The prognostic significance of gleason score in the cases that show extraprostatic extension and the importance of nestin expression for predicting extraprostatic extension in radical prostatectomy specimens

Objective: Prostate carcinoma is the most common malignancy in men. It ranks second after lung cancer in cancer-related deaths in men. The aim of this study is to investigate the prognostic significance of Gleason score of the tumor in the positive surgical margins and in the areas of extra-prostatic extension, the length of positive surgical margins, density of nestin expression and Her-2 gene amplification in tumor in radical prostatectomy specimens. Materials and Methods: 122 patients who were treated with radical prostatectomy in Dokuz Eylul University Medical Faculty Hospital between 1993-2006 were selected. The lenght of positive surgical margin (mm), Gleason score in the positive surgical margins and in the areas of extra-prostatic extension were evaluated. 6 tissue microarray blocks were prepared from different areas of Gleason pattern, including 30 cor with 3 mm. Nestin by immunohistochemical and Her-2 by CISH method was applied to the sections that prepared from these blocks. The intensity of nestin expression was rated. Her-2 gene amplification was evaluated. Results were statistically compared with other parameters which were known to have prognostic significance. Results: The average age of the 122 patients included in the study was calculated as 62.87. A significant relationship was determined statistically between Gleason score that was in positive surgical margin with pathological stage and extraprostatic extension. A significant relationship was not found between other parameters known to be prognostic with Gleason score that was evaluated in the areas of extraprostatic extension and the lenght of positive surgical margin (mm). Nestin expression was determined positive in all areas that was assessed in the areas including different Gleason scores. The staining intensity of nestin was rated as weak and strong positive. A significant relationship was ascertained statistically between the intensity of nestin expression with Gleason score and the tumor volume that composed of important prognostic factors. Her-2 amplification was determined to be negative in all the areas which was assessed by CISH method. Conclusion: Gleason score which was evaluated in positive surgical margins was related to pathological stage and extraprostatic extension. However, the prognostic significance of Gleason score in areas of extraprostatic extension was not found. Statistically, there was a significant relation between the intensity of nestin expression with Gleason score and the tumor volume. It was seen that Gleason score that was found in the areas of positive surgical margin and the intensity of nestin expression that was seen in tumors were found to be important candidates for predicting the prognosis.