Evaluation of clinicopathological significance of ALDH1a1 expression in prostatic tumors

Abstract

Background: Prostate cancer, the second most common solid organ malignancy among men, is primarily adenocarcinoma. Core needle biopsy is the standard method for non-operative diagnosis. While early-stage prostate carcinoma can be treated with radical prostatectomy or radiotherapy, advanced-stage metastatic prostate carcinoma has high mortality. Prostate cancer stem cells (CSCs), located in the basal cell layer, contribute to cancer progression. Aldehyde Dehydrogenase-1, family member A1 (ALDH1a1), a stem cell marker, plays a central role in tumor biology by protecting CSCs from oxidative injury and promoting proliferation. Methods: This retrospective cross-sectional study, conducted at the Babylon Training Center for Pathology in Al-Hilla Teaching Hospital from January 2023 to January 2024, analyzed 50 cases of prostatic adenocarcinoma and 10 cases of benign prostatic hyperplasia using ALDH1a1 immunohistochemical staining. Results: ALDH1a1 expression was negative in benign prostatic hyperplasia but positive in 70% of prostatic adenocarcinoma cases. A significant correlation was found between ALDH1a1 expression and Gleason grades, with higher H-scores in advanced grades (p = 0.01). ALDH1a1 H-scores also significantly correlated with pre-operative PSA levels and patient age (p = 0.03 and p = 0.001, respectively). Conclusion: ALDH1a1 expression increases with higher Gleason grades, PSA levels, and patient age, indicating tumor aggressiveness. Therefore, ALDH1a1 can be used as a prognostic and predictive marker for prostate cancer.