Chronic stress as a factor in the progression of prostate cancer under war conditions

Vollständiger Abstract

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Aim: To investigate the influence of stress factors on the development and progression of prostate cancer (PCa) with bone involvement in the pre-war period of 2011–2013 and during the period of the full-scale invasion of Russia from February 2022 to February 2025. Material and methods: A retrospective study of 549 patients with metastatic prostate cancer treated in outpatient and inpatient settings at the National Cancer Institute was performed. Patients were divided into two groups: Group 1 included 133 patients treated in 2011–2013, and Group 2 included 416 patients treated from February 2022 to February 2025. Pathohistological findings and Grade Group, mean age, TNM-8 stage, type of treatment, and progression-free survival were assessed. Statistical processing was performed using methods of variation statistics in Statistica 6.0. Pearson correlation analysis was used. Differences were considered significant at p < 0.05. Results: The proportion of patients with Grade Group 4–5 increased from 60.2% in Group 1 to 75.1% in Group 2 (p < 0.05). The frequency of bone metastases increased from 67.2% to 90.3% (p < 0.05), while visceral metastatic sites decreased from 32.8% to 9.7% (p < 0.05). The median progression-free survival increased from 19.9 months in 2011–2013 to 30.2 months in February 2022–February 2025 (p < 0.05). Conclusions: During the period of the full-scale invasion of Russia in Ukraine, significant changes occurred in the clinicopathological characteristics of prostate cancer, including an increase in aggressive forms, regional lymph node involvement, and bone metastases. Chronic stress associated with military actions, combined with limited access to medical care, disruption of screening programmes, and delayed patient presentation, may be a significant factor in prostate cancer progression. Activation of β-adrenergic signalling pathways, immune dysfunction, and disturbances in bone remodelling may contribute to acceleration of the metastatic process. Keywords: prostate cancer; chronic stress; war; bone metastases; progression; β-adrenergic signalling; bone remodelling