Prostate cancer is the primary cause of cancer-related deaths in males; rates range over 25 times globally, with North America, Western and Northern Europe, Australia, and New Zealand having the highest rates. Additionally, rates are lower in Asia and Eastern Europe and substantially higher in the Caribbean, South America, and South Africa [1]. The annual report of the Iraqi Cancer Registry from 2016 states that the incidence rate of cases of prostate cancer in 2016 was 4.1 (per 100,000 population), which was the lowest among the top ten cancers in males in Iraq in 2016. The highest percentage and incidence for the top ten cancers in 2016 in both genders was found in breast cancer[2]. Recently a research indicated that PSA is not a reliable PCA predictive biomarker (limited by poor specificity). The primary difficulty is the difficulties in differentiating between BPH and prostate cancer; the PSA readings between malignant and non-cancerous persons are significantly influenced by prostate tissue-specific biomarkers rather than prostate cancer-specific ones[3]. A lot of work has gone into developing novel biomarkers for the precise diagnosis of prostate cancer[4]. Prostate cancer originates from certain cells in the body called prostate gland cells that grow and spread uncontrollably for unknown causes. Almost of prostate cancers, however, are classified as adenocarcinomas[5]. Prostate cancer typically causes urological issues in older men and presents with unsettling obstructive and irritative sensations. Apart from androgen and age dependency, other recognized predisposing factors for prostate cancer include oxidative stress, infection, and inflammation[6]. Increases in oxidative markers or a decrease in antioxidant defense systems are two ways to characterize oxidative stress. Malondialdehyde (MDA) is the primary byproduct of the lipid peroxidation pathway and is used as a marker to indicate the oxidative status of both normal subjects and patients with prostate cancer. Overproduction of MDA is commonly associated with increased levels of free radicals, which in turn causes oxidative stress and the antioxidant status in cancer patients[7]. a metabolic process that is tailored to the prostate and includes zinc, cholesterol, and the enzymes citrate and kallikrein. synchronization of diverse bodily processes: blood pressure, skin desquamation, and semen liquefaction[8-10]. Numerous illnesses, including certain types of cancer, can be identified by means of "biomarkers," which include measurements of specific hormones, proteins, or genetic alterations. These chemicals cause the afflicted organs' aberrant processes to be reversed, and they serve as disease biomarkers that aid in diagnosis and treatment planning[11,12]. Measuring the concentration of prostate-specific antigens (PSA) has been used in recent decades as a reliable marker for both identifying prostate cancer and tracking the disease's progression in conjunction with other tests [13]. In view of the importance of hormonal and biochemical variations in prostate cancer patients, this research performed to study the hormonal and biochemical changes in these patients before and after chemotherapy in Kirkuk city, Iraq.

Study design and sample collection

The current study is a retrospective observational study was executed in Oncology center/Kirkuk, Iraq from January 25^th to July 26^th 2024  on 255 patients with mean age (62.07) years and prostate cancer. The patients were tracked on in two different time points, primarily before getting chemotherapy, then after getting chemotherapy. To get the patients' basic information, including their age and history of chronic illnesses, a questionnaire form was utilized. A 5 ml of blood specimen was collected from each patients to do hormonal and biochemical tests. 

Hormonal and Biochemical tests:

Hormonal tests including LH test, FSH test, Testosterone test, PSA test, Cortisol test (From Boditech Med Inc. Made in Korea), Insulin test (ELISA test from Crystal Chem), PTH test, and PAP test  (ELISA kit from MyBioSource). The biochemical tests included Cholesterol test, ALP test and LDH test (from Biolabo, made in France) and Glucose test (from RANDOX, made in UK). The assays were done according to manufacturer's directions. 

Statistical analysis:

Computerized statistical analysis was carried out using the Statistical Package for Scientific Services (SPSS) version 26. comparing data (P value) using probability (P) and the paired sample T-test. Results were deemed statistically significant (S) when the P value was less than 0.05, highly significant (HS) when the P value was less than 0.01.

The present study revealed significant increasing in the LH concentration (25.23 IU/L), this was also true for FSH concentration (30.15 IU/L), Cortisol level (19.62µg/dl), Insulin level (22.77 µIU/ml) and PTH mean level (42.32 pg/ml) after chemotherapy in patients with prostate cancer and the differences were highly significant since the P. value were less than 0.01 as shown in table 1.

The current study moreover displayed significant decreasing in the mean levels of PSA (4.05 ng/ml), Testosterone (57.52 ng/dl) and PAP (2.46 U/L) after treatment and the results were statistically highly significant as it revealed in table 1. 

There were highly significant decreasing in the levels of serum Cholesterol, Glucose, LDH and ALP after chemotherapy and the differences were highly significant. Table 2. 

Table 1: Concentrations of hormonal parameters before and after taking chemotherapy

By paired t-test

Table 2: Levels of biochemical markers before and after getting chemotherapy

By paired t-test

The body's prostate gland cells are the source of prostate cancer when they proliferate and spread uncontrolled due to unclear reasons. However, the majority of prostate malignancies are categorized as adenocarcinomas[5]. The leading cause of cancer-related mortality in men is prostate cancer; rates vary over 25 times worldwide, with the highest rates found in North America, Western and Northern Europe, Australia, and New Zealand. Furthermore, rates are significantly higher in the Caribbean, South America, and South Africa and lower in Asia and Eastern Europe[1]. 

The present study exhibited a significant correlation between some hormone levels including (LH, FSH, PSA, Cortisol, Insulin, PTH and PAP), and some biochemical levels including (Cholesterol, Glucose, LDH and ALP) before and after treatment in prostate cancer patients, these were close to a study conducted in Baghdad, Iraq [14], where they found significant association between hormones, biochemical levels and prostate cancer. Our study was also in line with another study conducted in Tikrit city, Iraq, where they found that PAP enzymes recorded greatest levels among prostate cancer patients [15]. The current study displayed an agreement with Tsuzuki et al,  who found that PSA levels dropped significantly after treatment [16]. Moreover our study showed disagreement to a study done who found that Insulin levels increased in prostate cancer, these differences might be attributed to the differences in the kinetic of insulin responses to the potency of the diabetes mellitus in these patients. Furthermore also showed some agreement with our study who found that Testosterone levels elevated in patients with prostate cancer[17]. reported that ALP, and LDH elevated positively with the PSA in prostate cancer patients, which is agreed with our findings [18]. The current study also displayed an agreement with a German study, that found ALP and LDH levels waned after chemotherapy and biological therapy[19]. Our findings were disagreed with a study achieved in USA, where they found negative association of PTH with treatment in prostate cancer patients, these differences might be due to the differences in the types of therapy that used in these patients, plus the strength of their cases in comparing to our patients[20]. Many years of research have shown that cholesterol builds up in solid tumors and that the prostate's cholesterol homeostasis degrades with aging and the transition to malignancy [21]

1. Older ages are more prone to get prostate cancer.

2. LH, FSH, PSA, PAP levels increased significantly among patients with prostate cancer.

3. ALP, and LDH levels increase significantly in prostate cancer patients.

4. Chemotherapy therapy has effective impact on dropping the levels of some hormones and biochemical elements among prostate cancer patients. 

The authors declare that they have no conflict of interest

No funding sources

The study was approved by the Kirkuk Medical College, University of Kirkuk, Iraq.

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