The impact of Skp2 overexpression on recurrence-free survival following radical prostatectomy.

BACKGROUND: In several human cancers, overexpression of Skp2 (S-phase kinase associated protein 2), which targets p27 for degradation, portends a poorer prognosis. We examined whether Skp2 overexpression is associated with recurrence following radical prostatectomy (RP) for prostate cancer. METHODS: Immunohistochemical staining for Skp2, p27, and MIB-1 was performed on 109 men with node-negative prostate cancer surgically managed from 1985-1996. Associations between the stains were tested and Cox regression was used to determine the association between Skp2 expression and time to biochemical recurrence following RP. RESULTS: The 12 tumors (11%) with Skp2 overexpression all had correspondingly low p27 expression (P=0.006), and a similar inverse Skp2/p27 relationship was seen in vitro in LNCap cells. Skp2 overexpression in tissue was associated with higher Gleason score (P=0.002), more advanced pathological stage (P=0.01), and higher MIB-1 index (P=0.03), but a more favorable PSA profile (P=0.04). Five men received a TURP. Among 104 who received RP, median follow-up was 67 months (range: 0.2-218). After adjusting for PSA, pathologic stage, and Gleason score, Skp2 overexpression remained significantly associated with a shorter time to biochemical recurrence (adjusted hazard ratio 4.8 (95% C.I. 1.6-14, P=0.004)). The median time to recurrence with high vs. low Skp2 was 4 vs. 54 months. CONCLUSIONS: Skp2 overexpression was seen in a significant minority of surgically-managed men and was independently associated with a higher risk of recurrence, raising the possibility that Skp2 could be useful as a prognostic biomarker and as a potential molecular target for novel systemic agents in prostate cancer.

The role of the pathologist in diagnosing prostate cancer and guiding therapy.

In summary, the role of the pathologist has proven indispensable in diagnosing prostate cancer, planning initial therapy, assessing prognosis, estimating the likely benefit of adjuvant therapy following prostatectomy or radiation therapy, and in following patients for possible recurrent disease. Moreover, the work of pathologists has been pivotal in the research that has lead to our present understanding of the natural history of prostate cancer and the present methods for estimating the likelihood of benefit from various therapies. Such work continues to be integral to scientific advancement in these areas.

Prostate carcinoma tissue proteomics for biomarker discovery.

BACKGROUND: The advent of the prostate-specific antigen (PSA) test has had a profound impact on the diagnosis and treatment of prostate carcinoma. However, the use of PSA levels alone for screening for prostate carcinoma was compromised by the variations in the amount of PSA produced by the benign prostatic tissue specimens. Proteins were involved in various pathways that determine the behavior of a cell. Therefore, information regarding proteins may reveal drug targets and/or markers for early detection. METHODS: The authors used surface-enhanced laser desorption/ionization time-of-flight mass spectrometry to determine the protein profiles from fresh tissues of the prostate. Laser capture microdissection was performed to isolate pure populations of cells. RESULTS: The authors identified a protein with an average m/Z of 24,782.56 +/- 107.27 that was correlated with the presence of prostate carcinoma. Furthermore, using laser capture microdissection, they demonstrated that the origin of this protein, which the authors designated PCa-24, was derived from the epithelial cells of the prostate. PCa-24 expression was detected in 16 of 17 (94%) prostate carcinoma specimens but not in paired normal cells. In addition, this protein was not expressed in any of the 12 benign prostatic hyperplasia specimens that were assayed. CONCLUSIONS: PCa-24 may be useful a marker for prostate carcinoma.

A nuclear form of the heparin-binding epidermal growth factor-like growth factor precursor is a feature of aggressive transitional cell carcinoma.

Heparin-binding epidermal growth factor-like growth factor (HB-EGF), a member of the ErbB receptor ligand family, exists in distinct molecular forms with disparate biological activities. Previous studies have shown that the HB-EGF precursor, proHB-EGF, localizes to the cytoplasm of transitional cells of the human bladder urothelium and that the soluble form of the growth factor is an autocrine urothelial cell mitogen. In this study, we identify a potential role for proHB-EGF in transitional cell carcinoma (TCC) of the bladder. In an analysis of 33 TCC specimens and 8 normal controls, proHB-EGF, identified using an antibody directed against the cytoplasmic tail domain, localized to cell nuclei in a manner that correlated positively with tumor stage and grade (P < 0.001). The ability of proHB-EGF to localize to the nucleus was independently confirmed in a TCC cell line (TCCSUP), in which approximately 40% of transfected proHB-EGF was found to reside in the nuclear compartment. In Kaplan-Meier survival analysis, TCC patients with >20% proHB-EGF-positive cell nuclei demonstrated markedly reduced survival compared with patients with <20% proHB-EGF-positive nuclei (P < 0.005, log-rank test). In multivariate analysis, nuclear localization of proHB-EGF of >20% was an independent prognostic indicator of disease-specific mortality. This is the first report in any cell type that HB-EGF is capable of translocating to the cell nucleus. In addition, our findings suggest that nuclear proHB-EGF may play a role in disease progression in bladder cancer and possibly other cancers.

Diagnostic utility of immunohistochemical staining for p63, a sensitive marker of prostatic basal cells.

Diagnostically reliable identification of prostatic basal cells has depended on staining for high molecular weight cytokeratin. The diagnosis of malignancy is often based on the absence of basal cells. False-negative staining is occasionally observed. Thus, a second method of identifying basal cells might prove useful. Selective expression of p63, a homologue of p53, has been demonstrated in prostatic basal cells. We investigated the diagnostic utility of p63 staining in 70 consecutive specimens for which the differential diagnosis included prostatic adenocarcinoma: 68 needle biopsies and 2 transurethral resection blocks. High molecular weight cytokeratin staining was the gold standard when material was available. A total of 61 specimens were diagnosed as carcinoma, 4 as atrophy, 2 as high-grade prostatic intraepithelial neoplasia, 2 as unclassified collections of benign glands, and 1 as carcinoma versus high-grade prostatic intraepithelial neoplasia. Sections mounted on charged slides were used for p63 staining for 14 specimens. Sections previously hematoxylin and eosin stained on uncharged slides were used for 56 specimens. In every case in which there was successful p63 staining (55 specimens), basal cells in benign lesions were properly marked and other cell types were not stained. Uninformative staining in the remaining 15 specimens was due to failure of tissue adherence in 14 specimens in which sections were on uncharged slides and, in 1 specimen, to poor positive internal control staining of benign glands. Thus, p63 staining was informative in 55 of 56 specimens (98%) for which there was material for examination. No case with satisfactory p63 and high molecular weight staining showed disagreement between the two stains. An additional group of 21 transurethral resection specimens was stained (p63 and high molecular weight cytokeratin). There was less false-negative staining for p63 compared with the case of high molecular weight cytokeratin. No false-positive staining was seen. We conclude that p63 staining is at least as sensitive and specific for the identification of basal cells in diagnostic prostate specimens as is high molecular weight cytokeratin staining.

An objective measure of architectural complexity and proliferative index in Gleason pattern 3 prostate cancer.

OBJECTIVE: To objectively characterize the architectural spectrum of Gleason pattern 3 prostate cancer (PCA) in a biologically meaningful manner. STUDY DESIGN: We define an objective architectural feature of PCA, "pinch point density" (PPD), and explore its relationship to proliferative index (PI). A pinch point (PP) is a site where the epithelium of two neighboring glandular structures is contiguous in one histologic section but not in an adjacent serial section. Seventeen radical prostatectomy specimens with areas of pure Gleason pattern 3 were studied. PPD was measured with computer aid using digital images of serial sections. PI was measured by computer-aided counting of Ki-67-positive cells. RESULTS: PPD correlated inversely with PI (PPD vs. log [PI], P < .004). Characteristics not significantly correlated with PI included total number of malignant glands, PP per gland and total number of malignant cells. Subjectively, tumors with high PPD and low PI tended to contain a larger number of smaller glands as compared to tumors with low PPD and high PI. This impression was confirmed analytically. CONCLUSION: PPD is an objective architectural feature of possible biologic significance. This is an early step toward identifying objective features of growth pattern in Gleason pattern 3 PCA that may be clinically meaningful.

Percentage of core lengths involved with prostate cancer: does it add to the percentage of positive prostate biopsies in predicting postoperative prostate-specific antigen outcome for men with intermediate-risk prostate cancer?

OBJECTIVES: To evaluate whether the percentage of core lengths involved with prostate cancer added clinically significant information concerning the time to postoperative prostate-specific antigen (PSA) failure in the intermediate-risk patient beyond what is provided by the percentage of positive biopsies. METHODS: Cox regression multivariable analysis was performed to compare the ability of the two measurements of biopsy cancer volume to predict the time to PSA failure from a series of 184 surgically treated intermediate-risk patients. PSA outcome was estimated using the actuarial method of Kaplan and Meier, and comparisons were made using the log-rank test. RESULTS: Both the percentage of core lengths involved with prostate cancer (P = 0.01) and the percentage of positive biopsies (P = 0.002) were significant predictors of the time to PSA failure on univariable analysis. The 4-year PSA outcome was 83% versus 47% (P = 0.0008) and 83% versus 53% (P = 0.007) for the percentage of positive biopsies stratified by 50% or less versus greater than 50% and the percentage of core lengths involved with prostate cancer stratified by 25% or less versus greater than 25%, respectively. However, only the percentage of positive biopsies remained significant (P = 0.03) on multivariable analysis. CONCLUSIONS: The percentage of core lengths involved with prostate cancer did not provide additional clinically relevant information to the percentage of positive biopsies for patients with intermediate-risk prostate cancer. Therefore, the routine measurement of core involvement may not be necessary in this patient population.