Bcl-2 correlates with tumor ploidy and nuclear morphology in early stage prostate carcinoma. A fine needle aspiration biopsy study.

We evaluated the nuclear morphology, ploidy, bcl-2 expression and in situ apoptosis in sections of fine-needle aspiration (FNA) biopsy specimens of thirty-one randomly selected Stage B prostate carcinomas. Sections of paraffin-embedded pelleted cells obtained from FNA biopsy specimens were studied. Nuclear grade was determined according to the WHO system. Nuclear morphometry and DNA ploidy were carried out using an automated image analyzer. We used immunostaining and the TUNEL method to evaluate bcl-2 expression and in situ apoptosis. The median nuclear area increased with increasing nuclear grade. Ploidy analysis showed that 54.8% of tumors were diploid, 3.2% tetraploid and 41.9% aneuploid. Bcl-2 overexpression was found in 10 of 31 tumors. There was a significant positive correlation between bcl-2 expression and nuclear area (r(s): 0.45 p < 0.01). Nine of ten bcl-2-positive tumors had a nuclear area larger than the median of the series, and 70% of bcl-2-positive tumors were of the aneuploid type. The apoptotic index had a negative correlation with nuclear area, and the lowest indexes were found in aneuploid tumors. Bcl-2 expression showed a highly significant association with both parameters of high aggressiveness: nuclear size and aneuploidy. The combined evaluation of nuclear morphology, ploidy and cell survival parameters might better identify patients with poor prognosis among early stage prostate carcinomas diagnosed by FNA biopsies.