Lactic Acidosis in Prostate Cancer: Consider the Warburg Effect

Case Rep Oncol. 2017 Nov 28;10(3):1085-1091. doi: 10.1159/000485242. eCollection 2017 Sep-Dec.

Abstract

Lactic acidosis is a commonly observed clinical condition that is associated with a poor prognosis, especially in malignancies. We describe a case of an 81-year-old patient who presented with symptoms of tachypnea and general discomfort. Arterial blood gas analysis showed a high anion gap acidosis with a lactate level of 9.5 mmol/L with respiratory compensation. CT scanning showed no signs of pulmonary embolism or other causes of impaired tissue oxygenation. Despite treatment with sodium bicarbonate, the patient developed an adrenalin-resistant cardiac arrest, most likely caused by the acidosis. Autopsy revealed Gleason score 5 + 5 metastatic prostate cancer as the most probable cause of the lactic acidosis. Next-generation sequencing indicated a nonsense mutation in the TP53 gene (887delA) and an activating mutation in the PIK3CA gene (1634A>G) as candidate molecular drivers. This case demonstrates the prevalence and clinical relevance of metabolic reprogramming, frequently referred to as "the Warburg effect," in patients with prostate cancer.

Keywords: Case report; IDH1 mutations; Lactic acidosis; Metabolic reprogramming; Mutation; PIK3CA mutations; PTEN mutations; Prostate cancer; Warburg effect; p53 mutations.

Publication types

  • Case Reports