Vergis R et al. (2008) Intrinsic markers of tumour hypoxia and angiogenesis in localised prostate cancer and outcome of radical treatment: a retrospective analysis of two randomised radiotherapy trials and one surgical cohort study. Lancet Oncol 9: 342–351

Although there are established prognostic markers for prostate cancer, such as the Gleason score and serum concentration of prostate-specific antigen, these markers do not accurately predict the variation in outcome seen in patients with this disease. Vergis et al. evaluated molecular markers of hypoxia and angiogenesis that might better predict outcome in prostate cancer.

Biopsy samples were obtained from 201 patients with localized prostate cancer before they underwent radical radiotherapy as part of one of two prospective, randomized trials in the UK, and from 289 patients with localized prostate cancer who had undergone radical prostatectomy in a hospital in Denmark. The biopsy samples were immunohistochemically stained for VEGF, hypoxia inducible factor 1α (HIF-1α) and osteopontin. Multivariate analysis showed that in the surgery cohort, increased VEGF, HIF-1α and osteopontin expression each significantly predicted decreased freedom from biochemical failure (P <0.0001 for VEGF and HIF-1α; P = 0.0005 for osteopontin); however, in the radiotherapy cohort, only increased VEGF and HIF-1α expression were significant predictors of poor outcome (P = 0.008 and P = 0.02, respectively). In both cohorts, the molecular markers were prognostic for outcome independent of the Gleason score and initial prostate-specific antigen concentration.

The authors suggest that these markers might help to identify high-risk patients, for whom standard therapy is not sufficient, and who might be suitable for enrollment into clinical trials investigating more-aggressive treatment.