Cross Sectional Study Of Lipid Peroxidation, Antioxidant Status And Serum Calcium In Benign Prostate Hypertrophy And Prostate Cancer

Abstract

Background and Objectives: ABSTRACT The most dramatic organic manifestation of andropause in terms of decrease in quality of life is Benign Prostate Hypertrophy ( BPH ) , in its ultimate consequences, a life threatening condition due to obstruction of urethra and finally uremia. Carcinoma of prostate is the second most common malignant disease in men. It often grows so slowly that, many men with prostate cancer "die with it, rather than from it.” Lipid peroxidation is a well established mechanism of cellular injury. This is widely accepted to be involved in the pathogenesis of human disease. Malondialdehyde is an end product derived from peroxidation of polyunsaturated fatty acids ( PUFA ) and related esters. Thus measurement of MDA levels provides a convenient in-vivo index of lipid peroxidation and represents a non invasive bio- marker of oxidative stress, often clinically employed to investigate radical mediated physiological and pathological conditions. To protect the body from these devastating free radicals, scavenging system is present in the body in the form of antioxidants. Enzymatic antioxidants include superoxide dismutase ( SOD ) , glutathione reductase, catalase ( CAT ) and non enzymatic antioxidants include vitamin E and vitamin C that is alpha-tocopherol and ascorbate respectively. There is good evidence that men whose diet include a lot of calcium or those who take calcium supplements are at increased risk for prostate cancer. But since there is little relationship between dietary calcium and serum calcium, this study does not address the question of how much calcium men should eat. Men whose serum calcium levels fall within the high end of normal range are three times more likely to develop fatal prostate cancer. vi Thus this study was done to know the extent of oxidative stress in BPH and Prostrate Cancer by estimating MDA, the role of antioxidants namely Glutathione Reductase, Vitamin C in protecting the body from these oxidative stress and Serum Calcium in prediction of Prostate Cancer. Materials and methods: All cases of BPH and prostate cancer in the age group of 65 to 75 years admitted or attending Urology unit of KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum. Based on previous hospital records minimum sample size will be 30 BPH and 30 Prostate Cancer. 10 ml of blood was collected from the patients and controls under aseptic precautionary measures using disposable syringe in heparinized tubes. 2 ml separated for MDA estimation, 2 ml for preparing hemolysate and 6 ml in plain tubes, centrifuged, serum separated and kept at 4 using colorimeter. Methods of assay Blood vii 0  Malondialdehyde – Thiobarbituric acid method. Hemolysate  Glutathione Reductase – Beutler E method. Serum  Vitamin C – Evelyn and Melloy method. C which was analysed within 24 hours  Serum calcium – Modification of O-Cresolphthalien complexone method. Results: The mean age of controls was 70.46±3.58 years ( 59-78 years) , the mean age in Benign Prostate Hypertrophy cases was 72.26±4.70 years ( 65-81 years) and in Prostate Cancer cases was 72.76±4.98 years ( 65-81 years) .There was no statistically significant difference between mean age of three groups ( p= 0.117) . The groups were age and sex matched. The mean level of MDA in controls was 6.17±1 nmol/ml. The value in BPH cases was 11.44±0.82 nmol/ml and in Prostate Cancer cases was 15.83±3.63 nmol/ml. The level was significantly increased ( P< 0.001 ) in all the cases of BPH and in cases of Prostate Cancer in comparison to controls. The mean glutathione reductase level in controls was 8.96±1.04 IU/g of Hb. The level in BPH cases was 3.39 ± 0.74 IU/g of Hb and in Prostate Cancer cases was 3.32±0.76 IU/g of Hb. The level was significantly decreased ( P< 0.001) in all the cases of BPH and also in cases of Prostate Cancer when compared to controls. The mean vitamin C level in controls was 0.87 ±0.01 mg/dl. The level in BPH cases was 0.42 ±0.14 mg/dl and in Prostate Cancer cases was 0.50 ±0.15. The level was significantly decreased ( p <0.001) in all the cases of BPH and in cases of Prostate Cancer in comparison to controls. The mean value of total serum calcium in controls was 9.08 ± 0.37 mg/dl. The level in BPH cases was 9.92±0.97 mg/dl and in Prostate Cancer cases was 9.55±1.35mg/dl. The value of total serum calcium was significantly increased ( p= 0.05) in all the BPH cases when compared to controls. But there was no statistical significant difference ( p=0.187) in total serum calcium levels in Prostate Cancer cases when compared to controls. viii Interpretation & Conclusion: Our study revealed that there was increased oxidative stress and decreased antioxidant defense in patients of Benign Prostate Hypertrophy and Prostate Cancer. Also it was found that serum calcium levels were in higher end of normal range in patients of Benign Prostate Hypertrophy and Prostate Cancer. Supplementation of natural antioxidants and drugs lowering serum calcium levels to the individuals who are prone for Benign Prostate Hypertrophy and Prostate Cancer may prevent the progression of these diseases to a certain extent. Since serum calcium levels were increased statistically only in BPH cases but not in Prostate Cancer, follow up is necessary to establish the association in these disease processes.