Advantages and limitations of 3D organoids and ex vivo tumor tissue culture in personalized medicine for prostate cancer

BACKGROUND

Current in vitro model systems do not fully reflect the bio-logical and clinical diversity of prostate cancer (PCa). Organoids are 3D in vitro cell cultures that may better recapitulate disease heterogeneity and retain parental tumor characteristics. Short-term ex vivo culture of PCa tissues may also facilitate drug testing in personalized medicine.

MATERIALS AND METHODS

For organoid culture, we have processed both cancer and normal tissues from 50 patients who underwent radical prostatectomy or transurethral resection of the prostate. In addition, we exploited the ex vivo tissue culture technique and performed short-term chemotherapy assay using gemcitabine and Chk1 inhibitor MU380 in 10 patient samples.

RESULTS

In total, we were able to cultivate organoids from 58% of tumors (29/50) and 69% of normal tissue (20/29). Immunohistochemical staining of two representative cases revealed cell positivity for pan-cytokeratin confirming the presence of epithelial cells. However, the overexpression of AMACR and ERG proteins in tumors was not recapitulated in organoids. Another limitation was the propagation of organoids only up to 3 weeks till the first passage. Next, a short-term drug test was performed for ten patients using ex vivo tissue culture. Samples from prostatectomies mostly presented a low proliferation rate as assessed by Ki-67 staining. Another drawback of this ap-proach was inconsistent tissue morphology among particular tissue fragments. Only one case showed a high proliferation rate for drug testing and tumor tissue was present in all tested samples. In our work, we also provide an overview of recent studies and a detailed comparison of culture conditions.

CONCLUSION

We have established cultures of both organoids and tissue fragments from PCa patient samples. However, the expression of tumor markers was not recapitulated in organoids. Inconsistent morphology among tissue fragments and low proliferation hampered the interpretation of the drug testing in most cases. Still, these approaches may be promising using tissues from metastatic castration-resistant prostate cancer.

Infiltration of Prostate Cancer by CD204+ and CD3+ Cells Correlates with ERG Expression and TMPRSS2-ERG Gene Fusion

BACKGROUND

The aim of the study was to detect CD204 + and CD3 + cells in the infiltrate of benign prostatic hyperplasia, prostatic intraepithelial neoplasia and prostatic cancer in prostate specimens after radical prostatectomy. Another goal was to determine correlation of the intensity of the infiltration with ERG oncoprotein expression as well as with the presence of activat-ing translocation TMPRSS2-ERG.

MATERIALS AND METHODS

To confirm the translocation, we used fluorescence in situ hybridization. Imunohistochemistry was used to detect the presence of ERG oncoprotein and for assesment of the number of CD204+ and CD3+ infiltrat-ing cells. We determined the capability to infiltrate malignant structures accord-ing to differences in infiltration of benign and malignant prostate structures.

RESULTS

Biometric analysis confirmed that the number of CD204+ macrophages in the malignant structure was significantly higher than in the benign prostatic hyperplasia regardless of the fusion pattern. Increased infiltration by CD3+ cells was only detected in malignant structures of the prostate in a group with normal signal pattern and in a group with TMPRSS2-ERG fusion. Expression of ERG positively correlated with CD204+ and CD3+ cells infiltration of malignant structures only in cases where the TMPRSS2-ERG fusion was found. In the group with a break in the TMPRSS2 gene, a positive correlation was only found between ERG expression and CD204+ macrophages infiltration. In cases with a normal signal pattern, no correlation was found. In the group with TMPRSS2-ERG fusion we observed significantly more cases with a good capability of CD204+ cells to infiltrate malignant structures, unlike the group with a normal signal pattern, where there were more cases with the weak reactivity of CD204 + cells to infiltrate the malignant structures. The same was observed for CD3+ cells. CD204+ macrophages and CD3+ T-lymphocytes in the group with TMPRSS2-ERG gene fusion, infiltrated the malignant prostate structures more intensely, but their effect on malignant transformation may be different.

CONCLUSIONS

The association between the presence of the TMPRSS2-ERG fusion and the different capability of inflammatory cells to infiltrate malignant structures has not been reported so far. The results confirm the important role of the activated ERG gene, due to TMPRSS2-ERG fusion, in the development of inflammation of the prostate as well as the effect of inflammatory cells on the course of neoplastic process. This leads to considerations about introduc-ing immunomodulatory modalities into prostate cancer therapeutic protocols. Key words: prostate cancer -  TMPRSS2-ERG gene fusion -  ERG -  immune response -  CD204+ macrophages -  CD3+ T-lymphocytes.

Androgenetic alopecia and polymorphism of the androgen receptor gene (SNP rs6152) in patients with benign prostate hyperplasia or prostate cancer

BACKGROUND

Both androgenetic alopecia (AGA) and carcinoma of the prostate (CaP) or benign prostatic hyperplasia (BPH) are androgen-dependent disorders.

OBJECTIVE

To investigate the relationships between male androgenetic alopecia, androgen receptor (AR) gene polymorphism (SNP rs6152) and clinical characteristics of BPH and prostate cancer.

METHODS

Overall, 309 male subjects with prostate disease (BPH or CaP) were examined. We evaluated the standard grades of AGA (I-VII) by Hamilton-Norwood classification and 195 patients were also assessed by phototrichogram. Prostate-specific antigen (PSA) and testosterone levels were also measured. Polymorphism rs6152 of the AR was evaluated from blood samples by PCR-RFLP. Data were statistically evaluated.

RESULTS

The expected positive correlation between age and AGA grade and the expected negative correlation between hair density and age and between anagen/telogen and AGA were found. A statistically significant difference between patients with A and G alleles in terms of AGA grade was found. The predominant G allele was more frequent in patients with higher grade of alopecia and in patients with significantly higher PSA. There was no correlation between diagnosis (BPH or CaP) and polymorphism. Patients with prostate inflammation had a statistically significant higher grade of AGA, together with higher PSA.

CONCLUSIONS

We confirmed that the AR gene polymorphism (SNP rs6152 G>A) is associated with the development of AGA and higher PSA levels in patients with BPH but not cancer. A novel finding of our study is that BPH patients with prostate inflammation had a significantly higher grade of AGA together with significantly higher PSA levels.

Relation of ETS transcription factor family member ERG, androgen receptor and topoisomerase 2β expression to TMPRSS2-ERG fusion status in prostate cancer

Fusion of TMPRSS2 with ERG in prostate cells is determined by double-strand DNA breaks induced by androgen signaling and transcription stress. The enzyme topoisomerase 2β (TOP2B) mediating DNA processing, plays an important role in DNA cleavage. The aim of this study was to analyse expression of AR, TOP2B and ERG in relation to TMPRSS2-ERG gene rearrangement and relevant clinicopathological characteristics in prostate cancer (CaP). Immunohistochemical staining and FISH were used for investigation. ERG expression in prostate cell lesions positively correlated with levels of TMPRSS2-ERG fusion gene (p<0.0001). The most significant co-expression of ERG was found with AR in CaP (p=0.001). Significantly more frequent co-expression of ERG was also revealed with TOP2B (p=0.028). ERG protein expression did not correlate with CaP differentiation status as we found no significant differences in ERG expression for different Gleason categories. We demonstrated a statistically significant positive correlation between the percentage of cells with fusion gene TMPRSS2-ERG in CaP and metastatic potential of tumors (p=0.011). Besides these positive corelations of AR with ERG (p=0.001) and TOP2B with ERG (p=0.028), we also demonstrated a significant co-expression of AR with TOP2B (p=0.007) in CaP. There was a statistically significant increase in the TOP2B H-index in locally advanced CaP in comparison with localized tumors (p=0.046). ERG expression correlates with occurrence of TMPRSS2-ERG fusion and with AR-driven malignant transformation. The results indicate that detection of the TMPRSS2-ERG fusion gene and parallel immunohistochemical examination of AR, TOP2B and ERG has diagnostic significance and may be useful in assessing the biological character of the prostate cancer as well as selecting the best treatment.

[What is the real importance of evaluating the expression of c-erbB-2 (HER-2/neu) in carcinoma of the breast and prostate? (A short review)]

This minireview covers the key data on biology and clinical implications of the c-erbB-2 oncogene in breast and prostate cancer. The aim was to provide basic information to practically oriented pathologists in order to make a reasonable application of methods for c-erbB-2 overexpression or amplification analysis. The clinical interpretation of c-erbB-2 abnormalities should reflect the complexity of c-erbB-2 mediated regulatory pathway and explain why tumours with overexpression/amplification of c-erbB-2 very often do not respond to therapy using Herceptin.

Nuclear receptors in early hormone refractory prostate cancer and their relationship to apoptosis-related proteins

The expression of several genes involved in apoptosis and cell cycle control can be regulated by steroid hormones and related agents via their nuclear receptors. Members of the bcl-2 gene family participate in the regulation of apoptosis in a diverse range of cell types and are implicated in the development of hormone refractory prostate cancer and resistance to anti-cancer therapy. The aim of this study, therefore, was to examine the expression of several nuclear receptors in relation to the expression of apoptosis and cell cycle related proteins in a series of patients with early hormone refractory prostate cancer. Analysis of protein expression revealed only a weak association between Bcl-2 and AR. Bax positivity and p27Kip1 expression were significantly more frequent in the AR-positive tumors, whereas RXRbeta expression was more frequently observed in the AR-negative group. The expression of AR, Bax and p27Kip1 was inversely related, and the expression of RXRbeta directly related, to Gleason pattern status. These results suggest that the immunophenotype of early hormone refractory prostate cancer may be different to that seen in more advanced stage disease. Androgen withdrawal therapy employing anti-androgens may elicit different signalling pathways that may be dependent on ARstatus and ARsensitivity.

Androgen sensitivity related proteins in hormone-sensitive and hormone-insensitive prostate cancer cell lines treated by androgen antagonist bicalutamide

Members of the bcl-2 gene family and endogenous inhibitors of cyclin-dependent kinases participate in the regulation of apoptosis and cell cycle in a diverse range of cell types and are implicated in the development of hormone refractory prostate cancer and resistance to anti-cancer therapy. The expression of several of these genes can be regulated by steroid hormones and related agents via their nuclear receptors. However, insufficient information considering the protein expression after the treatment by hormone antagonists is available. The aim of this study was to evaluate the expression of anti- and pro-apoptotic proteins, (Bcl-2, Bax), and to correlate this with the appearance of some nuclear receptors and cell cycle related proteins in androgen sensitive and androgen insensitive prostate cancer cell lines, LNCaP and DU-145, after the treatment by androgen antagonist bicalutamide. Our results revealed that androgen receptor (AR) expression in LNCaP cells decreased, however in DU-145 cells AR slightly increased following anti-androgen treatment. The same agent stimulated expression of p21Waf1/Cip5 and p27Kip1 in LNCaP, as well as in DU-145 cell lines. Bcl-2 level increased slightly in LNCaP cells and, in DU-145 cells was almost undetectable. Bax expression was not changed in LNCaP but significantly decreased in DU-145 cells. Similarly, retinoid X receptor beta (RXRbeta) level was significantly down regulated after 24 hours in DU-145 and also in LNCaP cells after 72 hours. These results confirm that androgen withdrawal therapy employing anti-androgens may elicit different signalling pathways in various types of prostate cancer that may be dependent on AR status and AR sensitivity.

Testicle hemodynamics in patients after laparoscopic varicocelectomy evaluated using color Doppler sonography

OBJECTIVES

Testicular blood supply and semen quality were compared in two groups of patients undergoing laparoscopic varicocelectomy: group I (n = 27) with spermatic artery ligation and group II (n = 48) with spermatic artery preservation.

METHODS

Laparoscopic varicocelectomy was performed on 75 patients divided on the basis of whether ligation took place during surgery or not. The blood flow parameter (resistance index-RI) measured using color Doppler sonography was the index of vascular efficiency selected.

RESULTS

Mean RI was 0.69 in group I and 0.65 in group II. The difference was not significant. Both groups showed improvements in sperm density and motility but there was no significant difference between groups for either parameter.

CONCLUSION

Using color Doppler sonography confirms that ligation of the testicular artery during varicocelectomy does not lead to major changes in testicular blood supply or sperm quality.

The value of examining blood supply in prostate cancer using Doppler frequency analysis

Stating the contribution of Doppler ultrasound examination (DU) of prostatic vascularisation towards timely diagnosing prostate cancer. 87 patients with bioptically proven prostate cancer and 10 healthy young men of control group were examined by transrectal ultrasound in B mode, colour flow mapping (CFM) and Doppler frequency analysis. (DFA) The distribution of vessels in prostate is not specific for carcinoma and using CFM, it is impossible to distinguish normal tissue from carcinoma. DU combined with other methods as rectal palpation, PSA, transrectal sonography in B mode may, however, increase carcinoma suspicion, and quicken the indication of considered bioptic puncture.

[Personal experience with peroperative study of testicular blood flow in laparoscopic surgery of varicocele]

Although the authors did not detect in 27 patients operated since October 1996 laparoscopically for varicocele, although the spermatic artery was ligatured a deteriorated blood supply of the testis, they evaluated the blood flow through the spermatic artery in the rete testis by coloured Doppler mapping during temporary peroperative ligature of the spermatic artery. In 14 patients the occlusion did not cause any changes of the blood supply of the testis, in one patient during occlusion of the artery the Doppler signal in the rete testis disappeared, after release of the ligature the blood flow reappeared in the coloured Doppler mapping. The authors conclude that in the great majority of men the blood supply of the testis is ensured by collateral circulation. If the ligature of the spermatic artery is inevitable they recommend to check during operation the blood supply of the testis in the rete testis by dopplerometry.

[Laparoscopic surgery of varicoceles and its effect on testicular hemodynamics and spermiogenesis]

Between December 1993 and October 1996 the authors performed laparoscopic operations of varicocele in 75 patients incl. 53 for concurrent subfertility. In all patients before operation by Doppler sonography and coloured Doppler mapping venous reflux was detected. The volume of the testis was also assessed by sonography. In subfertile patients changes of the spermiogram were assessed. After operation the blood supply was evaluated (the resistive index), the volume of the testes, the duration of the operation and changes in the spermiogram. The authors did not detect a significant difference between the group of 27 patients where with the vein also the artery was ligatured and the group of 48 patients where only the vein was ligatured. The patients were not damaged by ligature of the artery.

[Endosonography of the ureter--initial experience with a new method]

The authors had the opportunity to examine four patients, using a new intraureteral sensing unit and to study the basic ultrasonographic picture of the whole ureter. In addition to the ascendent application of the sensing unit they used also the descendent approach during percutaneous lithotripsy and peroperative exploration of the ureter during ureterotomy. The authors assume that the method will prove useful in particular for detection and assessment of the position of renal vessels before endopyelotomy in hydronephrosis.

[Psychiatrists, lawyers and shamans in the care of the mentally ill]

Ethical attitudes of our society to the mentally sick still lag behind the economic development and legal norms. There prevail fixed prejudices also against psychiatry, as revealed by a recent fraudulent newspaper campaign on the political abuse of psychiatry, supported by a few of our colleagues. Our amended legal regulations which ensure civic rights of patients are stricter than in western countries but rely more on slow legal control than on medical ethics. The retardation of our psychiatry diminished gradually since the ministerial and government resolution on its development was issued in 1958 and 1962 and after the introduction of psychopharmacological treatment and preparations psychotherapy was not neglected either. A further advance of our psychiatry should be made possible by objective evaluation and the use of procedures applied successfully in other countries and not imitation of serious mistakes such as the commercial abuse of health legislation, rash abolition of psychiatric hospitals, pseudoliberal attitudes to the drug misuse and the spread of therapeutic dilettantism.

[Transvaginal urethrovesicopexy]

The authors present their own modification of Stamey's operation of female stress incontinence. Using a two-needle applicator of their own design, they introduce by transvaginal punction fibres next to the cervix of the bladder into the epigastrium. By tightening the fibres they elevate the cervix of the bladder. The elevation is checked by endoscopy. Using this method they operated 25 women. They did not observe any serious complications of the operation. Previous operations in the pelvis minor did not affect the duration of the operation.

[Doppler ultrasonography in successful varicocele surgery]

The authors examined 47 patients after operation on account of varicocele by colour flow mapping and Doppler frequency analysis. In addition they evaluated the postoperative finding clinically and examined also the spermiogram. The greatest success of surgical treatment was observed after laparoscopic ligature of the v. spermatica--a success rate of 91% was recorded after this operation. Bernardi's operation was successful in 62%, Paloma's in 56% of the patients. From 18 patients with a pathological spermiogram before operation they observed improvement in 25%.

The initial experience with doppler diagnosis of scrotum disease abstract

Blood flow parameters in the scrota of 83 men with acute and chronic infra scrotal disease were compared with values from a sample of 70 healthy controls, using doppler ultrasonography. The results confirm the validity of this method in the diagnoses of scrotum disease when combined with other methods of examination. Technical difficulties are discussed.

[Expression of the blood group antigens A and B in carcinoma of the urinary bladder]

In 21 patients with transitional cell carcinoma of the urinary bladder expression of A and B blood group antigens was studied by means of monoclonal antibodies on using indirect immunoperoxide reaction. Expression of the investigated antigens was found to be dependent on the degree of histological differentiation of the tumor tissue. In well-defined carcinomas mostly pronounced expression of A and B blood group antigens was observed. Middle and low-differentiated carcinomas were characterized by reduction or even total deletion of expression. The expected favorable prognosis in transitional cell carcinomas expressing A and B blood group antigens failed to be confirmed. The expression of incompatible A-like antigens in 0 and B blood group patients with carcinoma is discussed. (Tab. 3, Fig. 3, Ref. 22.).

[Tuberous sclerosis from the viewpoint of the urologist]

Renal lesions in patients with tuberous sclerosis are angiomyolipomas which are found in 47-73% of patients and cysts which are less frequent and are encountered in 18-53%. Usually they are multiple and bilateral. In the majority they are asymptomatic, sometimes they cause however by their invasive growth renal damage and serious clinical manifestations. The greatest diagnostic asset is ultrasonography, CT and magnetic resonance. In patients with tuberous sclerosis and suspected angiomyolipoma it is always necessary to rule out a malignant renal tumour, which may be sometimes quite difficult. Asymptomatic lesions do not call for treatment. Surgery is indicated in case of complications--haemorrhage threatening life, dangerous compression of neighbouring organs and suspect malignant disease. The authors describe experience with two patients where surgery was necessary, in one instance unilateral nephrectomy and in the other patient consecutive bilateral nephrectomy.

[Expression of A,B and H blood group antigens in urothelial carcinoma of the urinary bladder]

Expression of blood group antigens A, B, and H was studied in transitional carcinoma of the urinary bladder. Positive result was obtained in 16 cases of a group of 21 tumours by indirect immunoperoxidase reaction with monoclonal antibodies. A relation of quantitative expression to histological grading of tumour differentiation was noticed. Well differentiated transitional carcinomas mostly had more conspicuous expression of A, B, and H antigens. However, expected more favourable prognosis in cases of transitional carcinoma with expression of A, B, and H blood group antigens failed to be proved.

Triorchidism

Polyorchidism is a rare congenital abnormality. This is a case of triorchidism that was suggested preoperatively by scrotal sonography.