Trefoil factor 3 (TFF3) As A Prognostic and Pathogenic Factor in Prostatic Adenocarcinoma in Iraqi Patients

Background: The prostate gland has a high rate of benign and malignant disease, including “benign prostatic hyperplasia (BPH)” and prostatic adenocarcinoma. BPH occurs in as many as 75% of males by the eighth decade of life. “Prostate cancer” is the second most common cancer in the world, and in Iraq, it is the third most common cancer after lung and colorectal cancers. “Trefoil factor 3 (TFF3)” is a member of the trefoil factor family, which has been associated with epithelial repair and tumorigenesis. TFF3 promotes a cancerous state by increasing cell migration, invasion, and the formation of the tumor microenvironment, and by inhibiting apoptosis, likely through the activation of a phosphoinositide 3-kinase-protein kinase B (PI3K/AKT) signaling pathway. Aim: This study aimed to evaluate TFF3 expression in prostatic adenocarcinoma versus BPH and to assess its correlation with pathological features, including age, preoperative PSA level, Gleason grade, perineural, and lymphovascular invasion. Method: An examination of sixty formalin-fixed paraffin-embedded prostatic tissue blocks was performed: 30 “benign prostatic hyperplasia (BPH)” and 30 prostatic adenocarcinomas. Hematoxylin and eosin (H&E) staining and immunohistochemical staining with anti-TFF3 monoclonal antibody were performed on each block. TFF3 expression was qualitatively evaluated under light microscopy and correlated with computer-derived clinicopathologic characteristics. Results: TFF3 expression was demonstrated in 93.3% of cases of prostatic adenocarcinoma and was expressed in only 20% of BPH cases. A highly statistically significant correlation was observed between TFF3 expression and Gleason grade (p = 0.00004) and with preoperative PSA (p = 0.000012). There was no statistically significant correlation with age, perineural, or lymphovascular invasion. TFF3 has a sensitivity of 93% and a specificity of 80% as a diagnostic marker. Conclusion: TFF3 is significantly overexpressed in prostatic adenocarcinoma compared to BPH, particularly in high-grade tumors, supporting its potential as a diagnostic biomarker.