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Molecular characterization of prostate cancer in Middle Eastern population highlights differences with Western populations with prognostic implication

  • Original Article – Cancer Research
  • Published:
Journal of Cancer Research and Clinical Oncology Aims and scope Submit manuscript

Abstract

Background

To investigate the incidence and prognostication of ERG, PTEN and SPINK1 protein expressions in prostate cancer cohort of Middle Eastern descent in comparison to published data from Western population.

Methods

Immunohistochemistry for ERG, PTEN and SPINK1 was performed in a cohort of localized PCA (n = 340). The data were correlated to pathological and clinical outcomes and compared to Western populations.

Results

ERG expression and PTEN loss were noted in 123/288 (42.7%) and 91/297 (30.6%) of patients, respectively. SPINK1 expression was assessed in a subset of cases, noted in 6/150 (4%) of patients. Only ERG expression was associated with grade groups, being more common in the lower grade groups (1–3 vs 4–5; p = 0.04). In contrast to the Western population, PTEN loss foci were more likely to be ERG negative, observed in 81% of tumor foci and patients with PTEN neg/ERG pos were more likely to exhibit biochemical recurrence (OR 2.831; 95% CI 1.10–726, p = 0.03). This association remained significant in multivariate analysis (OR 2.68; 95% CI 0.98–7.33, p = 0.05), after adjusting for GG, path stage and surgical margin.

Conclusion

This study documents significant differences in key molecular events in PCA in Middle Eastern population compared to Western populations that could explain differences in PCA incidence, progression and prognostication. ERG, PTEN and SPINK1 genomic alteration occur less frequently and the enrichment of ERG for PTEN loss is not observed. Additionally, patients with combined PTEN loss/ERG positive are at highest risk for BCR vs North American Caucasian population where PTEN loss alone seems to be associated with the worst clinical outcome. The data presented here further support differences in clonal evolution between Middle Eastern and Western population in relation to PCA and add further insight to understanding PCA molecular pathways.

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Abbreviations

PCA:

Prostate cancer

CRPC:

Castrate-resistant prostate cancer

ETS:

Erythroblast transformation-specific

PTEN:

Phosphatase and tensin homolog

SPINK1:

Serine protease inhibitor Kazal-type 1

BCR:

Biochemical recurrence

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Acknowledgements

We thank Ms. Ruby Reyes for her technical assistance in preparing this manuscript.

Funding

This work was supported in part by the Prostate Cancer Foundation, USA. Young Investigator Award and Prostate Cancer Canada, Translational Acceleration Grant and by funds from Calgary Laboratory Services (T.A.B). The Agency provides operating cost funds with no effect on actual research design or outcome.

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Author notes

  1. Ramy A. Abdelsalam and Ibrahim Khalifeh contributed equally.

Authors and Affiliations

  1. Department of Pathology and Laboratory Medicine, University of Calgary and Calgary Laboratory Services, Calgary, AB, Canada

    Ramy A. Abdelsalam, Alan Box, Maria Kalantarian, Hatem Abou-Ouf & Tarek A. Bismar

  2. Department of Pathology, Mansoura University, Mansoura, Egypt

    Ramy A. Abdelsalam

  3. Departments of Oncology, Biochemistry and Molecular Biology, Calgary, AB, Canada

    Tarek A. Bismar

  4. Arnie Charbonneau Cancer Institute and Tom Baker Cancer Center, Calgary, AB, Canada

    Tarek A. Bismar

  5. Department of Pathology and Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon

    Ibrahim Khalifeh & Tamara Lotfi

  6. Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA

    Mohammed Shahait

  7. Department of Urology, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA

    Nallasivam Palanisamy

  8. Alberta Health Services-Cancer Control and Department of Medical Oncology, University of Alberta, Edmonton, AB, Canada

    Sunita Ghosh

  9. Rockyview General Hospital, 7007, 14th st, Calgary, SW, ABT2V1P9, Canada

    Tarek A. Bismar

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Contributions

RA, AB, MK, HA performed analysis. IK, TL, MS collected data and performed analysis. SG performed statistical analysis. NP performed, supervised and provided input for manuscript and marker staining. TAB supervised and planned study. All authors have approved the final version of this manuscript.

Corresponding author

Correspondence to Tarek A. Bismar.

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All authors have no conflict of interest to declare.

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The study was approved by the University of Calgary Cumming School of Medicine ethics review board and in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Patient consent was waived by the ethics review board, due to the retrospective nature of the study.

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The study is retrospective with samples available from 1998–2008. Data sharing is not applicable.

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Abdelsalam, R.A., Khalifeh, I., Box, A. et al. Molecular characterization of prostate cancer in Middle Eastern population highlights differences with Western populations with prognostic implication. J Cancer Res Clin Oncol 146, 1701–1709 (2020). https://doi.org/10.1007/s00432-020-03221-x

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