Hereditary/Familial Versus Sporadic Prostate Cancer: Few Indisputable Genetic Differences and Many Similar Clinicopathological Features

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Hereditary/Familial Versus Sporadic Prostate Cancer: Few Indisputable Genetic Differences and Many Similar Clinicopathological Features European Review for Medical and Pharmacological Sciences 2010; 14: 31-41 Hereditary/familial versus sporadic prostate cancer: few indisputable genetic differences and many similar clinicopathological features C. ALBERTI Surgical Semeiotics, University of Parma, Parma (Italy) Abstract. – Genetic factors and their inter- VDR gene, that is a component of ligand actions with environmental conditions and inter- (steroid)-dependent nuclear transcription factor nal microenvironment influence the prostate superfamily, shows various polymorphisms cancer (PC) development, so that gene expres- which appear to be associated with PC risk. Ex- sion couldn’t strictly occur on the basis of re- cept an earlier age of onset, no anatomo-clinical ductionist determinisms of DNA causality but and tumor progression peculiarities between should also conform to multifactorial and sto- hereditary and sporadic PC have been generally chastic events, moreover, considering the pre- identified. Indeed, tumor progression and metas- RNA alternative splicing-mediated multi-protein tasis, both in hereditary and sporadic PC, are assemblying mechanisms. Nevertheless, after mainly influenced by a variety of biochemical age and ethnic background, the strongest epi- and immune-mediated tumor microenvironmen- demiological risk factor for PC is a positive fami- tal conditions rather than by the hereditary ge- ly history. However, apart from RNaseL-, ElaC2-, netic factors, thus gene expression associated MSR1-genes, there are not other identified high- with invasive ability representing a newly ac- risk genetic variants which might be considered quired genetic variant rather than a selection of responsible for hereditary PC, moreover sug- pre-existent gene abnormalities in PC cells. It’s gesting that familial PC is a genetically hetero- questionable whether genetic testing of unaf- geneous disease, many gene loci rather than a fected men of hereditary PC families might be specific major susceptibility gene predisposing actually useful. Nevertheless a suitable coun- to it. Gene-environment interactions play a cru- selling must be proposed. Family history and/or cial role in cancer development especially when gene profiling-guided preventive strategies for low penetrance genes, such as in case of genet- men at high risk of familial PC, range from di- ic polymorphisms, are the major players. Several etary to drug measures. Cancer chemopreven- epidemiological studies show, in some families, tive approaches may include 5-α-reductase in- a possible, either syncronous or metachronous, hibitors, histone deacetylase inhibitors, antioxi- association of other tumors (breast, brain, gas- dans, non-steroidal anti-inflammatory drugs, trointestinal tumors, lymphomas) with PC, thus cholesterol-lowering statins, vitamin D ana- suggesting a common genetic background. As logues. far as the role of androgen metabolism and an- drogen receptor (AR)-related genes in the devel- Key Words: opment of familial PC is concerned, a small Inheritance, Prostate cancer, Microenvironment, Tu- number of either guanine-guanine-cytosine (<16) mors, Urology. or cytosine-adenine-guanine (<18) repeats ap- pears to increase the AR activity, resulting in a raising PC risk. Regarding the expression of both androgen and estrogen receptor-related genes in sporadic and hereditary PC, the im- munohistochemistry findings show that the per- Introduction centage of AR-positive cancer cells is higher in hereditary PC than in sporadic forms, whereas In the developed Western countries, prostate the mean number of estrogen-α-receptor-posi- carcinoma (PC) is the most frequently diagnosed tive stromal cells is higher in sporadic PC rather α malignancy in men and the third most common than in that hereditary. As for 5- -steroid-reduc- cause of cancer-related mortality in North Amer- tase-2 gene, the dinucleotide thymine-adenine 1 repeated 18 times on the last exon, confers an ica . Its incidence and mortality vary consider- increased PC predisposition, as it is mainly ably among different ethnic groups, with high shown in African-American populations. Also prevalence in African-American men1,2. Corresponding Author: Contardo Alberti, MD; mobile: +39.331.9823032 31 C. Alberti Prostate carcinoma is a multifactorial disease predispose to it, likely interacting not only reci- whose etiology ranges from genetic factors to procally but also with environmental conditions, environmental conditions and internal microen- that, however, affect more strongly the sporadic vironment (“milieu intérieur”)3. Nevertheless, PC initiation4,9. after age and ethnic background, the strongest Hereditary transmission may be autosomal epidemiological risk factor for PC is a positive dominant – through the mother or the father – family history, several aggregation analyses and and even X-linked – through the mother to her linkage investigations showing that, on the one sons who will not transmit the susceptibility to hand, some alleles, with high penetrance, may their own sons –, and by the last way the disease confer a dominant inheritance susceptibility to jumping regularly one generation with subse- PC with rise in cases of the disease within indi- quent its under-estimation. Autosomal dominant vidual families (hereditary PC), and, on the oth- high-penetrant gene-related transmission is usu- er hand, many polymorphisms, with low pene- ally associated with disease onset at younger age trance, may influence, by integrating environ- while that recessive chromosome X-linked is mental conditions, the frequency of both familial characterized by late-onset disease4,8-10. and sporadic disease2,4-6. In this regard, a distinc- The first chromosome locus associated with tion must be made between hereditary and fa- hereditary PC was 1q24-25 and its putative gene milial forms, considering that hereditary trans- was named HPC1 (hereditary prostate carcinoma mission, compatible with Mendelian inheritance 1), which, in turn, was identified with RNaseL criteria, is demonstrated only in 5% of the cases gene (Table IA), involved in interferon-activated with PC family history whereas familial PC ac- apoptosis for virus-infected cells. Indeed, recent counts about 13-25% of cases. Indeed, families studies show that RNaseL gene mutations are re- with hereditary PC may be identified by having sponsible for PC particularly in men with γ-retro- three or more affected first-degree relatives (fa- virus-mediated prostate infections, among which ther, son, brother) within the nuclear family or, especially the xenotropic murine leukemia virus- differently, a frequency of PC in three successive related γ-retrovirus (XMRV). Actually, forty per- generations, or, at least, two affected relatives cent of hereditary PC patients homozigous for a before the age of 55 years4,6,7, given that genetic mutation in RNaseL are positive for XMRV susceptibility is proportionally more shown in whereas this virus is rarely detected in sporadic young patients rather than in old. Familial aggre- PC specimens, such finding meaning as a true gation of PC which don’t fulfill such criteria are breakthrough in the pathogenesis of PC. Poly- defined as familial forms, that, more properly, morphic variants within RNaseL gene are associ- are characterized by at least two affected first- ated with raised risk of hereditary PC4,8,10-12. degree relatives. Anyway, the risk of PC is about Other strong candidate susceptibility genes two-fold in the first-degree relatives of diseased are ElaC2/HPC2 (locus 17p11.2) and MSR1 men, it increasing proportionally to number of (macrophage scavenger receptor 1) (Table IA). diseased relatives and their decrease in age at the Also a mutation in a gene on 8q24 locus should diagnosis, so that the risk of developing a PC is appear to increase the risk of PC by 60%, but it assessed 8.5 for men with both first- and second- is more relevant to pathogenesis of familial and degree affected relatives4,6,8. sporadic PC. An indeterminate number of weak candidate susceptibility loci have been suggest- ed to be involved in hereditary PC (Table IB). Hereditary Form However, PC high risk alleles, that are able to drive a lifetime penetrance of at least 66%, have The definition of hereditary PC is mainly a frequency unlikely above 2-3% of the cases, based on the family history (pedigree). Despite whereas PC low risk alleles may have a more a strong support for a significant role of inherit- frequent impact on sporadic PC. With regard to ed genetic variants in PC etiopathogenesis, PC susceptibility locus 1q42.2-43 (PCAP, however few indisputable high-risk genetic ab- prostate cancer predisposing), the prostate carci- normalities have been shown in cases fulfilling noma tumor antigen-1 (PCTA-1), that is located the hereditary PC epidemiological criteria, thus within such chromosomal region, is not a PC suggesting that even the hereditary PC could be high risk gene while it could make one’s low a genetically heterogeneous disease. Many gene risk contribution to sporadic PC, but it must be loci rather than any major susceptibility gene throughly explored5,8,9,13. 32 Hereditary/familial versus sporadic prostate cancer Table I. Genes involved in hereditary PC. Gene Locus Encoding function Encoded protein A) Strong candidate susceptibility genes involved in hereditary prostate cancer • RNase L 1q24-25 Encodes RNaseL – RNaseL, endoribonuclease located (Ribonuclease L) HPC1 in cytoplasm and mithocondria. – Interferon-activated, it plays an antiviral and proapoptotic role • ElaC2 17p11.2 Encodes
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