Increase of hepcidin plasma and urine levels is associated with acute proctitis and changes in hemoglobin levels in primary radiotherapy for prostate cancer.

PURPOSE: To analyse hepcidin serum and urine levels during radiotherapy for prostate cancer.
METHODS: In 18 patients undergoing radiotherapy for prostate cancer, blood, plasma, and urine samples were taken before and during radiotherapy. Complete blood cell count, pro-hepcidin-, ferritin-, transferrin-, IL-1beta-, IL-6-, and TNF-alpha concentration was determined. Pro-hepcidin concentration was additionally measured in urine samples. Toxicity was evaluated weekly. Differences among tested factors were tested by Wilcoxon rank sign test for paired data.
RESULTS: In ten patients developing acute radiation-induced proctitis, a significant increase in pro-hepcidin, IL-6, and TNF-alpha plasma levels (p < 0.05) was detected. Pro-hepcidin urine levels also showed a strong trend towards increase (p = 0.06). Concurrently, hemoglobin, and leucocytes were significantly decreased in the patients with acute proctitis (p < 0.05). In eight patients showing no symptoms of proctitis, solely a significant decrease for leucocytes was detected. Additive, these patients showed a significant increase of ferritin, and a decrease of transferrin levels (p < 0.05).
CONCLUSIONS: Hepcidin levels are increased and hemoglobin is decreased during radiotherapy for prostate cancer in patients who develop acute proctitis. Radiation-induced expression of cytokines may be responsible for increased hepcidin expression in the liver. Regulation of iron metabolism by hepcidin may be an underestimated response in radiotherapy.