The combination of plumbagin with androgen withdrawal causes profound regression of prostate tumors in vivo

BACKGROUND Hormonal ablation is the standard treatment for disseminated androgen‐dependent prostate cancer. Although tumor growth is controlled at first, the tumor invariably recurs in the form of castration‐resistant prostate cancer. This study assessed the efficacy of a new therapeutic strategy that combines plumbagin, a naturally occurring naphthoquinone, with androgen ablation. METHODS Viewing microscopy chambers were placed in the dorsal skinfold of mice. Syngeneic prostate tissue was grafted within the chambers and allowed to vascularize. H2B‐GFP/PTEN‐P2 prostate cancer cells were co‐implanted on top of the grafted prostate tissue. Androgen ablation was achieved using surgical castration. Intact and castrated mice were administered plumbagin or sham treatment. Tumor growth, mitosis and apoptosis were monitored in real‐time using fluorescent Intra‐Vital Microscopy. The mechanism of action of plumbagin was explored using human and mouse prostate cancer cells. RESULTS Whereas both plumbagin and castration alone impeded tumor growth, only the combination of plumbagin and castration caused profound tumor regression in vivo, mostly due to increased apoptosis of the tumor cells. The cytotoxicity of plumbagin was not affected by androgens in vitro, suggesting that microenvironmental factors not present in culture play a crucial role in the combination effect. Plumbagin‐induced cell death was mediated, at least in part, by activation of ERK and was due to generation of reactive oxygen species, because it was abolished by the anti‐oxidant N‐acetyl‐L‐cysteine. CONCLUSION Androgen deprivation in combination with plumbagin may provide a significant improvement over androgen deprivation alone and deserves further evaluation. Prostate 73: 489–499, 2013. © 2012 Wiley Periodicals, Inc.