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Clinical Investigations |
Departments of Urology [G. Y., T. M. W., T. C. T.], Pathology [T. M. W., L. D. T.], Cell Biology [T. C. T.], and Radiology [T. C. T.], Baylor College of Medicine, Houston, Texas 77030
| ABSTRACT |
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| INTRODUCTION |
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We recently developed a strategy to identify mRNAs that are expressed differentially in cell lines derived from primary versus metastatic mouse prostate cancer using differential display PCR. In using this system, a number of metastasis-related sequences were identified including a cDNA that encodes caveolin-1 (9) . Caveolin-1, a Mr 22,000 protein is a major structural component of caveolae, specialized plasma membrane invaginations that are abundant in smooth muscle cells, adipocytes, and endothelium. Caveolae appear to mediate molecular transport, cell adhesion, and signal transduction activities in a cell- and context-specific fashion (10) . Caveolin-1 was found to be overexpressed in both mouse and human metastatic prostate cancer cells (9) . Recently, we documented that suppression of caveolin-1 gene expression with stably transfected antisense caveolin-1 cDNA converted androgen-insensitive metastatic mouse prostate cancer cells to an androgen-sensitive phenotype and that adenovirus-mediated sense caveolin-1 expression blocked androgen sensitivity (11) . Caveolin-1, therefore, has been shown to be a metastasis-related gene as well as a candidate gene for hormone-resistant human prostate cancer. Interestingly, recent studies also point to a potential role for caveolin-1 in the resistance of various malignances to multiple anti-neoplastic agents (12 , 13) .
In the present study, we investigated the possibility of using caveolin-1 expression as a predictive marker for prostate cancer progression. In this retrospective study, 189 clinically confined prostate cancer specimens obtained from radical prostatectomy were immunostained with a caveolin-1-specific antibody. Expression of caveolin-1 was associated with preoperative clinical information of the patients and with postoperative pathological diagnosis. Our results indicate that caveolin-1 expression is a novel independent prognostic marker for progression in clinically confined human prostate cancer.
| MATERIALS AND METHODS |
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Caveolin-1 Immunohistochemistry.
The sections were deparaffinized and rehydrated. They were then heated in citrate buffer (0.01 M; pH 6.5) with in an 800-Watt microwave oven for 9 min for antigen retrieval. Endogenous peroxidase in sections was inactivated in 2% H2O2 for 10 min. The sections were then blocked in 3% normal goat serum in 0.2 M PBS (pH 7.4), followed by incubation in a rabbit polyclonal antibody to caveolin-1 (Santa Cruz Biotechnology, Santa Cruz, CA). The caveolin-1 antibody was used at a dilution of 1:400 in PBS with 0.5% normal goat serum. The sections were incubated in the primary antibody for 2 h at room temperature. They were then processed following a standard ABC immunostaining procedure with an ABC kit (Vector Lab, Burlingame, CA). Immunoreaction products were visualized in a 3,3'-diaminobenzidine/H2O2 solution. To verify the specificity of the immunoreactions, some sections were incubated in primary antibody preabsorbed by corresponding caveolin-1 peptide (Santa Cruz Biotechnology) at a concentration of 25 µg/ml. The caveolin-1 immunoreactivities were abolished on the sections incubated in the antibody preabsorbed with the caveolin-1 peptide, confirming the specificity of immunostainings.
The immunostained sections were evaluated at a power of x200 under a Zeiss microscope. For each specimen, only the index cancer was evaluated. The entire cancer area was scanned, and an average of 21.76 ± 14.38 (mean ± SD) microscopic fields were evaluated. Positive caveolin-1 staining for a particular specimen was assigned if >50% of the cancer cells in any microscopic field demonstrated caveolin-1-positive granular immunoreaction products in their cytoplasm. All specimens were evaluated without any knowledge of the patients clinical information.
Statistical Analysis.
The correlation of caveolin-1 immunoreactivity with patients clinical and pathological variables was analyzed by the Spearman or Pearson correlation test. The predictive value of caveolin-1 and other clinical and pathological variables such as preoperative PSA, extraprostatic extension, positive surgical margins, and Gleason score were univariately tested in node-negative patients using a Kaplan-Meier actuarial analysis (17)
and the log-rank test. In addition, multivariate analysis of caveolin-1 immunostaining and the postoperative pathological markers was performed using the Cox proportional hazards regression model (18)
. The risk ratio and its 95% confidence interval were recorded for each marker. P < 0.05 was considered statistically significant in all of the analyses. Moreover, Fishers exact test was used to test the differences in the incidence rates of caveolin-1 expression in patients of different pathological and racial subgroups. All analyses were performed with a statistical software (Statview version 5.0; SAS Institute, Inc. Cary, NC).
| RESULTS |
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| Correlation of Caveolin-1 Expression with Clinical and Pathological Variables. |
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Gleason scores for prostatectomy specimens were stratified into well differentiated (Gleason score 35; n = 23), moderately differentiated (Gleason score 67, n = 143), and poorly differentiated (Gleason score 810, n = 23) groups. The caveolin-1-positive cancer rates were 13, 24, and 39% for these groups, respectively. A positive correlation between caveolin-1 and Gleason score was confirmed (correlation coefficient, 0.197; P = 0.0071).
In the caveolin-1-positive specimens for which there was more than one Gleason grade pattern, caveolin-1 expression tended to appear in the poorly differentiated one. To further determine whether there is a correlation between Gleason grade and caveolin-1 expression, a total of 77 cancer foci, which included 5 Gleason grade 2, 49 Gleason grade 3, 20 Gleason grade 4, and 3 Gleason grade 5 patterns, were screened from this set of specimens. The caveolin-1 expression rates were 0, 16, 35, and 33% for Gleason grades 2, 3, 4, and 5 cancers, respectively. A significant correlation between caveolin-1 expression and Gleason grade was found (Spearman correlation test, P = 0.0343).
The caveolin-1-positive cancer rates were significantly higher in the patients who had positive lymph node(s) (41%; n = 27) compared with those with negative nodes (22%; n = 162). A positive correlation between caveolin-1 expression and lymph node metastasis was confirmed (correlation coefficient, 0.150; P = 0.0399, Spearman rank correlation test).
Among the 27 node-positive patients, 21 had metastatic deposits in lymph nodes still available for caveolin-1 immunostaining. A higher caveolin-1-positive cancer rate was found in metastatic tumor deposits (12 of 21; 57%) relative to their primary tumor counterparts (9 of 21; 43%). Of the 21 patients, 8 of 9 who had caveolin-1-positive primary cancer also had caveolin-1-positive lymph node metastases. Subjectively, the proportion of caveolin-1-positive cancer in the metastatic deposits appeared higher than that in their primary counterpart as well.
The frequency of caveolin-1 expression was higher in the cancers with a positive surgical margin (42%; n = 33) compared with those with negative surgical margins (23%; n = 148), and a positive correlation of caveolin-1 with positive surgical margin status was confirmed (correlation coefficient, 0.177; P = 0.0267; Table 2
).
Caveolin-1 expression was somewhat higher in specimens with extraprostatic extension (30%) or seminal vesicle involvement (30%) compared with those without extraprostatic extension (equals level 3 extracapsular extension, Ref. 16
; 20%) or seminal vesicle involvement (24%) correspondingly, but these differences were not statistically significant (Table 2)
. In the 97 patients with extraprostatic extension, 21 also had positive surgical margins, 28 had seminal vesicle involvement, and 2 had both positive margins and seminal vesicle involvement. In the specimens with extraprostatic extension only (n = 46), no significant correlation between caveolin-1 expression and the extraprostatic extension status was found.
In this serial of 189 patients, 166 Caucasian Americans and 11 African Americans were included. The remainder included Hispanic (n = 4), Asian (n = 6), and unknown race (n = 2). The incidence of caveolin-1-positive cancers was higher in African Americans (5 of 11; 45%) than in the Caucasian Americans (42 of 166; 25%), although the difference was not statistically significant in this limited sample set (P = 0.1205, Fishers exact test).
| Caveolin-1 as a Predictor for Time to Disease Progression. |
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When the progression-free probability was plotted versus caveolin-1 staining status, the patients with a caveolin-1-positive cancer had an evident worse prognosis compared with those with caveolin-1-negative cancer (Fig. 2)
. The probabilities of being free of progression after surgery at 60 months were 0.68 ± 0.042 (mean ± SE) for caveolin-1-negative cancer and 0.43 ± 0.08 (mean ± SE) for the caveolin-1-positive cancer.
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| DISCUSSION |
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60% of newly diagnosed prostate cancers are believed to be organ confined (19)
, yet somewhat <50% of these cancers are found to be confined to prostates, as indicated by final pathological stage after surgical removal of the prostate (5)
. When the cancer is organ confined, progression-free survival is excellent after radical prostatectomy (20)
. In contrast, those that are found not to be confined to the prostate upon pathological analysis are not usually curable by surgery alone and have a much poorer prognosis (8)
. Preoperative PSA levels, clinical stage, and Gleason score have been shown to be useful in predicting clinical outcomes; however, in the middle ranges, these indices lose predictive power. We demonstrated previously that caveolin-1 expression was associated with metastasis in mouse and human prostate cancer (9)
and related to the androgen-resistant phenotype in mouse prostate cancer (11)
. The purpose of the present study was to determine whether caveolin-1 expression of caveolin-1 as determined by immunostaining could provide prognostic value for the patients with clinically confined prostate cancer. In a large set (n = 189) of prostate cancer specimens, 25% were determined to be positive for cancer cell-specific caveolin-1 immunoreactivity. There was a positive correlation of caveolin-1 expression with positive lymph nodes removed at surgery. It was also found that patients with caveolin-1-positive primary cancer tended to have caveolin-1-positive lymph node metastases. These results, together with our previous study that demonstrated a high (56%) incidence of caveolin-1 expression in metastatic deposits within pelvic lymph nodes (9) , indicate a clear association of caveolin-1 expression with development of lymph node metastasis. Once prostate cancer has spread to the regional pelvic lymph nodes, only rarely can it be controlled with any form of local or regional therapy (21) . Virtually all patients with positive nodes treated with surgery alone showed clinical evidence of progression within a 10-year period, and at least 70% of this group will eventually die of cancer rather than with it (22) . The correlation of caveolin-1 expression with positive lymph node metastases, positive surgical margins, as well as Gleason score/grade of the cancer, indicates that caveolin-1 expression is associated with progression/metastasis of prostate cancer. Although the molecular and cellular underpinnings for this relationship are not well understood, our recent study using a mouse prostate cancer model indicated that caveolin-1 levels were higher in metastatic lesions and metastasis-derived cell lines relative to primary tumors and primary tumor-derived cell lines, respectively (9) , and that suppression of caveolin-1 by antisense caveolin-1 vectors converted androgen-resistant metastatic mouse prostate cancer cells to the androgen-sensitive phenotype in vivo (11) . In contrast, adenoviral vector-mediated overexpression of caveolin-1 reestablished androgen resistance in vitro, preventing apoptosis that occurred in control cells after removal of testosterone (11) . These data strongly suggest that elevated caveolin-1 expression promotes survival of prostate cancer cells under conditions that can lead to cell death, including those encountered during metastasis and those generated by androgen withdrawal. Our present results further indicate that caveolin-1 expression in the primary tumor is heterogeneous and highly variable. This pattern of expression is similar to other molecular markers of prostate cancer progression (e.g., p53 mutations) that have been shown to occur at low frequency in the primary tumor but at significantly higher frequency in lymph node metastases (reviewed in Ref. 23 ). Interestingly, both mutations in p53 and overexpression of caveolin-1 have been associated with reduced capacity for apoptosis, supporting the notion that antiapoptotic mutations are important in prostate cancer metastasis. This concept is now further supported by the results from this present study, indicating that caveolin-1 is a positive prognostic marker for a shorter progression-free survival in the clinically localized cancer. Interestingly, two recent reports published shortly after our identification of caveolin-1 overexpression in prostate cancer metastasis (9) and its association with androgen resistance (11) provided strong correlative evidence that caveolin-1 is also associated with the drug resistance phenotype in multiple human carcinoma cell lines (12 , 13) .
In our study, there was also a trend toward higher incidence of caveolin-1-positive cancers in African American patients (45%) compared with Caucasian American patients (25%). The difference, however, was not statistically significant (P = 0.1205;
2 test), probably because of the relatively small sample size, especially in the black population. It is known that there is a significantly higher rate of prostate cancer incidence and mortality in African Americans compared with Caucasian Americans (24)
, and in general, prostate cancer in African-American men tends to be more aggressive (25)
. Socioeconomic, environmental, as well as biological factors have been attributed to the racial differences (24)
. An obvious question is whether elevated caveolin-1 expression is indeed higher in African-American prostate cancer relative to other ethnic groups and whether this contributes to the more aggressive profile. A larger scale of study with better population control could help to clarify this issue.
In summary, our present study has demonstrated that caveolin-1 expression, as determined by immunohistochemical staining, is associated with positive lymph nodes and positive surgical margins in clinically confined prostate cancers. The possibility of using caveolin-1 expression in needle biopsies as a preoperative marker to predict pathological stage remains to be investigated. However, this potential approach to the use of caveolin-1 immunostaining may be significantly complicated by the multicentric nature of prostate cancer in most patients (26 , 27) , the relatively small and potentially disproportionate quantity of cancer tissue in needle biopsies relative to the cancer volume, and the heterogeneity and likely small proportion of caveolin-1-positive cells in the cancer. On the other hand, the present study clearly revealed that caveolin-1 expression in lymph node-negative human prostate cancer predicts a shorter time to disease progression after radical prostatectomy. Multivariate analysis demonstrated that caveolin-1 expression provides additional prognostic value for disease progression over traditional pathological markers. Thus, evaluation of caveolin-1 expression in surgically removed cancer may facilitate clinical decisions regarding the need for the patients to receive adjuvant treatment postoperatively. The association of caveolin-1 with cancer progression also suggests to us that caveolin-1 itself and possibly specific molecular components involved in its regulation or downstream activities represent targets for the development of novel therapies for metastatic prostate cancer.
| ACKNOWLEDGMENTS |
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| FOOTNOTES |
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1 This study was supported by Grants CA68814 and Specialized Programs of Research Excellence P50-58204 from the National Cancer Institute. ![]()
2 To whom requests for reprints should be addressed, at Scott Department of Urology, Baylor College of Medicine, 6560 Fannin, Suite 2100, Houston, TX 77030. Phone: (713) 799-8718; Fax: (713) 799-8712; E-mail: timothyt{at}bcm.tmc.edu ![]()
3 The abbreviations used are: PSA, prostate-specific antigen; ABC, avidin-biotin complex. ![]()
Received 4/14/99. Accepted 9/22/99.
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M. L. Lu, M. C. Schneider, Y. Zheng, X. Zhang, and J. P. Richie Caveolin-1 Interacts with Androgen Receptor. A POSITIVE MODULATOR OF ANDROGEN RECEPTOR MEDIATED TRANSACTIVATION J. Biol. Chem., April 13, 2001; 276(16): 13442 - 13451. [Abstract] [Full Text] [PDF] |
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