Supplementary Figure S4 from Dysregulation of miR-212 Promotes Castration Resistance through hnRNPH1-Mediated Regulation of AR and AR-V7: Implications for Racial Disparity of Prostate Cancer.. [DOI: 10.1158/1078-0432.22458242.v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

<p>qRT-PCR analysis of miR-132 and miR-495 expression in microdissected prostate tumors</p>

Supplementary Figure S2 from Dysregulation of miR-212 Promotes Castration Resistance through hnRNPH1-Mediated Regulation of AR and AR-V7: Implications for Racial Disparity of Prostate Cancer.. [DOI: 10.1158/1078-0432.22458248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

<p>Suppressive subtractive hybridization and construction of race-based prostate tumor specific cDNA libraries</p>

Supplementary Figure S2 from Dysregulation of miR-212 Promotes Castration Resistance through hnRNPH1-Mediated Regulation of AR and AR-V7: Implications for Racial Disparity of Prostate Cancer.. [DOI: 10.1158/1078-0432.22458248.v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

<p>Suppressive subtractive hybridization and construction of race-based prostate tumor specific cDNA libraries</p>

Baseline differences in characteristics of a racially diverse group of men electing active surveillance

103

Background: To date, large populations of men from European ancestry have been prospectively evaluated on Active Surveillance (AS), a strategy reserved for low risk prostate cancer (PCa). African Americans (AA) deemed to be candidates for AS have yet to be fully characterized. We sought to determine the similarities and differences of our AS cohort stratified by race. Methods: We identified 308 men from our multi-institutional, prospective AS database were analyzed. Inclusion criteria was PSA < 20ng/mL, Gleason score ≤ 7, and clinical stage ≤ T2a. Men who sought treatment for their PCa or refused subsequent imaging and biopsy were excluded. Univariate analysis was done to analyze racial differences in demographic, clinical and pathologic variables. Results: We identified 308 men, 131 (43%) AA and 177 nonAA (57%). The groups were not significantly different with respect to age; 65 years, BMI 28.4, family history of PCa (22%), prior negative biopsy (21%) and clinical staging (87% T1c). Median follow-up is 25 months (IQR 12-44). Significant differences between the AA and nonAA cohorts did exist at baseline with respect to overall health, suggesting AA having worse overall health. More AA had diabetes (29 vs 14%; p = .03), were smokers (55 vs 29%; p < .01), cardiovascular disease (21 vs 9%) and erectile dysfunction (43 vs 18%; p < .01). Social characteristics also differed within the groups, with AA less likely to be married (47 vs 51%; p = .01). Despite a lack of difference with respect to biopsy Gleason score, AA had higher PSA (5.7 vs 5.0 ng/mL; p = 0.02), lower testosterone levels (250 vs 334 ng/dL; p = 0.05), greater PSA density (0.15 vs 0.12; p < 0.01), and greater linear length of cancer per biopsy core (16 vs 13mm; p < 0.01) at time of diagnosis and initiation of AS. Conclusions: Within our AS cohort, AA have worse overall health and more aggressive PCa features despite meeting inclusion criteria and selecting AS. Further prospective study is needed to determine how these competing factors may impact long term outcomes.

Utility of PCA3 and TMPRSS2: ERG urinary biomarkers to predict pathologic outcomes in African American men undergoing radical prostatectomy

e547

Background: Tremendous disparity exists between preoperative characteristics and pathologic outcomes in men electing radical prostatectomy (RP) for localized prostate cancer (PCa). We sought to determine the performance characteristics of urinary PCA3 andTMPRSS2:ERG (T2:ERG) to predict pathologic outcomes in a racially diverse group of men undergoing RP. Methods: Following IRB approval, post digital rectal exam (DRE) urine was prospectively collected in consecutive patients with known PCa prior to RP. PCA3 and T2:ERG RNA copies were quantified and normalized to PSA mRNA copies using the Progensa assay (Hologic, San Diego, CA). Nonparametric Mann-Whitney U tests were performed to determine the ability of PCA3 and T2:ERG to predict higher risk PCa and notable disease features. Results: The cohort consisted of 214 men with PCa who underwent RP, and 89 men (42%) were African American (AA). The men in the cohort generally had higher risk disease, with 75% having AUA risk stratification of intermediate/high-risk PCa. PCA3 discriminated between biopsy low- and intermediate/high-grade Gleason Score (p = .005) and pathologic low- and intermediate/high-grade Gleason Score (p = 0.001). For men with low-risk PCa, PCA3 also predicted Gleason Score upgrading from biopsy to prostatectomy specimen (p = 0.003). PCA3 could not predict the presence of perineural invasion, lymph node positivity, seminal vesical invasion, positive surgical margins or extraprostatic extension. When stratified by race, within the AA cohort, T2:ERG did predict upgrading from Gleason 6 disease at the time of biopsy to higher grade pathology at RP (p = 0.016). However, T2:ERG was not predictive for the overall cohort, nor was it predictive for any of the disease features found to be significant with PCA3. Conclusions: In a racially-diverse group of men undergoing RP, PCA3 and T2:ERG urinary assays have limited ability to characterize aggressive pathologic features at the time of RP regardless of race.

Outcomes of men who underwent treatment for prostate cancer from a prospective follow up of a racially diverse, multi-institutional active surveillance cohort

e536

Background: Active surveillance (AS) is an increasingly accepted alternative to treatment for low-grade prostate cancer (PCa). However, it remains unclear what factors may predict which patients will upgrade to a higher grade cancer. We sought to analyze the characteristics at time of diagnosis and outcomes of those men in our racially diverse AS cohort who underwent treatment for PCa. Methods: Men from our AS database were analyzed. Inclusion criteria was PSA < 20 ng/mL, Gleason Score ≤ 7, and clinical stage ≤ T2a. Men who elected active treatment for their PCa at diagnosis or refused subsequent imaging and biopsy were excluded from this cohort. Univariate analysis was done to compare the clinical variables of the treatment group with the entire cohort. Results: We identified 56 men who were treated for PCa from the 308 men currently enrolled in our AS cohort. All 56 men in the treatment group had low risk PCa at diagnosis and initiation of AS. At diagnosis, the treatment group was not significantly different in comparison with our entire cohort with respect to age, BMI, family history of PCa, PSA at diagnosis, prior negative biopsy, TRUS volume, PSAD, smoking status and clinical staging. However the eventual treatment group did differ at diagnosis with respect to greater linear length of cancer per core (p < 0.01), greater % involvement of disease (p = 0.03), and greater number of total cores at time of diagnosis (p = 0.04). The men in this group underwent treatment for PCa for the following reasons: 36 for Gleason Score upgrading, 5 due to increased volume of disease, 6 due to rising PSA, 1 due to MRI findings, 1 due to rising PSA on Avodart and 7 elected treatment despite no significant changes in disease. 31 of the men had RARPs, 17 XRT, 4 had XRT + ADT, 3 had Brachytherapy, and 1 with XRT + salvage RP. Conclusions: Within our prospectively enrolled racially diverse AS cohort, the patients who underwent treatment for PCa had clinical factors that differed in comparison to the whole cohort. Further prospective study is needed to determine how these factors may ultimately impact long term outcomes.

Identification of microRNA signature and potential pathway targets in prostate cancer

Prostate cancer (PC) is the most common and the second leading cause of cancer-related death among American men. Early diagnosis is a prerequisite to improving therapeutic benefits. However, the current clinical biomarkers for PC do not reliably decipher indolent PC from other urogenital disorders. Thus, effective clinical intervention necessitates development of new biomarkers for early detection of PC. The present study aimed to identify the miRNA signature in organ-confined (Gleason Score 6) prostate tumors. MicroRNA (miRNA/miR) array analysis identified 118 upregulated and 73 downregulated miRNAs in microdissected tumors in comparison to matched neighboring normal prostate epithelium. The miRs-Plus-A1083, -92b-5p, -18a-3p, -19a-3p, -639, -3622b-3p, -3189-3p, -155-3p, -410, -1179, 548b-5p, and -4469 are predominantly expressed (7-11-fold), whereas miRs-595, 4490, -3120-5p, -1299, -21-5p, -3677-3, -let-7b-5p, -5189, 3-121-5p, -4518, -200a-5p, -3682-5p, -3689d, -3149 represent the most downregulated (12-113-fold) miRNAs in microdissected prostate tumors. The array expression profile of selected miRNA signature and their potential mRNA targets was validated by qRT-PCR analysis in PC cell lines. Integrated in silico and computational prediction analyses demonstrated that the dysregulated miRNA signature map to key regulatory factors involved in tumorigenesis, including cell cycle, apoptosis, and p53 pathways. The newly identified miRNA signature has potential clinical utility as biomarkers, prognostic indicators, and therapeutic targets for early detection of PC. Further studies are needed to assess the functional significance and clinical usefulness of the identified miRNAs. Impact Statement To our knowledge his is the first study of identifying miRNA signatures in microdissected indolent (Gleason score 6) prostate cancer in comparison to matched normal prostate epithelium. By employing in silico and computational prediction analysis, the study provides a landscape of potential miRNA targets and key cellular pathways involved in prostate tumorigenesis. Identification if miRNAs and their relevant targets and pathways pave the way for underpinning their mechanistic role of miRNAs in human prostate tumorigenesis, and possibly other human cancers. Importantly, the outcome of the study has important clinical implications for the management of prostate cancer, including the use of miRNA(s) as biomarkers for early detection of prostate cancer.

Abstract 424: Urine cf-DNA SNPs as early biomarkers of prostate cancer

Background: The current strategies of prostate cancer (PC) detection, such as serum PSA, digital rectal examination (DRE) and prostate biopsy have been hampered by many limitations, including the degree of aggressiveness, invasiveness, non-specificity to PCa, over diagnosis and over treatment. Recent studies have proposed the use of cell-free circulating DNA (cf-DNA) as non-invasive biomarkers for cancer diagnosis, prediction of tumor burden and prognosis. We hypothesize that a selective subset of PC associated Single Nucleotide Polymorphisms (SNPs) in urine cf-DNA detects PCa with high specificity and sensitivity.

Aim: To identify PC specific SNPs in urine cf-DNA from prostate cancer (PC) patients and further validate their clinical utilities as non-invasive biomarkers for early detection of PC in comparison to other genitourinary conditions, such as benign prostate hyperplasia (BPH) and prostatitis.

Method and Results: A protocol was optimized for collection, processing and storage of urine samples and isolation of urine cf-DNA. Our discovery dataset was constructed by comparative Illumina HiSeq next generation sequencing (NGS) of urine cf-DNA from three different cohorts of patients presenting with PC (Gleason score 6), benign prostatic hyperplasia (BPH) or prostatitis. The data was analyzed by SNAPE-pooled and annotated using ANNOVAR; revealing 24 PC-specific non-synonymous SNPs. The selective detection of urine cf-DNAs in PC patients was verified by conventional PCR using primers flanking their genomic sites. Our validation analysis was performed in patients (n = 50/group) diagnosed with PC (Gleason score ≤ 3+4), Gleason score ≥ than 4 + 3, or patients deemed as “no cancer seen”. This was performed by Droplet Digital PCR (ddPCR) targeting wild-type versus variant (SNP) DNA in each patient sample. The results have revealed detection of two PC specific SNPs in urine cf-DNA (&gt;60% for SNP1 and &gt;75% SNP2 in 91 patients; patent pending).

Conclusion: Our study brings forth the potential clinical utility for two novel urine cf-DNA SNPs as early biomarkers for prostate cancer.

Citation Format: Amrita Datta, Hogyoung Kim, Allison Feibus, Melody Badoo, Adedoyin Johnson, Ahmed Moustafa, Jonathan Silberstein, Krishnarao Moparty, Raju Thomas, Asim B. Abdel-Mageed. Urine cf-DNA SNPs as early biomarkers of prostate cancer. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 424.

Racial variation in prostate needle biopsy templates directed anterior to the peripheral zone

OBJECTIVES

African Americans (AA) have been reported to have both increased incidence and increased aggressiveness of prostate cancer (PCa) located anterior to the peripheral zone (APZ). We sought to evaluate the utility of prostate biopsies directed toward the APZ in a predominantly AA cohort.

METHODS AND MATERIALS

We reviewed all patients with PCa found on biopsy schema that included needle biopsies directed at both the peripheral zone (PZ) and APZ from 2010 to 2014. Self-identified race was recorded for all patients. To evaluate the reliability of APZ-directed prostate biopsies, we performed pathologic secondary review of 25 radical prostatectomy specimens. A series of the Mann-Whitney U and Chi-square tests were used to compare variables.

RESULTS

We identified 398 men, of which 277 (70%) were AA. Compared with non-AA, AA had more National Comprehensive Cancer Network-defined intermediate or high-risk (50% vs. 39%, P = 0.25) PCa. Most patients had PCa limited to the PZ only (n = 190) or in both the PZ and APZ (n = 191). For 17 patients (4%), PCa was limited only to the APZ core(s), 14 (5%) AA vs. 3 (2%) non-AA (P = 0.24). Most of these 17 patients (n = 14, 82%) had Gleason 6 disease. Patients with PCa in both the PZ and APZ had higher serum prostate-specific antigen, prostate-specific antigen density, volume of disease, and increased grade and National Comprehensive Cancer Network category (all P<0.01). Of these patients, there were no differences in race (AA = 135, 71% vs. non-AA = 56, 29%; P = 0.48). In only 21 men (11%), without racial variation, APZ tumor grade was greater than PZ. Radical prostatectomy and APZ-directed biopsies demonstrated a concordance rate of 80% (20/25), false positive rate of 8% (2/25), and false negative rate of 12% (3/25).

CONCLUSIONS

APZ-directed prostate biopsies are rarely the sole location of PCa and do not show a clear racial predilection. In those men with PCa identified in both regions, the APZ biopsy did not frequently change treatment recommendations. Biopsies directed at the APZ are not of greater benefit to AA than non-AA.

Clinical Use of PCA3 and TMPRSS2:ERG Urinary Biomarkers in African-American Men Undergoing Prostate Biopsy

PURPOSE

Prostate specific antigen has decreased performance characteristics for the detection of prostate cancer in African-American men. We evaluated urinary PCA3 and TMPRSS2:ERG in a racially diverse group of men.

MATERIALS AND METHODS

After institutional review board approval, post-examination urine was prospectively collected before prostate biopsy. PCA3 and TMPRSS2:ERG RNA copies were quantified using transcription mediated amplification assays (Hologic, San Diego, California). Prediction models were created using standard of care variables (age, race, family history, prior biopsy, abnormal digital rectal examination) plus prostate specific antigen. Decision curve analysis was performed to compare the net benefit of PCA3 and TMPRSS2:ERG.

RESULTS

Of 304 patients 182 (60%) were African-American and 139 (46%) were diagnosed with prostate cancer (69% African-American). PCA3 and TMPRSS2:ERG scores were greater in men with prostate cancer, 3 or more cores, 33.3% or more cores, greater than 50% involvement of greatest biopsy core and Epstein significant prostate cancer (p <0.01). PCA3 added to the standard of care plus prostate specific antigen model for the detection of any prostate cancer in the overall cohort (0.747 vs 0.677, p <0.0001) in African-American men only (0.711 vs 0.638, p=0.0002) and nonAfrican-American men (0.781 vs 0.732, p=0.0016). PCA3 added to the model for the prediction of high grade prostate cancer for the overall cohort (0.804 vs 0.78, p=0.0002) and African-American men only (0.759 vs 0.717, p=0.0003) but not nonAfrican-American men. Decision curve analysis demonstrated improvement with the addition of PCA3. For African-American men TMPRSS2:ERG did not improve concordance statistics for the detection of prostate cancer.

CONCLUSIONS

For African-American men urinary PCA3 improves the ability to predict the presence of any and high grade prostate cancer. However, the TMPRSS2:ERG urinary assay does not add significantly to standard tools.

Racial variation in the outcome of subsequent prostate biopsies in men with an initial diagnosis of atypical small acinar proliferation (ASAP)

141

Background: African Americans (AA) are known to have more aggressive prostate cancer (PCa) and a greater probability of death from PCa. We sought to determine predictors of subsequent detection and risk stratification of PCa in a racially diverse group of men who presented with atypical small acinar proliferation (ASAP) on initial prostate biopsy. Methods: Upon receiving IRB approval, a retrospective analysis was performed on men from the Southeast Louisiana Veterans Health Care System and Tulane University Medical Center who presented with ASAP on initial prostate biopsy and subsequently received confirmatory prostate biopsies from September 2000 through July 2015. Confirmatory biopsy with a greater than 3-year interval from the initial were excluded. Self-identified race, age, body mass index (BMI), transrectal ultrasound (TRUS) volume, serum prostate-specific antigen (PSA), PSA velocity (PSAV), PSA density (PSAD), and elapsed time between biopsies were evaluated to determine if they were predictors of subsequent PCa diagnosis in patients with an initial finding of ASAP. Results: Of the 106 men in the analysis cohort, 75 (71%) were AA and 31 (29%) were not African American (non-AA). AA had higher PSA, PSAV, and PSAD (all p < 0.05). Age, BMI and TRUS volume were not statistically different between AA and non-AA. PCa was diagnosed in subsequent biopsy in 42 (40%) patients without significant racial variation; 30 (40%) AA vs 12 (39%) non-AA. Of the 42 men with PCa, 25 (24%) met Epstein pathological criteria for significant disease, although without racial variation; 18 (24%) AA vs 7 (23%) Non-AA. Only 10 (9%) men, again without racial variation, had any component of Gleason 4; 7 (9%) AA vs 3 (10%) non-AA. On multivariate analysis, increasing age, PSA and PSAD were significant predictors of cancer on repeat biopsy while race, BMI, TRUS volume and number of cores with ASAP were not. Conclusions: AA diagnosed with ASAP on initial prostate biopsy do not have increased risk of PCa on confirmatory biopsy compared to non-AA. Regardless of race, most cancers were low grade and lower volume, and AA with ASAP should be managed in a similar manner to non-AA with ASAP.

Pathologic upgrading on confirmatory biopsy in a racially diverse group of men on active surveillance for prostate cancer

142

Background: To evaluate the clinical variables associated with upgrading at confirmatory biopsy among a racially-diverse group of men with prostate cancer (PCa) who elect Active Surveillance (AS). Methods: Following IRB approval, of the more than 260 men from our multi-institutional prospective AS database we identified 140 that had undergone at least 1 confirmatory biopsy since their initial diagnosis. Patients whose diagnosis was made on TURP, had any Gleason 4 on their initial biopsy or whose initial and confirmatory biopsy were more than 2 years apart were excluded. The analysis cohort included 121 men who had Gleason Score ≤ 6, clinical stage ≤ T2a and PSA ≤ 20 ng/mL. Disease upgrading on confirmatory biopsy was Gleason score ≥ 7. Multiple variables were examined as univariate and MV predictors of upgrading. Results: We identified 121 men who fit inclusion criteria, 55 (45%) African Americans (AA) and 66 non-AA (55%) with a median follow-up of 22 months. The median age was 66, median number of biopsy cores taken at diagnostic biopsy was 12 and median time interval between diagnostic and confirmatory biopsy was 12 months. On confirmatory biopsy, no evidence of disease was noted for 51 (42%) men (26 AA, 25 non-AA), 48 (40%) men (18, AA, 30 non-AA) had findings consistent with their initial biopsy and 22 men (11 AA, 11 non-AA) experienced upgrading at repeat biopsy. Of the 22 (18%) men who were upgraded, 18 (8 AA, 10 non-AA) upgraded to a Gleason score of 7, 3 (2 AA, 1 non-AA) were upgraded to a Gleason score of 8 and 1 (AA) had a Gleason score of 9. In univariate analysis AA race was associated with a greater number of positive cores (p = 0.04) and greater total prostate volume (p = 0.03) at confirmatory biopsy. Multivariate analysis was performed and none of the clinical variables examined (race, age, BMI, PSA, volume, PSAD, number of positive cores, total number of cores, percentage of positive cores, time between biopsies) were associated with upgrading on repeat biopsy. Conclusions: Our findings suggest that race is not associated with an increased risk of upgrading at confirmatory biopsy. AA with low-risk PCa are reasonable candidates for inclusion in most AS protocols and should not be excluded based on race alone.

Utility of PCA3 and TMPRSS2:ERG urinary biomarkers in African American men undergoing prostate biopsy

126

Background: To determine the performance characteristics of urinary PCA3 andTMPRSS2:ERG (T2:ERG) in a racially diverse group of men. Methods: Following IRB approval, from 2013-2015, post digital rectal exam (DRE) urine was prospectively collected in patients without known prostate cancer (PCa), prior to biopsy. PCA3 and T2:ERG RNA copies were quantified and normalized to PSA mRNA copies using Progensa assay (Hologic, San Diego, CA). Prediction models for PCa and high-grade PCa were created using standard of care (SOC) variables (age, race, family history of PCa, prior prostate biopsy and abnormal DRE) plus PSA. Decision Curve Analysis was performed to compare the net benefit of using SOC, plus PSA, with the addition of PCA3 and T2:ERG. Results: Of 304 patients, 182 (60%) were AA; 139(46%) were diagnosed with PCa (69% AA). PCA3 and T2:ERG scores were greater in men with PCa, ≥ 3 cores, ≥ 33.3% cores, > 50% involvement of greatest biopsy core and Epstein significant PCa (p-values < 0.04). PCA3 added to the SOC plus PSA model for the detection of any PCa in the overall cohort (0.747 vs 0.677; p < 0.0001), in AA only (0.711 vs 0.638; p = 0.0002) and non-AA (0.781 vs 0.732; p = 0.0016). PCA3 added to the model for the prediction of high-grade PCa for the overall cohort (0.804 vs 0.78; p = 0.0002) and AA only (0.759 vs 0.717; p = 0.0003) but not non-AA. Decision curve analysis demonstrated significant net benefit with the addition of PCA3 compared with SOC plus PSA. For AA, T2:ERG did not improve concordance statistics for the detection any or high-grade PCa. Conclusions: For AA, urinary PCA3 improves the ability to predict the presence of any and high-grade PCa. However for this population, T2:ERG urinary assay does not add significantly to standard detection and risk stratification tools.

Dysregulation of miR-212 Promotes Castration Resistance through hnRNPH1-Mediated Regulation of AR and AR-V7: Implications for Racial Disparity of Prostate Cancer

PURPOSE

The causes of disproportionate incidence and mortality of prostate cancer among African Americans (AA) remain elusive. The purpose of this study was to investigate the mechanistic role and assess clinical utility of the splicing factor heterogeneous nuclear ribonucleoprotein H1 (hnRNP H1) in prostate cancer progression among AA men.

EXPERIMENTAL DESIGN

We employed an unbiased functional genomics approach coupled with suppressive subtractive hybridization (SSH) and custom cDNA microarrays to identify differentially expressed genes in microdissected tumors procured from age- and tumor grade-matched AA and Caucasian American (CA) men. Validation analysis was performed in independent cohorts and tissue microarrays. The underlying mechanisms of hnRNPH1 regulation and its impact on androgen receptor (AR) expression and tumor progression were explored.

RESULTS

Aberrant coexpression of AR and hnRNPH1 and downregulation of miR-212 were detected in prostate tumors and correlate with disease progression in AA men compared with CA men. Ectopic expression of miR-212 mimics downregulated hnRNPH1 transcripts, which in turn reduced expression of AR and its splice variant AR-V7 (or AR3) in prostate cancer cells. hnRNPH1 physically interacts with AR and steroid receptor coactivator-3 (SRC-3) and primes activation of androgen-regulated genes in a ligand-dependent and independent manner. siRNA silencing of hnRNPH1 sensitized prostate cancer cells to bicalutamide and inhibited prostate tumorigenesis in vivo

CONCLUSIONS

Our findings define novel roles for hnRNPH1 as a putative oncogene, splicing factor, and an auxiliary AR coregulator. Targeted disruption of the hnRNPH1-AR axis may have therapeutic implications to improve clinical outcomes in patients with advanced prostate cancer, especially among AA men.

Collagenase Clostridium histolyticum (Xiaflex) for the Treatment of Urethral Stricture Disease in a Rat Model of Urethral Fibrosis

OBJECTIVE

To evaluate the treatment effect of collagenase Clostridium histolyticum (CCH) in a rat model of urethral fibrosis.

MATERIALS AND METHODS

Thirty male Sprague-Dawley rats (300-350 g) were divided into 5 groups. The rat urethra was injected with normal saline in the sham group and, in the other 4 groups, the rat urethra was injected with 10 μg of transforming growth factor beta 1 to create fibrosis of the urethra. Two weeks following transforming growth factor beta 1 injection, the rats were injected with varying doses of CCH or vehicles, depending on their group. The rats were then euthanized at 4 weeks after CCH or vehicle injection. Urethral tissue was harvested for histologic and molecular analyses. Type I and III collagen levels were evaluated by Western blot analysis.

RESULTS

There was urethral fibrosis and to significant increase in collagen type I and III expressions in the urethral fibrosis group compared with the sham group (P <.05). Urethral injection of CCH appeared to be safe and significantly reduce urethral fibrosis as well as collagen type I and III expressions in the high-dose CCH treatment groups when compared with the treatment control group (P <.01).

CONCLUSION

This study demonstrated a beneficial effect of CCH injections in a rat model of urethral fibrosis. These findings suggest a potential role for CCH as a therapeutic option in urethral stricture patients and warrant further investigation.

Clinical performance of PCA3 and TMPRSS2:ERG urinary biomarkers for African American men undergoing prostate biopsy

91

Background: Urinary assaysfor PCA3 and TMPRSS2:ERG (T2:ERG) fusion are established biomarkers for the detection of prostate cancer (PCa). However few African Americans (AA) have been included in previous studies. We sought to determine the performance characteristics of these assays in a racially diverse group of men who elected to undergo prostate biopsy. Methods: Following IRB approval, from 12/2013-10/2014, post digital rectal exam urine was collected in 152 patients without a diagnosis of PCa, prior to biopsy. PCA3 and T2:ERG RNA copies were quantified using transcription-mediated amplification assays and normalized to PSA mRNA copies. Results: Of the 152 patients who met study inclusion, 93 (61%) were AA, 59 were non-AA (39%); 72(47%) were diagnosed with PCa (55% AA, 36% non-AA). Both PCA3 and T2:ERG scores were greater in men with biopsy-proven PCa, those with ≥3 PCa cores, ≥33.3% PCa cores, >50% PCa involvement of greatest biopsy core and Epstein significant PCa (all p-values ≤ 0.02). PCA3 but not T2:ERG scores were greater in men with Gleason grade ≥7 (p = 0.0003). ROC analyses for prediction of biopsy outcome resulted in AUCs of 0.7, 0.61 and 0.59 for PCA3, T2:ERG and serum PSA. For the subgroup of AA, PCA3 and T2:ERG scores were greater in men with biopsy-proven PCa, those with ≥3 PCa cores, ≥33.3% PCa cores, >50% PCa involvement of greatest biopsy core and Epstein significant PCa (all p-values ≤0.01). Both PCA3 and T2:ERG scores were greater in men with Gleason grade ≥7 (p ≤ 0.03). ROC analyses for prediction of biopsy outcome for AA only resulted in AUCs of 0.66, 0.66 and 0.58 for PCA3, T2:ERG and serum PSA. For the non-AA cohort, PCA3 scores were greater in men with biopsy-proven PCa, those with ≥3 PCa cores, ≥33.3% PCa cores, >50% PCa involvement of greatest biopsy core, Epstein significant PCa and Gleason grade ≥7 (all p-values ≤ 0.03). T2:ERG did not reach significance for any of these variables. In this subgroup, ROC analyses for prediction of biopsy outcome resulted in AUCs of 0.73, 0.54 and 0.56 for PCA3, T2:ERG and serum PSA. Conclusions: In AA men undergoing prostate biopsy, both PCA3 and T2:ERG urinary assays demonstrate clinical utility in predicting biopsy outcome and PCa disease characteristics.

Racial variation in positive prostate needle biopsy templates, which include the transition zone

125

Background: Reports have suggested that African Americans (AA) with prostate cancer (PCa) have both increased incidence and increased aggressiveness of tumors located in the transition zone (TZ). Our goal was to evaluate the utility of TZ−directed prostate biopsies in a predominantly AA population at a Veterans Affairs Hospital. Methods: After obtaining IRB approval, we retrospectively reviewed all patients with PCa found on a 14 core biopsy in which 12 needle biopsies were directed at the peripheral zone (PZ) and 2 at the TZ, between January 2010 and June 2014. Location of disease was determined by the results of the biopsy, either PZ alone, TZ alone or both. Aggressiveness of disease was defined by Gleason grade, percent involvement of PCa in any core and NCCN risk-stratification. Self−identified race was recorded for all patients. A series of Mann Whitney U and Chi−square tests were used to compare variables. Results: The total patient cohort consisted of 398 men, in which 277 (70%) were AA. When compared with Caucasian Americans (CA), AA patients had more NCCN intermediate or high risk (50% vs 39%, p = 0.25) PCa. Most patients had PCa limited to the PZ only (n=190) or in both the PZ and TZ (n=191). For 17 patients (4%) PCa was limited to TZ core(s) only, 14 (5%) AA vs 3 (2%) CA (p = 0.24). Of these 17 patients, 14 (82%) had Gleason 6 only disease. Patients with PCa in both the PZ and TZ had higher PSA and PSA density, greater volume of disease, higher-grade lesions and worse NCCN category (all values p <0.01) compared with patients in which the positive biopsy was limited to the PZ. Of these 191 TZ and PZ positive patients, a greater proportion were AA (n=135, 49%) compared to CA (n=56, 46%) (p = 0.48). For patients with PZ and TZ disease, the TZ had the highest-grade in 21 (11%) men, 10% AA and 13% CA (p = 0.67). For most patients (89%), PZ tumor grade was equal to or greater than TZ. Conclusions: TZ−directed prostate needle biopsy cores were rarely the sole location of PCa and when found were usually low grade without clear racial variation. Patients with PCa in both the PZ and TZ had aggressive disease regardless of race although the TZ core resulted in upgrading in a minority of patients. TZ-directed biopsies do not appear to be of greater benefit to AA than CA.

Neoplastic reprogramming of patient-derived adipose stem cells by prostate cancer cell-associated exosomes

Emerging evidence suggests that mesenchymal stem cells (MSCs) are often recruited to tumor sites but their functional significance in tumor growth and disease progression remains elusive. Herein we report that prostate cancer (PC) cell microenvironment subverts PC patient adipose-derived stem cells (pASCs) to undergo neoplastic transformation. Unlike normal ASCs, the pASCs primed with PC cell conditioned media (CM) formed prostate-like neoplastic lesions in vivo and reproduced aggressive tumors in secondary recipients. The pASC tumors acquired cytogenetic aberrations and mesenchymal-to-epithelial transition and expressed epithelial, neoplastic, and vasculogenic markers reminiscent of molecular features of PC tumor xenografts. Our mechanistic studies revealed that PC cell-derived exosomes are sufficient to recapitulate formation of prostate tumorigenic mimicry generated by CM-primed pASCs in vivo. In addition to downregulation of the large tumor suppressor homolog2 and the programmed cell death protein 4, a neoplastic transformation inhibitor, the tumorigenic reprogramming of pASCs was associated with trafficking by PC cell-derived exosomes of oncogenic factors, including H-ras and K-ras transcripts, oncomiRNAs miR-125b, miR-130b, and miR-155 as well as the Ras superfamily of GTPases Rab1a, Rab1b, and Rab11a. Our findings implicate a new role for PC cell-derived exosomes in clonal expansion of tumors through neoplastic reprogramming of tumor tropic ASCs in cancer patients.

Abstract C72: Estradiol-ERβ signaling axis in disparity of prostate cancer in African American men

Our study showed that high circulating estrogens and estrogen receptor beta (ERβ) may be implicated in prostate cancer (PCa) progression, and had higher expression level in African American (AA) than Caucasian American (CA) men. However, the underlying mechanisms remain elusive. The objective of this study was to investigate the signaling cross-talk between ERβ; and AR in vitro and in vivo levels. Prostate cancer cells; LNCaP, C4-2B and PC3 were treated with different concentrations and at different time points with 17β-Estradiol (E2) and 5α-dihydrotestosterone (DHT) and examined for cell proliferation by WST assay, promoter activity by luciferase assay, DNA-protein interaction by electrophoretic mobility shift assay (EMSA) and chromatin immunoprecipitation (ChIP) assay. After E2 or DHT treatment, the translocation of ERβ; and AR in PCa cells was also examined using fluorescence microscope.

Our results show that ERβ; was stimulated by treatment of cells with 10nM DHT and AR was also induced by treating PCa cells with10nM E2. These results were confirmed by promoter activity of truncated psPSA-luc in either PCa cell lines or Cos-7 cells. The predesigned Androgen Response Element (ARE) was bound to the protein's receptor after E2 induction. ChIP experiment corroborated the cross-talk between AR and ERβ; after treating C4-2B cells with 10nM E2 for 30 min up to 1.5 hr. Immunofluorescence depicted colocalization of AR and ERβ; in the nucleus after 30 min from E2 treatment. To our knowledge, this is the first report demonstrating crosstalk between ERβ; and AR signaling in PCa in response to E2 treatment. Our results implicate potential therapeutic application by targeting AR and ERβ; in castration-resistant PCa (CRPC).

Citation Format: Zakaria Y. Abd Elmageed, Hogyoung Kim, Raju Thomas, Krishnarao Moparty, Asim B. Abdel-Mageed. Estradiol-ERβ signaling axis in disparity of prostate cancer in African American men. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr C72. doi:10.1158/1538-7755.DISP13-C72

Active surveillance of prostate cancer in African American men

Active surveillance (AS) is a treatment strategy for prostate cancer (PCa) whereby patients diagnosed with PCa undergo ongoing characterization of their disease with the intent of avoiding radical treatment. Previously, AS has been demonstrated to be a reasonable option for men with low-risk PCa, but existing cohorts largely consist of Caucasian Americans. Because African Americans have a greater incidence, more aggressive, and potentially more lethal PCa than Caucasian Americans, it is unclear if AS is appropriate for African Americans. We performed a review of the available literature on AS with a focus on African Americans.

High circulating estrogens and selective expression of ERβ in prostate tumors of Americans: implications for racial disparity of prostate cancer

Although estrogen receptor beta (ERβ) has been implicated in prostate cancer (PCa) progression, its potential role in health disparity of PCa remains elusive. The objective of this study was to examine serum estrogens and prostate tumor ERβ expression and examine their correlation with clinical and pathological parameters in African American (AA) versus Caucasian American (CA) men. The circulating 17β-estradiol (E2) was measured by enzyme immunoassay in blood procured from racially stratified normal subjects and PCa patients. Differential expression profile analysis of ERβ was analyzed by quantitative immunohistochemistry using ethnicity-based tissue microarray encompassing 300 PCa tissue cores. In situ ERβ expression was validated by quantitative reverse transcription-PCR in matched microdissected normal prostate epithelium and tumor cells and datasets extracted from independent cohorts. In comparison with normal age-matched subjects, circulating E2 levels were significantly elevated in all PCa patients. Further analysis demonstrates an increase in blood E2 levels in AA men in both normal and PCa in comparison with age- and stage-matched counterparts of CA decent. Histochemical score analysis reveals intense nuclear immunoreactivity for ERβ in tumor cores of AA men than in CA men. Gene expression analysis in microdissected tumors corroborated the biracial differences in ERβ expression. Gene expression analysis from independent cohort datasets revealed correlation between ERβ expression and PCa progression. However, unlike in CA men, adjusted multivariate analysis showed that ERβ expression correlates with age at diagnosis and low prostate-specific antigen recurrence-free survival in AA men. Taken together, our results suggest that E2-ERβ axis may have potential clinical utility in PCa diagnosis and clinical outcome among AA men.

Abstract B30: Estrogen-ERβ axis: Implications for racial disparity of prostate cancer

Introduction: The roles of estrogens and estrogen receptors (ERs) in the disproportionate incidence and mortality of prostate cancer (PCa) among African Americans (AA) as opposed to Caucasian Americans (CA) have not been established. Although estrogens have been shown to be involved in normal and pathologic growth of prostate gland including prostate cancer (PCa). Because ERα and ERβ are different in terms of ligand binding, heterodimerization, transactivation, and estrogen response element activity, their aberrant expression may act as a key factor to determine the ultimate estrogen effects on prostate cancer cells. Although recent studies have reported a role for ERβ in PCa, its ethnic-based expression and underlying mechanisms are not fully understood.

Methods: Differential expression of ERβ was assessed using an NCI-designed ethnicity-based tissue microarray (TMA) slide encompassing 150 each of AA and CA prostate cancer tissue cores, 17 BPH, 13 normal biopsies, and 3 PCa cell lines (LNCaP, DU-145 and PC-3). In another set of experiments, androgen dependent (LNCaP) and independent (C4-2B and PC-3) cell lines were treated with various concentrations (up to 10 nM) of dihydrotestosterone (DHT) and estradiol (E2). Cell proliferation, expression of hormone receptors (qPCR and Western blot analysis), and crosstalk of AR and ERs transactivation using specific pharmacologic inhibitors and ERα and ERβ shRNA-stable-transfected COS-7 cells in presence or absence of hormones were performed.

Results: In comparison to normal subjects, circulating E2 levels were significantly elevated (p=0.016) in all PCa patients. Further analysis demonstrates an increase in circulating E2 levels in AA (p=0.002) in comparison to CA men with PCa. Histoscore analysis demonstrates intense nuclear immunoreactivity (p=0.002) for ERβ in tumor cores of AA than in CA men. The biracial expression of ERβ was validated by qRT-PCR on LCM-procured tumor cells (p=0.032). Adjusted multivariate analysis showed a positive correlation (p&lt;0.042) between ERβ expression and the age at diagnosis in AA men. However, no correlation found between ERβ and other clinical parameters in CA men. At the molecular level, mRNA and protein expression of AR were elevated in E2-treated PCs cells. Cell proliferation rate was accelerated after 72h of E2 treatment, especially in AR-independent PC cells. In addition, the activity of AR was increased by E2 treatment, an effect that was reversed by specific ER-inhibitors (ICI-182780 and Tamoxifen). Intriguingly, an AR ligand-independent increase in psPSA-luc promoter activity was observed in response to E2 in ERα/β-transfected COS-7 cells. Treatment of COS-7 cells with MPP or ERα shRNA apparently decreased the promoter activity in ERα-transfected CO7 cells after E2 treatment.

Conclusion: Taken together, estrogen-ERβ axis has a distinctive role in activating AR-signaling in prostate cancer cells. Importantly, high circulating levels of estrogens coupled with differential expression of ERβ in tumor cells suggest a potential role for estrogen-ERβ axis in development of castrate-resistant prostate cancer (CRPC) in AA men.

Citation Format: Krzysztof Moroz, Zakaria Abd Elmageed, Sudesh Srivastav, Krishnarao Moparty, Krishnarao Moparty, Raju Thomas, Asim B. Abdel-Mageed. Estrogen-ERβ axis: Implications for racial disparity of prostate cancer. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr B30.

Abstract 438: The importance of estrogen-ERβ axis in racial disparity of prostate cancer

Purpose: The role of estrogens and estrogen receptors (ERs) in the disproportionate incidence and mortality of prostate cancer (PCa) has not been established. Although ERβ has been implicated in PCa progression, its ethnic-based expression and underlying mechanisms are not fully understood. The aim of this study is to establish correlation between estrogen-ERβ axis and clinical outcome in African American (AA) in comparison to Caucasian American (CA) men. Patients and Methods: 17β-Estradiol (E2) was determined in the blood procured from normal (n=30) and PCa patients (n=50) by ELISA. The expression of ERβ was assessed using an NCI-designed ethnicity-based tissue microarray (TMA) slide encompassing 150 each of AA and CA PCa tissue cores, 17 BPH, 13 normal biopsies, and 3 PCa cell lines (LNCaP, DU-145 and PC-3). Validation of ERβ in situ was validated by qRT-PCR in matched microdissected tumors and normal glands from both populations. Results: In comparison to normal subjects, circulating E2 levels were significantly (p=0.0160) elevated in AA-men than in CA-men with PCa. Additionally, a significant difference in E2 blood levels (p=0.0015) was observed between AA and AA PCa patients. Histoscore analysis demonstrate intense nuclear immunoreactivity (p=0.0018) against ERβ in tumors of AA than CA men. This notion was further validated by qRT-PCR on LCM-procured tumor cells (p=0.0315). In the adjusted multivariate analysis there was no correlation between ERβ expression and any clinical parameters in PCa tissues. In AA, there was a positive correlation between Gleason score (GS) and age but a negative correlation was found between GS, age and PSA-recurrence free. However, no correlation was found in CA. Conclusion: Together, high circulating levels of blood estrogens and mRNA levels coupled with a differential expression of ERβ in PCa tissues suggest a potential role for estrogen-ERβ axis in the development of castrate-resistant prostate cancer in AA men. Key words: E2, ER beta, mRNA, TMA, histoscore, African Americans, health disparities.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 438. doi:1538-7445.AM2012-438

Abstract 2712: Heterogeneous nuclear ribonucleoprotein H1 confers transcription and transactivation of androgen receptor: Implications for prostate cancer progression in African American men

Caucasian American (CA) and other ethnic minority groups. The causes of this ethnic disparity in clinical manifestation and outcome of the disease are not well understood. Here we identified, by employing a combined approach of laser capture microdissected (LCM), suppressive subtractive hybridization (SSH), and custom race-based CaP cDNA microarray on fresh specimens, selective expression of heterogeneous nuclear ribonucleoprotein H1 (hnRNPH1) in prostate tumor cells of AA men in comparison to CA men. An ethnicity-based tissue microarray (TMA) analysis revealed selective nuclear accumulation of hnRNPH1 in tumor cells compared to adjacent normal epithelium and benign prostatic hyperplasia (BPH). We also show that hnRNPH1 up-regulates transcription, physically interact with, and confers hormone-dependent (HD) and independent (HI) transactivation of androgen receptor (AR) in CaP cells. Further, our reporter, ChIP, and EMSA analyses demonstrate hnRNPH1 binds to androgen response elements (AREs) on promoter and enhancer element of PSA gene and the ligand binding domain-encoding exons D, E and H of the AR gene, suggesting it acts as a coactivator of AR in CaP cells. Interestingly, siRNA silencing of hnRNPH1caused growth arrest and enhanced cytotoxicty of Bicalutamide in AR-expressing CaP cells. These findings support a model in which hnRNP H1 is an exclusive auxiliary factor for AR to elicit androgen-specific transcriptional regulation of androgen-regulated genes and drug resistance. Given heterogeneity of CaP and that AR is implicated in androgen independent progression of CaP, the results demonstrate a previously uncharacterized mechanism for AR-hnRNPH1 axis in disease progression and hormone refractory via enhancing HD and HI mediated transcription and transactivation of AR in a subset of prostate tumor cells in AA men. The results not only reveal racial differences in the biology of CaP, but also provide, for the first time, a new frontier for the development of diagnostic, preventive, and/or targeted therapeutic strategies to circumvent disease progression in AA men.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 2712.

Functional androgen receptor confers sensitization of androgen-independent prostate cancer cells to anticancer therapy via caspase activation

Therapeutic resistance remains an unresolved problem in the clinical management of human prostate cancer (PC). Despite initial positive response to androgen ablation therapy (AAT), virtually all PC patients will relapse due to acquisition of hormone refractory disease and selective outgrowth of tumor cells with multidrug resistance phenotype. We here provide the first experimental evidence that restoring a functional androgen receptor (AR) in the androgen-independent prostate cancer PC3 cells enhances their sensitivity to growth arrest and suppresses their colony-forming ability in response to paclitaxel and gamma-irradiation. Furthermore, functional AR increases the susceptibility of these cells to the apoptotic potentials of therapeutic agents, as evidenced by an increase in caspase activity, annexin V binding, and internucleosomal DNA fragmentation, by inducing caspase activation. The abrogation of the cytotoxic effects by 4-hydroxyflutamide suggests a crucial role for AR activation in enhancing the therapeutic sensitivity of these cells in a ligand-independent fashion. Our data thus demonstrate that a functional AR is a prerequisite for effective therapeutic response and that aberrant expression or blockade by AAT may trigger pathways leading to emergence of PC cells with therapeutic resistance phenotype. Since the mainstay of primary therapy for PC has been AAT by pharmaco-therapeutic or surgical means, this study thus provides a new frontier for revising the AAT therapeutic strategy in conjunction with radiation and/or chemotherapeutic agents.

Adenovirus-mediated inhibition of NF-kappaB confers chemo-sensitization and apoptosis in prostate cancer cells

Acquirement of multi-drug resistance by tumor cells represents a major obstacle in the management of prostate cancer. Such resistance was demonstrated in the androgen-independent DU-145 cells in response to paclitaxel and the mechanisms by which these cell develops resistance was not understood. The objective of this study was to examine whether abrogation of the constitutively active NF-kappaB in the chemoresistant, androgen independent DU-145 prostate cancer cells will enhance their sensitivity to cytototoxic agents. Inhibition of NF-kappaB by a dominant negative super-repressor IkappaB mutant adenoviral construct enhanced the apoptotic potentials of paclitaxel and rhTNF-alpha in these cells. Using reporter assays and RT-PCR analysis, we demonstrate that paclitaxel-induced cell death was associated with an increase in NF-kappaB activation and MDR-1 gene expression. Abrogation of these effects by the dominant negative IkappaB adenoviral construct suggests that induction and/or constitutive activation of NF-kappaB can block the paclitaxel-induced apoptotic signaling pathways in this cell line, possibly by increasing the expression of anti-apoptotic and MDR-1 gene products, leading to development of chemoresistance in these cells. We conclude that inhibition of NF-kappaB activation may have therapeutic implications for prostate cancer.

Patient and partner satisfaction and long-term results after surgical treatment for Peyronie's disease

OBJECTIVES

To assess the long-term functional outcome, patient and partner satisfaction, and predictive factors for unfavorable results in men treated with a surgical approach for severe Peyronie's disease.

METHODS

Sixty-one patients underwent surgical treatment for Peyronie's disease between 1997 and 2001 and were retrospectively evaluated. All patients were assessed preoperatively with a detailed sexual and medical history, focused physical examination, and penile duplex ultrasonography. Nineteen patients underwent penile plaque excision/incision and grafting with Tutoplast cadaveric pericardial grafting material (group 1). Penile prosthesis implantation and manual modeling was performed in 31 patients (group 2a), and 11 men were treated with penile prosthesis implantation and pericardial grafting (group 2b).

RESULTS

The mean follow-up of the patients was 21.9 +/- 13.6 months (range 12 to 48). Complete penile straightening was achieved in 15 patients (78.9%) in the excision/incision and grafting group. In the 42 men who underwent reconstruction using penile prosthesis implantation (group 2a,b), penile curvature resolved completely in 37 patients (88%). Long-term postoperative residual curvatures greater than 30 degrees occurred in 3 patients (15.7%) and 2 patients (4.8%) in groups 1 and 2a,b, respectively. One penile prosthesis (2.3%) was explanted in the second group for erosion. Patient responses to our questionnaire showed that overall 83.6% of the patients and 76.9% of the partners were satisfied with the surgical result.

CONCLUSIONS

According to the results of this long-term, retrospective study, pericardial grafting can be used successfully after plaque excision/incision procedures in men undergoing surgical treatment for severe Peyronie's disease. In patients with Peyronie's disease and erectile dysfunction, implantation of a penile prosthesis and correction of the curvature with a graft can provide an acceptable, functionally straight penis without any increased risk of complications compared with penile prosthesis implantation alone.