Relationship between androgen receptor binding activity in human prostate cancer and clinical response to endocrine therapy

Evaluation of neuroendocrine staining and androgen receptor expression in incidental prostatic adenocarcinoma: Prognostic implications

OBJECTIVES

To identify neuroendocrine cells and androgen receptors (ARs), possible predictors of cancer progression, in a series of untreated patients with incidental Stage T1a prostate cancer (PCa). Neuroendocrine cells may exert a dynamic role in the microenvironment of PCa. The AR is thought to have a central role in the propagation of prostate carcinogenesis.

METHODS

Prostatectomy specimens from 81 patients with Stage T1a PCa were available for analysis. Neuroendocrine cells were detected by immunohistochemistry using antibodies to chromogranin A (CgA) and neuron-specific enolase, and the antibody against AR enabled the evaluation of the nuclear AR status. Tumor cell proliferation was assessed with the Ki-67 labeling index using MIB-1 antibody. The patients were followed up for a mean of 63.9 months, and a subsequent rise in prostate-specific antigen or positive digital rectal examination findings confirmed by biopsy was considered disease progression.

RESULTS

Of the 81 specimens, 62 (76.54%) were positive for CgA and/or neuron-specific enolase and 19 (23.46%) were negative. A statistically significant correlation was found between CgA positivity and tumor dedifferentiation (P = 0.002). Well-differentiated tumors revealed an overexpression of ARs (P < 0.005). On multivariate analysis, worsening tumor differentiation emerged as the only independent predictor of progression-free survival (P = 0.041); however, only CgA positivity was an independent predictor of tumor progression in well and moderately differentiated tumors (P = 0.038).

CONCLUSIONS

The results of this study suggest that CgA may represent a useful marker for subsequent aggressive behavior and progression in incidental well and moderately differentiated Stage T1a PCa.

Androgen receptor antigen density and S-phase fraction in prostate cancer: a pilot study

PURPOSE

To determine whether quantitative flow cytometric androgen receptor density expression (MFC ratio) in prostate cancer was associated with S-phase fraction.

METHODS

Flow cytometry was performed to determine DNA aneuploidy, S-phase fraction, percentage of androgen receptor (AR)-positive cells, and MFC ratio in prostate cancer patients.

RESULTS

MFC ratio showed distinct clustering. Eight patients had a low MFC ratio of 1.78-2.74, while 10 patients had high MFC ratios between 4.99 and 6.48. The S-phase fraction had average values of 11.05 vs 4.92 in tumors with high vs low MFC ratio (P<0.01).

CONCLUSION

S-phase fraction was significantly higher in tumors with high AR density.

Molecular biology of the androgen receptor

Androgen receptor (AR) is a member of the steroid hormone receptor family of molecules. AR primarily is responsible for mediating the physiologic effects of androgens by binding to specific DNA sequences that influence transcription of androgen-responsive genes. The three-dimensional structure of the AR ligand-binding domain has shown it is similar to other steroid hormone receptors and that ligand binding alters the protein conformation to allow binding of coactivator molecules that amplify the hormone signal and mediate transcriptional initiation. However, AR also undergoes intramolecular interactions that regulate its interactions with coactivators and influence its activity. A large number of naturally occurring mutations of the human AR gene have provided important information about AR molecular structure and intermolecular interactions. AR is also a critical mediator of prostate cancer promotion, conferring growth signals to prostate cancer cells throughout the natural history of the disease. Late-stage prostate cancer, unresponsive to hormonal deprivation, sustains AR signaling through a diverse array of molecular strategies. Variations in the AR gene may also confer genetic predisposition to prostate cancer development and severity. Further understanding of AR action and new strategies to interfere with AR signaling hold promise for improving prostate cancer therapy.

Androgen receptor alterations in prostatic carcinoma

Intracellular action of androgens is mediated by the androgen receptor (AR), which is a key element of the androgen signal transduction cascade and a target of endocrine therapy for prostatic carcinoma. Therefore, the qualitative and quantitative alterations of AR expression in prostatic carcinomas and their possible implications for tumor progression and treatment are of great interest. Findings in prostatic tumor cell lines of rat and human origin suggest a reduction of AR protein expression accompanied by an increase in tumor malignancy. However, immunohistochemical studies and binding assays demonstrated presence of ARs in all histological types of prostatic tumors, in therapy-responsive as well as in therapy-unresponsive ones. AR content of prostatic tumor specimens did not correlate with outcome of endocrine therapy of advanced prostatic carcinoma in these studies. Solely the degree of heterogeneity of AR expression may be useful as an indicator of responsiveness to therapy. AR mutations have been detected in the LNCaP cell line and in three primary prostatic tumor specimens. Three of them are point mutations in the hormone-binding domain of the AR, the fourth mutation is a CAG-microsatellite depression in the N-terminus. Evidence coming from studies on AR in prostatic cancer highlights the possibility that AR structural alterations may have significance in tumor progression.

Nuclear localization of androgen receptor in heterogeneous samples of normal, hyperplastic and neoplastic human prostate

To facilitate an understanding of how androgens participate in the genesis of human benign hyperplasia and carcinoma we assayed androgen receptor in the epithelium and stroma of human prostatic tissue from 57 patients. Immunohistochemical staining of human androgen receptor was performed on 106 sections of normal prostate, benign prostatic hyperplasia (BPH) and prostate cancer. To determine variability of androgen receptor staining sections taken from different portions of the gland were studied. Frozen tissue sections were incubated with monoclonal antiandrogen receptor antibodies and staining was completed by the indirect avidin-biotin peroxidase method. Antibody staining was found mainly in the nucleus of prostatic epithelial cells, although some stromal cells also showed positive staining. Unlike normal prostate, there was a heterogeneous distribution of androgen receptor in BPH and prostate cancer. The androgen receptor content in well differentiated adenocarcinoma epithelium was significantly higher compared to moderately (p less than 0.05) and poorly (p less than 0.05) differentiated adenocarcinoma. Regardless of the origin of stromal tissue, some staining was observed. In each specimen studied the androgen receptor staining was consistent qualitatively and quantitatively for each pathological component throughout the specimen. These data confirm that androgen receptor is a nuclear receptor protein. Furthermore, they show the ability of monoclonal antibodies to reveal cellular/subcellular distribution of androgen receptor, and demonstrate a correlation between the degree of tumor differentiation and androgen receptor content in epithelial but not in stromal cells. These observations may have important implications for understanding the variable tumor response to hormone therapy.

Immunohistochemical study of androgen receptors in metastatic prostate cancer. Comparison of receptor content and response to hormonal therapy

A longstanding goal has been to determine whether androgen receptor (AR) levels could be used to predict the clinical response of metastatic prostate cancer to androgen withdrawal therapy. A major limitation of previous studies was the use of homogenized tissue, which yields an average AR content for all cells. By AR immunohistochemical study using an antibody specific for AR the authors assessed nuclear AR content specifically in the malignant epithelial cells of prostate needle biopsy specimens of 17 patients with Stage D prostate cancer. The authors found that prostate cancer contains AR-positive and AR-negative malignant cells before androgen withdrawal therapy, but the percentage of AR-positive cells did not predict the time to tumor progression after therapy. There was no significant correlation between the percentage of AR-positive malignant cells and the time to tumor progression. When patients were divided into two groups based on the median time to progression, the percentage of AR-positive nuclei was not significantly different in poor responders versus good responders. When patients were divided into two groups based on the median percentage of receptor-positive nuclei, Kaplan-Meier estimates of the progression-free interval revealed no significant difference between the group of patients with AR-poor tumors and patients with AR-rich tumors. Potential explanations for these results are discussed. The authors conclude that the percentage of AR-positive nuclei is not a sufficient criterion to predict tumor behavior.

Immunohistochemical study of androgen receptor in benign hyperplastic and cancerous human prostates

Androgen receptor was detected immunohistochemically in benign as well as malignant prostatic tissues by using a monoclonal rat anti-human androgen receptor antibody (AN 1-15). In both benign and malignant cells, the androgen receptor was exclusively localized in nuclei. In hyperplastic prostate, the androgen receptor was stained in the glandular and the stromal cells. In the gland, cells facing the lumen were stained more intensively than those adjacent to the basal membrane. In cancer tissue, receptor-positive and -negative cancer cells were intermingled. The percent of strongly positive cancer cells was correlated inversely with grade. Relapsed cells showed a low population of strongly positive cells irrespective of grade.