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Cancer Research Program, Garvan Institute of Medical Research, [L. G. H., S. M. H., D. R. H., D. I. Q., R. L. S.], and Departments of Urology [D. G., P. C. B., G. O., R. K., P. D. S.] and Medical Oncology [J. J. G.], St. Vincent’s Hospital, Darlinghurst, Sydney, NSW 2010, Australia; Department of Anatomical Pathology, Royal Prince Alfred Hospital and Department of Pathology, University of Sydney, Camperdown, NSW 2050, Australia [C. S. L.]; Department of Medical Nutrition and Biosciences, Karolinska Institute, NOVUM, S-141 86 Huddinge, Sweden [S. M., J-A. G.]; and Douglass Hanly Moir Pathology, North Ryde, NSW 2113, Australia [W. D.]
The role of estrogen and its receptors in the etiology and progression of prostate cancer (PC) is poorly understood. In normal and malignant human prostate, estrogen receptor-
is expressed only in the stroma, whereas estrogen receptor-ß (ERß) is present in both normal stroma and epithelium. Because loss of ERß expression is associated with prostate hyperplasia in ERß-null mice, this study determined patterns of ERß expression in normal, hyperplastic, and malignant human prostate and associations with clinical outcome. Five normal prostates from organ donors and 159 radical prostatectomy specimens from patients with clinically localized PC were assessed for ERß expression using immunohistochemistry. ERß-positivity was defined as 
5% of cells demonstrating nuclear immunoreactivity. All of the five normal prostates showed strong ERß-nuclear staining in >95% of the epithelium and 35% of the stromal cells. The number of ERß-positive cases declined to 24.2% (38/157) in hyperplasia adjacent to carcinoma and 11.3% (18/159) in PCs. ERß-positivity was related to decreased relapse-free survival (log-rank P = 0.04). Thus, loss of ERß expression is associated with progression from normal prostate epithelium to PC, whereas those cancers that retained ERß expression were associated with a higher rate of recurrence. These data identify the need to further investigate the potential role of ERß in the regulation of prostate epithelial cell proliferation and the functional consequences of decreased ERß expression in the evolution of PC.
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