INVESTIGATING PREVALENCE AND GENOTYPING OF HIGH-RISK HPV IN PROSTATE CANCER PATIENTS FROM PAKISTAN

Abstract

Human papillomavirus (HPV) attributable cancers are more pronounced in low-middle income countries (LMICs), where it presents a significant challenge due to limited access to screening and vaccination programs, coupled with inadequate hygiene conditions. In Pakistan, the etiological association of HPV with anogenital and urologic cancers remains under-researched. Globally, the association of HPV with prostate cancer remains elusive, and to date, no study has been conducted on this aspect in Pakistan. Therefore, this study aims to explore the link between HPV and the development of prostate cancer in the Pakistani population. This study included 50 men with primary prostate cancer, clinically confirmed through Hematoxylin and Eosin (H&E) staining and Immunohistochemistry (IHC) staining. Formalin-fixed paraffin-embedded (FFPE) prostate tissue biopsies, along with histopathological data, and clinicopathological data, were collected after informed consent. DNA was extracted and processed for HPV detection using L1 consensus primers, via conventional PCR. Histopathological and clinicopathological analysis revealed that in Pakistan, prostatic acinar adenocarcinoma was the only type of prostate cancer, with 64% (32/50) of patients having low to moderate grade cancer and 42% (21/50) patients having Gleason score of 7. The average age of patients was 65 years. All patients were married with 92% (46/50) belonging to urban areas. All patients had PSA levels above 4.0 ng/ml. Among co morbidities, 78% (39/50) patients had lower urinary tract symptoms (LUTS) followed by benign prostate enlargement (BPH) in 24% (12/50) patients, making them the most prevalent. Regarding contemporary lifestyle choices, 52% (26/50) of patients had an active lifestyle and 74% (37/50) were tobacco abstainers. HPV detection via PCR did not identify the virus in any patient and thus the study did not establish a causal link between HPV and prostate cancer. To gain a deeper understanding of the link between HPV and prostate cancer, more comprehensive research is needed. This should involve larger and more diverse sample Abstract xvii sizes, including cases of benign prostatic hyperplasia and samples from different regions of Pakistan, consideration of additional risk factors such as sexual history, and the use of techniques beyond molecular analysis, such as immunohistochemistry (IHC) for protein detection and sequencing.