Kinetic profiles of intraepithelial and invasive prostatic neoplasias: The key role of down-regulated apoptosis in tumor progression

The cell kinetic of prostatic intraepithelial neoplasia (PIN) is poorly understood. Herein we report the kinetic pattern of PIN, both not associated (primary) and associated (secondary) with coexistent invasive carcinoma (PCa). Surgical specimens collected in 20 cases of primary PIN, 20 of secondary PIN and 20 of PCa were studied by MIB- 1 immunostaining, in situ end-labeling (ISEL) and DNA histogram analysis, and the cell density in each case was estimated using the formula N = (nπ/4)². Fifty high-power fields (HPF), or the complete lesion if smaller, were screened in each lesion, and both mean and standard deviation were recorded. Statistical differences were studied by means of Fisher's exact test. ISEL indices were significantly (P < 0.0001) lower in PCa (0.1 ± 0.3) than in primary PIN (0.5 ± 0.3), while the MIB-I indices were similar in both conditions (P = 0.56). Statistically significant differences were also detected for both MIB-1 and ISEL indices when secondary PIN (MIB-1 1.9 ± 0.7, ISEL 3.7 ± 3.3) was compared with primary PIN (MIB-1 2.5 ± 2.1, ISEL 0.5 ± 0.3) and PCa (P < 0.0001). In terms of cellularity, primary PIN (26.3 ± 7.1) revealed scores significantly lower (P < 0.0001) than those recorded in PCa (39.0 ± 8.8) and secondary PIN (32.9 ± 14.3). In conclusion, early prostatic tumor is mainly defined by down-regulated apoptosis rather than by increased proliferation. Secondary PIN displays unique kinetic features suggesting an evolved stage of primary PIN.