Centre de recherche du CHUM et Institut du cancer de Montréal, 1560 Sherbrooke Est, Montréal, Qc, Canada, H2L 4M1
Prostate cancer is the most commonly diagnosed malignancy and the third cause of cancer-related death in Canadian men. Although most tumors are detected at an early stage and treated efficiently, a number of these cases will progress to a metastatic and hormone-refractory state where therapeutic options are essentially palliative. Due to a limited number of clinical prognostic markers, it is often difficult to identify cancers at risk of progression. To address this problem, uro-oncologic researchers are turning to molecular markers that can be detected biochemically in the blood or urine, as well as by immunohistochemistry on prostate cancer tissues. These markers are generally involved in cellular processes such as cell proliferation, apoptosis, and angiogenesis. Among the most promising markers is the transcription factor NFκB that controls the expression of many genes that play a role in oncogenesis. In particular, immunohistochemical analyses have shown that the nuclear expression of the RelA subunit in primary prostate tumors is associated with poor clinical outcome. Indeed, the nuclear localization of RelA upgrades the histological grade to allow a better classification of patients at risk of progression. Moreover, nuclear RelA is an independent predictor of biochemical recurrence and lymph node metastasis. Other subunits of the NFκB family may also become useful prognostic markers since they are also detected in the nucleus of prostate cancer cells. The addition of NFκB and other molecular markers to current clinical markers will facilitate the identification of high risk patients and guide clinicians in the choice of an appropriate therapeutic approach.