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Tribian LS, Lennartz M, Höflmayer D, de Wispelaere N, Dwertmann Rico S, von Bargen C, Kind S, Reiswich V, Viehweger F, Lutz F, Bertram V, Fraune C, Gorbokon N, Weidemann S, Hube-Magg C, Menz A, Uhlig R, Krech T, Hinsch A, Burandt E, Sauter G, Simon R, Kluth M, Steurer S, Marx AH, Lebok P, Dum D, Minner S, Jacobsen F, Clauditz TS, Bernreuther C. Diagnostic Role and Prognostic Impact of PSAP Immunohistochemistry: A Tissue Microarray Study on 31,358 Cancer Tissues. Diagnostics (Basel) 2023; 13:3242. [PMID: 37892063 PMCID: PMC10606209 DOI: 10.3390/diagnostics13203242] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
Prostate-specific acid phosphatase (PSAP) is a marker for prostate cancer. To assess the specificity and prognostic impact of PSAP, 14,137 samples from 127 different tumor (sub)types, 17,747 prostate cancers, and 76 different normal tissue types were analyzed via immunohistochemistry in a tissue microarray format. In normal tissues, PSAP staining was limited to the prostate epithelial cells. In prostate cancers, PSAP was seen in 100% of Gleason 3 + 3, 95.5% of Gleason 4 + 4, 93.8% of recurrent cancer under androgen deprivation therapy, 91.0% of Gleason 5 + 5, and 31.2% of small cell neuroendocrine cancer. In non-prostatic tumors, PSAP immunostaining was only found in 3.2% of pancreatic neuroendocrine tumors and in 0.8% of diffuse-type gastric adenocarcinomas. In prostate cancer, reduced PSAP staining was strongly linked to an advanced pT stage, a high classical and quantitative Gleason score, lymph node metastasis, high pre-operative PSA levels, early PSA recurrence (p < 0.0001 each), high androgen receptor expression, and TMPRSS2:ERG fusions. A low level of PSAP expression was linked to PSA recurrence independent of pre- and postoperative prognostic markers in ERG-negative cancers. Positive PSAP immunostaining is highly specific for prostate cancer. Reduced PSAP expression is associated with aggressive prostate cancers. These findings make PSAP a candidate marker for prognostic multiparameter panels in ERG-negative prostate cancers.
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Affiliation(s)
- Laura Sophie Tribian
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.S.T.); (M.L.); (D.H.); (S.D.R.); (C.v.B.); (S.K.); (V.R.); (F.V.); (F.L.); (V.B.); (C.F.); (N.G.); (S.W.); (C.H.-M.); (A.M.); (R.U.); (T.K.); (A.H.); (E.B.); (G.S.); (M.K.); (S.S.); (P.L.); (D.D.); (S.M.); (F.J.); (T.S.C.); (C.B.)
| | - Maximilian Lennartz
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.S.T.); (M.L.); (D.H.); (S.D.R.); (C.v.B.); (S.K.); (V.R.); (F.V.); (F.L.); (V.B.); (C.F.); (N.G.); (S.W.); (C.H.-M.); (A.M.); (R.U.); (T.K.); (A.H.); (E.B.); (G.S.); (M.K.); (S.S.); (P.L.); (D.D.); (S.M.); (F.J.); (T.S.C.); (C.B.)
| | - Doris Höflmayer
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.S.T.); (M.L.); (D.H.); (S.D.R.); (C.v.B.); (S.K.); (V.R.); (F.V.); (F.L.); (V.B.); (C.F.); (N.G.); (S.W.); (C.H.-M.); (A.M.); (R.U.); (T.K.); (A.H.); (E.B.); (G.S.); (M.K.); (S.S.); (P.L.); (D.D.); (S.M.); (F.J.); (T.S.C.); (C.B.)
| | - Noémi de Wispelaere
- Department of General, Visceral, and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany;
| | - Sebastian Dwertmann Rico
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.S.T.); (M.L.); (D.H.); (S.D.R.); (C.v.B.); (S.K.); (V.R.); (F.V.); (F.L.); (V.B.); (C.F.); (N.G.); (S.W.); (C.H.-M.); (A.M.); (R.U.); (T.K.); (A.H.); (E.B.); (G.S.); (M.K.); (S.S.); (P.L.); (D.D.); (S.M.); (F.J.); (T.S.C.); (C.B.)
| | - Clara von Bargen
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.S.T.); (M.L.); (D.H.); (S.D.R.); (C.v.B.); (S.K.); (V.R.); (F.V.); (F.L.); (V.B.); (C.F.); (N.G.); (S.W.); (C.H.-M.); (A.M.); (R.U.); (T.K.); (A.H.); (E.B.); (G.S.); (M.K.); (S.S.); (P.L.); (D.D.); (S.M.); (F.J.); (T.S.C.); (C.B.)
| | - Simon Kind
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.S.T.); (M.L.); (D.H.); (S.D.R.); (C.v.B.); (S.K.); (V.R.); (F.V.); (F.L.); (V.B.); (C.F.); (N.G.); (S.W.); (C.H.-M.); (A.M.); (R.U.); (T.K.); (A.H.); (E.B.); (G.S.); (M.K.); (S.S.); (P.L.); (D.D.); (S.M.); (F.J.); (T.S.C.); (C.B.)
| | - Viktor Reiswich
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.S.T.); (M.L.); (D.H.); (S.D.R.); (C.v.B.); (S.K.); (V.R.); (F.V.); (F.L.); (V.B.); (C.F.); (N.G.); (S.W.); (C.H.-M.); (A.M.); (R.U.); (T.K.); (A.H.); (E.B.); (G.S.); (M.K.); (S.S.); (P.L.); (D.D.); (S.M.); (F.J.); (T.S.C.); (C.B.)
| | - Florian Viehweger
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.S.T.); (M.L.); (D.H.); (S.D.R.); (C.v.B.); (S.K.); (V.R.); (F.V.); (F.L.); (V.B.); (C.F.); (N.G.); (S.W.); (C.H.-M.); (A.M.); (R.U.); (T.K.); (A.H.); (E.B.); (G.S.); (M.K.); (S.S.); (P.L.); (D.D.); (S.M.); (F.J.); (T.S.C.); (C.B.)
| | - Florian Lutz
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.S.T.); (M.L.); (D.H.); (S.D.R.); (C.v.B.); (S.K.); (V.R.); (F.V.); (F.L.); (V.B.); (C.F.); (N.G.); (S.W.); (C.H.-M.); (A.M.); (R.U.); (T.K.); (A.H.); (E.B.); (G.S.); (M.K.); (S.S.); (P.L.); (D.D.); (S.M.); (F.J.); (T.S.C.); (C.B.)
| | - Veit Bertram
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.S.T.); (M.L.); (D.H.); (S.D.R.); (C.v.B.); (S.K.); (V.R.); (F.V.); (F.L.); (V.B.); (C.F.); (N.G.); (S.W.); (C.H.-M.); (A.M.); (R.U.); (T.K.); (A.H.); (E.B.); (G.S.); (M.K.); (S.S.); (P.L.); (D.D.); (S.M.); (F.J.); (T.S.C.); (C.B.)
| | - Christoph Fraune
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.S.T.); (M.L.); (D.H.); (S.D.R.); (C.v.B.); (S.K.); (V.R.); (F.V.); (F.L.); (V.B.); (C.F.); (N.G.); (S.W.); (C.H.-M.); (A.M.); (R.U.); (T.K.); (A.H.); (E.B.); (G.S.); (M.K.); (S.S.); (P.L.); (D.D.); (S.M.); (F.J.); (T.S.C.); (C.B.)
| | - Natalia Gorbokon
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.S.T.); (M.L.); (D.H.); (S.D.R.); (C.v.B.); (S.K.); (V.R.); (F.V.); (F.L.); (V.B.); (C.F.); (N.G.); (S.W.); (C.H.-M.); (A.M.); (R.U.); (T.K.); (A.H.); (E.B.); (G.S.); (M.K.); (S.S.); (P.L.); (D.D.); (S.M.); (F.J.); (T.S.C.); (C.B.)
| | - Sören Weidemann
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.S.T.); (M.L.); (D.H.); (S.D.R.); (C.v.B.); (S.K.); (V.R.); (F.V.); (F.L.); (V.B.); (C.F.); (N.G.); (S.W.); (C.H.-M.); (A.M.); (R.U.); (T.K.); (A.H.); (E.B.); (G.S.); (M.K.); (S.S.); (P.L.); (D.D.); (S.M.); (F.J.); (T.S.C.); (C.B.)
| | - Claudia Hube-Magg
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.S.T.); (M.L.); (D.H.); (S.D.R.); (C.v.B.); (S.K.); (V.R.); (F.V.); (F.L.); (V.B.); (C.F.); (N.G.); (S.W.); (C.H.-M.); (A.M.); (R.U.); (T.K.); (A.H.); (E.B.); (G.S.); (M.K.); (S.S.); (P.L.); (D.D.); (S.M.); (F.J.); (T.S.C.); (C.B.)
| | - Anne Menz
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.S.T.); (M.L.); (D.H.); (S.D.R.); (C.v.B.); (S.K.); (V.R.); (F.V.); (F.L.); (V.B.); (C.F.); (N.G.); (S.W.); (C.H.-M.); (A.M.); (R.U.); (T.K.); (A.H.); (E.B.); (G.S.); (M.K.); (S.S.); (P.L.); (D.D.); (S.M.); (F.J.); (T.S.C.); (C.B.)
| | - Ria Uhlig
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.S.T.); (M.L.); (D.H.); (S.D.R.); (C.v.B.); (S.K.); (V.R.); (F.V.); (F.L.); (V.B.); (C.F.); (N.G.); (S.W.); (C.H.-M.); (A.M.); (R.U.); (T.K.); (A.H.); (E.B.); (G.S.); (M.K.); (S.S.); (P.L.); (D.D.); (S.M.); (F.J.); (T.S.C.); (C.B.)
| | - Till Krech
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.S.T.); (M.L.); (D.H.); (S.D.R.); (C.v.B.); (S.K.); (V.R.); (F.V.); (F.L.); (V.B.); (C.F.); (N.G.); (S.W.); (C.H.-M.); (A.M.); (R.U.); (T.K.); (A.H.); (E.B.); (G.S.); (M.K.); (S.S.); (P.L.); (D.D.); (S.M.); (F.J.); (T.S.C.); (C.B.)
- Institute of Pathology, Clinical Center Osnabrueck, 49076 Osnabrueck, Germany
| | - Andrea Hinsch
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.S.T.); (M.L.); (D.H.); (S.D.R.); (C.v.B.); (S.K.); (V.R.); (F.V.); (F.L.); (V.B.); (C.F.); (N.G.); (S.W.); (C.H.-M.); (A.M.); (R.U.); (T.K.); (A.H.); (E.B.); (G.S.); (M.K.); (S.S.); (P.L.); (D.D.); (S.M.); (F.J.); (T.S.C.); (C.B.)
| | - Eike Burandt
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.S.T.); (M.L.); (D.H.); (S.D.R.); (C.v.B.); (S.K.); (V.R.); (F.V.); (F.L.); (V.B.); (C.F.); (N.G.); (S.W.); (C.H.-M.); (A.M.); (R.U.); (T.K.); (A.H.); (E.B.); (G.S.); (M.K.); (S.S.); (P.L.); (D.D.); (S.M.); (F.J.); (T.S.C.); (C.B.)
| | - Guido Sauter
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.S.T.); (M.L.); (D.H.); (S.D.R.); (C.v.B.); (S.K.); (V.R.); (F.V.); (F.L.); (V.B.); (C.F.); (N.G.); (S.W.); (C.H.-M.); (A.M.); (R.U.); (T.K.); (A.H.); (E.B.); (G.S.); (M.K.); (S.S.); (P.L.); (D.D.); (S.M.); (F.J.); (T.S.C.); (C.B.)
| | - Ronald Simon
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.S.T.); (M.L.); (D.H.); (S.D.R.); (C.v.B.); (S.K.); (V.R.); (F.V.); (F.L.); (V.B.); (C.F.); (N.G.); (S.W.); (C.H.-M.); (A.M.); (R.U.); (T.K.); (A.H.); (E.B.); (G.S.); (M.K.); (S.S.); (P.L.); (D.D.); (S.M.); (F.J.); (T.S.C.); (C.B.)
| | - Martina Kluth
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.S.T.); (M.L.); (D.H.); (S.D.R.); (C.v.B.); (S.K.); (V.R.); (F.V.); (F.L.); (V.B.); (C.F.); (N.G.); (S.W.); (C.H.-M.); (A.M.); (R.U.); (T.K.); (A.H.); (E.B.); (G.S.); (M.K.); (S.S.); (P.L.); (D.D.); (S.M.); (F.J.); (T.S.C.); (C.B.)
| | - Stefan Steurer
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.S.T.); (M.L.); (D.H.); (S.D.R.); (C.v.B.); (S.K.); (V.R.); (F.V.); (F.L.); (V.B.); (C.F.); (N.G.); (S.W.); (C.H.-M.); (A.M.); (R.U.); (T.K.); (A.H.); (E.B.); (G.S.); (M.K.); (S.S.); (P.L.); (D.D.); (S.M.); (F.J.); (T.S.C.); (C.B.)
| | - Andreas H. Marx
- Department of Pathology, Academic Hospital Fuerth, 90766 Fuerth, Germany;
| | - Patrick Lebok
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.S.T.); (M.L.); (D.H.); (S.D.R.); (C.v.B.); (S.K.); (V.R.); (F.V.); (F.L.); (V.B.); (C.F.); (N.G.); (S.W.); (C.H.-M.); (A.M.); (R.U.); (T.K.); (A.H.); (E.B.); (G.S.); (M.K.); (S.S.); (P.L.); (D.D.); (S.M.); (F.J.); (T.S.C.); (C.B.)
- Institute of Pathology, Clinical Center Osnabrueck, 49076 Osnabrueck, Germany
| | - David Dum
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.S.T.); (M.L.); (D.H.); (S.D.R.); (C.v.B.); (S.K.); (V.R.); (F.V.); (F.L.); (V.B.); (C.F.); (N.G.); (S.W.); (C.H.-M.); (A.M.); (R.U.); (T.K.); (A.H.); (E.B.); (G.S.); (M.K.); (S.S.); (P.L.); (D.D.); (S.M.); (F.J.); (T.S.C.); (C.B.)
| | - Sarah Minner
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.S.T.); (M.L.); (D.H.); (S.D.R.); (C.v.B.); (S.K.); (V.R.); (F.V.); (F.L.); (V.B.); (C.F.); (N.G.); (S.W.); (C.H.-M.); (A.M.); (R.U.); (T.K.); (A.H.); (E.B.); (G.S.); (M.K.); (S.S.); (P.L.); (D.D.); (S.M.); (F.J.); (T.S.C.); (C.B.)
| | - Frank Jacobsen
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.S.T.); (M.L.); (D.H.); (S.D.R.); (C.v.B.); (S.K.); (V.R.); (F.V.); (F.L.); (V.B.); (C.F.); (N.G.); (S.W.); (C.H.-M.); (A.M.); (R.U.); (T.K.); (A.H.); (E.B.); (G.S.); (M.K.); (S.S.); (P.L.); (D.D.); (S.M.); (F.J.); (T.S.C.); (C.B.)
| | - Till S. Clauditz
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.S.T.); (M.L.); (D.H.); (S.D.R.); (C.v.B.); (S.K.); (V.R.); (F.V.); (F.L.); (V.B.); (C.F.); (N.G.); (S.W.); (C.H.-M.); (A.M.); (R.U.); (T.K.); (A.H.); (E.B.); (G.S.); (M.K.); (S.S.); (P.L.); (D.D.); (S.M.); (F.J.); (T.S.C.); (C.B.)
| | - Christian Bernreuther
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.S.T.); (M.L.); (D.H.); (S.D.R.); (C.v.B.); (S.K.); (V.R.); (F.V.); (F.L.); (V.B.); (C.F.); (N.G.); (S.W.); (C.H.-M.); (A.M.); (R.U.); (T.K.); (A.H.); (E.B.); (G.S.); (M.K.); (S.S.); (P.L.); (D.D.); (S.M.); (F.J.); (T.S.C.); (C.B.)
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Harnden P, Shelley MD, Coles B, Staffurth J, Mason MD. Should the Gleason grading system for prostate cancer be modified to account for high-grade tertiary components? A systematic review and meta-analysis. Lancet Oncol 2007; 8:411-9. [PMID: 17466898 DOI: 10.1016/s1470-2045(07)70136-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Gleason system for grading prostate cancer assigns a score on the basis of the most prevalent and second most prevalent grade. Several studies have investigated the clinical significance of a tertiary grade in radical prostatectomy samples. A systematic search of the published work identified seven studies that reported the prognostic value of a tertiary Gleason grade. Three studies correlated the presence of a tertiary grade with pathological stage, and six with prostate-specific antigen recurrence or clinical progression. In the small number of studies available, the frequency of a tertiary grade was consistently higher in samples characterised with pathological variables of poor outcome, such as extra-prostatic extension and positive surgical margins, but not lymph-node metastases. In five studies the presence of a tertiary grade increased the risk of prostate-specific antigen recurrence after radical prostatectomy by a factor of 2.5. However, modification of the Gleason score to include a tertiary grade in Gleason 4+3 tumours might overestimate the risk of seminal-vesicle or lymph-node invasion. This systematic review has established the association of a tertiary grade with poorer outcome than that associated with no tertiary grade. A tertiary grade should, therefore, be included in the pathological reporting of prostate cancer and be considered in the interpretation and design of clinical trials. However, all studies assessed for this review were retrospective, potentially affected by selection bias, and based on radical prostatectomy samples or transurethral resections rather than biopsy samples. Therefore, more evidence is needed to warrant the adaptation of the Gleason system to account for the presence of a tertiary grade, especially when scoring prostatic biopsies and applying predictive algorithms.
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Affiliation(s)
- Patricia Harnden
- Cancer Research UK Clinical Centre, St James's University Hospital, Leeds, UK
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Singh SS, Kim D, Mohler JL. Java Web Start based software for automated quantitative nuclear analysis of prostate cancer and benign prostate hyperplasia. Biomed Eng Online 2005; 4:31. [PMID: 15888205 PMCID: PMC1145186 DOI: 10.1186/1475-925x-4-31] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2005] [Accepted: 05/11/2005] [Indexed: 11/16/2022] Open
Abstract
Background Androgen acts via androgen receptor (AR) and accurate measurement of the levels of AR protein expression is critical for prostate research. The expression of AR in paired specimens of benign prostate and prostate cancer from 20 African and 20 Caucasian Americans was compared to demonstrate an application of this system. Methods A set of 200 immunopositive and 200 immunonegative nuclei were collected from the images using a macro developed in Image Pro Plus. Linear Discriminant and Logistic Regression analyses were performed on the data to generate classification coefficients. Classification coefficients render the automated image analysis software independent of the type of immunostaining or image acquisition system used. The image analysis software performs local segmentation and uses nuclear shape and size to detect prostatic epithelial nuclei. AR expression is described by (a) percentage of immunopositive nuclei; (b) percentage of immunopositive nuclear area; and (c) intensity of AR expression among immunopositive nuclei or areas. Results The percent positive nuclei and percent nuclear area were similar by race in both benign prostate hyperplasia and prostate cancer. In prostate cancer epithelial nuclei, African Americans exhibited 38% higher levels of AR immunostaining than Caucasian Americans (two sided Student's t-tests; P < 0.05). Intensity of AR immunostaining was similar between races in benign prostate. Conclusion The differences measured in the intensity of AR expression in prostate cancer were consistent with previous studies. Classification coefficients are required due to non-standardized immunostaining and image collection methods across medical institutions and research laboratories and helps customize the software for the specimen under study. The availability of a free, automated system creates new opportunities for testing, evaluation and use of this image analysis system by many research groups who study nuclear protein expression.
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Affiliation(s)
- Swaroop S Singh
- University of North Carolina Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Desok Kim
- School of Engineering, Information and Communications University, Daejeon, Korea
| | - James L Mohler
- University of North Carolina Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
- Department of Urologic Oncology, Roswell Park Cancer Institute, Buffalo, USA
- Department of Urology, State University of New York at Buffalo, Buffalo, USA
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Fischer AH, Bardarov S, Jiang Z. Molecular aspects of diagnostic nucleolar and nuclear envelope changes in prostate cancer. J Cell Biochem 2004; 91:170-84. [PMID: 14689589 DOI: 10.1002/jcb.10735] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Prostate cancer is still diagnosed by pathologists based on subjective assessment of altered cell and tissue structure. The cellular-level structural changes diagnostic of some forms of cancer are known to be induced by cancer genes, but the relation between specific cellular-level structural features and cancer genes has not been explored in the prostate. Two important cell structural changes in prostate cancer-nucleolar enlargement and nuclear envelope (NE) irregularity-are discussed from the perspective that they should also relate to the function of the genes active in prostate cancer. Enlargement of the nucleolus is the key diagnostic feature of high-grade prostatic intraepithelial neoplasia (PIN), an early stage that appears to be the precursor to the majority of invasive prostate cancers. Nucleolar enlargement classically is associated with increased ribosome production, and production of new ribosomes appears essential for cell-cycle progression. Several cancer genes implicated in PIN are known (in other cell types) to augment ribosome production, including c-Myc, p27, retinoblastoma, p53, and growth factors that impact on ERK signaling. However, critical review of the available information suggests that increased ribosome production per se may be insufficient to explain nucleolar enlargement in PIN, and other newer functions of nucleoli may therefore need to be invoked. NE irregularity develops later in the clonal evolution of some prostate cancers, and it has adverse prognostic significance. Nuclear irregularity has recently been shown to develop dynamically during interphase following oncogene expression, without a requirement for post-mitotic NE reassembly. NE irregularity characteristic of some aggressive prostate cancers could reflect cytoskeletal forces exerted on the NE during active cell locomotion. NE irregularity could also promote chromosomal instability because it leads to chromosomal asymmetry in metaphase. Finally, NE irregularity could impact replication competence, transcriptional programming and nuclear pore function.
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Affiliation(s)
- Andrew H Fischer
- Department of Pathology, University of Massachusetts UMMHC, Worcester, Massachusetts 01655, USA.
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Ross JS, Sheehan CE, Fisher HAG, Kauffman RA, Dolen EM, Kallakury BVS. Prognostic markers in prostate cancer. Expert Rev Mol Diagn 2002; 2:129-42. [PMID: 11962333 DOI: 10.1586/14737159.2.2.129] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In this review, a series of relatively well-documented ancillary biomarkers and emerging molecular assays are evaluated for their relative ability to predict prognosis in prostate cancer. Prognostic factors that have achieved widespread use and classified as Category I by the College of American Pathologists Solid Tumor Prognostic Factor Consensus Conference are compared with newer tests that are beginning to be used in clinical practice (Category II) and emerging molecular-based assays that have yet to be widely validated in the published literature or clinical trials (Category III).
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Affiliation(s)
- Jeffrey S Ross
- Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, New York 12208, USA.
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6
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Ross JS, Sheehan CE, Dolen EM, Kallakury BVS. Morphologic and molecular prognostic markers in prostate cancer. Adv Anat Pathol 2002; 9:115-28. [PMID: 11917165 DOI: 10.1097/00125480-200203000-00003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
In this review, a series of traditional morphology-based measurements, relatively well-documented ancillary biomarkers, and emerging molecular assays are evaluated for their relative ability to predict prognosis in prostate cancer. Prognostic factors that have achieved widespread use and are classified as category I by the College of American Pathologists' Solid Tumor Prognostic Factor Consensus Conference are compared with newer tests that are beginning to be used in clinical practice (category II) and emerging molecular-based assays that have yet to be widely validated in the published literature or in clinical trials (category III).
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Affiliation(s)
- Jeffrey S Ross
- Department of Pathology, Albany Medical College, Albany, New York 12208, USA.
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7
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Abstract
The development of drugs to prevent prostate cancer is underway, yet monitoring the potential efficacy of these agents during clinical trials relies on measuring intermediate endpoints. In this review, various candidate markers are presented that are under different stages of evaluation as intermediate endpoint biomarkers. In addition, the near future will bring an unprecedented wave of new potential biomarkers. For instance, through genomics-based methods many new genes are being discovered whose altered expression may be involved in different phases of prostate cancer development and progression. In the development of rational approaches for selecting which of these untested biomarkers may be useful to measure systematically, there must be an improved understanding of the mechanisms of prostatic carcinogenesis. We submit that this improved understanding will come through new knowledge of the biology of normal prostate epithelial cells, the determination of the precise target cells of transformation, and how their growth regulation is genetically and epigenetically perturbed during the phases of initiation and progression. In this review, therefore, we also present our recent immune-mediated oxidant injury and regeneration hypothesis of why and how the prostate is targeted for carcinogenesis.
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Affiliation(s)
- A M De Marzo
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
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8
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Volavsek M, Masera A, Ovcak Z. Incidental prostatic carcinoma. A predictive role of neoangiogenesis and comparison with other prognostic factors. Pathol Oncol Res 2000; 6:191-6. [PMID: 11033459 DOI: 10.1007/bf03032372] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Incidental prostatic carcinoma (ICP) has good prognosis related to low stage at diagnosis. Few rogressive cases demanding aggressive treatment need early identification. Neoangiogenesis proved its predictive role in prostatic carcinoma after radical prostatectomy. To reveal its value in ICP authors investigated specimens after transurethral resection of prostate (TURP). Retrospective study was performed on 68 ICP diagnosed in years 1985 1989. Microvessels highlighted by factor VIII were counted in a x200 microscope field (0,8012 mm 2 ) in most active areas of neovascularisation. Microvessel count was correlated with tumor differentiation degree, Gleason score, disease stage, and patients survival in at least 9 years after diagnosis. Higher maximal microvessel counts were associated with lower degree of tumor differentiation (p=0,005), Gleason score (p=0,001), and disease stage (0,003). No association with disease progression and patients survival was found. Mean microvessel counts showed less significant values when correlated with tumor differentiation degree (p=0,003) and Gleason score (p=0, 01), and no correlation with other variables. Microvessel density in TURP specimens of ICP retains its prognostic value already demonstrated in carcinoma of peripheral prostatic lobes. Maximal microvessel counts were prognostically more reliable than mean values.
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Affiliation(s)
- M Volavsek
- Medical Faculty, University of Ljubljana, Institute of Pathology Korytkova 2, Ljubljana, 1000, Slovenia
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9
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Hurwitz MD, DeWeese TL, Zinreich ES, Epstein JI, Partin AW. Nuclear morphometry predicts disease-free interval for clinically localized adenocarcinoma of the prostate treated with definitive radiation therapy. Int J Cancer 1999; 84:594-7. [PMID: 10567904 DOI: 10.1002/(sici)1097-0215(19991222)84:6<594::aid-ijc9>3.0.co;2-d] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Men treated for prostate cancer often have unexpected outcomes despite predictive models based on stage, grade and prostate-specific antigen (PSA). Previous results have indicated that nuclear morphometry can predict patient outcome in urologic malignancies. Application of this analytical method in prostate cancer treated with radiation therapy is limited. We have evaluated the predictive ability of nuclear morphometry in such patients. Histologic sections from 23 men with clinically localized adenocarcinoma of the prostate treated with radiation therapy were studied. Nuclear morphometric parameters were assessed using a previously described and validated system. Univariate and multivariate logistic regression analyses and a Cox proportional hazards model were used to assess the ability of nuclear morphometric parameters to predict recurrence and disease-free interval. Ten patients had no recurrence with median follow-up of 47. 5 months, while 13 had recurrence. Gleason grade was not predictive of treatment outcome. Pre-treatment PSA data, available for only 11 patients, were predictive of treatment outcome. Several nuclear morphometric parameters predicted recurrence, including upper quartile of suboptimal circle fit and upper quartile of feret-diameter ratio. A prognostic factor score incorporating these 2 parameters was derived, which predicted disease-free interval (p = 0.0014). Int. J. Cancer (Pred. Oncol.) 84:594-597, 1999.
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Affiliation(s)
- M D Hurwitz
- Joint Center for Radiation Therapy, Harvard Medical School, Boston, MA 02115, USA
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Affiliation(s)
- J P Van Brussel
- Department of Urology, Erasmus University and Academic Hospital Rotterdam, Rotterdam, The Netherlands
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11
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O'Connor KC. Three-dimensional cultures of prostatic cells: tissue models for the development of novel anti-cancer therapies. Pharm Res 1999; 16:486-93. [PMID: 10227701 DOI: 10.1023/a:1011906709680] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This review addresses the application of three-dimensional cultures of prostatic cells to the development of novel anti-cancer therapies. A variety of therapeutic agents to combat prostate cancer are currently under development. These include cytotoxins, differentiation agents and, more recently, genetically modified tumor vaccines. Three-dimensional cultures of prostatic cells are increasingly used in preclinical research in the design of new therapies and in the development of delivery strategies for these treatments. These tissue-like structures more realistically model the structural architecture and differentiated function of the human prostate than a cellular monolayer. In doing so, three-dimensional cultures produce an in vivo-like response to therapeutic agents. Advances in tissue engineering have improved the variety, fidelity and quantity of these prostate models. To date, they have been applied to estimate the dose of new drug therapies, evaluate drug penetration into solid tumors, assess the effectiveness of drug combinations, and develop tumor vaccines.
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Affiliation(s)
- K C O'Connor
- Department of Chemical Engineering, Tulane University, New Orleans, Louisiana 70118, USA.
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Sauvageot J, Epstein JI. Immunoreactivity for prostate-specific antigen and prostatic acid phosphatase in adenocarcinoma of the prostate: relation to progression following radical prostatectomy. Prostate 1998; 34:29-33. [PMID: 9428385 DOI: 10.1002/(sici)1097-0045(19980101)34:1<29::aid-pros4>3.0.co;2-f] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Although, in general, immunoperoxidase staining for prostate-specific antigen (PSA) and prostate-specific acid phosphatase (PSAP) cannot distinguish between benign and malignant prostatic epithelium, immunoreactivity of these antigens may be helpful in predicting prognosis of prostate cancer. The purpose of this study was to evaluate intensity and extent of immunoperoxidase staining for PSA and PSAP as a prognostic tool in prostate adenocarcinomas. METHODS We studied radical prostatectomy specimens from 68 patients with the following stages: organ-confined, 34.3%; focal capsular penetration, 38.8%; established capsular penetration, 25.3%; and seminal vesicle invasion, 1.6%. Ninety-one percent of cases were Gleason score 5-7. The mean follow-up for those men without progression was 8.9 years, compared to 3.5 years for those with progression. Progression was defined as an elevated postoperative serum PSA level (> 0.2 ng/ml). Intensity of PSA and PSAP staining was recorded and based on a scale of 0-3 (0, no staining; 1, weak; 2, moderate; 3, intense). Extent was quantitated on a scale of 0-4 (0, 0-5% staining; 1, 6-35%; 2, 36-65%; 3, 65-95%; 4, 95-100%). A score (0-12) was computed by multiplying intensity and extent of the stain in the tumor area. RESULTS AND CONCLUSIONS Intensity and extent of PSA and PSAP immunoreactivity did not predict progression in adenocarcinomas of the prostate following radical prostatectomy.
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Affiliation(s)
- J Sauvageot
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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13
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14
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Shankey TV, Jin JK, Dougherty S, Flanigan RC, Graham S, Pyle JM. DNA ploidy and proliferation heterogeneity in human prostate cancers. CYTOMETRY 1995; 21:30-9. [PMID: 8529468 DOI: 10.1002/cyto.990210108] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
DNA ploidy determinations have been shown to have clinical application in predicting disease progression, survival, or response to anti-androgen therapies in prostate carcinomas. Since intra-tumor heterogeneity may have a profound effect on DNA measurements, we determined the frequency of DNA ploidy and proliferation (here S-phase fraction) heterogeneity in early prostatic carcinomas, and estimated the potential impact of heterogeneity on predicting disease course, survival, or response to therapy. Using image and flow cytometric analysis of archival, paraffin-embedded prostate tumors, we measured DNA ploidy in individual foci of prostatic carcinoma in stage T1a, T1b and T1c disease. Image analysis studies included the use of Feulgen stained tissue sections, and a comparison of these results with flow cytometric DNA ploidy determinations on nuclei isolated from the same tumor foci. Flow cytometry was also used to measure DNA Index and tumor S-phase fraction, in some cases using multiparameter analysis of isolated nuclei to determine DNA content and the level of the proliferation-associated antigen, p105. Our results indicate that DNA aneuploid foci of prostate carcinoma are infrequently seen in stage T1a disease (13% of the individuals studied), and that the presence of both DNA diploid and aneuploid foci in the same sample is seen in less than 10% of these individuals. Stage T1b and T1c tumors containing only DNA diploid nuclei are seen, though these are likely most common in low volume, low Gleason grade tumors. By using flow cytometry to compare these results with those using image analysis of the same tumor foci, we demonstrated that the majority (> 75%) of these aneuploid tumors are DNA tetraploid. Our data on prostate tumor S-phase fractions indicate that DNA diploid tumors generally have a lower S-phase than DNA aneuploid foci (including comparisons of DNA diploid and aneuploid foci in the same prostate tumor). These results support the model that early prostate tumors are DNA diploid and have a low S-phase, and that these tumors likely evolve to DNA tetraploid tumors with a similar low S-phase fraction.
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Affiliation(s)
- T V Shankey
- Department of Urology, Loyola University Medical Center, Maywood, IL 60153, USA
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15
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Quinlan DM, Partin AW, Walsh PC. Can aggressive prostatic carcinomas be identified and can their natural history be altered by treatment? Urology 1995; 46:77-82. [PMID: 7653023 DOI: 10.1016/s0090-4295(99)80254-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The factors that determine tumor aggressiveness are multifactorial: age, stage, and grade. Even a well differentiated tumor in a young patient may be aggressive someday because of genetic drift and tumor heterogeneity. In a recent review of 826 favorably selected cases managed with conservative therapy, metastatic disease had developed in 19% with grade I tumors, 42% with grade II, and 74% with grade III at 10 years. Recognizing that < 20% of men present with grade I disease, most prostate cancers are a threat to life in men who are going to live longer than 10 years. On the other hand, some tumors at presentation are too far advanced to cure. To improve the accuracy of preoperative staging in identifying these cases, we have developed nomograms based upon clinical stage, grade, and serum prostate-specific antigen (PSA). Traditionally, patients with high-grade tumors (Gleason 8-10) were never considered candidates for radical prostatectomy because of their poor expectancy for long-term survival. However, with improvements in the staging of prostate cancer and with a reduction in the morbidity of radical prostatectomy, a subset of these patients are potential candidates for curative therapy. We have recently studied the clinical outcome of 72 men with Gleason scores of 8-10 on needle biopsies who presented with clinically localized disease (9 T1c, 22 T2a, 17 T2b, 13 T2c, and 11 T3a). Of the 63 men who underwent radical prostatectomy, 46 (68%) had negative lymph nodes; nine did not undergo surgery because of positive lymph nodes identified from frozen section. The actuarial likelihood of an undetectable serum PSA at 5 years was 43% for men with negative lymph nodes and 45% for men with organ-confined disease. Thus, with proper evaluation, some men with even the most aggressive tumors can be cured by surgery if their pelvic lymph nodes are negative.
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Affiliation(s)
- D M Quinlan
- Department of Urology, St. Vincent's Hospital, University College, Dublin, Ireland
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16
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Vesalainen S, Lipponen P, Talja M, Kasurinen J, Syrjänen K. Nuclear morphometry is of independent prognostic value only in T1 prostatic adenocarcinomas. Prostate 1995; 27:110-7. [PMID: 7638083 DOI: 10.1002/pros.2990270208] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A series of 325 patients with prostatic adenocarcinoma followed-up for over 13 years was subjected to histomorphometric analysis for the following prognostic factors: the Gleason score and 10 nuclear morphometric factors (mean nuclear area, nuclear perimeter, shortest and longest nuclear axis, form factor and their SDs), using the IBAS 1&2 image analyzer. Nuclear factors, Gleason score (P = 0.0013-0.0148), and T-category (P = 0.004-0.0107) were significantly interrelated, while the M-category was independent of the morphometric parameters. Nuclear factors (P = 0.0003-0.5), Gleason score (P < 0.0001), T-category (P < 0.0001) and M-category (P < 0.0001) predicted the disease outcome. In T1-2M0 tumors, the T-category (P = 0.0001), Gleason score (P < 0.0001), SD of nuclear area (P = 0.057), SD of nuclear perimetry (P = 0.039), mean shortest nuclear axis (P = 0.030), SD of the shortest nuclear axis (P = 0.0045), SD of the longest nuclear axis (P = 0.009), and nuclear form factor (P = 0.0123) were significant prognostic factors. In the multivariate survival analysis, the nuclear area had independent prognostic significance only in T1 tumors, whereas in other subcategories, the clinical stage, Gleason score, and patient age included all the available prognostic information. The results indicate that nuclear morphometric measurements are of borderline significance only in evaluating the intrinsic malignancy of prostatic adenocarcinoma.
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Affiliation(s)
- S Vesalainen
- Department of Surgery, University of Kuopio, Finland
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17
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Hammond EH, Grignon DJ. Current status of tissue markers as prognostic factors in prostatic adenocarcinoma. Int J Radiat Oncol Biol Phys 1995; 31:419-22. [PMID: 7530701 DOI: 10.1016/0360-3016(94)00582-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Abstract
Screening for prostate cancer has intensified, due both to increased patient and physician awareness and to the availability of new, more sensitive diagnostic tools (prostate-specific antigen [PSA], rectal ultrasound, etc.). Consequently, the number of newly diagnosed cases of prostatic cancer is rising rapidly, whereas the frequency of death due to prostate cancer remains almost stable. It must therefore be assumed that the number of patients in whom a diagnosed prostate cancer will not be fatal is also increasing. Consequently, not every prostatic carcinoma requires radical treatment when diagnosed. Also, it must be concluded that not every man who is a long-term survivor after radical prostatectomy owes his survival to the treatment. Long-term survival may reflect the relatively benign biological potential of this disease in an individual patient. Therefore there is an inherent risk of overtreating patients and this must be weighed against the costs, the postoperative morbidity, and the mortality, albeit low, of a radical prostatectomy. Nevertheless, as long as we do not have diagnostic tools which, at an early stage of prostatic cancer, enable us to determine whether a carcinoma will ultimately have a fatal outcome, we are obliged to offer a radical prostatectomy to younger patients (who have a life expectancy of more than 10 years) as long as they have organ-confined disease.
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Affiliation(s)
- U E Studer
- Department of Urology, University of Berne, Switzerland
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19
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Mohler JL, Figlesthaler WM, Zhang XZ, Partin AW, Maygarden SJ. Nuclear shape analysis for the assessment of local invasion and metastases in clinically localized prostate carcinoma. Cancer 1994; 74:2996-3001. [PMID: 7954263 DOI: 10.1002/1097-0142(19941201)74:11<2996::aid-cncr2820741117>3.0.co;2-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Nuclear shape analysis of histologic sections from radical prostatectomy specimens has retrospectively predicted outcome in patients with clinically localized prostate carcinoma. If outcome could be predicted preoperatively by nuclear shape analysis, patients might be selected better for definitive surgical therapy. Morphometric analysis of preoperative biopsies, however, has not correlated positively with values obtained from analysis of prostatectomy specimens. METHODS The nuclear shapes of histologic specimens of 20 organ-confined carcinomas, 10 periprostatic fat-invasive carcinomas, 10 seminal vesicle-invasive carcinomas, and 12 lymph node-metastatic carcinomas from 52 patients who had undergone radical prostatectomy for clinically localized disease were evaluated. RESULTS Nuclei from areas of extraprostatic invasion or regional lymph node metastases were less round than those from the corresponding intraprostatic portion of the tumor (nuclear roundness factor (mean +/- SD) PPF, 51.2 +/- 3.1 vs. 31.2 +/- 3.2; SV, 52.4 +/- 4.1 vs. 31.6 +/- 2.5; and LN, 57.3 +/- 3.1 vs. 36.4 +/- 1.8; paired Student's t tests, P < 0.001). Cells sampled from the periphery of organ-confined tumors had a greater nuclear roundness factor (49.1 +/- 1.5) than did those sampled from the center (34.5 +/- 2.0; P < 0.001) or randomly throughout the tumor (37.8 +/- 1.6; P < 0.001). Nuclear roundness factors for all extraprostatic tumor foci and for peripheral tumor cells in organ-confined disease were similar (analysis of variance, P > 0.05). The intraprostatic portions of randomly sampled primary tumors had similar nuclear roundness factors, regardless of pathologic stage (P > 0.05). Among organ-confined carcinomas, nuclear shape was unrelated to tumor volume. CONCLUSIONS Pathologic stage in clinically localized prostate carcinoma cannot be determined by the nuclear shape profiles of intraprostatic tumor cells. Thus, patients with a poor prognosis or high pathologic stage can be recognized only when samples for morphometric analysis include high proportions of nuclei from the extra-prostatic carcinoma and nuclei from the periphery of organ-confined carcinoma that may not be sampled routinely by prostate biopsy.
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Affiliation(s)
- J L Mohler
- Department of Surgery, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill 27599-7235
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Ross JS, Figge H, Bui HX, del Rosario AD, Jennings TA, Rifkin MD, Fisher HA. Prediction of pathologic stage and postprostatectomy disease recurrence by DNA ploidy analysis of initial needle biopsy specimens of prostate cancer. Cancer 1994; 74:2811-8. [PMID: 7954242 DOI: 10.1002/1097-0142(19941115)74:10<2811::aid-cncr2820741012>3.0.co;2-b] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND DNA ploidy determination of carcinomas in radical prostatectomy specimens has shown significant correlation with patient outcome, but the predictive value of ploidy status of cancers obtained by transrectal ultrasound-guided needle biopsies has not been studied extensively. METHODS Eighty-nine paired needle biopsy specimens (NBX) and radical prostatectomy (RPX) specimens from patients with early clinical stage (A2-B2) prostate cancer were evaluated for DNA content by image analysis of Feulgen stained tissue sections. Findings were compared with Gleason grading on the same specimens by univariate and multivariate analyses for prediction of local tumor invasion, metastasis, disease recurrence, and serum prostate specific antigen concentration during a 0.9-6.0 year clinical follow-up period. RESULTS There was excellent correlation of ploidy status between NBX and RPX specimens (P < 0.0001); NBX and RPX grades did not correlate. On RPX specimens, aneuploid status correlated with high tumor grade (P < 0.0005). Aneuploidy in NBX specimens was associated with a twofold higher rate of extracapsular spread (ECS) (P = 0.04). Aneuploid NBX tumors featured a tenfold greater frequency of metastasis than did diploid NBX tumors (P < 0.005). Radical prostatectomy grade correlated with ECS (P < 0.001) and presence of metastatic disease (P = 0.04). On multivariate logistic regression analysis, aneuploidy in both NBX and RPX specimens was the most significant variable and independently predicted the presence of metastasis (P = 0.006 for NBX; P = 0.028 for RPX). Tumor grade of NBX and RPX specimens did not independently predict metastatic disease or disease recurrence, but RPX grade was associated independently with ECS (P = 0.005). Aneuploid NBX tumors recurred after RPX three times more often than did diploid cases, which was significant on univariate (P < 0.001) and multivariate (P = 0.018) analyses using the Cox proportional hazards model. There was no correlation with NBX or RPX Gleason score and disease recurrence. Preoperative serum PSA concentration did not correlate with tumor grade or ploidy status, but on multivariate analysis, when paired with ploidy status, independently contributed to the propensity for ECS, metastasis, and disease recurrence. CONCLUSIONS DNA content analysis of early clinical stage prostate carcinoma needle biopsy specimens by image analysis directly correlates with radical prostatectomy specimen ploidy status and is associated independently, with the presence of metastasis, postprostatectomy disease recurrence, and ECS. Needle biopsy tumor grading did not correlate with prostatectomy grade and did not predict disease outcome accurately.
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Affiliation(s)
- J S Ross
- Department of Pathology and Laboratory Medicine, Albany Medical College, NY 12208
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Fox SB, Persad RA, Coleman N, Day CA, Silcocks PB, Collins CC. Prognostic value of c-erbB-2 and epidermal growth factor receptor in stage A1 (T1a) prostatic adenocarcinoma. BRITISH JOURNAL OF UROLOGY 1994; 74:214-20. [PMID: 7921940 DOI: 10.1111/j.1464-410x.1994.tb16589.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To determine whether the presence or absence of the oncoproteins epidermal growth factor receptor (EGFR) and c-erbB-2 could predict tumour behaviour. PATIENTS AND METHODS Tissue from 45 stage A1 (T1a) prostatic adenocarcinomas from patients with a mean age of 65 years were immunostained for EGFR (12E) and c-erbB-2 (NCL-CB11). Their expression in the tumour and surrounding benign hyperplastic epithelium was correlated with each other and with survival. RESULTS Forty percent (18 of 45) and 36% (16 of 45) of patients respectively were EGFR and c-erbB-2 positive in the tumour. Expression of these tyrosine kinase oncogenes was not confined to the tumour and the surrounding hyperplastic prostate was also positive for EGFR in 76% (34/45) of patients and for c-erbB-2 in 16% (11 of 45). EGFR and c-erbB-2 expression was weakly associated in both benign and malignant epithelium. Statistical analysis of survival showed that tumour c-erbB-2 expression was associated with a significantly worse prognosis (exact two tailed P = 0.0316), whereas no significant association was observed between EGFR expression and survival (P = 0.737). CONCLUSION As c-erbB-2 expression increases the rate of dying by 4.2 times, recording its expression by these tumours may be useful in selecting patients who would benefit from treatment in stage A1 (T1a) disease.
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Affiliation(s)
- S B Fox
- Department of Pathology, University of Sheffield Medical School, UK
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Leader M, Kay E, Barry Walsh C, Dolan J. Assessment of DNA ploidy: A review of methods and significance. ACTA ACUST UNITED AC 1994. [DOI: 10.1016/s0968-6053(06)80017-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Miller J, Horsfall DJ, Skinner JM, Rao DM, Leong AS, Marshall VR. Nuclear shape and prognosis following orchiectomy in stage D2 prostate cancer. Prostate 1994; 24:306-12. [PMID: 7516069 DOI: 10.1002/pros.2990240606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In this study, we have examined whether tumor grade and morphometric nuclear features can predict the outcome of treatment by orchiectomy in patients with stage D2 prostate cancer. Two outcome groups based on duration of survival postorchiectomy were examined, a bad outcome group of 63 patients who died from prostate cancer within 12 months and a good outcome group of 34 patients who survived beyond 5 years. Tumors were histologically classified as well (17%), moderate (17%), or poorly differentiated (66%). Tumor grade and patient outcome were significantly associated (Mann-Whitney test; P < 0.005), with 76% of poorly differentiated tumors in the bad outcome group, and 65% of well-differentiated tumors in the good outcome group. Using discriminant function analysis, tumor grade correctly predicted outcome in 70% of cases. A statistically significant difference was also detected in nuclear shape values between the two outcome groups (P < 0.05) and histological grades (P < 0.05). Using discriminant function analysis, 51% of cases were correctly classified into outcome groups using nuclear shape factors, a figure which rose to 65% when all nuclear morphometric features were used. This demonstrates that nuclear morphometric features are of no clinical value in predicting the outcome of treatment in stage D2 disease. Furthermore, these evaluations cannot select patients who might be spared orchiectomy on the basis of a predicted poor response. However, nuclear shape and variance measurements of benign glandular epithelial cells within cancerous prostates were significantly different from those of malignant cells (P < 0.005). We conclude that, while video image analysis of prostatic nuclear shape can reliably discriminate between benign and malignant cells, nuclear morphometric features are of minimal prognostic value in men with stage D2 prostate cancer treated by androgen ablation.
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Affiliation(s)
- J Miller
- Department of Surgery, Flinders Medical Centre, Bedford Park, Australia
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Ross JS, Nazeer T, Church K, Amato C, Figge H, Rifkin MD, Fisher HA. Contribution of HER-2/neu oncogene expression to tumor grade and DNA content analysis in the prediction of prostatic carcinoma metastasis. Cancer 1993; 72:3020-8. [PMID: 8106140 DOI: 10.1002/1097-0142(19931115)72:10<3020::aid-cncr2820721026>3.0.co;2-#] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Recent advances in the early detection of prostatic adenocarcinoma have stimulated interest in the development of techniques for determining metastatic potential. METHODS One hundred cases of adenocarcinoma, including 66 biopsy and radical prostatectomy specimens; 20 biopsies alone; and 14 transurethral resection specimens, were evaluated for Gleason tumor grade, DNA content and HER-2/neu expression. DNA content was determined on Feulgen-stained touch preparations and tissue sections (18 cases) or tissue sections alone. HER-2/neu expression level was determined by image-analysis-assisted quantitative immunocytochemistry. RESULTS Tumor grade and ploidy status were independent significant predictors of metastasis. HER-2/neu overexpression was found in 16 (16%) of the 100 cases and significantly correlated with high-tumor grade and aneuploid status, but was not of independent value in the prediction of metastasis. CONCLUSIONS HER-2/neu overexpression is not uncommon in prostatic adenocarcinoma and is associated with high-tumor grade, abnormal DNA content, and distant metastasis. Tumor grade and DNA ploidy values are of the greatest value in determining the presence of metastasis.
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Affiliation(s)
- J S Ross
- Department of Pathology and Laboratory Medicine, Albany Medical College, New York 12208
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Fox SB, Persad RA, Coleman N, Silcocks PB. Natural history of prostate cancer. Lancet 1993; 341:699. [PMID: 8095609 DOI: 10.1016/0140-6736(93)90472-s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Shankey TV, Kallioniemi OP, Koslowski JM, Lieber ML, Mayall BH, Miller G, Smith GJ. Consensus review of the clinical utility of DNA content cytometry in prostate cancer. CYTOMETRY 1993; 14:497-500. [PMID: 8354122 DOI: 10.1002/cyto.990140508] [Citation(s) in RCA: 82] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- T V Shankey
- Department of Urology, Loyola University Medical Center, Maywood 60153
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Boone CW, Kelloff GJ. Intraepithelial neoplasia, surrogate endpoint biomarkers, and cancer chemoprevention. JOURNAL OF CELLULAR BIOCHEMISTRY. SUPPLEMENT 1993; 17F:37-48. [PMID: 8412208 DOI: 10.1002/jcb.240531007] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Neoplasia is a progression of molecular, cellular, and tissue changes starting with a critical cell mutation and advancing by clonal evolution, involving further multiple mutations and expanding mutated clones. This process is characterized by five general stages: latency, focal growth of normal-appearing but disorganized cells, abnormal-appearing cells (dysplasia), microinvasion, and finally, metastasis. The two driving forces of neoplastic progression in an epithelium are mutagenesis and mitogenesis. These forces frequently occur concurrently, produced by exposure of the epithelium to environmental and endogenous mutagens and mitogens. The major strategy of chemoprevention is to block the effects of both mutagens and mitogens during the early stages of predysplasia and dysplasia. Surrogate endpoint biomarkers (SEBs) are tissue, cellular, and molecular changes that correlate with the later development of cancer. Because of the savings in cost, labor, and time, SEBs are urgently needed to replace the use of cancer incidence reduction as the endpoint for chemopreventive agent clinical trials. The advent of computer-assisted cytometry allows each of the seven basic criteria of dysplasia to be individually assayed as an SEB. Since the dysplastic changes that characterize intraepithelial neoplasia are embodied in the causal pathway to invasive neoplasia, they are already validated as predictors of cancer incidence. More attention should be paid to the quality control of SEB assays, including control of variation in cell composition of tissue samples, assay protocol, instrumentation used, and observer performance. The dose-response relationship between a known chemopreventive agent and the SEB should also be evaluated. The Division of Cancer Prevention and Control, National Cancer Institute, has begun a program to test chemopreventive agents in short-term Phase II clinical trials using dysplasia-based SEBs. The SEBs are assayed, when possible, by computerized cytometry. Trials are being conducted for oral leukoplakia, cutaneous actinic keratosis, superficial bladder cancer, pulmonary metaplasia/dysplasia, cervical dysplasia (CIN III), and adenomatous colonic polyps.
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Affiliation(s)
- C W Boone
- Division of Cancer Prevention and Control, National Cancer Institute, National Institutes of Health, Bethesda, MD 20982
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Dalton LW. Computer-based image analysis of prostate cancer: comments with emphasis on use of commercially available systems. Hum Pathol 1992; 23:280-6. [PMID: 1555839 DOI: 10.1016/0046-8177(92)90109-g] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This review is concerned with computer-based image analysis (CBIA) in prostate cancer. The emphasis is placed on evaluating extent and grade of prostate cancer. The quest for reproducibility in these evaluations has provided an important area of possible application for CBIA studies. Commercially available CBIA systems allow an opportunity for increased efforts in studying the merits of CBIA in prostate cancer. Many CBIA systems with various capabilities are currently on the market. They can be described as either "general" or "dedicated" CBIA systems and are exemplified by two systems: the Werner Frei Imlab/Imtool (Werner Frei Associates, Venice, CA) and the CAS 200 (Cell Analysis Systems, Inc, Lombard, IL), respectively. "General" systems are composed of individual components with data being stored and analyzed using a personal computer (Werner Frei Imlab/Imtool). "Dedicated" systems are integrated systems, usually with little variability of either software or hardware specifications (CAS 200). It is helpful to be cognizant of the contrasting abilities provided by these two systems when evaluating which CBIA system would be most appropriate for a particular application in the study of prostate cancer.
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Affiliation(s)
- L W Dalton
- Brackenridge Hospital, Central Texas Medical Foundation, Austin 78701
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