Alpha-Methylacl-Coa Racemase (Amacr) Expression in Prostate Cancer and Its Association with Gleason Grade & Other Histomorphological Parameters: An Immunohistochemically Analysis

Abstract

Prostate cancer remains one of the most prevalent malignancies affecting men worldwide, with a significant impact on morbidity and mortality. Objectives: The main objective of the study is to find the Alpha-Methylacl-CoA Racemase (AMACR) expression in prostate cancer and its association with Gleason Grade and other histomorphological parameters. Material and Methods: This retrospective observational study was conducted at Women Medical College, Abbottabad from January 2022 to February 2023. Data was collected from 110 patients diagnosed with prostate cancer. Clinical and pathological data including patient demographics, preoperative serum prostate-specific antigen (PSA) levels, imaging findings, biopsy results, and surgical pathology reports were collected from electronic medical records. Formalin-fixed paraffin embedded (FFPE) tissue blocks from prostatectomy specimens or biopsy cores was retrieved from the pathology archives. Tissue sections (4-μm thick) were cut and subjected to immunohistochemical staining for AMACR expression using a commercially available antibody according to standard protocols. Positive and negative controls were included in each staining batch to ensure accuracy and reproducibility. Results: Data were collected from 110 patients according to inclusion and exclusion criteria. Patients with a mean age of 65.4 years (± 7.2), presenting with preoperative PSA levels averaging 9.8 ng/mL (± 4.3). Most patients underwent MRI imaging (70%), while the remaining 30% underwent TRUS imaging. Biopsy results indicated a predominance of positive cases (105), with only 5 cases negative for prostate cancer. Gleason scores varied, with 30 cases classified as 6 (3+3), 50 as 7 (3+4), 20 as 7 (4+3), and 10 as 8-10. Patients with Gleason score 6 had a mean PSA level of 7.5 ng/mL (± 3.1) and a mean AMACR level of 0.45 (± 0.06). In contrast, patients with Gleason score 7 had a higher mean PSA level of 10.2 ng/mL (± 4.7) and a correspondingly higher mean AMACR level of 0.58 (± 0.09). Patients with more aggressive disease, classified as Gleason score 8-10, exhibited the highest mean PSA level of 12.4 ng/mL (± 5.6), accompanied by a higher mean AMACR level of 0.65 (± 0.11).