Abstract.
Transcription
Abstract.
ANTICANCER RESEARCH 26: 1253-1260 (2006) Significance of Pituitary Tumor Transforming Gene 1 (PTTG1) in Prostate Cancer XUHUI ZHU1, ZEBIN MAO2, YANQUN NA1, YINGLU GUO1, XIANGHONG WANG3 and DIANQI XIN1 1Department of Urology, Peking University First Hospital and Institute of Urology, Peking University, Beijing 100034; of Biochemistry and Molecular Biology, Peking University Health Science Center, Beijing 100083; 3Department of Anatomy, The University of Hong Kong, SAR, China 2Department Abstract. Recently, the pituitary tumor transforming gene 1 (PTTG1) has been suggested to be an oncogene. To investigate whether PTTG1 plays a positive role in the pathogenesis of prostate cancer, PTTG1 protein expression was examined in prostate tissue samples by immunohistochemistry. PTTG1 expression was detected in a high percentage of prostate cancer tissues (34/41, 82.9%), but to a much lesser extent in nonmalignant tissues (5/14, 35.7%). To further confirm these results, the expression vectors containing either the PTTG1 or antisensePTTG1 gene were transfected into a prostate cancer cell line, LNCaP, and the cell proliferation rate was studied, as well as tumorigenicity in the LNCaP cells expressing different levels of the PTTG1 protein. Ectopic PTTG1 gene expression promoted prostate cancer cell proliferation and tumorigenesis both in vitro and in nude mice. In contrast, down-regulation of PTTG1 led to suppression of tumor cell growth. These results suggest that PTTG1 may be a potential prognostic marker for prostate cancer and that the down-regulation of PTTG1 may be a therapeutic target in the suppression of prostate cancer growth. The pituitary tumor transforming gene (PTTG) was originally isolated from rat pituitary tumor GH4 cells by differential display PCR (1), and the human homologous cDNA was subsequently cloned from fetal liver. Human PTTG1 is 85% similar to rat PTTG1 at the cDNA level and 89% similar to rat PTTG1 at the amino acid sequence level (2). In addition, PTTG1 is expressed in a cell cycle-dependent manner with a peak in the G2/M-phase (3). The PTTG1 protein seems to be involved in several of the important mechanisms of cell proliferation and differentiation signaling pathways. Abnormal Correspondence to: Dianqi Xin, Associate Professor, Department of Urology, Peking University First Hospital and Institute of Urology, Peking University, No. 8, Xishiku Street, Xicheng District, Beijing 100034, China. Tel: 8610-66551122-2604, Fax: 8610-66551032, e-mail: xin-dianqi@163.com Key Words: PTTG1, prostate cancer. 0250-7005/2006 $2.00+.40 overexpression of PTTG1 causes the inhibition of chromatid separation, resulting in chromosomal gain or loss (4). Overexpression of PTTG1 also increases cell proliferation, induces cell transformation in vitro and promotes tumorigenesis in nude mice (5, 6). PTTG1 is abundantly expressed in human tumors including ovarian (7), esophageal (8), pancreatic (9), kidney (10), hemopoietic system (11, 12) and colorectal tumors (13). PTTG1 encodes for a securin involved in the regulation of chromatid separation during cell division. Conceivably, when PTTG1 is abnormally high in cells, disruption of cell division and chromosomal instability may occur and, thereby, the cells become vulnerable to the accumulation of more mutations during ensuing divisions. Subsequent chromosomal aneuploidy and genetic instability may lead to the activation of proto-oncogenes or loss of heterozygosity of tumor suppressors, resulting in malignant transformation. Moreover, PTTG1 also regulates the secretion of the basic fibroblast growth factor (bFGF) (14), which induces angiogenesis, a key determinant and rate-limiting step in tumor progression and metastatic spread. These lines of evidence indicate that overexpression of PTTG1 may play an important role in the development and progression of human cancer. Prostate cancer is one of the leading causes of cancerrelated death in men in the Western world. Although a large percentage of prostate cancers are manageable with androgen depletion therapy at an early stage of the disease, the majority of them will progress to the androgen-independent stage after 2-3 years and, currently, there is no effective way to control tumor growth at this stage(15). Therefore, it is essential to identify novel markers that are specifically expressed in tumor cells for the early prognosis of prostate cancer. In this study, using clinical tissue specimens, an up-regulation of the PTTG1 protein in prostate cancer and its positive correlation with Gleason grading were demonstrated. In addition, to study the direct effect of PTTG1 gene overexpression on prostate cancer growth, the PTTG1 gene was ectopically expressed into a prostate cancer cell line, LNCaP, while it was also inactivated by antisense technology in the same cell line. Our 1253 ANTICANCER RESEARCH 26: 1253-1260 (2006) results demonstrated that PTTG1 is a key factor in the growth of prostate cancer cells and that inactivation of the PTTG1 gene may be a therapeutic target for suppression of prostate cancer cell growth. Materials and Methods Prostate samples and cell culture. Fifty-five prostate specimens were obtained from a tissue bank in the Institute of Urology, Peking University, China. Forty-one specimens were diagnosed as prostate carcinoma and 14 as benign prostate hyperplasia. Of the 41 prostate carcinoma samples, normal prostatic tissues adjacent to the tumors were available from 18 cases. The samples were fixed in 10% formaldehyde and paraffin-embedded. Frozen prostate cancer tissues from 3 surgical samples and normal prostate tissue samples from 3 postmortem examinations were also obtained for Western blot analysis. LNCaP, an androgen-dependent human prostate cancer cell line, was grown in RPMI 1640 medium supplemented with 10% fetal calf serum and 2 mM L-glutamine, in a 5% CO2 humidified atmosphere at 37ÆC. Immunohistochemistry. Paraffin sections of 5 Ìm thickness were used for immunohistochemistry. The slides were rehydrated in xylene and heated for antigen retrieval. Rabbit anti-human PTTG1 polyclonal antibody and secondary were incubated with the sections, respectively (Santa Cruz Biotechnology Inc., CA, USA). Signals were developed by horseradish peroxidase-conjugated streptavidin and diaminobenzidine. Cytoplasmic staining was semi-quantitated by assessment in at least 5 randomly-selected light microscopic fields (x400). The cytoplasmic staining was graded into negative staining (–), weak (+), moderate (++) and strong staining (+++) by two independent observers, and the results were expressed as the average staining intensity. Western blot analysis. Prostate tissues or cells were homogenized and lysed in 2% SDS containing 1 mM phenylmethyl-sulfonylfluoride, 2 Ìg/ml aprotinin and 200 Ìg/ml leupeptin. The protein concentration was determined by the Bradford assay using BSA as a standard. Sixty Ìg protein were separated in 12% SDS-PAGE and transferred to a nitrocellulose membrane. After blocking, the membrane was blotted by the primary antibody 1:500 rabbit anti-human PTTG1 polyclonal antibody or 1:1000 goat anti-human actin polyclonal antibody (Santa Cruz Biotechnology Inc.) for 24 h at 4ÆC. The primary antibody was recognized by a secondary antibody (anti-rabbit IgG) linked to horseradish peroxidase. The enhanced chemiluminescence (ECL) method was used to detect the conjugated horseradish peroxidase. Blotted signals were visualized by positive bands on Hyperfilm ECL and were quantitated using a scanning densitometer. Immunoblotting with actin antibody was used for comparison of the sample loading in each lane. Construction of recombinant plasmid expressing human PTTG1 and stable transfection of LNCaP cells. Total RNA was isolated and PCR was performed using primers as follows: forward primer: 5’-AGA ATG GCT ACT CTG ATC TATG and reverse primer: 5’-CAC AAA CTC TGA AGC ACT AAG to amplify the PTTG1 gene. The PCR conditions involved an initial denaturing step of 95ÆC for 3 min, 32 cycles of 94ÆC for 30 sec, 50ÆC for 45 sec and 72ÆC for 60 sec. At the end of the amplification, there was an elongation step at 72ÆC for 1254 10 min. The PCR product was purified and cloned into the pGEM-TEasy vector (Promega Corp., Madison, WI, USA), and the coding region of human PTTG1 cDNA was confirmed by sequencing. The recombinant pGEM plasmid was digested with EcoRI and the insert was cloned into the EcoRI site of the eukaryotic expression vector pIRES2-EGFP (Clontech, Palo Alto, CA, USA) in a sense or antisense direction. The two recombinant pIRES2-EGFP plasmids were confirmed again by Sal I digestion and sequencing. LNCaP cells were transfected with the two plasmids containing either sense or antisense of the PTTG1 gene using Lipofectamine 2000 (Invitrogen, Carlsbad, CA, USA), following the manufacturer’s protocol. After transfection for 24 h, the cells were serially-diluted and grown in selection medium containing 500 Ìg/ml G418 for 2 weeks. Finally, 3 cell lines were generated: LNCaP cells stably transfected with sense PTTG1 cDNA (LNCaP/PTTG1), with anti-sense PTTG1 cDNA (LNCaP/ASPTTG1) and with the vector (LNCaP/vector). PTTG1 protein expression in the 3 cell lines was examined by Western blot. Flow cytometry. Cells stably expressing sense, anti-sense PTTG1 cDNA or empty vector were trypsinized, washed with PBS and fixed in 2 ml 70% cold ethanol at 4ÆC overnight, then treated with propidium iodide and ribonuclease A for 30 min. The cell cycle analysis was performed using a fluorescence-activated cell sorter. 3-(4,5-Dimethyl thiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay. To study the effect of PTTG1 overexpression on proliferation, the MTT assay was performed using CellTiter 96 (Promega), following the manufacturer’s protocol. Stably transfected LNCaP cells were cultured in RPMI 1640 medium supplemented with 10% fetal calf serum and 2 mM L-glutamine at 2x103 cells/well in a 96-well plate and incubated at 37ÆC for 1-7 days. To measure cell viability, dimethyl sulphoxide (DMSO) was added to each well and the plate was further incubated at 37ÆC for 1 h. Absorbance at 570 nm was measured using an ELISA reader. The absorbance is directly proportional to the number of living cells in a culture. For each timepoint, the experiment was carried out in triplicate and was repeated at least twice. The data were analyzed using GraphPad Prism (GraphPad Software, Inc., San Diego, CA, USA). Colony formation assay. Cells (5x103) were plated into a 100-mm tissue culture dish containing G418 with RPMI 1640 medium supplemented with 10% fetal calf serum and incubated for 2 weeks to allow colonies to develop. The medium was replaced every week. To count the colony number, the medium was removed and the colonies were washed with PBS, stained with 0.5% crystal violet for 5 min, then washed with de-ionized water to remove the excess stain. Stained colonies larger than 1 mm in diameter were counted. Each colony formation assay was carried out in triplicate and repeated at least 3 times. All the data obtained from the colony formation assays were analyzed using GraphPad Prism. In vivo tumorigenicity. LNCaP/PTTG1, LNCaP/AS-PTTG1 or LNCaP/vector transfected LNCaP cells (1x106 in 250 Ìl of regular RPMI 1640 medium mixed with an equal volume of Matrigel) were subcutaneously inoculated into the armpits of nude mice (male, aged 4 to 6 weeks). The length and width of the tumor were measured weekly. The tumor volume was calculated using the formula: volume = (length x width2)/2. Tumor formation was defined as a size of >40 mm3. After 2 months, the animals were sacrificed and the tumors were weighed. Figure 1. PTTG1 expression in prostate tissues. A. PTTG1 expression in prostate cancer, adjacent normal tissues and benign prostate hyperplasia (BPH) examined by immunostaining. Note that the PTTG1 protein is undetectable in non-malignant tissues while it is up-regulated in cancer tissues. B. Western blotting analysis of PTTG1 expression in the non-malignant and cancer tissues (indicated as T). Note that PTTG1 protein expression levels are much lower in the BPH and normal tissues compared to the cancer tissues. Zhu et al: PTTG1 Gene in Prostate Cancer 1255 ANTICANCER RESEARCH 26: 1253-1260 (2006) Table I. PTTG1 expression in prostate cancer, benign prostate hyperplasia and normal prostate tissue adjacent to the cancer. Table II. PTTG1 expression in different clinical stage and differentiation of prostate cancer. Immunostaining for PTTG1 Sample Clinical course (ABCD stage) No. of cases Positive (+ to +++) Negative (–) Prostate cancer Benign prostate hyperplasia Normal prostate tissue adjacent to the cancers 41 14 18 34 (82.9%)* 5 (35.7%)* 0 (0%) 7 9 18 Total 73 39 (53.4%) 34 A B C Differentiation of cancer cells (Gleason score) Well Moderate Poor No. of cases 5 22 14 5 27 6 Immunostaining 4 20 10 1 23 5 PTTG1 (+ – +++) (80%) (90.9%) (71.4%) (20%) (85.2%)* (83.3%)* Immunostaining PTTG1 (–) 1 2 4 4 4 1 * p<0.05, Student's t-test, as compared to that of normal prostate tissues adjacent to the cancers. * p<0.05 as compared to that of the well-differentiated group. Statistical analysis. The results are expressed as mean±SEM. Statistical analysis was performed using analysis of variance (ANOVA) and Student's t-test by the SPSS11.0 statistical package, taking p values less than 0.05 as significant. no statistical significance was found between moderately- and poorly-differentiated cancers (p<0.05). These results suggest that high PTTG1 expression may indicate unfavorable prognosis in prostate cancer patients. Results Differential PTTG1 expression in malignant and non-malignant prostate tissues. Immunohistochemistry was performed to estimate the PTTG1 expression in 41 prostate cancer, 14 benign prostate hyperplasia and 18 normal prostate tissues adjacent to the cancers (Figure 1A). In contrast to the negative results observed in the non-malignant tissues, PTTG1 was detected in 34 out of 41 (82.9%) of the cancer and 5 out of 14 (35.7%) of the benign prostate hyperplasia (Table I). To further confirm these results, Western blotting was performed on 3 pairs of malignant and non-malignant prostate tissues. As shown in Figure 1B, the expression of PTTG1 was much lower in the non-malignant tissues compared to the cancerous tissues. These results suggest an up-regulation of PTTG1 protein expression in prostate cancer. Correlation of PTTG1 expression with clinical stage and Gleason score of prostate cancer tissues. To further study if there was a correlation between PTTG1 expression and prostate cancer staging, we analyzed the PTTG1 expression among different stages of prostate cancer specimens. It was found that positive PTTG1 immunostaining in clinical stages A, B and C were 4/5 (80%), 20/22 (90.9%) and 10/14 (71.4%), respectively. No statistical difference (p>0.05) was found among the 3 stages. For the differentiation degree of the cancer cells, Gleason scoring was commonly used. Positive PTTG1 immunostaining in well-, moderately- and poorly-differentiated cancers were 1/5 (20%), 23/27 (85.2%) and 5/6 (83.3%), respectively (Table II). The positive PTTG1 rate in immunostaining in welldifferentiated cancers was significantly lower than that in moderately- and poorly-differentiated cancers (p<0.05), but 1256 Effect of PTTG1 overexpression on cell proliferation. In order to study the direct effect of PTTG1 on prostate cancer cell growth, expression vectors containing the PTTG1 cDNA (PTTG1), antisense PTTG1 (AS-PTTG1) as well as the control vector were transfected into LNCaP cells and the following stable transfectants generated: LNCaP/PTTG1, LNCaP/AS-PTTG1 and LNCaP/vector. Western blotting analysis showed (Figure 2A) that, while LNCaP/PTTG1 had much higher levels of PTTG1, the LNCaP/AS-PTTG1 cells showed the lowest PTTG1 expression compared to the vector control (LNCaP/vector). Cell cycle analysis showed (Figure 2B, arrows) that the percentage of S+G2- phase cells was much higher in the LNCaP/PTTG1 cells (S+G2=60.8%) but much lower in the LNCaP/AS-PTTG1 cells (S+G2=26.7%) compared to the vector control (S+G2=45.8%). In contrast, the percentage of cells in the G1-phase was lower in the PTTG1 transfectants (G1=39.2%) but higher in the AS-PTTG1 transfectants (G1=73.3%) compared to the vector control (G1=54.2%) (Figure 2B). These results suggest that overexpression of PTTG1 promotes cell cycle progress and the inactivation of PTTG1 results in cell cycle G1 arrest. To further confirm the flow cytometry results and study whether PTTG1 had any effect on the cell proliferation rate, the MTT assay was performed. As shown in Figure 2C, LNCaP/PTTG1 cells exhibited a much higher proliferation rate (upper dotted line) than the vector control (solid line), while LNCaP/AS-PTTG1 cells (lower dotted line) showed a lower proliferation rate, especially at later time-points (i.e. days 4-5) compared to the vector control. These results indicated that PTTG1 plays a positive role in the proliferation of prostate cancer cells. Zhu et al: PTTG1 Gene in Prostate Cancer Figure 2. Effect of PTTG1 expression on prostate cancer cell proliferation. Vectors containing the PTTG1, AS-PTTG1 were transfected into LNCaP cells and stable transfectants were generated. A. PTTG1 expression in LNCaP/ PTTG1, LNCaP/AS-PTTG1 and LNCaP/vector examined by Western blot. B. Cell cycle analysis of the vector control, PTTG1 and AS-PTTG1 transfectants. C. MTT assay of cell proliferation rate. ** p<0.01 as compared to the LNCaP/vector. Effect of PTTG1 on tumorigenicity of LNCaP cells. The colony forming assay showed that the LNCaP/PTTG1 cells formed more and larger colonies of 150±6 colonies/dish as compared to the control groups (p<0.01). In contrast, wild-type LNCaP, LNCaP/vector and LNCaP/AS-PTTG1 exhibited 40±1, 30±6 and 6±1 colonies/dish, respectively (Figure 3A). To further confirm these results, 3 transfectant cell lines were injected into nude mice and tumorigenesis was studied. As shown in Figure 1257 ANTICANCER RESEARCH 26: 1253-1260 (2006) Figure 3. Effect of PTTG1 on in vitro and in vivo tumorigenicity of LNCaP cells. A. Colony formation assay showing decreased colony forming ability of AS-PTTG1 cells (panel D) compared to the cell lines with high levels of PTTG1 (panels B-C). B. Tumor formation of LNCaP/ PTTG1 (middle), LNCaP/AS-PTTG1 (right) and LNCaP/vector (left) in nude mice (circled area). Each mouse was injected subcutaneously with 1x106 cells and sacrificed after 2 months. 3B and Table III, after 2 months large tumors were formed in the mice injected with LNCaP/PTTG1 (circled area). In contrast, no tumor formation was found when the mice were inoculated with LNCaP/AS-PTTG1, and much smaller tumors were formed in mice inoculated with the LNCaP/vector. These results suggest that overexpression of PTTG1 in LNCaP cells promoted tumorigenesis, while inactivation of the PTTG1 gene suppressed the tumorigenicity of LNCaP cells in nude mice. Discussion In this study, using clinical prostate tissues, PTTG1 was found to be highly expressed in prostate cancer tissues, but at low levels in normal prostate tissues (Figure 1). In addition, higher 1258 PTTG1 expression was found to be closely correlated to the Gleason score but not to the clinical stage of the disease (Table I). Since the Gleason score shows a better correlation with the aggressiveness of prostate cancer, including cell proliferation, aneuploidy, activation of oncogenes and mutations of tumor suppressor genes (16-20), our results suggest that increased PTTG1 protein expression may be an indicator of poor clinical outcome in prostate cancer patients. These results also agree with previous reports on pituitary and colorectal cancers (7-9), supporting the hypothesis that PTTG1 may be a potential oncogene. The results generated from the cell culture and animal experiments in this study suggest that the ability of LNCaP cells to proliferate and form tumors was greatly affected by the Zhu et al: PTTG1 Gene in Prostate Cancer Table III. In Vivo tumorigenesis of LNCaP/PTTG1 in nude mice. LNCaP cell line inoculated LNCaP/vector LNCaP/PTTG1 LNCaP/AS-PTTG1 No. of inoculated animals Tumor formation after 2 months Tumor volume (cm3) 6 6 6 3/6 5/6 0/6 0.22±3 0.51±1 0 7 8 9 expression levels of PTTG1. When LNCaP cells was ectopically expressed the PTTG1 gene, their replication processes and tumorigenesis were significantly enhanced (Figures 2 and 3). As a consequence, PTTG1 may be a marker for invasive prostate cancer as indicated by the immunostaining results. The fact that the down-regulation of PTTG1 in prostate cancers suppressed tumor cell proliferation and tumor formation in nude mice strongly suggests a novel therapeutic target for the suppression of prostate cancer growth. Our results are also supported by previous studies on NIH 3T3 cells, where overexpression of PTTG1 led to cellular transformation in vitro and promoted tumor formation in vivo (4). In conclusion, our observations suggest that PTTG1 expression was substantially enhanced in prostate cancer tissues compared with normal prostate tissue. PTTG1 expression in tumors had a significant positive correlation to their Gleason score. It was also demonstrated that the up- or down-expression of PTTG1 can significantly change the cell cycle progression, the in vitro proliferation rate and the in vivo tumorigenesis of human LNCaP cells. PTTG1 may, therefore, play an important role in the early molecular events leading to the generation, progression and prognosis of prostate carcinoma. It may have the potential to serve as a therapeutic target for prostate cancer. 10 11 12 13 14 15 16 References 1 Pei L and Melmed S: Isolation and characterization of a pituitary tumor-transforming gene (PTTG). Mol Endocrinol 11: 433-441, 1997. 2 Zhang X, Horwitz GA, Prezant TR, Valentini A, Nakashima M, Bronstein MD and Melmed S: Structure, expression and function of human pituitary tumor-transforming gene (PTTG). Mol Endocrinol 13: 156-166, 1999. 3 Yu R, Ren SG, Horwitz GA, Wang Z and Melmed S: Pituitary tumor transforming gene (PTTG) regulates placental JEG-3 cell division and survival: evidence from live cell imaging. Mol Endocrinol 14: 1137-1146, 2000. 4 McCabe C: Genetic targets for the treatment of pituitary adenomas: focus on the pituitary tumor transforming gene. Curr Opin Pharmacol 1: 620-625, 2001. 5 Hamid T, Malik MT and Kakar SS: Ectopic expression of PTTG1/securin promotes tumorigenesis in human embryonic kidney cells. Mol Cancer 4: 3, 2005. 6 Stratford AL, Boelaert K, Tannahill LA, Kim DS, Warfield A, Eggo MC, Gittoes NJ, Young LS, Franklyn JA and McCabe CJ: 17 18 19 20 Pituitary tumor transforming gene binding factor: a novel transforming gene in thyroid tumorigenesis. J Clin Endocrinol Metab 90: 4341-4349, 2005. Fel'ker A and Mezhova EA: Comparative effectiveness of different methods of treatment of trichophytosis caused by zoophilic Trichophyton. Vestn Dermatol Venerol 6: 71-73, 1975. Adamson U and Cerasi E: Acute suppressive effect of human growth hormone on insulin release induced by glucagon and tolbutamide in man. Diabet Metab 1: 51-56, 1975. Grutzmann R, Pilarsky C, Ammerpohl O, Luttges J, Bohme A, Sipos B, Foerder M, Alldinger I, Jahnke B, Schackert HK, Kalthoff H, Kremer B, Kloppel G and Saeger HD: Gene expression profiling of microdissected pancreatic ductal carcinomas using highdensity DNA microarrays. Neoplasia 6: 611-622, 2004. Ai J, Zhang Z, Xin D, Zhu H, Yan Q, Xin Z, Na Y and Guo Y: Identification of over-expressed genes in human renal cell carcinoma by combining suppression subtractive hybridization and cDNA library array. Sci China C Life Sci 47: 148-157, 2004. Dominguez A, Ramos-Morales F, Romero F, Rios RM, Dreyfus F, Tortolero M and Pintor-Toro JA: hpttg, a human homologue of rat pttg, is overexpressed in hematopoietic neoplasms. Evidence for a transcriptional activation function of hPTTG. Oncogene 17: 2187-2193, 1998. Zhang X, Horwitz GA, Heaney AP, Nakashima M, Prezant TR, Bronstein MD and Melmed S: Pituitary tumor transforming gene (PTTG) expression in pituitary adenomas. J Clin Endocrinol Metab 84: 761-767, 1999. Heaney AP, Singson R, McCabe CJ, Nelson V, Nakashima M and Melmed S: Expression of pituitary-tumour transforming gene in colorectal tumours. Lancet 355: 716-719, 2000. Heaney AP, Horwitz GA, Wang Z, Singson R and Melmed S: Early involvement of estrogen-induced pituitary tumor transforming gene and fibroblast growth factor expression in prolactinoma pathogenesis. Nat Med 5: 1317-1321, 1999. Salesi N, Carlini P, Ruggeri EM, Ferretti G, Bria E and Cognetti F: Prostate cancer: the role of hormonal therapy. J Exp Clin Cancer Res 24: 175-180, 2005. Bostwick DG, Grignon DJ, Hammond ME, Amin MB, Cohen M, Crawford D, Gospadarowicz M, Kaplan RS, Miller DS, Montironi R, Pajak TF, Pollack A, Srigley JR and Yarbro JW: Prognostic factors in prostate cancer. College of American Pathologists Consensus Statement 1999. Arch Pathol Lab Med 124: 995-1000, 2000. Ross JS, Sheehan CE, Fisher HA, Kauffman RA, Dolen EM and Kallakury BV: Prognostic markers in prostate cancer. Expert Rev Mol Diagn 2: 129-142, 2002. Alers JC, Rochat J, Krijtenburg PJ, Hop WC, Kranse R, Rosenberg C, Tanke HJ, Schroder FH and van Dekken H: Identification of genetic markers for prostatic cancer progression, Lab Invest 80: 931-942, 2000. Koch MO, Foster RS, Bell B, Beck S, Cheng L, Parekh D and Jung SH: Characterization and predictors of prostate specific antigen progression rates after radical retropubic prostatectomy. J Urol 164: 749-753, 2000. Stattin P: Prognostic factors in prostate cancer. Scand J Urol Nephrol Suppl 185: 1-46, 1997. Received September 23, 2005 Revised January 13, 2006 Accepted January 26, 2006 1259