Prostate cancer (PCa) is the most frequently diagnosed cancer in men across nearly two-thirds of countries worldwide. In 2022, approximately 1.5 million new cases were reported, resulting in 3,97,000 deaths globally. These figures make PCa the second most common cancer and the fifth leading cause of cancer-related mortality among men1.
PCa is a multifocal and biologically complex disease, marked by substantial intertumoral heterogeneity2,3,4, diverse molecular subtypes, and variable clinical outcomes5,6, all of which significantly influence prognosis and therapeutic response7.
While the critical role of the tumor microenvironment (TME) in prostate tumor initiation and progression is well established8,9, the molecular interactions between tumor cells and the surrounding stromal compartment remain incompletely understood. While it is well established that the prostate tumor microenvironment (TME) plays a critical role in tumor initiation and progression, the molecular interactions between tumor cells and the surrounding stroma remain insufficiently defined. The TME comprises a variety of stromal cells, including those of mesenchymal and immune origin, which become activated in response to tumor-derived signals and subsequently acquire tumor-promoting functions10,11. Among these, cancer-associated fibroblasts (CAFs) often represent the most abundant stromal population. CAFs contribute to extracellular matrix (ECM) remodeling, promote tumor growth, and facilitate cancer cell invasion and migration4,11,12,13. Through secreted factors and direct cell-cell interactions, CAFs also influence proliferation, invasion, and therapy resistance. Notably, CAFs are a heterogeneous population. While generally associated with pro-tumorigenic functions, some subtypes may exert tumor-suppressive roles14,15. Importantly, the absence of unique markers for CAFs poses challenges for their precise identification and the functional dissection of their diverse roles12,16.
A robust approach to investigate the functional crosstalk between CAFs and tumor cells involves isolating primary CAFs and matched normal fibroblasts (NFs), then assessing their respective influence on tumor cell behaviors such as proliferation, migration, colony formation, and anchorage-independent growth17,18,19. This article describes a refined, highly reproducible protocol for isolating CAFs and NFs from radical prostatectomy specimens of high-risk PCa patients. A critical component of this protocol is the accurate identification and dissection of tumor and tumor-free regions by an expert uropathologist, allowing the derivation of CAFs and NFs from the same patient. This paired-sample approach helps control for intertumoral heterogeneity and individual patient-specific variables that can influence fibroblast phenotypes20,21,22. To ensure sufficient tumor tissue is available, we focus on specimens from patients with a Gleason score ≥7.
Reliable phenotypic characterization of the isolated fibroblasts requires the use of multiple markers to distinguish them from other cell types, particularly epithelial cells, which may share overlapping marker expression16. As primary PCa fibroblasts typically undergo senescence after 10-15 passages, complicating long-term analyses, we also present a protocol for cell immortalization via stable expression of the human telomerase reverse transcriptase (hTERT)23.
To explore the functional effects of CAFs and NFs on tumor cells, we tested and optimized several experimental strategies. Given that CAFs exert their influence through both secreted factors and direct cell-cell contact24, two complementary assay systems are developed: (1) treatment of cancer cells with fibroblast-conditioned medium (CM), and (2) direct co-culture of fibroblasts and tumor cells. These assays evaluate key cancer cell properties, including proliferation, anchorage-independent growth, and migration. To standardize the influence of secreted factors, conditioned media from CAFs and NFs were concentrated and quantified (conCM) based on total protein content.
Demonstrating significant functional effects through these assays can support the identification of critical mediators of CAF-driven tumorigenesis, offering potential targets for therapeutic intervention.