Title: Effects of Broccoli-Derived Sulphur Compounds on the Prostate Microenvironment

Epidemiological studies suggest a negative association between prostate cancer risk and dietary intake of cruciferous vegetables. These vegetables have a characteristic sulphur metabolism, delivering specialised compounds including glucosinolates, such as glucoraphanin, and S-methyl cysteine sulfoxide (SMCSO). An interim analysis of ongoing clinical trials at Quadram Institute Bioscience suggested an increase in inorganic sulphate, adenosine 5’-diphosphate (ADP) and potential antioxidant capacity of prostate tissue following broccoli consumption. Sulforaphane, a hydrolytic product of glucoraphanin, influences multiple pathways relevant to prostate cancer prevention. Furthermore, degradation of SMCSO produces reactive intermediates, which induce apoptosis in prostate cancer cells, and ultimately yields high proportions of inorganic sulphate in human metabolism. Sulphate is likely to drive synthesis of phosphoadenosine 5’-phosphosulphate. Adenosine 5’-triphosphate (ATP) fuels this process, producing ADP and phosphate. As cancerous cells are unable to adjust their metabolism, depleting ATP by diet could prove an effective strategy for cancer prevention. A high-dose, randomised, parallel-unblinded broccoli-intervention study was carried out in men awaiting trans-perineal prostate biopsies. Global metabolomic and targeted metabolite analyses were undertaken on prostate, adipose and urine samples to test the biological availability and activity of sulphur-containing metabolites from the study diet. In vitro experiments were undertaken to investigate the effects of sulforaphane and SMCSO on real-time prostate bioenergetics and redox status of proteins relevant to prostate cancer. S MCSO was present at significantly higher levels (p<0.01) in both the urine and prostates of men receiving a broccoli-enriched diet. Whereas sulforaphane and its conjugates were undetectable in tissue. Levels of ATP and sulphate were not different between study groups. At physiological concentrations neither sulforaphane nor SMCSO affected mitochondrial function or redox status in vitro. SMCSO accumulation in tissue after broccoli consumption may mediate the putative effects of cruciferous vegetables towards prostate cancer prevention through its degradation to highly-reactive intermediate products

Accumulation of Dietary S-Methyl Cysteine Sulfoxide in Human Prostate Tissue

Scope: Observational studies have associated consumption of cruciferous vegetables with reduced risk of prostate cancer. This effect has been associated with the degradation products of glucosinolates—thioglycosides that accumulate within crucifers. The possible role of S-methyl cysteine sulfoxide, a metabolite that also accumulates in cruciferous vegetables, and its derivatives, in cancer prevention is relatively unexplored compared to glucosinolate derivatives. The hypothesis that consuming a broccoli soup results in the accumulation of sulfate (a SMCSO derivative) and other broccoli-derived metabolites in prostate tissue is tested. Methods and results: Eighteen men scheduled for transperineal prostate biopsy were recruited into a 4-week parallel single blinded diet supplementation study (NCT02821728). Nine men supplemented their diet with three 300 mL portions of a broccoli soup each week for four weeks prior to surgery. Analyses of prostate biopsy tissues reveal no detectable levels of glucosinolates and derivatives. In contrast, SMCSO is detected in prostate tissues of the participants, with significantly higher levels in tissue of men in the supplementation arm. SMCSO was also found in blood and urine samples from a previous intervention study with the identical broccoli soup. Conclusion: The consequences of SMCSO accumulation in prostate tissues and its potential role in prevention of prostate cancer remains to be investigated

Real world outcomes of biopsy-proven oncocytic neoplasm of the kidney managed by surveillance.

OBJECTIVES: To evaluate outcomes of patients diagnosed with oncocytic renal neoplasms on routine renal mass biopsy and to describe the natural history of these tumours when managed with surveillance as opposed to immediate intervention. To report disease-specific survival. PATIENTS AND METHODS: Patients were identified from a retrospective review of pathology databases from three tertiary referral centres that utilise renal mass biopsy in routine clinical practice. All patients with biopsy-proven oncocytic tumours were included and a retrospective review of online patient records was undertaken. RESULTS: There were 184 biopsy-proven oncocytic renal neoplasms identified in 172 patients. There were two biopsy complications (both pneumothorax, Clavien-Dindo Grade I). Of these lesions, 135 were reported as oncocytomas or oncocytic renal neoplasms that were not further classified and 37 were reported as chromophobe carcinoma (ChRCC). The median age at diagnosis was 70 (33-88). The average tumour diameter at diagnosis was 33 mm. One hundred seven tumours were initially managed with surveillance (including 13 ChRCC) with a minimum follow-up of 6 months and a median of 39 months (6-144) whereas 49 patients underwent immediate treatment. The mean growth rate across all oncocytic renal neoplasms managed by surveillance was 3 mm/year. There was no statistically significant difference in growth rates between oncocytic renal neoplasms and ChRCC. Thirteen patients with oncocytic renal neoplasms initially managed by surveillance moved on to an active management strategy during follow-up. The clinical indication given for a change from surveillance was tumour growth in 12 cases and patient choice in 1 case. Where definitive pathology was available, there was 85% concordance with the biopsy. There were no cases of development of metastatic disease or disease-related morbidity or mortality during the study. CONCLUSIONS: This multicentre retrospective cohort study supports the hypothesis that selected biopsy-proven oncocytic renal neoplasms can be safely managed with surveillance in the medium term. Routine renal mass biopsy may reduce surgery for benign or indolent renal tumours and the potential associated morbidity for these patients

Transcriptional changes in prostate of men on active surveillance after a 12-mo glucoraphanin-rich broccoli intervention—results from the Effect of Sulforaphane on prostate CAncer PrEvention (ESCAPE) randomized controlled trial

Background Epidemiological evidence suggests that consumption of cruciferous vegetables is associated with reduced risk of prostate cancer progression, largely attributed to the biological activity of glucosinolate degradation products, such as sulforaphane derived from glucoraphanin. Because there are few therapeutic interventions for men on active surveillance for prostate cancer to reduce the risk of cancer progression, dietary approaches are an appealing option for patients. Objective We evaluated whether consumption of a glucoraphanin-rich broccoli soup for 1 y leads to changes in gene expression in prostate tissue of men with localized prostate cancer. Methods Forty-nine men on active surveillance completed a 3-arm parallel randomized double-blinded intervention study for 12 mo and underwent transperineal template biopsy procedures and dietary assessment at the start and end of the study. Patients received a weekly 300 mL portion of soup made from a standard broccoli (control) or from 1 of 2 experimental broccoli genotypes with enhanced concentrations of glucoraphanin, delivering 3 and 7 times that of the control, respectively. Gene expression in tissues from each patient obtained before and after the dietary intervention was quantified by RNA sequencing followed by gene set enrichment analyses. Results In the control arm, there were several hundred changes in gene expression in nonneoplastic tissue during the 12 mo. These were associated with an increase in expression of potentially oncogenic pathways including inflammation processes and epithelial–mesenchymal transition. Changes in gene expression and associated oncogenic pathways were attenuated in men on the glucoraphanin-rich broccoli soup in a dose-dependent manner. Although the study was not powered to assess clinical progression, an inverse association between consumption of cruciferous vegetables and cancer progression was observed. Conclusion Consuming glucoraphanin-rich broccoli soup affected gene expression in the prostate of men on active surveillance, consistent with a reduction in the risk of cancer progression. This trial was registered at clinicaltrials.gov as NCT01950143