Comparison of annexin II, p63 and alpha-methylacyl-CoA racemase immunoreactivity in prostatic tissue: a tissue microarray study

BACKGROUND: Current ancillary markers for diagnosis in prostate biopsies include p63 and alpha-methylacyl-CoA racemase (AMACR). Annexin II (ANXII), a calcium and phospholipid binding protein, is lost in prostate cancer. AIMS: To investigate ANXII expression in order to assess its utility as a novel diagnostic marker in comparison to p63 and AMACR. METHODS: Using immunohistochemistry on six tissue microarrays, ANXII, p63, and AMACR expression was analysed from 210 radical prostatectomy cases. Staining was evaluated in benign and atrophic glands, high-grade prostatic intraepithelial neoplasia (HGPIN), and prostatic adenocarcinoma. Separate scores were given for ANXII, AMACR and p63 expression. RESULTS: Diffuse cytoplasmic expression of ANXII correlated with p63 reactivity in basal cells. Benign glands were positive for ANXII in 286/292 cores (98%) and negative for AMACR in all 292 cores. HGPIN showed heterogeneous expression of AMACR and ANXII. A significantly larger proportion of HGPIN glands were correctly identified as ANXII negative than as positive for AMACR. ANXII loss in prostate cancer was found in 282/320 cores (88%) and correlated with positive AMACR expression (272/320 cores, 85%), which was not statistically significant. There was no statistically significant correlation between ANXII scores and the clinical parameters examined. CONCLUSIONS: Immunohistochemical staining for ANXII is a consistent and reliable marker of prostatic neoplasia. The findings of this study suggest the potential utility of ANXII as a diagnostic aid in prostate cancer histopathology.     

A narrative review of pelvic lymph node dissection in prostate cancer

Pelvic lymph node dissection (PLND) is an important component in the staging and prognostication of prostate cancer. We performed a narrative review to assess the literature surrounding PLND: (I) the current guideline recommendations and contemporary utilization, (II) the calculation of patient-specific risk to perform PLND using available nomograms, (III) to review the extent of dissection, and its associated outcomes and complications. Due to the improved lymph node yield, better staging, and theoretical improvement in the control of micro-metastatic disease, guidelines have supported the use of (extended-) PLND in patients deemed to be at intermediate or high risk of lymph node involvement (often at a threshold of 5% on modern risk nomograms). However, in practice, real-world utilization of PLND varies considerably due to multiple reasons. Conflicting evidence persists with no clear oncological benefit to PLND, and a small, but important, risk of morbidity. Complications are rare, but include lymphoceles; thromboembolic events; and more rarely, obturator nerve, vascular, and ureteric injury. Furthermore, changing disease incidence and stage migration in the context of earlier detection overall have led to a decreased risk of nodal disease. The trade-offs between the benefits, harms, and risk tolerance/threshold must be carefully considered between each patient and their clinician.     

Health-related quality of life following radical prostatectomy: long-term outcomes

Purpose

To identify the health-related quality of life (HRQoL) domains that radical prostatectomy (RP) impacts most negatively and to define the recovery of these domains over 30 months of observation.

Patients and methods

A total of 1,200 RP patients completed the Patient-Oriented Prostate Utility Scale-Psychometric (PORPUS-P; range 0–100, higher is better), a prostate cancer-specific HRQoL measure, prior to RP and at 0–3 (T1), 3–9 (T2), 9–18 (T3) and 18–30 (T4) months post-RP. HRQoL changes were examined using paired t tests and a mixed-effect growth curve model. Multivariable analyses were performed to investigate demographic and treatment factors predicting the change in HRQoL.

Results

Mean baseline PORPUS-P score, 83.1, fell to 66.5 (p < 0.001) at T1. Over time HRQoL improved but did not return to baseline (T4 mean 76.4, p < 0.001). Domain analysis revealed that sexual function (p < 0.001), sexual drive (p < 0.001), energy (p = 0.001) and bladder control (p < 0.001) failed to return to baseline at T4. Sexual function demonstrated the greatest impairment overall. The multivariable model revealed Black men experienced greater losses in global HRQoL compared with White men (coefficient ?2.77, 95 % CI ?5.00 to ?0.54, p = 0.015). High baseline HRQoL, pro-erectile aid use and bilateral nerve-sparing were significantly associated with smaller reductions in HRQoL post-RP.

Conclusion

Overall HRQoL, sexual drive, sexual function, energy and bladder control do not return to preoperative levels within 30 months post-RP. Black patients experience the greatest reductions in HRQoL. HRQoL losses may be ameliorated by use of pro-erectile aids. These findings help to identify at-risk patient populations and inform survivorship programs.