Advanced Prostate Cancer
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Inflammation - Albumin and Fibrinogen

New study below.

This type of paper is now quite common. One's inflammation status has a profound effect on prognosis. Subclinical infammation kills. But inflammation can be reversed.

Albumin is a blood protein that transports all sorts of things. Almost half of our testosterone is lightly bound to albumin. Inflammation leads to lower levels of albumin.

- 4.5 or higher is excellent

- <4.0 is not good. Intervention required.

Fibrinogen is the precursor of fibrin, which forms blood clots. Fibrinogen itself is inactive until it meets thrombin. Higher levels don't necessarily mean that there will be clotting activity, but clotting risk is elevated in cancer. I would not care to have excessive fibrinogen.

Inflammation increases fibrinogen levels. I like to be low in the normal range. Being above the normal range is a bad sign - intervention required..

"The objective of this study was to determine the prognostic value of pretreatment albumin and fibrinogen combined prognostic grade (AFPG) in prostate cancer (PCa)."

There is probably nothing complicated about the way that the AFPG was calculated. Presumably, it is more helpful than albumin or fibrinogen alone, although both have value.

"analyses identified AFPG as an independent prognostic indicator for {progression-free survival, cancer-specific survival and overall survival}"

It is worth noting that "overall survival" finding. Inflammation can effect mortality even when one has not been diagnosed with disease. In PCa, inflammation control can reduce cancer-related mortality AND non-cancer mortality.

Albumin & fibrinogen are easily monitored. Albumin is part of a cheap basic blood panel.

High-dose polyphenols inhibit NF-kB, the initiator of inflammation in PCa. I mentioned curcumin recently. Products such as Zyflamend contain polyphenols in a blend that is specifically aimed at inflammation.

As with all such studies:

"we recommend adding AFPG according to optimal cut-off values to traditional prognostic model to improve the predictive accuracy."

So, from a professional viewpoint, such tests can be used to identify patients that are not going to do well. From my viewpoint, the test could be used to trigger intervention. But we don't need a doctor for that.

-Patrick

ncbi.nlm.nih.gov/pubmed/291...

J Cancer. 2017 Oct 23;8(19):3992-4001. doi: 10.7150/jca.21061. eCollection 2017.

Albumin and Fibrinogen Combined Prognostic Grade Predicts Prognosis of Patients with Prostate Cancer.

Wang Y1, Chen W2, Hu C3, Wen X4, Pan J1, Xu F1, Zhu Y1, Shao X1, Shangguan X1, Fan L1, Sha J1, Wang Z5, Cai Y5, Liu Q6, Dong B1, Xue W1.

Author information

1

Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.

2

Department of Urology, Zhongshan Hospital of Fudan University, Shanghai, China.

3

Department of Urology, Shanghai Pudong New Area Gongli Hospital, Shanghai, China.

4

Department of Urology, East Hospital, Tongji University School of Medicine, Shanghai, China.

5

School of Public Health, Shanghai Jiao Tong University, Shanghai, China.

6

Department of Pathology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.

Abstract

Background: The nutritional status and systemic inflammation are thought to be associated with outcome in multiple types of cancer. The objective of this study was to determine the prognostic value of pretreatment albumin and fibrinogen combined prognostic grade (AFPG) in prostate cancer (PCa). Methods: 462 prostate cancer patients who had undergone androgen deprivation therapy (ADT) as first-line therapy at four cencters were retrospectively analyzed. The serum albumin levels and plasma fibrinogen levels were measured at the time of diagnosis. The AFPG was calculated according to albumin and fibrinogen levels dichotomized by optimal cut-off values or clinical reference values. Univariate and multivariate cox regression analyses were performed to determine the associations of AFPG with progression-free survival (PFS), cancer-specific survival (CSS) and overall survival (OS). Prognostic accuracy was evaluated with the Harrell concordance index. Results: Multivariate analyses identified AFPG as an independent prognostic indicator for PFS, CSS and OS (each p < 0.01). According to optimal cut-off values, the addition of AFPG to the final models improved predictive accuracy for PFS, CSS and OS compared with the clinicopathological base models, which included Gleason score and incidence of metastasis. Moreover, AFPG according to optimal cut-off values was a better prognostic predictor than albumin levels alone or fibrinogen levels alone or AFPG according to clinical reference values. Conclusion: Decreased AFPG could predict a significantly poor prognosis in patients with PCa. Thus, we recommend adding AFPG according to optimal cut-off values to traditional prognostic model to improve the predictive accuracy.

KEYWORDS:

albumin; biomarker.; fibrinogen; prognosis; prostate cancer

PMID: 29187874 PMCID: PMC5706001 DOI: 10.7150/jca.21061

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About 12 years ago I learned of both relationships with inflammation. Oddly enough, it was from someone with no medical background who had written a book on how to prevent or cure PCa. This guy, by the way, did his own study a couple of years later involving the use of specially prepared suppositories to treat PCa. Since I had purchased his book and had contacted him, I was asked whether or not I wanted to participate in the study. I declined. Most doctors, at the time, had heard (not read, I'm sure) about this guy and his theories and had labelled him an outright quack. One thing I do remember from his book (I can no longer remember the title) was that the status of one's albumin score was a good indicator of systemic inflammation. He maintained that one's albumin value should be close to 5. My albumin at its highest in 1976 (my records don't go much further back than this) was 4.6. Over the years, it has declined. In the past, I tried to increase my albumin values but was not successful. Question: if one could increase one's albumin, this would imply that one has also reduced inflammation, right? It seems a simpler goal than just going after inflammation, in general, which we all try to do in our own ways. The fibrinogen issue is simple: just take proteolytic enzymes to lyse the stuff. Albumin, on the other hand, is a much harder nut to crack.

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