Prognostic markers for radical prostatectomy

Introduction: Some 30-40% of patients with clinically localized prostate cancer treated by radical prostatectomy relapse. This preliminary study assesses the ability of immunohistochemical stains (p27, BCL-2. MIB-1. PSA and androgen receptor), Gleason grade and tumour volume to predict concurrent lymph node metastases or a rising post-operative serum PSA level. Materials and methods: Sections of prostate from 39 radical prostatectomy specimens were stained immunohistochemically. In 18 cases the disease was organ-confined, in 13 the margins were positive and in eight the lymph nodes were involved. During a minimum 3-year follow-up, rising PSA levels were detected in seven of 18 of the patients with negative margins, compared with six of 1 3 of those with positive margins. Results: High percentages of MIB-1-positive cancer nuclei and volume of disease were associated with rising PSA levels in lymphnode-negative disease. Comparing the 18 patients in whom serum PSA levels were undetectable for at least 3 years after radical prostatectomy with the 13 with rising PSA levels, the mean (SD, range, 95% CI) MIB-1 (% nuclei positive) was 3.6 (0.6, 0.1-9.4, 2.3-4.9) and 13.6 (3.7, 1.1-52.3, 5.5-21.6), respectively, and for volume of disease (mL) was 1.5 (0.4, 0.1-5.8, 0.6-2.3) and 6.5 (1.7, 0.3-21.5, 2.8-10.2). The expression ofp27 was lowest in lymph-node-positive disease, BCL-2 and PSA were variable within and between tumours, whilst androgen receptor expression was almost uniformly consistent and strong. Conclusion: It appears that MIB-1 staining may help in the selection of patients for radical prostatectomy. The degree of correlation between MIB-1 staining in needle biopsies, radical prostatectomy specimens and rising PSA level needs to be determined. © 1998 British Journal of Urology.