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Background <p>Reprogrammed lipid metabolism with massive upregulation of tumor cell-autonomous synthesis of saturated fatty acids is a hallmark of prostate cancer (PCa) and is driven in part by aberrations in androgen receptor (AR) signaling. While lipid alterations are well described in primary PCa, the extent to which the circulating lipidome reflects tumor-associated metabolic changes in metastatic disease, and its role in therapy response, remains to be determined. This study aims to assess whether plasma lipid profiling captures tumor metabolic rewiring, and whether this reflects response to AR-targeting therapy, in metastatic castration-resistant PCa (mCRPC).</p> Methods <p>Quantitative plasma lipidomics was performed on plasma samples collected from patients with mCRPC (<i>n</i> = 50) and cancer-free subjects (C-FS, <i>n</i> = 14). Samples from patients with mCRPC were collected longitudinally at the time of progression on androgen deprivation therapy prior to initiation of first-line enzalutamide (Enza), after the start of treatment with Enza, before progression on Enza.</p> Results <p>Compared to C-FS, patients with mCRPC showed distinct lipidomic signatures, characterized by increased levels of monounsaturated lipids and altered composition of the phospholipid and sphingolipid pool, mimicking the aberrations known to occur in primary PCa tissue. Enza treatment markedly reduced total lipid levels, decreased major phospholipid classes and ceramides, while increasing sphingomyelins. Notably, quantitative differences in specific sphingolipid species occurring after Enza treatment correlated with survival outcomes.</p> Conclusions <p>Plasma lipidomics reflects key metabolic features of PCa and is profoundly impacted by AR inhibition, with prognostic relevance in patients with mCRPC. These findings support its potential as a non-invasive tool for monitoring disease activity and treatment response, and lay the groundwork for lipid-based biomarkers in mCRPC, while indicating that the lipidomic alterations observed may help inform ongoing and forthcoming research on metabolic targeting.</p>

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Lipidomic profiling in metastatic prostate cancer captures tumor metabolic rewiring and its modulation by androgen receptor–targeting therapy

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月13日

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  • Sara Bleve,
  • Francesco Ravera,
  • Silvia Rodrigues,
  • Filippo Pederzoli,
  • Hubert Pakula,
  • Nicole Brighi,
  • Emilio Francesco Giunta,
  • Giuseppe Schepisi,
  • Alessandra Virga,
  • Giorgia Gurioli,
  • Salvatore Luca Burgio,
  • Giuseppe Nicolo’ Fanelli,
  • Lisa M. Butler,
  • David M. Nanus,
  • Johannes V. Swinnen,
  • Pier Vitale Nuzzo,
  • Cristian Lolli,
  • Ugo De Giorgi,
  • Massimo Loda

摘要

Background

Reprogrammed lipid metabolism with massive upregulation of tumor cell-autonomous synthesis of saturated fatty acids is a hallmark of prostate cancer (PCa) and is driven in part by aberrations in androgen receptor (AR) signaling. While lipid alterations are well described in primary PCa, the extent to which the circulating lipidome reflects tumor-associated metabolic changes in metastatic disease, and its role in therapy response, remains to be determined. This study aims to assess whether plasma lipid profiling captures tumor metabolic rewiring, and whether this reflects response to AR-targeting therapy, in metastatic castration-resistant PCa (mCRPC).

Methods

Quantitative plasma lipidomics was performed on plasma samples collected from patients with mCRPC (n = 50) and cancer-free subjects (C-FS, n = 14). Samples from patients with mCRPC were collected longitudinally at the time of progression on androgen deprivation therapy prior to initiation of first-line enzalutamide (Enza), after the start of treatment with Enza, before progression on Enza.

Results

Compared to C-FS, patients with mCRPC showed distinct lipidomic signatures, characterized by increased levels of monounsaturated lipids and altered composition of the phospholipid and sphingolipid pool, mimicking the aberrations known to occur in primary PCa tissue. Enza treatment markedly reduced total lipid levels, decreased major phospholipid classes and ceramides, while increasing sphingomyelins. Notably, quantitative differences in specific sphingolipid species occurring after Enza treatment correlated with survival outcomes.

Conclusions

Plasma lipidomics reflects key metabolic features of PCa and is profoundly impacted by AR inhibition, with prognostic relevance in patients with mCRPC. These findings support its potential as a non-invasive tool for monitoring disease activity and treatment response, and lay the groundwork for lipid-based biomarkers in mCRPC, while indicating that the lipidomic alterations observed may help inform ongoing and forthcoming research on metabolic targeting.