Predictors of Metastasis and Prognosis in Prostate Carcinoma: Immunohistochemical Study of the Role of Neovascularity and Proliferating Cell Nuclear Antigen

Yoo, Tag Keun; Lee, Tchun Yong

Abstract

PURPOSE: The best predictors of prognosis in prostate cancer are the stage of disease and histologic differentiation. But, preoperative prediction of pathologic stage in prostate cancer is currently limited and histologic differentiation may be somewhat subjective. Therefore, more accurate predictors of biological progression are needed. The author designed this study to determine the prediction efficacies of neovascularity and proliferating cell nuclear antigen (PCNA) labeling index using immunohistochemical staining.
MATERIALS AND METHODS
Immunohistochemical stains in 48 cases of prostate cancers and 5 cases of benign prostatic hyperplasia (BPH) were performed and analysed. Microvessels were identified by immunostaining of endothelial cells for factor VIII-related antigen. PCNA labeling indices were obtained in 200X field by counting more than 1,000 cells.
RESULTS
1. The mean microvessel count (MVC) was 34.2+/-5.9 per 200X field in BPH group and 63.5+/-38.6 (p<0.05) in prostate cancer group. The mean MVCs were 32.2, 38.3, 58.8, 78.1 and 86.8, from grade I to V respectively. According to stage, the mean MVCs were 40.8, 48.5, 55.0 and 89.0 from A to D. Between well (grade I-III) and poorly (grade IV-V) differentiated cancer group, there was significant difference in MVC (p<0.05). And also, the difference between localized and metastatic groups was statistically significant. High MVC (MVC->60) group survived longer than low MVC group, but the difference was not significant. 2. The mean PCNA labeling indices were 14.6+/-8.0% in BPH group and 32.3 +/- 15.4% in cancer group. According to Gleason grade, the mean PCNA labeling indices showed 33,4%, 30.8%, 26.3%, 38.0% and 36.6% from I to V respectively. The mean values were 23.1%, 27.4%, 30.4% and 36.2% in stage A, B, C and D. Between localized and metastatic groups, the difference of PCNA labeling index was not statistically significant. The mean survival of high labeling index (>=30%) group was 66.0 +/- 12.2 months contrasted with 72.4 +/- 14.6 months of low labeling index group (p>0.05).
CONCLUSIONS
Microvessel density in prostate adenocarcinoma may be an another prognostic factor supporting clinical stage and histologic differentiation. But negative results were obtained for PCNA labeling index from this study. To further define MVC as a predictor of prostate cancer, more enthusiastic and well designed studies are needed.