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      Prostate Cancer and Bone Metastases: The Underlying Mechanisms

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          Abstract

          Patients with advanced prostate cancer often develop bone metastases, leading to bone pain, skeletal fracture, and increased mortality. Bone provides a hospitable microenvironment to tumor cells. The disease manifestation is driven by the interaction between invading tumor cells, bone-forming osteoblasts, and bone-resorbing osteoclasts. The increased level of osteoclast-activating factor (parathyroid hormone-related peptide, PTHrP) is believed to induce bone resorption by upregulating receptor activator of nuclear factor-kappa B ligand (RANKL) and the release of various growth factors into the bone microenvironment to enhance cancer cell growth. However, the underlying molecular mechanisms remain poorly understood. This review outlines the possible molecular mechanisms involved in governing bone metastases driven by prostate cancer, which further provide the basis in searching for new molecular targets for the development of potential therapy.

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          Most cited references74

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          Metastatic patterns of prostate cancer: an autopsy study of 1,589 patients.

          The prognosis of prostate cancer is mainly determined by the presence or absence of metastases. Nevertheless, the metastatic pathways in prostate cancer are not entirely understood. Among 19,316 routine autopsies performed from 1967 to 1995 on men older than 40 years of age, the reports from those 1,589 (8.2%) with prostate cancer were analyzed. Hematogeneous metastases were present in 35% of 1,589 patients with prostate cancer, with most frequent involvement being bone (90%), lung (46%), liver (25%), pleura (21%), and adrenals (13%). Several lines of evidence suggested the existence of a backward metastatic pathway through veins from the prostate to the spine in addition to classical hematogeneous tumor spread via the vena cava. First, there was an inverse relationship between spine and lung metastases, suggesting that metastasis to the spine is independent of lung metastasis. Second, the maximum frequency of spine involvement occurred in smaller tumors (4 to 6 cm) as compared with the maximum spread to lung (6 to 8 cm) and liver (>8 cm), suggesting that spine metastases precede lung and liver metastases in many prostate cancers. Third, there was a gradual decrease in spine involvement from the lumbar to the cervical level (97% v 38%), which is consistent with a subsequent upward metastatic spread along spinal veins after initial lumbar metastasis. The results of this study show that bone, lung, and liver are the most frequent sites of distant prostate cancer metastases. Besides the cava-type of metastasis through lung passage, there are strong arguments for the existence and clinical significance of a backward venous spread to the spine, which is likely to occur early in the metastatic process.
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            Estrogen and the skeleton.

            Estrogen is the major hormonal regulator of bone metabolism in women and men. Therefore, there is considerable interest in unraveling the pathways by which estrogen exerts its protective effects on bone. Although the major consequence of the loss of estrogen is an increase in bone resorption, estrogen deficiency is associated with a gap between bone resorption and formation, indicating that estrogen is also important for maintaining bone formation at the cellular level. Direct estrogen effects on osteocytes, osteoclasts, and osteoblasts lead to inhibition of bone remodeling, decreased bone resorption, and maintenance of bone formation, respectively. Estrogen also modulates osteoblast/osteocyte and T-cell regulation of osteoclasts. Unraveling these pleiotropic effects of estrogen may lead to new approaches to prevent and treat osteoporosis. Copyright © 2012 Elsevier Ltd. All rights reserved.
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              Bone morphogenetic proteins: multifunctional regulators of vertebrate development.

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                Author and article information

                Journal
                Int J Mol Sci
                Int J Mol Sci
                ijms
                International Journal of Molecular Sciences
                MDPI
                1422-0067
                27 May 2019
                May 2019
                : 20
                : 10
                : 2587
                Affiliations
                Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia; jocylnwsk@ 123456gmail.com (S.K.W.); vaizuramohd@ 123456gmail.com (N.-V.M.); rtgiaze1143@ 123456gmail.com (T.R.G.); chinkokyong@ 123456ppukm.ukm.edu.my (K.-Y.C.); azlina@ 123456ppukm.ukm.edu.my (N.M.)
                Author notes
                [* ]Correspondence: imasoel@ 123456ppukm.ukm.edu.my ; Tel.: +60-3-9145-9579
                Author information
                https://orcid.org/0000-0003-1184-4551
                https://orcid.org/0000-0001-6628-1552
                https://orcid.org/0000-0003-2480-0224
                https://orcid.org/0000-0001-9655-438X
                Article
                ijms-20-02587
                10.3390/ijms20102587
                6567184
                31137764
                48f386c9-607b-4f89-9d75-7235941eadd5
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 22 April 2019
                : 23 May 2019
                Categories
                Review

                Molecular biology
                hormone,inflammation,osteoprotegerin,estrogen
                Molecular biology
                hormone, inflammation, osteoprotegerin, estrogen

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