by Kwan Yiu Wing. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1999. / Includes bibliographical references (leaves 167-187). / Abstracts in English and Chinese. / ACKNOWLEDGMENTS --- p.IV / ABSTRACT --- p.1 / Chapter CHAPTER 1. --- INTRODUCTION --- p.5 / Chapter I. --- Epidemiology of Prostate Cancer --- p.5 / Chapter II. --- The Normal Prostate - Prostatic Anatomy --- p.9 / Chapter III. --- Pathology of Prostatic Cancers --- p.12 / Chapter CHAPTER 2. --- PROSTATIC INTRAEPITHELIAL NEOPLASIA --- p.16 / Chapter I. --- Introduction --- p.16 / Chapter II. --- "Definition, Characteristics and Grading" --- p.16 / Chapter III. --- Incidence and Prevalence of PIN --- p.26 / Chapter IV. --- Evidence Linking PIN with Prostatic Carcinoma --- p.27 / Chapter V. --- Conclusion --- p.37 / Chapter CHAPTER 3. --- HISTOLOGIC BIOMARKERS --- p.39 / Chapter I. --- p53 Protein --- p.39 / Chapter II. --- Proliferating Cell Nuclear Antigen (PCNA) --- p.44 / Chapter III. --- Ki-67 Antigen --- p.48 / Chapter IV. --- Epidermal Growth Factor Receptor --- p.49 / Chapter V. --- E-Cadherin --- p.51 / Chapter VI. --- CD44 --- p.54 / Chapter VII. --- nm23 --- p.58 / Chapter CHAPTER 4. --- OBJECTIVES OF STUDY --- p.62 / Chapter CHAPTER 5. --- MATERIALS AND METHODS --- p.63 / Chapter I. --- Materials --- p.63 / Chapter II. --- Methods --- p.71 / Chapter III. --- Interpretation of Immunostaining Results --- p.78 / Chapter IV. --- Statistical Analysis --- p.82 / Chapter CHAPTER 6. --- RESULTS --- p.83 / Chapter I. --- Immunohistochemical Results for p53 Protein --- p.83 / Chapter II. --- Results of Immunostaining of PCNA --- p.90 / Chapter III. --- Immunostaining and Quantitation of Ki-67 Expression --- p.97 / Chapter IV. --- Immunohistochemical Expression of EGFr --- p.105 / Chapter V. --- E-Cadherin --- p.110 / Chapter VI. --- CD44 --- p.115 / Chapter VII. --- Expression of nm23 in Prostatic Lesions --- p.122 / Chapter VIII. --- Correlation and Association of Expressions of All Biomarkers in Prostatic Lesions --- p.128 / Chapter CHAPTER 7. --- DISCUSSION --- p.132 / Chapter I. --- p53 Protein --- p.135 / Chapter II. --- PCNA --- p.137 / Chapter III. --- Ki-67 --- p.140 / Chapter IV. --- EGFr --- p.143 / Chapter V. --- E-Cadherin --- p.146 / Chapter VI. --- CD44 --- p.148 / Chapter VII. --- nm23 --- p.151 / Chapter VIII. --- Association between Biomarkers and Prostate lesions --- p.154 / Chapter CHAPTER 8. --- SUMMARY AND CONCLUSION --- p.157 / APPENDICES --- p.164 / Chapter I. --- Table of incidence and mortality rates of prostate cancer in the United States from 1973 to 1995 by race --- p.164 / Chapter II. --- Table of leading cancer deaths in Hong Kong from 1971 to 1996 --- p.165 / Chapter III. --- Table of incidence and mortality rate caused by prostate cancer in Hong Kong --- p.166 / Chapter IV. --- Reagents --- p.167 / REFERENCES --- p.169

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 5 uppsatser.

High grade intraepithelial neoplasia (HGPIN) and atypical small acinar proliferation (ASAP) are two pathological lesions associated with prostate adenocarcinoma. HGPIN is an architectural finding, while ASAP is a term used to describe a lesion that cannot confidently be diagnosed as prostate adenocarcinoma. The mean incidence rate for HGPIN is 7.7% with a median of 5.2% and range of 0-24.6% and the cancer detection rate mean is 18.1%. The mean incidence rate for ASAP is 5.0% with a median of 4.4% and a range of 0.7-23.4%. The mean cancer detection rate is 40.2%. Currently, the incidence and cancer detection rates for HGPIN and ASAP for Winnipeg, Manitoba, have not been published. A retrospective study was conducted on all prostate biopsies collected from the Manitoba Cancer Care Prostate Centre (MCCPC) from 2008 and 2009. Prostate biopsies with a diagnosis of isolated HGPIN and or ASAP and no previous history of cancer were included in this study. In Winnipeg, Manitoba, from 2008-2009, the mean HGPIN incidence rate was 5.0% and the mean cancer detection rate was 46.1%. The mean ASAP incidence rate was 4.6% and the mean cancer detection rate of 48.2%. As a control, the cancer detection rate following a benign diagnosis was also calculated at 33.3%. The mean incidence and cancer detection rates for HGPIN and ASAP for Winnipeg, Manitoba are slightly lower than literature, but still fall within the published range. In addition, the mean ASAP cancer detection rate is similar to the cancer detection rate following a benign diagnosis indicating that, in our study, both a benign finding and a diagnosis of ASAP hold the same predictive value for cancer on a subsequent re-biopsy.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 4 uppsatser.

O cão é a única espécie, além do homem, em que o câncer de próstata (CP), a neoplasia intraepitelial prostática (PIN) e a hiperplasia prostática benigna (HPB) ocorrem espontaneamente, permitindo dessa forma que se realize estudo comparativo de afecções benignas e malignas da próstata. Acredita-se que a existência de stem cells malignas, localizadas na camada de células basais da próstata, seja um dos fatores responsáveis pelo insucesso da terapia por ablação androgênica que ocorre na maioria dos carcinomas prostáticos avançados. O objetivo deste estudo foi caracterizar a próstata canina quanto a aspectos envolvidos na evolução para o carcinoma prostático, tentando identificar a origem celular e as alterações das lesões pré-neoplásicas. Foram obtidas 44 próstatas na necrópsia. Amostras prostáticas foram fixadas em metacarne, embebidas em parafina e seccionadas a 5µm para a coloração com hematoxilina eosina (HE) e avaliadas em relação à presença de hiperplasia, prostatite, PIN e neoplasia. Além disso, cortes corados em HE representando cada afecção foram utilizados na determinação da área nuclear média por morfometria computadorizada. Cortes histológicos obtidos em lâminas silanizadas foram utilizados na imunoistoquímica para células basais (p63 e 34E-12), conexinas 32 e 43, receptor de andrógeno (AR) e antígeno nuclear de proliferação celular (PCNA). Amostras foram coletadas também em nitrogênio líquido e mantidas a 80o C para a realização do PCR quantitativo em tempo real, para a determinação da expressão do RNAm do AR, e para a realização do Western blot, para a determinação da expressão da conexina 43. As afecções mais freqüentes foram a prostatite e a hiperplasia prostática benigna. Foi observada uma maior porcentagem de células basais e um alto índice proliferativo, como demonstrado pela imunoistoquímica para o PCNA, na neoplasia intraepitelial prostática. Além disso, observou-se nessas lesões marcação nuclear heterogênea para o AR, menor em relação à dos ácinos benignos. Ao contrário do observado na próstata humana, não foi observada expressão das conexinas 32 e 43 na próstata canina (normal ou com PIN). A área nuclear média, obtida pela morfometria computadorizada, foi maior em células epiteliais de ácinos apresentando PIN e/ou neoplasia em relação à de células epiteliais de ácinos benignos. Observou-se expressão variável do RNAm para o AR nas PINs e neoplasias, utilizando-se o PCR em tempo real. Estes achados sugerem que células basais malignas desempenham papel na origem da neoplasia intraepitelial prostática e possuem capacidade de proliferar a despeito da expressão heterogênea do receptor de andrógeno. / Dogs are the only animal other than man to develop prostate cancer, prostatic intraepithelial neoplasia (PIN) and benign prostatic hyperplasia (HPB) spontaneously, allowing the comparison between benign and malignat affections of prostate. Malignant stem cells among the basal cell layer of the prostate are believed to play an important role in the failure of androgen-ablation therapy that occurs in most advanced prostate cancer. The goal of this study was to characterize the canine prostate in relation to evolution to prostatic carcinoma, trying to identify the cellular origin and the alterations of pre-neoplastic lesions. Forty-four canine prostates were obtained at necropsy. Prostatic samples were fixed in methacarn, embedded in paraffin wax and sectioned into 5µm-thick slices for hematoxylin eosin (HE) staining and evaluated for the presence of hyperplasia, prostatitis, PIN and neoplasia. Moreover, HE stained sections representing each affection were used to determine the mean nuclear area by computerized morphometry. Tissue sections obtained in silanized slides were used in immunohistochemical staining for basal cells (p63 and 34E-12), connexins 32 and 43, androgen receptor (AR) and proliferating-cell nuclear antigen (PCNA). Quantitative real-time PCR to determine the expression level of AR at the mRNA level and Western blot to protein levels of connexin 43 were examined in samples collected using liquid nitrogen and kept at 80o C. The most common lesions were prostatitis and benign prostatic hyperplasia. The prostatic intraepithelial neoplasia exhibited a higher percent of basal cells and was highly proliferative, as demonstrated by PCNA immunohistochemistry. Moreover, these lesions exhibited heterogeneous nuclear AR staining, lower in comparision with benign acini. In contrast to human prostate, the canine prostate (normal or harboring PIN) did not express the connexins 32 and 43. The mean nuclear area measured by computerized morphometry was greater in epithelial cells of PIN and neoplastic acini than that of benign acini. We found variable RNAm AR expression in prostatic intraepithelial neoplasia and neoplasia by real-time PCR. These findings suggest that malignant basal cells may play a role in the origin of PIN and can proliferate despite the heterogeneous AR expression.

O cão é a única espécie, além do homem, em que o câncer de próstata (CP), a neoplasia intraepitelial prostática (PIN) e a hiperplasia prostática benigna (HPB) ocorrem espontaneamente, permitindo dessa forma que se realize estudo comparativo de afecções benignas e malignas da próstata. Acredita-se que a existência de stem cells malignas, localizadas na camada de células basais da próstata, seja um dos fatores responsáveis pelo insucesso da terapia por ablação androgênica que ocorre na maioria dos carcinomas prostáticos avançados. O objetivo deste estudo foi caracterizar a próstata canina quanto a aspectos envolvidos na evolução para o carcinoma prostático, tentando identificar a origem celular e as alterações das lesões pré-neoplásicas. Foram obtidas 44 próstatas na necrópsia. Amostras prostáticas foram fixadas em metacarne, embebidas em parafina e seccionadas a 5µm para a coloração com hematoxilina eosina (HE) e avaliadas em relação à presença de hiperplasia, prostatite, PIN e neoplasia. Além disso, cortes corados em HE representando cada afecção foram utilizados na determinação da área nuclear média por morfometria computadorizada. Cortes histológicos obtidos em lâminas silanizadas foram utilizados na imunoistoquímica para células basais (p63 e 34E-12), conexinas 32 e 43, receptor de andrógeno (AR) e antígeno nuclear de proliferação celular (PCNA). Amostras foram coletadas também em nitrogênio líquido e mantidas a 80o C para a realização do PCR quantitativo em tempo real, para a determinação da expressão do RNAm do AR, e para a realização do Western blot, para a determinação da expressão da conexina 43. As afecções mais freqüentes foram a prostatite e a hiperplasia prostática benigna. Foi observada uma maior porcentagem de células basais e um alto índice proliferativo, como demonstrado pela imunoistoquímica para o PCNA, na neoplasia intraepitelial prostática. Além disso, observou-se nessas lesões marcação nuclear heterogênea para o AR, menor em relação à dos ácinos benignos. Ao contrário do observado na próstata humana, não foi observada expressão das conexinas 32 e 43 na próstata canina (normal ou com PIN). A área nuclear média, obtida pela morfometria computadorizada, foi maior em células epiteliais de ácinos apresentando PIN e/ou neoplasia em relação à de células epiteliais de ácinos benignos. Observou-se expressão variável do RNAm para o AR nas PINs e neoplasias, utilizando-se o PCR em tempo real. Estes achados sugerem que células basais malignas desempenham papel na origem da neoplasia intraepitelial prostática e possuem capacidade de proliferar a despeito da expressão heterogênea do receptor de andrógeno. / Dogs are the only animal other than man to develop prostate cancer, prostatic intraepithelial neoplasia (PIN) and benign prostatic hyperplasia (HPB) spontaneously, allowing the comparison between benign and malignat affections of prostate. Malignant stem cells among the basal cell layer of the prostate are believed to play an important role in the failure of androgen-ablation therapy that occurs in most advanced prostate cancer. The goal of this study was to characterize the canine prostate in relation to evolution to prostatic carcinoma, trying to identify the cellular origin and the alterations of pre-neoplastic lesions. Forty-four canine prostates were obtained at necropsy. Prostatic samples were fixed in methacarn, embedded in paraffin wax and sectioned into 5µm-thick slices for hematoxylin eosin (HE) staining and evaluated for the presence of hyperplasia, prostatitis, PIN and neoplasia. Moreover, HE stained sections representing each affection were used to determine the mean nuclear area by computerized morphometry. Tissue sections obtained in silanized slides were used in immunohistochemical staining for basal cells (p63 and 34E-12), connexins 32 and 43, androgen receptor (AR) and proliferating-cell nuclear antigen (PCNA). Quantitative real-time PCR to determine the expression level of AR at the mRNA level and Western blot to protein levels of connexin 43 were examined in samples collected using liquid nitrogen and kept at 80o C. The most common lesions were prostatitis and benign prostatic hyperplasia. The prostatic intraepithelial neoplasia exhibited a higher percent of basal cells and was highly proliferative, as demonstrated by PCNA immunohistochemistry. Moreover, these lesions exhibited heterogeneous nuclear AR staining, lower in comparision with benign acini. In contrast to human prostate, the canine prostate (normal or harboring PIN) did not express the connexins 32 and 43. The mean nuclear area measured by computerized morphometry was greater in epithelial cells of PIN and neoplastic acini than that of benign acini. We found variable RNAm AR expression in prostatic intraepithelial neoplasia and neoplasia by real-time PCR. These findings suggest that malignant basal cells may play a role in the origin of PIN and can proliferate despite the heterogeneous AR expression.

ABSTRACT The morphological premalignant changes in prostate epithelium such as high grade prostatic intraepithelial neoplasia (HGPIN) precede invasive prostate cancer (PC) by several decades. The overall aim of this project was to identify patterns of gene expression in HGPIN and early PC which increase our understanding of the early biology of PC and identify genes and pathways that correlate with an aggressive phenotype. A comprehensive tissue cohort of premalignant prostate lesions was collected in a tissue microarray (TMA) platform that was utilised for high-throughput validation of target genes. Using this unique resource, the expression of the tumour suppressor gene PTEN was assessed using immunohistochemistry in an initial candidate gene approach based on mouse models implicating PTEN in carcinogenesis. No significant difference in expression of PTEN was detected in premalignant and benign epithelium. A transcript profiling approach was undertaken by integrating laser capture microdissection, linear RNA amplification and oligonucleotide microarrays to perform a screen of matched patient samples of normal, HGPIN and PC cells. The expression patterns of two genes encoding secreted proteins, neuropeptide Y (NPY) and macrophage inhibitory cytokine (MIC-1) were validated using immunohistochemistry on TMAs representing the progression model of early PC. Increased expression of these proteins in PC was confirmed to occur early in the disease process and altered expression of NPY and MIC-1 was associated with worse clinical outcome. Further analysis of global gene expression patterns using a structured network knowledge base identified a notable aberration in the expression of extracellular matrix and extracellular matrix associated proteins in HGPIN and provided novel evidence for the role of this class of molecules in the development of PC. In summary, contrary to current dogma based on work in animal models, altered PTEN expression is unlikely to represent an important event in the development of malignancy in the human prostate. In contrast, the expression patterns and prognostic value of NPY and MIC-1 in HGPIN support their further evaluation as biomarkers for the development and progression of PC. The aberrant expression of genes and networks of genes detected in HGPIN will assist in further identification of biological pathways which may be targeted in therapeutic strategies against the development and progression of PC.

ABSTRACT The morphological premalignant changes in prostate epithelium such as high grade prostatic intraepithelial neoplasia (HGPIN) precede invasive prostate cancer (PC) by several decades. The overall aim of this project was to identify patterns of gene expression in HGPIN and early PC which increase our understanding of the early biology of PC and identify genes and pathways that correlate with an aggressive phenotype. A comprehensive tissue cohort of premalignant prostate lesions was collected in a tissue microarray (TMA) platform that was utilised for high-throughput validation of target genes. Using this unique resource, the expression of the tumour suppressor gene PTEN was assessed using immunohistochemistry in an initial candidate gene approach based on mouse models implicating PTEN in carcinogenesis. No significant difference in expression of PTEN was detected in premalignant and benign epithelium. A transcript profiling approach was undertaken by integrating laser capture microdissection, linear RNA amplification and oligonucleotide microarrays to perform a screen of matched patient samples of normal, HGPIN and PC cells. The expression patterns of two genes encoding secreted proteins, neuropeptide Y (NPY) and macrophage inhibitory cytokine (MIC-1) were validated using immunohistochemistry on TMAs representing the progression model of early PC. Increased expression of these proteins in PC was confirmed to occur early in the disease process and altered expression of NPY and MIC-1 was associated with worse clinical outcome. Further analysis of global gene expression patterns using a structured network knowledge base identified a notable aberration in the expression of extracellular matrix and extracellular matrix associated proteins in HGPIN and provided novel evidence for the role of this class of molecules in the development of PC. In summary, contrary to current dogma based on work in animal models, altered PTEN expression is unlikely to represent an important event in the development of malignancy in the human prostate. In contrast, the expression patterns and prognostic value of NPY and MIC-1 in HGPIN support their further evaluation as biomarkers for the development and progression of PC. The aberrant expression of genes and networks of genes detected in HGPIN will assist in further identification of biological pathways which may be targeted in therapeutic strategies against the development and progression of PC.

ABSTRACT The morphological premalignant changes in prostate epithelium such as high grade prostatic intraepithelial neoplasia (HGPIN) precede invasive prostate cancer (PC) by several decades. The overall aim of this project was to identify patterns of gene expression in HGPIN and early PC which increase our understanding of the early biology of PC and identify genes and pathways that correlate with an aggressive phenotype. A comprehensive tissue cohort of premalignant prostate lesions was collected in a tissue microarray (TMA) platform that was utilised for high-throughput validation of target genes. Using this unique resource, the expression of the tumour suppressor gene PTEN was assessed using immunohistochemistry in an initial candidate gene approach based on mouse models implicating PTEN in carcinogenesis. No significant difference in expression of PTEN was detected in premalignant and benign epithelium. A transcript profiling approach was undertaken by integrating laser capture microdissection, linear RNA amplification and oligonucleotide microarrays to perform a screen of matched patient samples of normal, HGPIN and PC cells. The expression patterns of two genes encoding secreted proteins, neuropeptide Y (NPY) and macrophage inhibitory cytokine (MIC-1) were validated using immunohistochemistry on TMAs representing the progression model of early PC. Increased expression of these proteins in PC was confirmed to occur early in the disease process and altered expression of NPY and MIC-1 was associated with worse clinical outcome. Further analysis of global gene expression patterns using a structured network knowledge base identified a notable aberration in the expression of extracellular matrix and extracellular matrix associated proteins in HGPIN and provided novel evidence for the role of this class of molecules in the development of PC. In summary, contrary to current dogma based on work in animal models, altered PTEN expression is unlikely to represent an important event in the development of malignancy in the human prostate. In contrast, the expression patterns and prognostic value of NPY and MIC-1 in HGPIN support their further evaluation as biomarkers for the development and progression of PC. The aberrant expression of genes and networks of genes detected in HGPIN will assist in further identification of biological pathways which may be targeted in therapeutic strategies against the development and progression of PC.

Le cancer de la prostate est la forme de cancer la plus fréquente et la troisième cause de décès par cancer chez l’homme dans les sociétés occidentales. Alors que la plupart des cancers de la prostate localisés sont éradiqués chirurgicalement, la plupart des tumeurs métastatiques répondant initialement aux thérapies par privation d’androgènes deviennent résistantes au traitement, causant généralement le décès du patient. Les gènes suppresseurs de tumeur PTEN et p53 étant fréquemment mutés dans les cancers de la prostate métastatiques et résistants à la castration, le laboratoire d’accueil a généré des modèles murins dans lesquels Pten et/ou Trp53 sont sélectivement invalidés à l’âge adulte dans les cellules épithéliales prostatiques dans le but de déterminer les évènements clés conduisant à la progression du cancer de la prostate. Notre étude révèle que l’invalidation de PTEN stimule la prolifération des cellules épithéliales prostatiques et conduit à des néoplasmes prostatiques intraépithéliaux en quelques mois. Cette hyper-prolifération induit un stress réplicatif et une réponse aux dommages de l’ADN qui va conduire à un arrêt progressif de la croissance cellulaire et une entrée en sénescence. Les cellules sénescentes sécrètent de nombreuses cytokines et de chimiokines, et peuvent accumuler des mutations contribuant ainsi à la progression de la tumeur. Il est notable qu’en l’absence de Trp53, les épithéliums prostatiques dépourvus de Pten développent des néoplasmes prostatiques intraépithéliaux entrant en sénescence. Cependant, la formation d’adénocarcinomes est accélérée et des tumeurs sarcomatoïdes pouvant générer à long terme des métastases apparaissent. En l’absence de Pten, certaines cellules épithéliales prostatiques perdent leur identité moléculaire en exprimant des marqueurs caractéristiques de cellules souches et différenciation neuroendocrinienne. Nous avons également mis en évidence des cellules épithéliales prostatiques déficientes en PTEN et p53 résistantes à la castration exprimant à la fois des marqueurs de cellules basales et luminales. En conclusion, nos travaux ont permis une avancée dans la compréhension des mécanismes conduisant à des formes incurables de cancer de la prostate. Les traitements actuels ayant des effets secondaires importants et pouvant générer des résistances, le développement de nouvelles stratégies thérapeutiques permettant l’élimination des cellules sénescentes mais aussi des cellules épithéliales prostatiques exprimant des marqueurs de cellules basales et luminales dans les lésions précancéreuses représente des perspectives intéressantes pour traiter le cancer de la prostate. / Prostate cancer (PCa) is a leading cause of male cancer death worldwide. While most locally PCa are curable, metastatic tumors initially respond to androgen deprivation therapy but ultimately relapse to castration-resistant prostate cancer (CRPC), which is a lethal disease. Since the tumor suppressor genes PTEN and p53 are frequently mutated in metastatic and CRPC, the host laboratory generated mouse models in which Pten and/or Trp53 are selectively ablated in adult prostatic epithelial cells (PECs) in order to unravel the key events leading to prostate cancer progression. Our study reveals that Pten ablation stimulates PECs proliferation forming prostatic intraepithelial neoplasia (PIN) within a few months. This hyper-proliferation induces replicative stress and a DNA damage response (DDR), which in turn leads to a progressive growth arrest with characteristics of cell senescence. As senescent cells secrete a large number of cytokines and chemokines, and can accumulate other mutations, they might contribute to tumor progression. Importantly, in the absence of Trp53, most Pten-null PECs develop PINs that enter senescence. However partial loss of PECs identity is detected as we show enhanced stemness and focal neuroendocrine differentiation of luminal Pten-null PECs. In some cases, adenocarcinoma and sarcomatoid tumors are formed, and more than one-third of the latter develop metastases. Strikingly, we also show formation of a castrate-resistant cell entity of both Pten and Pten/Trp53-null PECs sharing luminal and basal markers. Taken together, as current treaments lead to side effects and resistance, the development of therapeutic strategies to eliminate senescent cells/and or PECs expressing luminal and basal/stem progenitor in pre- cancerous lesions represents promising option for prostate cancer treatment.