Multiple aspects of the molecular biology and genetics of prostate cancer were discussed in this research section. Comuzzi and colleagues described the role of the androgen receptor co-activator CBP in AIPC [androgen independent prostate cancer]. It is detected in most samples of high grade cancer prostate cancer yet absent in two thirds of lower grade tumors in AIPC specimens suggesting a role in the AIPC phenotype.

REG IV a member of the regenerating protein gene family was differentially expressed in an array of prostate tissues. Reiter, et al described that none of the benign tissues demonstrated protein expression yet 44.6% of primary tumors and 62.5% of metastatic tumors stained positively suggesting it as a candidate marker for AIPC.

Further evaluation of 5 alpha reductase type I and type II expression in prostate cancer demonstrated enhanced staining of type I enzyme with progression of prostate cancer, yet unchanged levels of staining in type II among benign and neoplastic tissue specimens. Lazier, et al suggest that this increase in the frequency and area of staining of type I 5 alpha reductase suggests that dual inhibition of these enzymes may be an appropriate approach to the prevention or delay of prostate cancer progression.

Stamey et al suggest that serum PSA levels no longer correlate to the volume of prostate cancer and that since 1998 it is more closely associated with the level of BPH in the gland. In a related abstract, Al-Azab and associates in reviewing a data set of prostate needle biopsies concluded that when the PSA level is between 2 and 9 ng/ml, prostate volume is the strongest predictor of cancer.

Several studies looking at the yield and nature of tumors detected by extended biopsy strategies [multiple cores] and/lower PSA thresholds demonstrate detection rates in the 37 to 40% range with an average of 20-25% of these tumors labeled clinically insignificant by general criteria.{Stephenson, et al and Ohori, et al)

Sanchez-Ortiz and colleagues demonstrated in a series of T1c radical prostatectomy specimens from African American men and from Caucasians that the T1c lesions of AA men exhibited higher Gleason scores, greater tumor volume, and higher volume per ng of PSA. These findings support the role of lowering PSA screening thresholds in AA men.

Written by S.Bruce Malkowicz, MD, a Contributing Editor with UroToday.

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