Purpose
Existing data regarding the expression of estrogen receptors (ER) and
prostate cancer outcomes have been limited. We evaluated the relationship of
expression profiles of ERβ subtypes and the estrogen receptor GPR30
with patient factors at diagnosis and outcomes following radical
prostatectomy.
Materials and Methods
Tissue microarrays constructed from 566 men with long-term clinical
follow-up were analyzed with immunohistochemistry targeting ERβ1,
ERβ2, ERβ5 and GPR30. An experienced pathologist scored
receptor distributions and staining intensities. Tumor staining
characteristics were evaluated for associations with patient
characteristics, recurrence free survival, and prostate cancer-specific
mortality (PCSM) following radical prostatectomy. Results: Prostate cancer
cells had unique receptor subtype staining patterns with ERβ1
demonstrating predominantly nuclear localization, while ERβ2,
ERβ5 and GPR30 were predominantly cytoplasmic. After controlling for
patient factors, intense cytoplasmic ERβ1 staining was independently
associated with time to recurrence (HR 1.7, 95% CI 1.1-2.6,
p=0.01) and PCSM (HR 6.6, 95% CI 1.8-24.9, p=0.01).
Similarly, intense nuclear ERβ2 staining was independently
associated with PCSM (HR 3.9, 95% CI 1.1-13.4, p=0.03).
Patients with cytoplasmic ERβ1 and nuclear ERβ2 co-staining
had significantly worse 15-year PCSM vs. patients expressing only
cytoplasmic ERβ1, only nuclear ERβ2, or neither
(16.4% vs. 4.3% vs. 0.0% vs 2.0 %,
respectively p=0.001).
Conclusions
Increased cytoplasmic ERβ1 and nuclear ERβ2
expression are associated with worse cancer-specific outcomes following
radical prostatectomy. These findings suggest that tumor ERβ1 and
ERβ2 staining patterns provide prognostic information for radical
prostatectomy patients.