title: Predictability of PSA failure in prostate cancer by computerized cytometric assessment of tumoral cell proliferation.
abstract: OBJECTIVE
  To evaluate the relationship of DNA ploidy and cell proliferation (CP) with Gleason score (GS) and clinical outcome in prostate cancer.
  
  
  METHODS
  Sixteen patients with benign prostatic hyperplasia (BPH) and 65 patients with prostate cancer classified by GS (four groups: 2 to 4, 5 to 6, 7, and 8 to 10) were studied. All patients with carcinoma underwent prostatectomy and were separated into prostate-specific antigen (PSA) failure and nonfailure groups (failure if PSA 0.1 ng/mL or more three times after surgery). Tumoral CP (Ki-67 inmunostaining and SG2M phase) and DNA ploidy were evaluated by computerized cytometry.
  
  
  RESULTS
  BPH were diploid with low CP (8% SG2M cells or less). Carcinomas were either diploid with high CP (greater than 8% SG2M cells) or aneuploid. CP was significantly higher (P <0.001) in tumors with GS 7 or greater than in tumors with GS less than 7 (mean percent Ki-67 cells 18.3% versus 7.8%, respectively). PSA failure increased with GS (7.1% in GS 2 to 4, 21% in GS 5 to 6, 28.6% in GS 7, and 50% in GS 8 to 10), as well as with aneuploidy (18.5% in diploid tumors versus 72.7% in aneuploid tumors). Those experiencing PSA failure had significantly higher (P <0.001) CP than those not failing (mean percent Ki-67 cells 24% and mean percent SG2M 30.4% versus 8.7% and 13.5%, respectively). Cox regression analysis showed GS, DNA ploidy, Ki-67, and SG2M to each be univariately prognostic for time to PSA failure; however, Ki-67 and SG2M were more highly significant (P <0.0001 for both) than GS (P = 0.007) or DNA ploidy (P = 0.002). After adjusting for either SG2M or Ki-67 measures of CP, neither ploidy nor GS contained additional prognostic value.
  
  
  CONCLUSIONS
  Tumor CP and DNA ploidy can be reliably determined in prostate cancer by computerized cytometry. On the basis of our preliminary results, CP correlates well with GS and predicts PSA failure better than DNA ploidy or GS.
authors.affiliation: Department of Pathology, University of South Florida College of Medicine and H. Lee Moffitt Cancer and Research Institute, Tampa 33612, USA.
authors.forename: J I
authors.initials: JI
authors.lastname: Diaz
authors.forename: L B
authors.initials: LB
authors.lastname: Mora
authors.forename: P F
authors.initials: PF
authors.lastname: Austin
authors.forename: C A
authors.initials: CA
authors.lastname: Muro-Cacho
authors.forename: A B
authors.initials: AB
authors.lastname: Cantor
authors.forename: S V
authors.initials: SV
authors.lastname: Nicosia
authors.forename: J M
authors.initials: JM
authors.lastname: Pow-Sang
mesh_terms: D000368:Aged; D002455:Cell Division; D003936:Diagnosis, Computer-Assisted; D006801:Humans; D008297:Male; D008875:Middle Aged; D011003:Ploidies; D017430:Prostate-Specific Antigen / Q000097:blood*; D011470:Prostatic Hyperplasia / Q000097:blood / Q000235:genetics / Q000473:pathology; D011471:Prostatic Neoplasms / Q000097:blood* / Q000235:genetics / Q000473:pathology*; D017211:Treatment Failure
chemical_list: D017430:Prostate-Specific Antigen