**9. Author's contribution**

24 Prostate Cancer – Diagnostic and Therapeutic Advances

disorders (Hsing et al., 2007). Especially insulin resistance, higher IGF-1 and leptin levels are recognized responsible for such aggressiveness (Hedlund et al., 1994; Prabhat et al., 2010). IGF-1 is involved in angiogenesis, responsible for bone metastases and developing androgen-independent progression of Pca. Leptin is responsible for cell migration and

It is not proven that worse treatment outcomes in obese patients are due to unfavorable features of prostate cancer itself. In one of the studies it was reported that obesity was positively correlated with clinical progression independently of prostate cancer grade, stage

Higher rate of cancer progression is also due to unfavorable features of obese men after radical prostatectomy. It was proven that increased BMI is associated with high grade disease, positive surgical margins, extraprostatic extension of the disease and lymph node metastases. Biochemical recurrence after radical prostatectomy is also more frequent in

Pharmacological castration with GnRH agonists is the standard treatment for patients with locally advanced or metastatic Pca. However, it is burdened with several adverse effects like osteoporosis, loss of libido, erectile dysfunction and finally metabolic syndrome. Increased levels of total cholesterol, LDL and decreased HDL, diabetes and hypertension contribute to

Obese patients receiving ADT are at highest risk for developing ACS as ADT therapy and obesity shares the cardiovascular risk through the metabolic syndrome. They should be constantly monitored and treated accordingly (Cleffi et al., 2011). Osteoporosis in Pca is not only the result of cancer itself. Osteoblastic metastases of prostate cancer contribute to pathologic spine fractures which may be fatal eventually. Immediate spine decompression

The situation may be worse when patient is given ADT. I was proven that hypogonadism leads to osteopenia and finally to osteoporosis. As obese patients have lower levels of testosterone, abovementioned unfavorable factors may contribute to pathologic fractures. To prevent such mournful course patients are advised to take bisphospfonates (alendronic, zolendronic, clodronic acid, etc.) or denosumab (RANK ligand inhibitor) which inhibit

Undoubtedly, a negative feature of PSA concentration is the fact that it is subject to hemodilution. Some authors claim that in overweight and obese patients PSA concentration is lower, which is, in the first place, caused by the aforementioned phenomenon. This phenomenon is supposed to consist in the dissolution of PSA mass in a large amount of plasma, finally resulting in lower PSA concentration. PSA is a protease which physiological

Every man is characterized by a quite invariable amount (mass) of this secreted into the blood protein, depending on age, the size of prostate, the presence of cancer or other prostate diseases. However, standard PSA determination means that PSA mass is dissolved

growth factor expression in hormone-resistant cells of Pca.

obese patients compared to non-obese men (Freedland et al., 2005).

and primary treatment (Gong et al., 2007).

**7. Androgen deprivation therapy (ADT)** 

higher risk of acute coronary syndrome (ACS).

in orthopedics department is indicated in such condition.

osteoclasts and slow down progression of the disease.

**8. Hemodilution** 

function consists in liquefying semen.

Hereby we present our work on hemodilution (Bryniarski et al., 2011). The aim of our study was to prove the superiority of PSA mass over standard PSA concentration in predicting biochemical recurrence after radical prostatectomy.
