Histopathological and Molecular Markers in the Assessment of Prostate Cancer Aggressivity

Prostate cancer (PCa) in most patients does not cause significant clinical symptoms, but high-risk disease, accounting for approximately 15% of PCa, has the potential to progress to a lethal phenotype. Individual approaches for assessing tumor aggressiveness and stratifying patients to reduce PCa-specific mortality while avoiding overtreatment are a great challenge. Detailed and precise histopathological examination of aggressivity in PCa, including differentiation by Gleason, perineural invasion, specific variants of PCa and tumor volume at needle or radical prostatectomy biopsies can influence therapeutic approaches. Analyses of molecular regulator proteins of the cell cycle, apoptosis, epigenetic regulators and the chemokine axis allow the assessment of tumor growth, local invasion and distant metastases and provide additional knowledge of aggressivity compared to standard markers. Current research has shown that prostate cancer stem cells, which may play a role in tumor initiation and development, disease progression, recurrence and metastasis, modification of the effect of chemotherapy and disease prognosis, are important indicators of prostate cancer aggressiveness.