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Obesity plays a significant role in driving the aggressiveness of prostate cancer and increasing mortality rates. Various mechanisms contribute to this, including the effects of diet and lifestyle, changes in energy balance and hormone regulation, and the activation of signaling pathways by growth factors, cytokines, and immune system components. Recent research has focused on the role of peri-prostatic white adipose tissue, which produces factors that stimulate the progression of prostate cancer. Adipocytes and their progenitor cells, known as adipose stromal cells (ASCs), have been identified as key drivers of cancer progression in obesity. Adipocytes provide lipids to neighboring cancer cells, while ASCs promote tumor growth by remodeling the extracellular matrix, supporting blood vessel formation, recruiting immunosuppressive cells, and inducing epithelial-mesenchymal transition. Targeting ASCs may hold promise for developing therapies to suppress cancer aggressiveness in obese patients, as ASCs contribute to chemotherapy resistance and metastasis.
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