Prognostic and diagnostic role of PSA immunohistochemistry: A tissue microarray study on 21,000 normal and cancerous tissues
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Sarah Bonk2, Martina Kluth1, Claudia Hube-Magg1, Adam Polonski2, Greta Soekeland1, Georgia Makropidi-Fraune1, Christina Möller-Koop1, Melanie Witt1, Andreas M. Luebke1, Andrea Hinsch1, Eike Burandt1, Stefan Steurer1, Till S. Clauditz1, Thorsten Schlomm3, Daniel Perez2, Markus Graefen4, Hans Heinzer4, Hartwig Huland4, Jakob R. Izbicki2, Waldemar Wilczak1, Sarah Minner1, Guido Sauter1 and Ronald Simon1
1 Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
2 General, Visceral and Thoracic Surgery Department, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
3 Urology Clinic, Charite – Universitätsmedizin Berlin, Berlin, Germany
4 Martini Clinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Keywords: prostate specific antigen; specificity; immunohistochemistry; prognosis marker; tissue microarray
Received: May 07, 2019 Accepted: July 17, 2019 Published: September 10, 2019
To assess the prognostic and diagnostic utility of PSA immunostaining, tissue microarrays containing 17,747 prostate cancers, 3,442 other tumors from 82 different (sub) types and 608 normal tissues were analyzed at two different antibody concentrations (1:100 and 1:800). In normal tissues, PSA expression was limited to prostate epithelial cells. In prostate cancers, PSA staining was seen in 99.9–100% (1:800–1:100) primary tumors, 98.7–99.7% of advanced recurrent cancers, in 84.6–91.4% castration resistant cancers, and in 7.7–18.8% of 16 small cell carcinomas. Among extraprostatic tumors, PSA stained positive in 0–3 (1:800-1:100) of 19 osteosarcomas, 1-2 of 34 ovarian cancers, 0-2 of 35 malignant mesotheliomas, 0–1 of 21 thyroid gland carcinomas and 0–1 of 26 large cell lung cancers. Reduced staining intensity and loss of apical staining were strongly linked to unfavorable tumor phenotype and poor prognosis (p < 0.0001 each). This was all the more the case if a combined “PSA pattern score” was built from staining intensity and pattern. The prognostic impact of the “PSA pattern score” was independent of established pre- and postoperative clinico-pathological prognostic features. In conclusion, PSA immunostaining is a strong prognostic parameter in prostate cancer and has high specificity for prostate cancer at a wide range of antibody dilutions.
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