The epithelial–mesenchymal transition regulators Twist, Slug, and Snail are associated with aggressive tumour features and poor outcome in prostate cancer patients

Abstract The prognostic importance of transcription factors promoting epithelial–mesenchymal transition (EMT) and angiogenesis has not been well explored in prostate cancer patients with long follow‐up, nor the interplay between these factors. The objective of this study was to assess the individual protein expression and co‐expression of Twist, Slug (Snai2), Snail (Snai1), and hypoxia‐inducible factor‐1 alpha (Hif‐1α) in prostate cancer in relation to EMT, angiogenesis, hypoxia, tumour features, disease recurrence, and patient survival. Immunohistochemical staining was performed on tissue microarray sections from 338 radical prostatectomies with long follow‐up. In addition, 41 cases of prostatic hyperplasia, 33 non‐skeletal metastases, 13 skeletal metastases, and 33 castration‐resistant prostate carcinomas were included. Our findings were validated in external gene expression data sets. Twist was overexpressed in primary prostate cancer and markedly reduced in distant metastases (p