Dr. Schwen highlights zonal-based variations in prostate cancer biology

In this video, Zeyad Schwen, MD, highlights the background and key findings from the study, “Transcriptomic features of clinically localized prostate cancer arising from distinct prostate zonal regions,” which was presented at the 2024 American Urological Association Annual Meeting in San Antonio, Texas. Schwen is a urologic oncologist at the Cleveland Clinic in Cleveland, Ohio.

Video Transcript:

This was a very interesting study that stemmed from some of our acknowledgments and recognition of different behaviors of prostate cancers that arise from different zones of the prostate, namely the peripheral zone compared to the transition zone. We have noticed, from a radiographic side, that a lot of times these anterior and transition zone prostate cancers are oftentimes really scary looking on the MRI. This is actually something that has been presented in a number of different abstracts throughout the AUA this year. We wanted to find out is there any difference in potential behavior or transcriptomic features that we looked at using the Decipher score. We actually had the benefit of having all of the raw genes of the 42,000 ones that were sent from the Decipher microarray. We [looked at] people who had a transition zone lesion and compared those to people who had a peripheral zone lesion, seeing if there were any differences in the transcriptomic signature using the Decipher score.

We actually saw that [in] the transition zone lesions, after we matched these lesions to peripheral zone lesions, they tended to have a lower Decipher score. However, they were, interestingly, larger in size. The outcomes suggests that potentially they could have a lower chance of biochemical recurrence following treatment. We looked at also the various differences in the specific genes that were differentially expressed. There were about 220 genes that were differentially expressed, comparing transition zone to the peripheral zone, and certain patterns arose where certain genes were differentially expressed that have well established roles in prostate cancer biology and tumor genesis. This is something that we looked at in certain specific ones; one of them was SOX2, another is FOXF2, and ERG. These are well known ones in the prostate cancer biology. It's really interesting to see how potentially these differentially expressed genes could suggest a different biology based on the zone that they arose from. So perhaps this is a sign of a need for more study to come forward, looking at maybe how do these cancers behave, maybe they could be managed differently, and maybe watched more frequently than we currently are doing.

This is very interesting, because it played into a theme, like I had mentioned, [of] our recognition of how they look differently on imaging – they're larger, scarier looking. I think a lot of the other abstracts showed that they also were less likely to have clinically significant prostate cancer on biopsy. So, I think this certainly was a theme that I recognized coming from different areas of the prostate cancer research that was presented at AUA. It's great to see people coming to similar findings that we have seen and noticed here at the Cleveland Clinic.

This transcription has been edited for clarity.