Immunohistochemical expression of α-methylacyl coenzyme-A racemase in prostatic carcinoma: correlation with image morphometric parameters

Abstract

Background/aim Prostate cancer is the second leading cause of death in men. Although prostate-specific antigen is the most commonly used biomarker for monitoring prostate cancer, it has poor specificity. This study aimed to evaluate the diagnostic utility of α-methylacyl coenzyme-A racemase (AMACR) as a predictive marker for prostate carcinoma. The expression of AMACR will be correlated with nuclear and glandular morphometric parameters with the aim to enhance the possibility of finding a sensitive immune marker for diagnosing prostatic carcinoma.Patients and methods Prostatic lesions including 30 benign prostatic hyperplasia, 25 prostatic intraepithelial neoplasia (PIN), and 50 prostatic carcinoma cases were included in this study. Immunohistochemical staining for AMACR was done in formalin-fixed, paraffin-embedded tissue sections. Nuclear and glandular morphometric parameters for all cases were evaluated using an image analysis system.Results All cases of benign prostatic hyperplasia as well as normal controls were negative for AMACR. In contrast, 28% of PIN cases and 94% of prostatic carcinoma cases were positively stained for AMACR. Its expression was associated with high-grade PIN and carcinoma. Glandular area and glandular area% were significantly different between the studied prostatic lesions, and they were significantly increased with grade in cases of carcinoma.Conclusion Expression of AMACR plays an important role in the diagnosis of prostatic lesions and may be used as a potentially important prostatic tumor marker. A combination of AMACR and morphometry is of great value in increasing the diagnostic accuracy of prostatic carcinoma and may have value for resolving suspicious cases.