SOX2 expression in the primary tumor of castration-naive metastatic prostate adenocarcinoma in association with metastasis extent

BACKGROUND Poor prognosis in patients with metastatic prostate adenocarcinoma (mPCa) may be due to the expression of stem cell-related genes. This study aimed to demonstrate the association between the expression of cancer stem cell markers and metastasis in patients with castration-naive mPCa. METHODS This cross-sectional, analytical study investigated a formalin-fixed paraffin-embedded prostate specimens from patients diagnosed in Cipto Mangunkusumo Hospital. Patients aged ≥50 years old were grouped based on the extent of metastases (high-volume disease [HVD] and low-volume disease [LVD]). In each case, immunohistochemical staining for CD133, CD44, SOX2, and androgen receptor was performed and analyzed using H-score. All data were recorded and analyzed using SPSS software version 20.0. RESULTS A total of 61 patients were recruited from 2020 to 2023 and divided into the HVD (n = 38) and LVD (n = 23) groups, with a mean age of 67.9 years. 45 of the patients had International Society of Urological Pathology (ISUP) grade 5 disease, while 16 of them had grade