Prostate Cancer - Old Problems and New Approaches Part II.

Diagnostic and Prognostic Markers, Pathology and Biological Aspects

Kenneth V HONN1, Amer AREF1, Yong Q CHEN2, Michael CHER3, John D CRISSMAN2, Jeffrey D FORMAN1, Xiang GAO1, David GRIGNON2, Maha HUSSAIN4, Arthur T PORTER1, J Edson PONTES3, Isaac POWELL3, Bruce REDMAN4, Wael SAKR2, Richard SEVERSON5, Dean G TANG1, David P WOOD Jr.3

1Department of Radiation Oncology, Wayne State University, Detroit, USA
2Department of Pathology, Wayne State University, Detroit, USA
3Department of Urology, Wayne State University, Detroit, USA
4Department of Medicine, Wayne State University, Detroit, USA
5Department of Family Medicine, Wayne State University, Detroit, USA
6Barbara Ann Karmanos Cancer Institute, Detroit Medical Center, Detroit, USA


Diagnostic and prognostic markers for prostatic cancer (PCa) include conventional protein markers (e.g., PAP, PSA, PSMA, PIP, OA-519, Ki-67, PCNA, TF, collagenase, and TIMP 1), angiogenesis indicator (e.g., factor VIII), neuroendocrine differentiation status, adhesion molecules (E-cadherin, integrin), bone matrix degrading products (e.g., ICPT), as well as molecular markers (e.g., PSA, PSMA, p53, 12-LOX, and MSI). Currently, only PSA is used clinically for early diagnosis and monitoring of PCa. The histological differential diagnosis of prostatic adenocarcinoma includes normal tissues such as Cowper's gland, paraganglion tissue and seminal vesicle or ejaculatory duct as well as pathological conditions such as atypical adenomatous hyperplasia, atrophy, basal cell hyperplasia and sclerosing adenosis. A common PCa is characterized by a remarkable heterogeneity in terms of its differentiation, microscopic growth patterns and biological aggressiveness. Most PCa are multifocal with signi ficant variations in tumor grade between anatomically separated tumor foci. The Gleason grading system which recognizes five major grades defined by patterns of neoplastic growth has gained almost uniform acceptance. In predicting the biologic behavior of PCa clinical and pathological stages are used as the major prognostic indicators. Among the cell proliferation and death regulators androgens are critical survival factors for normal prostate epithelial cells as well as for the androgen-dependent human prostatic cancer cells. The androgen ablation has been shown to increase the apoptotic index in prostatic cancer patients and castration also promotes apoptotic death of human prostate carcinoma grown in mice. The progression of PCa, similarly to other malignancies, is a multistep process, accompanied by genetic and epigenetic changes, involving phenomenons as adhesion, invasion and angiogenesis (without prostate specific features). Pathology & Oncology Research, Vol 2, Nr 3, 191-211, 1996

Key words: prostate cancer; diagnosis; prognosis; pathology; biology

Received: Mar 2, 1996; accepted: Apr 1, 1996
Correspondence: Kenneth V HONN, Department of Radiation Oncology, Wayne State University, 431 Chemistry Detroit 48202, USA; Tel: 313-5771018, Fax: 313-5770798

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