Prostate Cancer Telomere Length Predicts Metastases, Mortality

Key Takeaway

  • A combination of telomere measurements in prostatectomy tissue samples — more variable telomere length in cancer cells plus shorter telomere length in associated stromal cells — predicts the subsequent risk of metastasis and death.

Why This Matters

  • Current biomarkers — prostate-specific antigen level, grade group, and clinical stage — don’t work well to predict how men will fare after prostatectomy.

  • There is an urgent need for better biomarkers to distinguish men who need additional treatment from those who don’t.

  • Telomere length variability and shortening indicate chromosomal instability, a hallmark of aggressive prostate cancer.

  • Determining if telomere aberrations predict how men will fare after prostatectomy could improve treatment and surveillance decisions.

Study Design

  • The team assessed telomere length in tissue microarrays from prostatectomies in 2255 men across five cohorts.

  • Relative telomere length was determined through a semiautomated process involving immunofluorescence, fluorescent microscopy, and image analysis of individual cells.

  • The findings were correlated with disease outcomes.

Key Results

  • Compared with men who had less variable telomere length in prostate cancer cells and longer telomere length in stromal cells, men with more variable and shorter telomere lengths after surgery had 3.76-times the risk for death from prostate cancer (P = .01) and 2.23-times the risk of progression to metastasis (P = .05).

  • The findings held in men with intermediate-risk disease and with PTEN-intact tumors.

  • Only more variable telomere length in cancer cells — not shorter length in stromal cells — was associated with recurrence.


  • It’s unknown if the telomere biomarker is associated with poor outcomes in men undergoing radiation or hormone treatment. 

  • Recurrence, progression to metastasis, and prostate cancer death couldn’t be assessed for every cohort because of study designs and/or study population issues.


  • The work was funded by the Department of Defense, the National Cancer Institute, and the Prostate Cancer Foundation. The investigators had no disclosures.

This is a summary of a preprint research report led by Christopher Heaphy, PhD, at Johns Hopkins University, Baltimore, Maryland, provided to you by Medscape. This study has not yet been peer-reviewed. The full text can be found at

M. Alexander Otto is a physician assistant with a master’s degree in medical science, and an award-winning medical journalist who has worked for several major news outlets before joining Medscape. He is an MIT Knight Science Journalism fellow. Email: [email protected]

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