PTEN Protein Loss in Diagnostic Prostate Biopsies Is Associated with Gleason Score Upgrading in Radical Prostatectomy

Area of Science:

• Urology
• Oncology
• Pathology

Background:

• Prostate needle biopsy may underestimate cancer aggressiveness, leading to Gleason score upgrading post-radical prostatectomy (RP).
• Phosphatase and Tensin Homolog (PTEN) loss is a recognized marker of adverse prostate cancer biology.

Purpose of the Study:

• To investigate if reduced or absent PTEN immunoreactivity in diagnostic biopsies correlates with Gleason score and ISUP Grade Group upgrading in RP specimens.

Main Methods:

• Retrospective analysis of 85 prostate cancer patients undergoing mpMRI-guided biopsy and RP.
• Assessment of PTEN expression via immunohistochemistry on biopsy samples.
• Stratification into PTEN-preserved (n=75) and PTEN-deficient (n=10) groups.

Main Results:

• Gleason score upgrading occurred in 70% of PTEN-deficient cases versus 20% of PTEN-preserved cases (p=0.0024).
• PTEN-deficient patients had a 3.50-fold higher relative risk of upgrading.
• No significant difference in preoperative PSA or PI-RADS scores between groups.

Conclusions:

• Reduced PTEN expression in prostate biopsies is significantly associated with Gleason score/ISUP Grade Group upgrading after RP.
• PTEN immunohistochemistry may serve as a complementary marker for biopsy undergrading.
• Further evaluation is needed to establish PTEN as an independent predictor of upgrading.