ORIGINAL ARTICLE

Computer based receptogram approach: an objective way of assessing immunohistochemistry of androgen receptor staining and its correlation with hormonal response in metastatic carcinoma of prostate

G Nabi¹, A Seth², A K Dinda³, N P Gupta⁴

¹ Department of Surgery, Medical School, University of Aberdeen, Aberdeen AB25 2ZD, UK
² Department of Urology, All India Institute of Medical Sciences, New Delhi-29, India
³ Department of Pathology, All India Institute of Medical Sciences
⁴ Departments of Urology and Pathology, All India Institute of Medical Sciences

Correspondence to:
Correspondence to:
Mr G Nabi
Department of Surgery, Medical School, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK; nabeegholam{at}hotmail.com

Aims: To categorise the immunostaining heterogeneity of androgen receptors in metastatic carcinoma of the prostate using a pattern oriented approach and to correlate the results with response to hormonal treatment.

Methods: Paraffin wax embedded tumour sections from 85 patients with metastatic carcinoma of the prostate were processed for immunocytochemistry and stained for the androgen receptor using antiandrogen receptor antibodies. A computer based image analysis system was used to analyse the pattern of nuclear immunostaining in a minimum of 500 nuclei/slide. Depending on the nuclear receptor content and concentration, receptogram patterns were established for each specimen. The receptogram pattern was correlated with clinical response to hormonal treatment.

Results: Clinical response to hormonal treatment was documented using prostate specific antigen as the marker into responders (good, fair, stable) and non-responders. Forty four of 48 patients who responded to hormonal treatment had type 1 (35) or type 3 (nine) receptograms, which are characterised by a unimodal peak or multimodal peaks within a narrow concentration range. Thirteen of the 18 patients who stabilised had type 1 or type 3 receptograms. Seventeen of the 19 patients who did not respond to hormonal treatment had either type 2 or type 4 receptograms, which are characterised by skewed or bimodal androgen receptor distribution. Positive and negative predictive values of receptograms were 96.5% and 63%, respectively.

Conclusions: Image analysis of androgen receptor immunostaining with a receptogram oriented approach provides important prognostic information that can be used to predict response to hormone treatment in patients with metastatic carcinoma of the prostate.

Keywords: androgen receptors; prostate carcinoma; hormonal treatment

Abbreviations: PSA, prostate specific antigen

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