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Summary Prostate cancer (PCa) is the most common type of cancer found in men from western countries and is the leading cancer death next to lung cancer and colorectal cancer. Proteomic studies on PCa identified a number of differentially expressed proteins and some of them were reported as potential markers, but clinical application of these markers is mostly missing. Most of the expression profiling studies have been carried out on radical prostatectomy specimens, formalin-fixed paraffin-embedded (FFPE) tissue sections, serum, urine and prostate fluids. To define the protein expression pattern of prostate biopsies, in the present study we investigated biopsy samples from benign prostate hyperplasia (BPH) and PCa patients by two-dimensional gel electrophoresis (BPH n=11 and PCa n=12) and mass spectrometry to identify potential biomarkers which might distinguish the two clinical situations. 2-DE results revealed 88 protein spots expressed differentially among hyperplasia and cancer groups with statistical significance. Interesting spots were analyzed by MALDI-TOF-MS-MS and 79 different proteins identified. The important proteins identified included, Prohibitin and NDRG1 tumor suppressor proteins, HSPs, cytoskeletal proteins, enzymes like DDAH1 and ALDH2. Prohibitin expression was investigated in detail at mRNA level and protein level using immunohistochemistry on prostatectomized specimens. We found that the level of mRNA for prohibitin correlates with the increased amount of protein indicating the involvement of changes at transcriptional level. Furthermore, immunohistochemistry revealed no staining in BPH, moderate staining in prostate intraepithelial neoplasia (PIN) and strong staining in PCa. From the list of differentially proteins compared to PCa, TPD52 is over expressed in prostate cancer and also mRNA estimation by real-time PCR confirmed over expression of TPD52 at transcriptional level in cancer. TPD52 is a protein over expressed in prostate and breast cancer due to gene amplification but its exact physiological function is not investigated in detail. In the present study, we explored the responsiveness of LNCaP cells after dysregulation of TPD52 expression. Transfection of LNCaP cells with specific shRNA giving efficient knockdown of TPD52 resulted in a significant cell death of the carcinoma LNCaP cells. As evidenced by the activation of caspases (caspase-3 and -9) and by the loss of mitochondrial membrane potential, cell death occurs due to apoptosis. The disruption of the mitochondrial membrane potential indicates that TPD52 acts upstream of the mitochondrial apoptotic reaction. To study the effect of TPD52 expression on cell proliferation, LNCaP cells were either transfected with EGFP-TPD52 or a specific shRNA. EGFP-TPD52 overexpressing cells showed an increased proliferation rate whereas TPD52-depleted cells showed a reverse effect. Additionally, we demonstrated that the exogenous expression of TPD52 promotes cell migration via ávâ3 integrin in prostate cancer cells through the activation of protein kinase B (PKB/Akt) pathway. In an attempt to identify new interacting proteins for TPD52, GST pulldown assays provided evidence for the physical interaction between TPD52 and Prx1 in LNCaP cells. Further, immunoprecipitation results confirmed this interaction. Our results demonstrates that protein profiling and mRNA studies can be performed on prostate biopsies. Moreover, our study revealed a significant up-regulation of prohibitin in prostate cancer compared to BPH which may be a potential marker to distinguish PCa and BPH. From the results for functional characterization of TPD52, we conclude that TPD52 plays an important role in various molecular events particularly in morphological diversification and dissemination of PCa. It may be a promising target to investigate further in detail to develop new therapeutic strategies to treat PCa patients. Caspases represent a family of cysteine proteases that are regarded as central executioners of apoptotic cell death. Activation of caspase cascade is an essential prerequisite in the induction of apoptosis in cellular systems. So far, in many tumors caspases were shown to be downregulated while anti-apoptotic Bcl-2 is up-regulated. To get insight in their putative role in PCa progression we determined the expression of caspase-1, uncleaved caspases 3 and 6, cleaved (activated) caspases 3 and 6, caspase-9 and antiapoptotic protein Bcl-2 in benign prostate epithelium (BPE) and prostate carcinoma. In the current study 20 prostates were obtained from patients undergoing radical prostatectomy due to PCa. Paraffin embedded prostate whole mounts were cut at (4 µm) and investigated immunohistochemically using anti-mouse monoclonal antibodies directed against caspases 1 and 9, uncleaved caspases 3 and 6, cleaved caspases 3 and 6, and Bcl-2. In BPE all caspases were localized in the cytoplasm of glandular cells. Comparing BPE to PCa, no differences were found for caspase-1, uncleaved caspases 3 and 6 as well as caspase-9. Immunostaining for cleaved caspases 3 and 6, however, revealed a statistically significant reduction in PCa compared to non-neoplastic tissue. Whereas in BPE Bcl-2 protein was detected in the basal compartment of epithelial gland cells no immunostaining was seen in PCa. As our results show a decreased amount of activated caspases may be due to the alterations of posttranslational cleavage rather than expression of caspases 3 and 6. This suggests that the modification in their activation pathway could play an important role during PCa progression.
MicroRNAs (miRNA) are ubiquitous non-coding RNAs that have a prominent role in cellular regulation. The expression of many miRNAs is often found deregulated in prostate cancer (PCa) and castration-resistant prostate cancer (CRPC). Although their expression can be associated with PCa and CRPC, their functions and regulatory activity in cancer development are poorly understood. In this study, we used different proteomics tools to analyze the activity of hsa-miR-3687-3p (miR-3687) and hsa-miR-4417-3p (miR-4417), two miRNAs upregulated in CRPC. PCa and CRPC cell lines were transfected with miR-3687 or miR-4417 to overexpress the miRNAs. Cell lysates were analyzed using 2D gel electrophoresis and proteins were subsequently identified using mass spectrometry (Maldi-MS/MS). A whole cell lysate, without 2D-gel separation, was analyzed by ESI-MS/MS. The expression of deregulated proteins found across both methods was further investigated using Western blotting. Gene ontology and cellular process network analysis determined that miR-3687 and miR-4417 are involved in diverse regulatory mechanisms that support the CRPC phenotype, including metabolism and inflammation. Moreover, both miRNAs are associated with extracellular vesicles, which point toward a secretory mechanism. The tumor protein D52 isoform 1 (TD52-IF1), which regulates neuroendocrine trans-differentiation, was found to be substantially deregulated in androgen-insensitive cells by both miR-3687 and miR-4417. These findings show that these miRNAs potentially support the CRPC by truncating the TD52-IF1 expression after the onset of androgen resistance.
Simple Summary
This multicenter study investigated the extent of patient’s decision regret (PatR) in patients with prostate cancer comparing different surgical modalities. Robot-assisted radical prostatectomy has replaced open radical prostatectomy as the surgical standard of care in many countries worldwide. However, a broad scientific basis evaluating the difference in patient-relevant outcomes between both approaches is still lacking. In this context, PatR is increasingly moving into the scientific focus. Our study shows a critical PatR in slightly more than one third of patients about 15 months after surgery. Patients who underwent robot-assisted surgery, and also patients without postoperative urinary stress incontinence, report significantly lower PatR. Likewise, this difference was also demonstrated for patients who decided together with their treating physician on the specific surgical procedure (consensual decision making). Our study helps to further establish PatR as an important endpoint in the setting of radical prostatectomy and identifies criteria which may be addressed to reduce PatR.
Abstract
Patient’s regret (PatR) concerning the choice of therapy represents a crucial endpoint for treatment evaluation after radical prostatectomy (RP) for prostate cancer (PCA). This study aims to compare PatR following robot-assisted (RARP) and open surgical approach (ORP). A survey comprising perioperative-functional criteria was sent to 1000 patients in 20 German centers at a median of 15 months after RP. Surgery-related items were collected from participating centers. To calculate PatR differences between approaches, a multivariate regressive base model (MVBM) was established incorporating surgical approach and demographic, center-specific, and tumor-specific criteria not primarily affected by surgical approach. An extended model (MVEM) was further adjusted by variables potentially affected by surgical approach. PatR was based on five validated questions ranging 0–100 (cutoff >15 defined as critical PatR). The response rate was 75.0%. After exclusion of patients with laparoscopic RP or stage M1b/c, the study cohort comprised 277/365 ORP/RARP patients. ORP/RARP patients had a median PatR of 15/10 (p < 0.001) and 46.2%/28.1% had a PatR >15, respectively (p < 0.001). Based on the MVBM, RARP patients showed PatR >15 relative 46.8% less frequently (p < 0.001). Consensual decision making regarding surgical approach independently reduced PatR. With the MVEM, the independent impact of both surgical approach and of consensual decision making was confirmed. This study involving centers of different care levels showed significantly lower PatR following RARP.
Simple Summary
This German multicenter study investigated the importance of different supportive measures offered to patients with prostate cancer who undergo surgery (radical prostatectomy). A number of these supportive measures are required during the certification of a urologic hospital as prostate cancer center. However, a broad scientific basis evaluating these measures from the patient’s perspective is still lacking. In this study, patients were asked to rate the relevance of several supportive measures and to estimate the effective availability of these different supportive measures at their urologic clinic about 15 months after surgery. Our study highlights that only six of fifteen different supportive measures were rated as very relevant by patients. None of these six supportive measures were offered more intensively at the certified clinics compared to the non-certified clinics according to the patients. Our study helps to identify those supportive measures with the highest subjective impact on patients in this setting.
Abstract
Certification as a prostate cancer center requires the offer of several supportive measures to patients undergoing radical prostatectomy (RP). However, it remains unclear how patients estimate the relevance of these measures and whether the availability of these measures differs between certified prostate cancer centers (CERTs) and non-certified centers (NCERTs). In 20 German urologic centers, a survey comprising questions on the relevance of 15 supportive measures was sent to 1000 patients at a median of 15 months after RP. Additionally, patients were asked to rate the availability of these measures using a four-item Likert scale. The aim of this study was to compare these ratings between CERTs and NCERTs. The response rate was 75.0%. In total, 480 patients underwent surgery in CERTs, and 270 in NCERTs. Patients rated 6/15 supportive measures as very relevant: preoperative medical counselling concerning treatment options, a preoperative briefing answering last questions, preoperative pelvic floor exercises (PFEs), postoperative PFEs, postoperative social support, and postoperative rehabilitation addressing physical fitness recovery. These ratings showed no significant difference between CERTs and NCERTs (p = 0.133–0.676). In addition, 4/9 of the remaining criteria were rated as more detailed by patients in CERTs. IMPROVE represents the first study worldwide to evaluate a patient-reported assessment of the supportive measures accompanying RP. Pertinent offers vary marginally between CERTs and NCERTs.