EURURO Vol. 71 No. 5

697 844

Brief Correspondence
Prevalence and Prognostic Significance of PTEN Loss in
African-American and European-American Men Undergoing
Radical Prostatectomy
Jeffrey J. Tosoian , Fawaz Almutairi , Carlos L. Morais Stephanie Glavaris Jessica Hicks
Debasish Sundi Elizabeth Humphreys Misop Han Angelo M. De Marzo Ashley E. Ross
Scott A. Tomlins Edward M. Schaeffer Bruce J. Trock Tamara L. Lotan
a Department of Urology, Johns Hopkins School of Medicine, Baltimore, MD, USA; bDepartment of Pathology, Johns Hopkins School of Medicine, Baltimore,
MD, USA; cDepartment of Urology, UT MD Anderson Cancer Center, Houston, TX, USA; dDepartment of Pathology, University of Michigan, Ann Arbor, MI,
USA; e Department of Urology, University of Michigan, Ann Arbor, MI, USA; f Department of Urology, Northwestern University, Chicago, IL, USA; g Department
of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA
Diverse molecular subtypes of prostate cancer (PCa) may
contribute to the wide range of clinical behaviors observed
for the disease. Intriguingly, the prevalence of molecular
subtypes may vary according to racial and ethnic background
; however, it remains unclear whether this may account
in part for racial disparities in disease outcome. Two of the
most common genomic alterations in primary PCa have been
studied predominantly in European-American (EA) men:
ava ilable at
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Article info
Article history:
Accepted July 20, 2016
Associate Editor:
Giacomo Novara
Keywords:
Prostatic carcinoma
PTEN
ERG
Race
African-American
European-American
Immunohistochemistry
Radical prostatectomy
Biomarker
Abstract
African-American (AA) men have a higher risk of lethal prostate cancer (PCa) compared
to European-American (EA) men. However, the molecular basis of this difference, if any,
remains unclear. In EA PCa, PTEN loss, but not ERG rearrangement, has been associated
with poor outcomes in most studies. Although ERG rearrangement is less common in AA
compared to EA PCa, the relative frequency of PTEN loss and the association of PTEN/ERG
molecular subtypes with outcomes is unknown for AA PCa. We examined PTEN/ERG
status by immunohistochemistry in self-identified AA patients undergoing radical
prostatectomy at Johns Hopkins with tumor tissue available on tissue microarray
(TMA; n = 169) and matched these cases by pathologic parameters to 169 EA patients
from the same TMAs. The rate of PTEN loss was significantly lower in AA compared to EA
PCa (18% vs 34%; p = 0.001), similar to the lower rate of ERG expression (25% vs 51%;
p < 0.001). To examine the association of PTEN/ERG status with oncologic outcomes, we
created an additional TMA of 87 AA tumors with Gleason score > 4 + 3 = 7. Among the
total population of AA men with outcome data from all TMAs (n = 222), PTEN loss was
associated with higher risk of biochemical recurrence (hazard ratio [HR] 2.25, 95%
confidence interval [CI] 1.33–3.82) and metastasis (HR 3.90, 95% CI 1.46–10.4) in
multivariable models.
Patient summary: PTEN and ERG alterations in prostate cancer are less likely in African-
American than in European-Americanmen. However, PTEN loss remains associated with
poor prostate cancer outcomes among African-American men.
# 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.
y These author contributed equally.
* Corresponding author. Department of Pathology, Johns Hopkins School of Medicine, 1550 Orleans
Street, Baltimore, MD 21231, USA. Tel. +1 410 6149196; Fax: +1 410 6140671.
E-mail address: (T.L. Lotan).
0302-2838/# 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.