a reliable and quantifiable experimental PCa metastasis model in NOD/SCID mice, we show that PCa cells implanted orthotopically (i.e., in the prostate) metastasize much more extensively and widely than those implanted ectopically (i.e., subcutaneously or s.c). Microarray-based gene expression profiling reveals that the orthotopically implanted human PCa cells prominently overexpress not only several classes of molecules involved in proteolysis/invasion/angiogenesis and inflammation, but also numerous developmental and SC regulating genes. These latter observations suggest that the orthotopic microenvironment (i.e. mouse prostate) appears to be promoting the manifestation of CSC phenotypes and these CSCs might be involved in enhanced metastasis in the orthotopic microenvironment and later distant organ metastasis. In support, shRNA-mediated knockdown in many metastatic and CSC genes greatly inhibits PCa cell metastasis. Importantly, PCa cells that express high levels of osteopontin (OPN) or CD24, when prospectively purified out and used in spontaneous metastasis assays, demonstrate high metastatic capacities characteristic of metastatic CSCs. In sharp contrast, PCa cells negative for OPN and CD24 expression show little metastatic property. Finally, we provide multiple pieces of additional evidence that metastatic/metastasizing PCa cells possess CSC properties. / text

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / abstract / toc / Biochemistry / Master / Master of Philosophy

published_or_final_version / abstract / toc / Anatomy / Doctoral / Doctor of Philosophy

No description available.

Η εγκαθίδρυση και ανάπτυξη καρκίνου του προστάτη διαμεσολαβείται από τη δράση μιας πλειάδας ογκογενετικών αυξητικών παραγόντων. Μέχρι σήμερα έχει αναδειχθεί η εμπλοκή του αυξητικού παράγοντα HARP στην ανάπτυξη καρκινικών όγκων διαφορετικής προελεύσεως. Στην παρούσα εργασία, διερευνήθηκε η πιθανή συμμετοχή της HARP στην ανάπτυξη καρκίνου του προστάτη. Με εφαρμογή μιας αντινοηματικής στρατηγικής πραγματοποιήθηκε καταστολή έκφρασης της HARP στην καρκινική κυτταρική σειρά προστάτη LNCaP και μελετήθηκε τόσο ο ρόλος της HARP στην αύξηση και μεταναστευτική ικανότητα των καρκινικών κυττάρων, όσο και η ενδεχόμενη αγγειογενετική δράση της in vitro και in vivo. Η εξωγενώς χορηγούμενη ανασυνδυασμένη HARP ανθρώπου, ήταν μιτογόνος για τα κύτταρα LNCaP. Επιπρόσθετα η καταστολή έκφρασης της ενδογενούς HARP, ανέδειξε την αναγκαιότητα του συγκεκριμένου αυξητικού παράγοντα για τη μετανάστευση των κυττάρων LNCaP καθώς και για την κυτταρική αύξηση τόσο σε συνθήκες εξαρτώμενες όσο και ανεξάρτητες από την προσκόλληση σε υπόστρωμα. Οι επαγόμενες, από τα κύτταρα LNCaP, λειτουργίες των ενδοθηλιακών κυττάρων in vitro και ο σχηματισμός νέων αγγείων in vivo, αναχαιτίστηκαν όταν ανεστάλη η έκφραση της HARP. Ο αυξητικός παράγοντας ινοβλαστών FGF-2 είναι ένας πλειοτροπικός αυξητικός παράγοντας, ο οποίος διαδραματίζει σημαντικό ρόλο στην εγκαθίδρυση και ανάπτυξη καρκίνου του προστάτη. Τα αποτελέσματα της παρούσας διατριβής, κατέδειξαν ότι ο FGF-2 δύναται να επάγει σε σημαντικό ποσοστό τον πολλαπλασιασμό και τη μετανάστευση των κυττάρων LNCaP. Το μόριο της HARP φαίνεται να μεσολαβεί προκειμένου να εκδηλωθούν οι διεγερτικές δράσεις του FGF-2, δεδομένου ότι τελευταίος δεν επηρέασε αντίστοιχες λειτουργίες των κυττάρων LNCaP στα οποία είχε κατασταλεί η έκφραση της HARP. Επιπλέον, ο FGF-2 διέγειρε την έκφραση και έκκριση της HARP από τα κύτταρα LNCaP και αύξησε τη δραστηριότητα λουσιφεράσης πλασμιδιακού οχήματος αναφοράς, στο οποίο είχε κλωνοποιηθεί η ρυθμιστική περιοχή του γονιδίου της HARP. Ο ειδικός αναστολέας του υποδοχέα FGFR-1, SU-5402, αναχαίτισε την επαγόμενη από τον FGF-2 ενεργοποίηση του γονιδίου της HARP και την επακόλουθη έκκριση της πρωτεΐνης, οδηγώντας με τον τρόπο αυτό σε εξασθένιση του κυτταρικού πολλαπλασιασμού. Επώαση των κυττάρων LNCaP με πυροσταφυλικό νάτριο, το οποίο απομακρύνει με έμμεσο τρόπο το υπεροξείδιο του υδρογόνου, ανέδειξε την εξάρτηση των διεγερτικών δράσεων του FGF-2 από την ενδοκυτταρική παραγωγή υπεροξειδίου του υδρογόνου, ενώ ανάσχεση της δραστικότητας του FGFR-1 ανέστειλε τον επαγόμενο από τον FGF-2 σχηματισμό δραστικών μορφών οξυγόνου. Με χρησιμοποίηση ολιγονουκλεοτιδικών δολωμάτων έναντι του ΑΡ-1 και εφαρμογή κατευθυνόμενης μεταλλαξιγένεσης στη ρυθμιστική περιοχή του γονιδίου της HARP, διαπιστώθηκε η εμπλοκή του ΑΡ-1 στην επαγόμενη από τον FGF-2 έκφραση και έκκριση της HARP. Η επίδραση του FGF-2 στα κύτταρα LNCaP, φαίνεται να οφείλεται στη δέσμευση των Fra-1, JunD και της ενεργού μορφής της c-Jun στη ρυθμιστική περιοχή του γονιδίου της HARP. Συμπερασματικά, καταδεικνύεται ο σημαντικός ρυθμιστικός ρόλος του αυξητικού παράγοντα HARP σε ποικίλες βιολογικές διεργασίες των καρκινικών κυττάρων ανθρώπινου προστάτη. Επιπλέον, στην παρούσα εργασία προτείνεται ο ρόλος και ο μηχανισμός δράσης του αυξητικού παράγοντα FGF-2 στα κύτταρα LNCaP, ενώ ταυτόχρονα αντικατοπτρίζεται η πολυπλοκότητα των μονοπατιών αυξητικών παραγόντων που εμπλέκονται στον καρκίνο του προστάτη. / The development and growth of human prostate cancer is mediated by many tumor cell-derived growth factors. Heparin affin regulatory peptide (HARP) seems to be involved in the progression of several tumors of diverse origin. In the present work, we sought to determine if HARP is implicated in human prostate cancer. An antisense strategy for inhibition of HARP expression in the human prostate cancer cell line LNCaP was used to study the role of HARP on cancer cell growth, migration and angiogenic potential in vitro and in vivo. Exogenous human recombinant HARP was mitogenic for LNCaP cells. By decreasing the expression of endogenous HARP, we found that HARP was essential for LNCaP cell migration, as well as anchorage-dependent and independent growth. Endothelial cell functions in vitro and blood vessel formation in vivo induced by LNCaP cells were also inhibited when HARP expression was diminished. Fibroblast growth factor 2 (FGF-2) is a pleiotropic growth factor that has been implicated in prostate carcinoma formation and progression. In the present study we found that exogenous FGF-2 significantly increased human prostate cancer LNCaP cell proliferation and migration. HARP seems to be an important mediator of FGF-2 stimulatory effects, since the latter had no effect on stably transfected LNCaP cells that did not express HARP. Moreover, FGF-2 significantly induced HARP expression and secretion by LNCaP cells and increased luciferase activity of a reporter gene vector carrying the full length promoter of HARP gene. The FGFR1-specific inhibitor SU-5402 blocked the FGF-2-increased HARP gene activation and the consequent protein release, leading to impairment of LNCaP cell proliferation. Treatment of LNCaP cells with the hydrogen peroxide scavenger pyruvate, pointed to the dependence of FGF-2-induced HARP expression and LNCaP cell proliferation on hydrogen peroxide generation, and blockade of FGFR1 activity abrogated the FGF-2-induced production of reactive oxygen species. Activator protein-1 (AP-1) seems to be involved in FGF-2-stimulated HARP expression and secretion by LNCaP cells, as revealed using AP-1 decoy oligonucleotides and point mutation analyses in the HARP gene promoter. Binding of AP-1 complexes consisting of Fra-1, JunD and phospho-c-Jun, to the HARP promoter seems to be amenable for FGF-2 effect. These results point to an important regulator role of HARP in diverse biological activities in human prostate cancer cells. Furthermore, the present work establishes the role and the mode of activity of FGF-2 in LNCaP cells and reflects the many-sidedness of growth factor pathways within prostate cancer.

Membrane type-1 matrix metalloproteinase (MT1-MMP) is a metalloproteinase which becomes upregulated in prostate cancer and has been implicated in processes of prostate cancer metastasis. Here, we show that MT1-MMP is minimally expressed in nonmalignant primary prostate cells, moderately expressed in DU-145 cells, and highly expressed in invasive PC-3 and PC-3N cells. Using MT1-MMP promoter reporters and mobility shift assays, we show that Sp1 regulates MT1-MMP expression in DU-145, PC-3, and PC-3N cells and in PC3-N cells using chromatin immunoprecipitation analysis and silencing RNA. Investigation of signaling pathways in these cells showed that DU-145 cells express constitutively phosphorylated extracellular stress-regulated kinase (ERK), whereas PC-3 and PC-3N cells express constitutively phosphorylated AKT/PKB and c-Jun NH2 terminal kinase (JNK). We show that MT1-MMP and Sp1 levels are decreased in PC-3 and PC-3N cells when PI-3K and JNK are inhibited, and that MT1-MMP levels are decreased in DU-145 cells when MEK is inhibited. Transient transfection of PC-3 and PC-3N cells with a dominant-negative JNK or p85, and DU-145 cells with a dominant negative ERK, reduced MT1-MMP promoter activity. We also identified the insulin-like growth factor (IGF-1R) as an upstream regulatory component of MT1-MMP in PC-3N and LNCaP cells, which express high and low levels of the enzyme, respectively. Treatment of PC-3N cells with an IGF-1R specific inhibitor decreased MT1-MMP promoter activity, RNA and protein levels. Additionally, treatment of LNCaP cells with a synthetic androgen to increase IGF-1R levels and subsequent treatment with IGF-I increased MT1-MMP promoter activity, RNA and protein levels. Analysis of MT1-MMP and IGF-1R expression in human prostate cancer tissues demonstrated that MT1-MMP expression was high in the apical cytoplasmic regions of PIN and prostate cancer and less intense in the basalateral cytoplasmic membrane regions of benign glands. IGF-1R was expressed in normal glands and highly expressed in prostate cancer. In conclusion, we have identified several novel mechanisms regulating MT1-MMP expression in prostate cancer cell lines as well as differential localization of the enzyme in human prostate cancer tissues. These results provide insight into the complex mechanisms of prostate cancer metastasis and may be useful for developing future diagnostic procedures or therapies.