CLINICAL UTILITY OF BLOOD E2F3 MRNA ASSAY IN THE EARLY DIAGNOSIS OF PROSTATIC CANCER BY REAL-TIME POLYMERASE CHAIN REACTION

Abstract

SUMMARY AND CONCLUSION C ancer prostate is considered one of the major health problems and during the past fifteen years has become an important concern of public health; as it is considered the most common malignancy and the second leading cause of cancer-related deaths. Prostate carcinogenesis starts by gene mutations and ends by loss of control on cellular proliferation and reduction in cellular apoptosis. One of the most important genes involved in prostate carcinogenesis is E2F3 mRNA. E2F3 over-expression can bear a classical oncogenic axis in many tumors including cancer bladder and cancer prostate. E2F3 expression was found to be an independent factor predicting worse overall and cause-specific survival. E2F3 can also promote prostatic cell proliferation and its over-expression was found to be associated with tumor aggressiveness. It was found that blocking the DNA-binding site of E2F3 prevents its oncogenic activity. This approach can be used in treating cancer prostate patients. In this study, the aim of the work was to evaluate the clinical significance of peripheral blood E2F3 mRNA assay in the early diagnosis of patients with localized prostate cancer and to compare its expression in the blood of cancer prostate, benign prostatic hypertrophy and age matched healthy males. In this study, whole blood samples were collected from 25 newly diagnosed cancer prostate patients, 15 benign prostatic hyperplasia patients, in addition to 10 healthy age matched males. These samples were tested to detect blood E2F3 mRNA level by real-time reverse transcriptase polymerase chain reaction. In this study, 25 cancer prostate patients out of 25 patients had E2F3 gene over-expression and none of the benign prostatic hyperplasia patients or the healthy control males had any E2F3 gene over-expression. E2F3 mRNA level in blood was statistically higher in cancer prostate patients than in benign prostatic hyperplasia and healthy control males. However, E2F3 mRNA level in blood showed no statistical difference between benign prostatic hyperplasia patients and the healthy control males. On the other hand, E2F3 showed no correlation with serum PSA level in any of the studied groups. Total PSA was significantly higher in cancer prostate patients than in benign prostatic hyperplasia patients and the healthy control group. However, total PSA showed no significant difference between benign prostatic hyperplasia patients and the healthy control group. Family history of cancer prostate was statistically higher in cancer prostate patients than in benign prostatic hyperplasia patients and the healthy control subjects. In conclusion, the results of the current study indicate clearly that blood E2F3 mRNA is a sensitive diagnostic biomarker for cancer prostate as it showed a 100% sensitivity, specificity and efficacy when using a sensitive real-time RT-PCR assay in monitoring E2F3 gene expression as a cancer specific marker. Hence, addition of E2F3 mRNA to the current standard tests may be of added value for diagnosis of cancer prostate at an early stage which in turn would improve the disease prognosis. Moreover, E2F3 mRNA has the potential to eliminate the areas of overlap in serum PSA measurements which makes accurate diagnosis difficult without the use of biopsy, hence, avoiding unnecessary biopsies.