The following is reprinted from

The Prostate Forum

Volume 4 Number 6, June 1999, p.8.

Ý Chondroitin sulfate is used to treat osteoarthritis. New studies link this drug to the development of metastatic prostate cancer. Do not take this supplement if you have prostate cancer.

Chondroitin Sulfate

Charles E. Myers, Jr., MD

Tablets or capsules containing chondroitin sulfate and glucosamine have been marketed as a treatment for osteoarthritis. The surface of joints, like the knee, is lined with cartilage and the joint space is filled with synovial fluid. In osteoarthritis, the cartilage lining the joint surface is damaged or destroyed. Chondroitin sulfate and glucosamine are key components of cartilage. It is believed that these compounds as supplements might enhance the ability of the body to repair the joint surface. Based on the men I see in our second opinion clinic, the use of this combination is commonly used as a treatment for osteoarthritis in men with prostate cancer. It is my clinical impression that these capsules do lessen the symptoms of osteoarthritis.

Chondroitin sulfate is a member of a larger group of chemicals, called proteoglycans, which are known to play a role in cancer biology. Recently several papers have reported a link between chondroitin sulfate and the spread of prostate cancer.

The first study examined the proteoglycans present in normal prostate tissue compared with benign prostate hypertrophy and cancer. Of all of the proteoglycans, chondroitin sulfate was most commonly increased in prostate cancer compared with normal tissues.

The second study measured the amount of chondroitin sulfate present in the stromal tissue surrounding prostate cancer in radical prostatectomy specimens. They found that the amount of chondroitin sulfate present in the radical prostatectomy specimens correlated with the percentage of men who had a recurrence of prostate cancer within five years of surgery. This was especially true for men with a PSA under 10 nanograms per milliliter, a group with a generally good prognosis. However, in those men with a high concentration of chondroitin sulfate surrounding the cancer, 47% had recurred within five years compared with only 14% in the men with low chondroitin sulfate levels.

Research shows that in prostate tissue, chondroitin sulfate is attached to two proteins, decorin and versican. Decorin has been reported to suppress the ability of cancer to spread, while versican tends to increase the spread of cancer. The third study examined cancer versican and decorin levels in radical prostatectomy specimens. The amount of versican, not decorin, correlated with the risk of cancer recurrence within five years of surgery. They found that among men with high tumor versican levels, 89% had recurred within five years compared with 27% of those with low levels.

These studies indicate that the development of chondroitin sulfate-containing versican may play an important role in the progression of human prostate cancer independent of Gleason grade or PSA. Is there any relationship between taking chondroitin sulfate-containing capsules and the development of chondroitin sulfate containing versican within the cancer? None of the published studies addressed this question. The rationale for taking oral chondroitin sulfate is that it will be incorporated into joint proteins. Chondroitin-containing versican is an important component of cartilage and its presence stimulates the growth of chondrocytes, the cells responsible for the synthesis of cartilage. It may well be that relief of joint pain in people taking oral chondroitin sulfate is dependent on increased production of versican in the cartilage lining the joint surface. If oral chondroitin sulfate has any impact on joint function, it might also increase chondroitin sulfate deposition surrounding prostate cancer cells. This is the reason I think it would be wise to consider other options.

I think you should consider Celebrex, a drug recently approved by the FDA for the treatment of osteoarthritis. The basis of its approval is that it causes much less stomach irritation than does aspirin, ibuprofen, or similar drugs. The standard dose is 100 to 200 milligrams twice a day. One major caution: if you are allergic to sulfa antibiotics, you may also be allergic to Celebrex.

References:

S. Iida, et al. "Analysis of glycosaminoglycans in human prostate by high-performance liquid chromatography" British Journal of Urology 79(5): 763-769, 1997.

C. Ricciardelli, et al. "Elevated levels of peritumoral chondroitin sulfate are predictive of poor prognosis in patients treated by radical prostatectomy for early-stage prostate cancer" Cancer Research 59(10): 2324-2328, 1999.

C. Ricciardelli et al. "Elevated levels of versican but not decorin predict disease progression in early-stage prostate cancer" Clinical Cancer Research 4(4): 963-971, 1998.

Y. Zhang, et al. "Promotion of chondrocyte proliferation by versican mediated by G1 domain and EGF-like motifs" Journal of Cellular Biochemistry 73(4): 445-457, 1999.

Z. Isogai, et al. "2B1 antigen characteristically expressed on extracellular matrices of human malignant tumors is a large chondroitin sulfate proteoglycan, PG-M/versican" Cancer Research 56(17): 3902-3908, 1996.

The following is reprinted from

The Prostate Forum

Volume 4 Number 8

August 1999, p.7, written and published February, 2000.

Chondroitin Sulfate and Glucosamine

In the June, 1999, issue of this newsletter, we described recent publications suggesting that chondroitin sulfate might pose a risk to men with prostate cancer. Chondroitin sulfate helps with joint pain because it forms a complex with a protein called versican found in joint cartilage. Prostate cancer cells produce versican also and the greater the amount of chondroitin sulfate attached to this protein, the more aggressively the cancer can spread throughout the body. For this reason, I do not think that the risk is worth it.

After we published this commentary, many patients called and asked about glucosamine, the other substance frequently added to chondroitin sulfate for the treatment of joint problems. I can find no published evidence indicating any risk associated with glucosamine and I think there is no reason for you to be concerned about dangers associated with it.

References:

C. Ricciardelli, et al. "Elevated Levels of Peritumoral Chondroitin Sulfate Are Predictive of Poor Prognosis in Patients Treated by Radical Prostatectomy for Early-Stage Prostate Cancer" Cancer Research 59(10): 2324-2328, 1999.

C. Ricciardelli, et al. "Elevated Levels of Versican, But Not Decorin, Predict Disease Progress-ion in Early-Stage Prostate Can-cer" Clinical Cancer Research 4(4): 963-971, 1998.

Y. Zhang, et al. "Promotion of Chondrocyte Proliferation by Versican Mediated by G1 Domain and EGF-Like Motifs" Journal of Cellular Biochemistry 73(4): 445-457, 1999.