title: Assessing prostate cancer growth with citrate measured by intact tissue proton magnetic resonance spectroscopy.
abstract: BACKGROUND
  Annual PSA tests have led to a significant increase in the number of prostate cancer (PCa) cases diagnosed. This increased incidence has led to overtreatment of many patients, as current pathology often cannot distinguish latent from aggressive PCa. Studies have shown that the depletion of zinc in prostate cells correlated with cell-line growth rates, and may therefore relate to the progression of PCa. Furthermore, as zinc is normally an inhibitor of citrate oxidation, the reduction of zinc in PCa may cause a decrease in citrate secretion levels in the glandular epithelia of PCa patients.
  
  
  METHODS
  Using high-resolution magic angle spinning proton magnetic resonance spectroscopy followed by quantitative histopathology, we investigate unit histo-benign prostate epithelial citrate concentrations in intact tissue samples obtained from 18 patients with pre-surgical PSA values less than 20 ng/ml. Using these data, we evaluate correlations between citrate concentrations and PSA velocities, densities and blood percent-free PSA.
  
  
  RESULTS
  We observe different linear patterns between citrate concentrations and histo-benign glandular epithelia from patients of different PSA velocities. More importantly, we obtain a significant correlation between PSA velocity, density and percent-free PSA, and citrate concentrations in unit volume of histo-benign epithelial glands of the peripheral zone.
  
  
  CONCLUSIONS
  Low levels of citrate in unit volume represent rapidly increasing PSA values, and, therefore, may be used as an indicator of fast-growing PCa. Thus, tissue samples obtained at the time of biopsy may be evaluated for their citrate concentrations for the prediction of PCa growth rates, allowing for the implementation of alternative treatment options and reducing overtreatment.
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA.
authors.forename: R
authors.initials: R
authors.lastname: Dittrich
authors.forename: J
authors.initials: J
authors.lastname: Kurth
authors.forename: E A
authors.initials: EA
authors.lastname: Decelle
authors.forename: E M
authors.initials: EM
authors.lastname: DeFeo
authors.forename: M
authors.initials: M
authors.lastname: Taupitz
authors.forename: S
authors.initials: S
authors.lastname: Wu
authors.forename: C-L
authors.initials: CL
authors.lastname: Wu
authors.forename: W S
authors.initials: WS
authors.lastname: McDougal
authors.forename: L L
authors.initials: LL
authors.lastname: Cheng
mesh_terms: D000328:Adult; D000368:Aged; D019343:Citric Acid / Q000378:metabolism*; D018450:Disease Progression; D004848:Epithelium / Q000378:metabolism; D006801:Humans; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000473:pathology
chemical_list: D019343:Citric Acid; D017430:Prostate-Specific Antigen