Testing for glutamine levels to check for transformation to neuroendocrine cancer from adenocarcinoma?

[SuppWife]

sciencedaily.com/releases/2...

This article is about a Cedars-Sinai study that says ADT or ATT "causes" adenocarcinoma to transform to the more aggressive neuroendocrine type in 25% of men and monitoring glutamine levels might be useful in determining if it is transforming to the neuroendocrine type.

"While glutamine is known to spur cancer growth, its role in prostate cancer cells to trigger reprogramming of adenocarcinoma cells into neuroendocrine cancer cells is a new and important finding,"

The team also examined how androgen-targeted therapy affected the cancer microenvironment.

"To our surprise, we found this type of therapy further changed the cellular environment in a way that caused adenocarcinoma cells in the prostate to transform into neuroendocrine cancer-type cells," said Bhowmick, professor of Medicine and Biomedical Sciences.

"The study raises the possibility that a simple blood test measuring glutamine might be able to pinpoint when androgen-targeted therapy is failing in a prostate cancer patient and even predict when therapy resistance will occur," said Posadas, who co-authored the study. He said the team is designing a new study to test this hypothesis.

Any insights or thoughts on this?

[Tall_Allen]

"a rare type that normally appears in fewer than 1 percent of prostate cancer patients."

This was a lab study - not an incidence study. Your body manufactures glutamine, so there's nothing you can do about it anyway. Ignore it.

[SuppWife in reply to Tall_Allen]

Thank you for pointing out that detail. I read that to mean ALL neuroendocrine cancer was "a rare type" that normally appears in fewer than 1 percent.

[Tall_Allen in reply to SuppWife]

I know that some people on this board see the neuroendocrine bogey man around every turn, but it is really quite rare. Incidence does go up over time as the cancer progresses, reaching as high as 17% in heavily pre-treated metastatic castration-resistant PC.

pcnrv.blogspot.com/2016/12/...

There is nothing to be gained by worrying about it in advance.

[SuppWife in reply to Tall_Allen]

Good to know and good advice. I'll stop borrowing trouble. The headlines written to call attention to that study are inflammatory and misleading. I'm trying hard to make sure I'm keeping myself informed. Thanks again.

[pjoshea13]

I always think that a test has no real value unless it can lead to a change in treatment direction. Glutamine seems to have prognostic value, but what does one do if there is an upward trend? Could we block the glutamine in some way? Or stop ADT?

While glutamine is not generally elevated in pre-ADT PCa, or when ADT is working well, it is elevated in many cancers. i.e. glutamine is a problem that has received a lot of attention over the years, & there doesn't seem to be a ready solution.

"Glutamine, the most abundant amino acid in plasma, is a well-known nutrient used by cancer cells to increase proliferation as well as survival under metabolic stress conditions." [1]

"Despite the significant advances in the understanding of glutamine metabolism in cancer cells, there are still obstacles to overcome in the clinical application of inhibitors of glutamine metabolism pathways."

If an increase in glutamine is a sign of impending ADT failure, perhaps one could do a U-turn & reinstate normal-high testosterone [T] levels? Neuroendocrine PCa is no picnic. Perhaps a month or so with high T, followed by Denmeade's BAT protocol thereafter?

-Patrick

[1] ncbi.nlm.nih.gov/pmc/articl...

[SuppWife in reply to pjoshea13]

Thank you for this reply. Studies that indicate ADT can cause a not otherwise lethal cancer to become lethal are terrifying. My husband has just begun his ADT protocol and we're waiting for an appointment for a second opinion about how long he should continue before trying intermittent treatment. Thanks for your help and the link.

[ITCandy]

Red meat, dairy and wheat are all high dietary sources of glutamine and may also be added to some supplements. It might be helpful to minimize these foods if one wishes to decrease levels of this essential amino acid.

However, once cancer cells have enough to spur growth, I don't know if having higher levels make any difference in acceleration.

[pjoshea13 in reply to ITCandy]

A thorny issue is that cancer cells can learn to synthesize the stuff.

-Patrick

[ITCandy in reply to pjoshea13]

Like playing a chess game against Bobby Fischer. Pretty smart opponent that we're engaging.

[j-o-h-n in reply to ITCandy]

Our opponent cheats....

Good Luck, Good Health and Good Humor.

J-o-h-n Tuesday 03/05/2019 6:04 PM EST