Estimation of Nestin and AMACR markers expression in Iraqi patients with prostate tumor: histopathological and immunohistochemical study

Background: Prostate tumours constitute a major cause of urological morbidity among Iraqi men. Prostate cancer was one of the top six male cancers, with an age-standardized incidence rate (ASIR) of 8.64 per 100,000 in Iraq, according to GLOBOCAN 2020. By contrast, BPH continues to be the most common resected prostatic lesion globally, impacting up to 50% of men by the age of 50 and more than 80% by the age of 80, Prostate tumor evaluation using Nestin, an intermediate filament protein linked to stem/progenitor cells, and α-methylacyl-CoA racemase (AMACR), a lipid metabolism enzyme, is a promising marker. Objective: To compare Nestin and AMACR expression in Iraqi patients' and correlate with clinicopathological characteristics. Methods: In this retrospective study, a total of 85 prostate tissue specimens (including 40 carcinomas, 30 benign hyperplasias and 15 control) were retrieved from the archives of Iraqi hospitals in medical city. Immunohistochemical staining for AMACR and Nectin was independently evaluated by two pathologists using the H‑score method (range 0–300), calculated as the product of staining intensity (0–3) and percentage of positive cells (0–100%). Statistical analyses were performed in SPSS program. Results: Nestin H-scores were substantially higher in malignant tissues compared to benign and controls. A moderate positive connection was found between Nestin H-score and Gleason score, AMACR expression was significantly higher in malignant cases than in benign and control tissues, independent of Gleason grade. Patient age did not affect either marker. Conclusion: Nestin and AMACR can consistently differentiate malignant from benign prostate tissues in this Iraqi population. Nestin correlates marginally with tumor grade, suggesting prognostic potential, while AMACR has excellent sensitivity and specificity regardless of grade adding diagnostic panels may improve accuracy in difficult instances.