Tumor Prostate-Specific Antigen Density Can Predict Tumor Aggressiveness and Heterogeneity in Prostate Cancer

Area of Science:

• Oncology
• Radiology
• Pathology

Background:

• Prostate cancer exhibits significant heterogeneity.
• Tumor prostate-specific antigen density (TPSAD) is a novel metric for assessing prostate cancer characteristics.

Purpose of the Study:

• To investigate the association between tumor prostate-specific antigen density (TPSAD) and tumor heterogeneity in prostate cancer.
• To correlate TPSAD with clinical and molecular features of nonmetastatic prostate cancer.

Main Methods:

• Retrospective analysis of 172 patients with nonmetastatic prostate cancer.
• Tumor volume delineation using multi-parametric MRI and 3D Slicer software.
• Calculation of TPSAD and correlation with clinical data, immunohistochemistry (IHC) for RB1, TP53, PTEN, and neuroendocrine differentiation (NED) markers.

Main Results:

• Low TPSAD was associated with higher tumor volume, higher ISUP grade, and advanced T stage.
• TPSAD was an independent protective factor for ISUP 5 pathology and predicted shorter recurrence-free survival after radical prostatectomy.
• Low TPSAD correlated with reduced PSA expression, higher Ki67 index, increased PTEN loss, and higher incidence of NED.

Conclusions:

• TPSAD is a valuable predictor of prostate cancer heterogeneity.
• Low TPSAD signifies aggressive disease with a poor prognosis, characterized by low PSA expression and high tumor heterogeneity.