ABSTRACT
INTRODUCTION: Bicalutamide is widely used in the treatment of prostate cancer. Among its side effects, central nervous system disorders are relatively rare, and the information about bicalutamide-associated hallucinations is limited. CASE REPORT: We report an uncommon case of a patient with metastatic prostate cancer, who had hallucinations due to the use of bicalutamide. MANAGEMENT AND OUTCOME: The patient accepted to receive only hormonal therapy (bicalutamide and leuprolide acetate). But he developed hallucinations due to bicalutamide use. His hallucinations disappeared after discontinuation of bicalutamide. A good response was obtained with the use of luteinizing hormone-releasing hormone agonist monotherapy. DISCUSSION: The pathophysiology of bicalutamide-induced hallucinations is unclear. We hypothesize that antiandrogens can indirectly cause hallucinations through changes in plasma testosterone and cerebral reelin expression. Additionally, luteinizing hormone-releasing hormone agonist monotherapy is a good option in metastatic prostate cancer patients who have intolerable side effects due to the use of antiandrogens.
Subject(s)
Anilides/adverse effects , Antineoplastic Agents/adverse effects , Hallucinations/chemically induced , Nitriles/adverse effects , Prostatic Neoplasms/drug therapy , Tosyl Compounds/adverse effects , Aged, 80 and over , Drug-Related Side Effects and Adverse Reactions/diagnosis , Hallucinations/diagnosis , Humans , Male , Prostatic Neoplasms/diagnosis , Reelin ProteinABSTRACT
BACKGROUND: Nuclear factor-kappa B (NF-ð B) activation and its inhibition by NF-ð B inhibitor (Ið B) have been functionally linked to germ cell apoptosis, which may affect human infertility. We hypothesized a possible relationship between the NF-ð B1-94ins/del ATTG (rs28362491) and NF-ð BIA 3'UTR AâG (rs696) polymorphism, which are common polymorphisms and the susceptibility to oligospermia in the context of the sperm apoptosis. METHODS: In order to evaluate this association, we studied the polymorphisms and sperm apoptosis rates of 114 men with idiopathic oligospermia, as well as 130 normospermic men, using PCR-RFLP and TUNEL staining methods, respectively. RESULTS: Univariate analysis revealed that heterozygous ID genotype at the NF-ð B1 -94ins/del ATTG polymorphism is associated with an approximately 2.4-fold reduced risk of oligospermia (P = 0.006, 95% confidence intervall = 1.34 - 4.13). However, the genotype and allele frequencies of NF-ð BIA 3'UTR AâG polymorphism, and the genotype frequencies of all possible rs28362491/rs696 genotype combinations did not show any significant differences between oligospermic and normospermic men. Furthermore, neither polymorphism appeared to affect sperm apoptosis, although the sperm apoptosis index was detected to be significantly higher in the oligospermic patients compared with those in the controls (P < 0.05). CONCLUSION: Our findings suggested that the heterozygosity of rs28362491 in the NF-ð B1 gene may have a protective effect against oligospermia and could modify the susceptibility of oligospermia in a group with idiopathic male infertility in a Turkish population.