Abstract:
The invention relates to the identification and selection of novel genomic regions (biomarker) and the identification and selection of novel genomic region combinations which are hypermethylated in subjects with prostate cancer compared to subjects without prostate cancer. Nucleic acids which selectively hybridize to the genomic regions and products thereof are also encompassed within the scope of the invention as are compositions and kits containing said nucleic acids and nucleic acids for use in diagnosing prostate cancer. Further encompassed by the invention is the use of nucleic acids which selectively hybridize to one of the genomic regions or products thereof to monitor disease regression in a patient and the efficacy of therapeutic regimens.

Description:
FIELD OF THE INVENTION 
       [0001]    The present invention is in the field of biology and chemistry. In particular, the invention is in the field of molecular biology. More particular, the invention relates to the analysis of the methylation status of genomic regions. Most particularly, the invention is in the field of diagnosing prostate cancer. 
       BACKGROUND 
       [0002]    Reversible methylation of cytosines is a major epigenetic modification in multicellular organisms and is found in many human diseases including cancer. Cancer epigenomes are found to be globally hypomethylated with promoter-specific hypermethylations. Furthermore, cytosine methylation results in transcriptional repression, which, in the case of tumour suppressor genes, apoptotic genes, DNA repair genes and factors controlling cell cycle check points leads to tumour progression. 
         [0003]    Prostate cancer (PC) is the third most common cause of male cancer deaths in developed countries. Diagnosed at an early stage PC is a curable disease. Therapies reach from watchful waiting to radical prostatectomy, hormone or radiation therapy. Nevertheless, because of its yet mostly unpredictable outcome patients are often treated without clear benefit. 
         [0004]    Prostate specific antigen (PSA) is used as a biomarker to screen men for potential tumour development. However, low specificity and sensitivity leads to wrong diagnoses. In particular, elevated PSA can also result from an inflammation or precedent transrectal ultrasound, i.e. disclosure within the state of the art lacks an unequivocal diagnosis of PC. 
         [0005]    It is therefore clear that there has been and remains today a long standing need for an accurate and reliable test to diagnose PC. 
         [0006]    Recent years have brought a marked extension of our understanding of the somatic basis of prostate cancer. With one to three mutations per megabase the mutation frequency is similar to that observed in acute myeloid leukemia and breast cancer and lies within the lower range of cancer. Based on the frequency and the fact that primarily a diverse array of genes is affected the main genomic alterations appear to be genomic rearrangements and changes in the epigenetic structure of the DNA. 
         [0007]    Michael Weber et al. (Nature Genetics, Vol. 37, No. 8, Aug. 1, 2005, pages 853-862) disclose DNA methylation markers for colorectal cancer. For the analyses colorectal cancer cell lines and tissues, and a prostate cancer cell line were used, but no primary prostate cancer tissues. In addition, experiments are based on arrays which narrow down the possibility to detect new DMRs. 
         [0008]    Ilana Keshet et al (Nature Genetics, Vol. 38, No. 2, Feb. 1, 2006, pages 149-153) disclose methylation of GSTP1 and CDKN2A in Caco2 and PC3 cell lines (has been shown before) by PCR analyses. Furthermore, they compare methylation information obtained by MeDIP array (10.000 promoter elements) analyses of PC3, Caco2, normal lymphoblasts, normal colon tissue and six colon tumors. Again, no primary prostate cancer tissues have been used, and experiments are restricted to array regions. 
         [0009]    Tokumaru (Clinical Cancer Research, Vol. 10, No. 16, Aug. 15, 2004, pages 5518-5522) disclose the usability of combinations of the methylation values of four genes obtained by qPCR to help in tumour classification of needle biopsies: Combinations of RARRES1, APC, RARB2, and GSTP1 methylation were used to classify 72 prostate samples (56 cancer, only 16 normal) with 100% specificity and 97% sensitivity. RARB2 as well as GSTP1 are listed in our patent application (SEQ ID NO: 36 and 108). 
         [0010]    Hoque Mohammad Obaidul et al (Journal of clinical oncology, American Society of Clinical Onoclogy, Vol. 23, No. 27, Sep. 20, 2005, pages 6569-6575) disclose the usability of the methylation values of CDKN2A, p14 ARF , MGMT, and GSTP1 as markers for qMSP based PCa detection in urinary sediment in 52 PCa cases and 91 age matched controls without precedent PCa history with a sensitivity of 87% and a specificity of 100%. Only GSTP1 may overlap with the regions listed below. 
         [0011]    Jacinto Filipe V et al (Biotechniques, January 2008, Vol. 44, No. 1) review MeDIP experiments 
         [0012]    Ke Xi-Song et al (BMC Genomics, Biomed Central, London, Vol. 11, No, 1, Nov. 25, 2010) performed array profiling (17.000 RefSeq genes −5.5 kb-+2.5 kb) of histone modifications (chromatin IP) and DNA methylation (MeDIP) in EP156T, EPT1 and EPT2 cells and correlated the results to gene expression profiles (Agilent 44 k chip) and disclose histone modifications with correlating gene expression changes during epithelial to mesenchymal transition (EMT). Here only cell lines are used, no DNA methylation PCa markers are named. 
         [0013]    Matheys Lesley A et al (Molecular Cancer, Biomed Central, London, GB, Vol. 9, No. 1, October 2010) disclose hypomethylation in BMX and SOX1 in the invasive subpopulations of LNCaP and DU145 cells causing overexpression of said genes and name alterations in the STAT3 pathway as key features of invasiveness. Using MeDIP array analyses they found 869 genes hypermethylated in invasive LNCaP (1015 in invasive DU145) and 44 genes hypomethylated in invasive LNCaP and DU145 cells. They compared subpopulations of prostate cancer cell lines and did not include prostate tissue specimens to validate the significance of their findings in clinical samples. 
         [0014]    U.S. Pat. No. 6,812,339 disclose single nucleotide polymorphisms (SNPs) in genes that have been identified as being involved in pathologies associated with human disease. The diseases/pathologies that each gene is known in the art to be associated with is specifically indicated in Table 1 therein. The US patent does not relate to methylation patterns at all and uses a different approach. A nucleic acid disclosed therein shares some similarity with SEQ ID NO. 1 herein. 
         [0015]    Aberrant DNA methylation plays an important role in prostate cancer development and seems to be one of the earliest events in tumourigenesis. The most prominent differentially methylated gene in prostate cancer is glutathione S-transferase pi 1 (GSTP1). 
         [0016]    Other genes with changes in promoter methylation include multidrug resistance protein 1 (MDR1), O-6-methylguanine-DNA methyltransferase (MGMT), Ras association domain family member 1 (RASSF1), retinoic acid receptor beta (RARB), adenomatous polyposis coli (APC), androgen receptor (AR), cyclin-dependent kinase inhibitor 2A (CDKN2A), E-cadherin (CDH1) and CD44, but show inconsistent methylation levels in different studies. 
         [0017]    Even though the relevance of DNA methylations for normal cell homeostasis is undeniable, little is known about the genomic distribution in normal and diseased states. Accordingly, there is a need in the state of the art of studying genome-wide aberrant DNA methylation that can be associated with high confidence to PC and identifying biomarkers for PC diagnosis based on the epigenetic cancer information. 
       SUMMARY OF THE INVENTION 
       [0018]    The invention encompasses the identification and selection of novel genomic regions (biomarkers) and the identification and selection of novel genomic region pairs which are hypermethylated in subjects with prostate cancer compared to subjects without prostate cancer so as to provide a simple and reliable test for prostate cancer. Nucleic acids which selectively hybridize to the genomic regions and products thereof are also encompassed within the scope of the invention as are compositions and kits containing said nucleic acids and nucleic acids for use in diagnosing prostate cancer. Further encompassed by the invention is the use of nucleic acids each thereof selectively hybridizing to one of the genomic regions or products thereof to monitor disease regression in a patient and the efficacy of therapeutic regimens. 
         [0019]    For the first time the inventors have identified genomic regions by genome-wide approaches based on high throughput sequencing (methylated DNA immunoprecipitation, MeDIP-Seq), having cytosines that are hypermethylated in PC (Table 1) and thus, by quantifying the methylation status of specific genomic regions, permit the accurate and reliable diagnosis of prostate cancer (PC). Notably, the regions are not always in promoter regions or genes. 
         [0000]    
       
         
               
             
               
               
               
               
             
               
               
               
               
             
           
               
                 TABLE 1 
               
             
             
               
                   
               
               
                 Hypermethylated genomic regions in prostate cancer positive samples. 
               
               
                 Column 1: Number according to Sequence ID; Column 2: locus in 
               
               
                 genome determined by the chromosome number and start and stop 
               
               
                 position of the sequence; Column 3: length of sequence; Column 
               
               
                 4: associated or nearby gene; Column 5: minimal distance to the 
               
               
                 nearest transcription start site in base pairs. 
               
             
          
           
               
                 SEQ 
                   
                   
                 Gene in the 
               
               
                 ID NO 
                 Locus 
                 length 
                 proximity 
               
               
                   
               
             
          
           
               
                 1 
                 chr7: 157481151-157482600 
                 1450 
                 PTPRN2 
               
               
                 2 
                 chr7: 116140001-116140800 
                 800 
                 AC073130.3|CAV2 
               
               
                 3 
                 chr14: 31344301-31345250 
                 950 
                 COCH 
               
               
                 4 
                 chr9: 37002401-37003250 
                 850 
                 WASF2 
               
               
                 5 
                 chr8: 70946751-70947700 
                 950 
                 AP006222.2 
               
               
                 6 
                 chr7: 157484001-157486250 
                 2250 
                 AP006222.2 
               
               
                 7 
                 chr6: 26017301-26018000 
                 700 
                 HIST1H1A| 
               
               
                   
                   
                   
                 HIST1H1PS2 
               
               
                 8 
                 chr9: 112810101-112811000 
                 900 
                 AKAP2 
               
               
                 9 
                 chr12: 65218251-65220500 
                 2250 
                 TBC1D30 
               
               
                 10 
                 chr12: 54440251-54442000 
                 1750 
                 AC114498.2 
               
               
                 11 
                 chr6: 29973901-29975600 
                 1700 
                 HLA-J|PPP1R11| 
               
               
                   
                   
                   
                 HCG4P3 
               
               
                 12 
                 chr4: 185936801-185937900 
                 1100 
                 CR1 
               
               
                 13 
                 chr6: 56818401-56819300 
                 900 
                 BEND6|DST 
               
               
                 14 
                 chr11: 58940301-58941400 
                 1100 
                 DTX4 
               
               
                 15 
                 chr9: 126774501-126776750 
                 2250 
                 AC006450.3|LHX2 
               
               
                 16 
                 chr12: 104852001-104853350 
                 1350 
                 CHST11 
               
               
                 17 
                 chr4: 85414401-85415000 
                 600 
                 DENND1B 
               
               
                 18 
                 chr7: 143579051-143580250 
                 1200 
                 FAM115A 
               
               
                 19 
                 chr3: 170745901-170746800 
                 900 
                 SLC2A2 
               
               
                 20 
                 chr2: 235404251-235405000 
                 750 
                 ARL4C 
               
               
                 21 
                 chr4: 85402101-85403500 
                 1400 
                 DENND1B 
               
               
                 22 
                 chr7: 29185426-29186350 
                 925 
                 CPVL|CHN2 
               
               
                 23 
                 chr4: 41880751-41883500 
                 2750 
                 AL358857.1 
               
               
                 24 
                 chr3: 138154101-138154650 
                 550 
                 ESYT3 
               
               
                 25 
                 chr17: 43973501-43975400 
                 1900 
                 AL449063.1 
               
               
                 26 
                 chr1: 15480801-15481550 
                 750 
                 TMEM51 
               
               
                 27 
                 chr1: 203598351-203599000 
                 650 
                 ATP2B4 
               
               
                 28 
                 chr13: 100640801-100642200 
                 1400 
                 FAM87B 
               
               
                 29 
                 chr3: 172165201-172166800 
                 1600 
                 GHSR 
               
               
                 30 
                 chr4: 41867301-41869700 
                 2400 
                 ATP2B4 
               
               
                 31 
                 chr11: 3181451-3182200 
                 750 
                 FAM87B 
               
               
                 32 
                 chr11: 62690651-62691675 
                 1025 
                 CHRM1 
               
               
                 33 
                 chr7: 116140101-116141200 
                 3100 
                 AC073130.3|CAV2 
               
               
                 34 
                 chr19: 17246001-17246750 
                 750 
                 AL449063.1 
               
               
                 35 
                 chr14: 36991501-36994250 
                 2750 
                 AL132857.1 
               
               
                 36 
                 chr3: 25469201-25470000 
                 800 
                 AC098477.3|RARB 
               
               
                 37 
                 chr1: 119526751-119530700 
                 3950 
                 TBX15 
               
               
                 38 
                 chr2: 201450351-201451000 
                 650 
                 AOX1|AC080164.1 
               
               
                 39 
                 chr20: 50721001-50722800 
                 1800 
                 ZFP64 
               
               
                 40 
                 chr7: 127807851-127809100 
                 1250 
                 AL928711.1 
               
               
                 41 
                 chr1: 197887251-197890900 
                 3650 
                 LHX9 
               
               
                 42 
                 chr9: 126775751-126779750 
                 4000 
                 LHX2 
               
               
                 43 
                 chr6: 150285251-150286700 
                 1450 
                 ULBP1 
               
               
                 44 
                 chr1: 24648501-24649600 
                 1100 
                 AL590683.2|GRHL3 
               
               
                 45 
                 chr2: 237077751-237080600 
                 2850 
                 AC019068.1 
               
               
                 46 
                 chr1: 119526751-119528200 
                 1450 
                 AL449063.1 
               
               
                 47 
                 chr20: 37356001-37358250 
                 2250 
                 NTRK1 
               
               
                 48 
                 chr4: 85402001-85404750 
                 2750 
                 DENND1B 
               
               
                 49 
                 chr19: 16436501-16438750 
                 2250 
                 KLF2 
               
               
                 50 
                 chr6: 127835401-127836600 
                 1200 
                 AL096711.2 
               
               
                 51 
                 chr1: 58714251-58716500 
                 2250 
                 DAB1 
               
               
                 52 
                 chr1: 146549751-146552750 
                 3000 
                 U1|AL596177.3 
               
               
                 53 
                 chr3: 148631601-48632850 
                 1250 
                 COL7A1 
               
               
                 54 
                 chr15: 90039101-90040250 
                 1150 
                 RHCG 
               
               
                 55 
                 chr20: 20345251-20346650 
                 1400 
                 TMEM51 
               
               
                 56 
                 chr14: 29253901-29255300 
                 1400 
                 TNFRSF9 
               
               
                 57 
                 chr10: 94821701-94822900 
                 1200 
                 AL358613.1| 
               
               
                   
                   
                   
                 CYP26C1 
               
               
                 58 
                 chr18: 56939401-56941750 
                 2350 
                 RAX 
               
               
                 59 
                 chr7: 151107751-151108900 
                 1150 
                 AC005996.2|WDR86 
               
               
                 60 
                 chr1: 119541501-119545250 
                 3750 
                 AL139420.1| 
               
               
                   
                   
                   
                 AL139420.2 
               
               
                 61 
                 chr20: 50720751-50722750 
                 2000 
                 ZFP64 
               
               
                 62 
                 chr19: 48983501-48984100 
                 600 
                 AL449063.1 
               
               
                 63 
                 chr3: 125898501-125900400 
                 1900 
                 ALDH1L1 
               
               
                 64 
                 chr7: 129421101-129423700 
                 2600 
                 AP006222.2 
               
               
                 65 
                 chr2: 27529501-27531700 
                 2200 
                 UCN|TRIM54 
               
               
                 66 
                 chr6: 28367001-28368100 
                 1100 
                 ZSCAN12 
               
               
                 67 
                 chr5: 140810001-140812200 
                 2200 
                 PCDHGA12 
               
               
                 68 
                 chr11: 20618151-20619600 
                 1450 
                 SLC6A5 
               
               
                 69 
                 chr9: 135620101-135621000 
                 900 
                 C9orf98 
               
               
                 70 
                 chr7: 19145401-19147900 
                 2500 
                 AL590683.1 
               
               
                 71 
                 chr7: 45613251-45613800 
                 550 
                 ADCY1 
               
               
                 72 
                 chr2: 73147201-73148200 
                 1000 
                 AL449063.1 
               
               
                 73 
                 chr4: 11428951-11429850 
                 900 
                 HS3ST1 
               
               
                 74 
                 chr6: 28367001-28368050 
                 1050 
                 ZSCAN12 
               
               
                 75 
                 chr10: 102894701-102897000 
                 2300 
                 C1orf212 
               
               
                 76 
                 chr1: 146555301-146557500 
                 2200 
                 RP11-325P15.2|U1 
               
               
                 77 
                 chr14: 85996251-85999250 
                 3000 
                 AL049775.1|FLRT2 
               
               
                 78 
                 chr6: 137809001-137810400 
                 1400 
                 AP006222.2 
               
               
                 79 
                 chr14: 85996751-85998400 
                 1650 
                 AL049775.1|FLRT2 
               
               
                 80 
                 chr9: 135461001-135463300 
                 2300 
                 AL117337.4 
               
               
                 81 
                 chr7: 96632101-96633450 
                 1350 
                 DLX6AS 
               
               
                 82 
                 chr1: 70034801-70036500 
                 1700 
                 LRRC7 
               
               
                 83 
                 chr7: 157478101-157479750 
                 1650 
                 AP006222.2 
               
               
                 84 
                 chr12: 54440351-54442300 
                 1950 
                 AC114498.2 
               
               
                 85 
                 chr17: 41363301-41364700 
                 1400 
                 TMEM106A 
               
               
                 86 
                 chr7: 97360551-97361900 
                 1350 
                 TAC1 
               
               
                 87 
                 chr2: 87015901-87016700 
                 800 
                 CD8A 
               
               
                 88 
                 chr12: 54446751-54449000 
                 2250 
                 HOXC4 
               
               
                 89 
                 chr5: 77268001-77268500 
                 500 
                 USH2A 
               
               
                 90 
                 chr3: 68979651-68981600 
                 1950 
                 FAM19A4 
               
               
                 91 
                 chr12: 122016501-122017250 
                 750 
                 KDM2B 
               
               
                 92 
                 chr4: 16084551-16085900 
                 1350 
                 PROM1 
               
               
                 93 
                 chr19: 46915001-46917000 
                 2000 
                 CCDC8 
               
               
                 94 
                 chr6: 29973751-29975600 
                 1850 
                 HLA-J|PPP1R11| 
               
               
                   
                   
                   
                 HCG4P3 
               
               
                 95 
                 chr3: 154145501-154147250 
                 1750 
                 GPR149 
               
               
                 96 
                 chr10: 94821601-94823300 
                 1700 
                 CYP26C1 
               
               
                 97 
                 chr2: 220117251-220118350 
                 1100 
                 TUBA4B|TUBA1 
               
               
                 98 
                 chr7: 32981501-32982250 
                 750 
                 RP9P|AC018648.1 
               
               
                 99 
                 chr2: 45169501-45170400 
                 900 
                 AC012354.4|SIX3 
               
               
                 100 
                 chr10: 102905501-102906300 
                 800 
                 C1orf212 
               
               
                 101 
                 chr16: 54970051-54972800 
                 2750 
                 AL449063.1 
               
               
                 102 
                 chr17: 78806501-78807750 
                 1250 
                 AL121999.1 
               
               
                 103 
                 chr7: 128337251-128338000 
                 750 
                 5S_rRNA| 
               
               
                   
                   
                   
                 AC018638.7 
               
               
                 104 
                 chr3: 129024351-129025150 
                 800 
                 AL390856.3 
               
               
                 105 
                 chr5: 140892051-140893750 
                 1700 
                 AC092765.3 
               
               
                 106 
                 chr2: 162283301-162284650 
                 1350 
                 AL449063.1 
               
               
                 107 
                 chr4: 54975401-54976500 
                 1100 
                 AL391845.2 
               
               
                 108 
                 chr11: 67350751-67352100 
                 1350 
                 GSTP1 
               
               
                 109 
                 chr19: 158219801-58220950 
                 1150 
                 ZNF154 
               
               
                 110 
                 chr10: 112837801-112838800 
                 1000 
                 ADRA2A 
               
               
                   
               
             
          
         
       
     
         [0020]    The present invention contemplates a method for diagnosis of prostate cancer, comprising the steps of analyzing in a sample of a subject the DNA methylation status of the genomic regions of at least one genomic region pair selected from the group of Table 2, wherein, if at least one genomic region pair is hypermethylated, the sample is designated as prostate cancer positive. 
         [0000]    
       
         
               
             
               
               
               
               
             
               
               
               
               
             
           
               
                 TABLE 2 
               
             
             
               
                   
               
               
                 Genomic region pairs for the diagnosis of prostate cancer. A genomic 
               
               
                 region pair (grp; Column 1) is determined by a combination of genomic 
               
               
                 region 1 (Column 2) and genomic region 2 (Column 3). 
               
             
          
           
               
                   
                 Genomic region 
                 Genomic region 1 
                 Genomic region 2 
               
               
                   
                 pair (grp) 
                 [SEQ ID NO.] 
                 [SEQ ID NO.] 
               
               
                   
                   
               
             
          
           
               
                   
                 grp 1 
                 29 
                 86 
               
               
                   
                 grp 2 
                 8 
                 13 
               
               
                   
                 grp 3 
                 8 
                 27 
               
               
                   
                 grp 4 
                 8 
                 39 
               
               
                   
                 grp 5 
                 8 
                 86 
               
               
                   
                 grp 6 
                 6 
                 95 
               
               
                   
                 grp 7 
                 3 
                 31 
               
               
                   
                 grp 8 
                 19 
                 62 
               
               
                   
                 grp 9 
                 6 
                 7 
               
               
                   
                 grp 10 
                 8 
                 90 
               
               
                   
                 grp 11 
                 7 
                 62 
               
               
                   
                 grp 12 
                 8 
                 22 
               
               
                   
                 grp 13 
                 23 
                 95 
               
               
                   
                 grp 14 
                 8 
                 12 
               
               
                   
                 grp 15 
                 8 
                 50 
               
               
                   
                 grp 16 
                 8 
                 95 
               
               
                   
                 grp 17 
                 31 
                 98 
               
               
                   
                 grp 18 
                 3 
                 8 
               
               
                   
                 grp 19 
                 8 
                 9 
               
               
                   
                 grp 20 
                 6 
                 86 
               
               
                   
                 grp 21 
                 14 
                 95 
               
               
                   
                 grp 22 
                 8 
                 47 
               
               
                   
                 grp 23 
                 16 
                 23 
               
               
                   
                 grp 24 
                 21 
                 98 
               
               
                   
                 grp 25 
                 22 
                 95 
               
               
                   
                 grp 26 
                 6 
                 16 
               
               
                   
                 grp 27 
                 12 
                 19 
               
               
                   
                 grp 28 
                 13 
                 19 
               
               
                   
                 grp 29 
                 16 
                 41 
               
               
                   
                 grp 30 
                 27 
                 44 
               
               
                   
                 grp 31 
                 31 
                 95 
               
               
                   
                 grp 32 
                 46 
                 62 
               
               
                   
                 grp 33 
                 55 
                 86 
               
               
                   
                 grp 34 
                 62 
                 86 
               
               
                   
                 grp 35 
                 4 
                 8 
               
               
                   
                 grp 36 
                 7 
                 98 
               
               
                   
                 grp 37 
                 8 
                 19 
               
               
                   
                 grp 38 
                 8 
                 43 
               
               
                   
                 grp 39 
                 19 
                 65 
               
               
                   
                 grp 40 
                 22 
                 86 
               
               
                   
                 grp 41 
                 27 
                 31 
               
               
                   
                 grp 42 
                 95 
                 98 
               
               
                   
                 grp 43 
                 8 
                 30 
               
               
                   
                 grp 44 
                 8 
                 33 
               
               
                   
                 grp 45 
                 8 
                 108 
               
               
                   
                 grp 46 
                 9 
                 59 
               
               
                   
                 grp 47 
                 20 
                 95 
               
               
                   
                 grp 48 
                 26 
                 47 
               
               
                   
                 grp 49 
                 31 
                 33 
               
               
                   
                 grp 50 
                 42 
                 95 
               
               
                   
                 grp 51 
                 60 
                 97 
               
               
                   
                 grp 52 
                 88 
                 95 
               
               
                   
                 grp 53 
                 6 
                 57 
               
               
                   
                 grp 54 
                 8 
                 21 
               
               
                   
                 grp 55 
                 8 
                 45 
               
               
                   
                 grp 56 
                 8 
                 46 
               
               
                   
                 grp 57 
                 20 
                 86 
               
               
                   
                 grp 58 
                 47 
                 62 
               
               
                   
                 grp 59 
                 12 
                 21 
               
               
                   
                 grp 60 
                 19 
                 37 
               
               
                   
                 grp 61 
                 27 
                 101 
               
               
                   
                 grp 62 
                 29 
                 95 
               
               
                   
                 grp 63 
                 31 
                 37 
               
               
                   
                 grp 64 
                 46 
                 59 
               
               
                   
                 grp 65 
                 55 
                 95 
               
               
                   
                 grp 66 
                 59 
                 95 
               
               
                   
                 grp 67 
                 3 
                 47 
               
               
                   
                 grp 68 
                 6 
                 98 
               
               
                   
                 grp 69 
                 8 
                 65 
               
               
                   
                 grp 70 
                 9 
                 98 
               
               
                   
                 grp 71 
                 13 
                 95 
               
               
                   
                 grp 72 
                 23 
                 86 
               
               
                   
                 grp 73 
                 25 
                 95 
               
               
                   
                 grp 74 
                 31 
                 57 
               
               
                   
                 grp 75 
                 33 
                 95 
               
               
                   
                 grp 76 
                 62 
                 98 
               
               
                   
                 grp 77 
                 4 
                 95 
               
               
                   
                 grp 78 
                 8 
                 68 
               
               
                   
                 grp 79 
                 12 
                 16 
               
               
                   
                 grp 80 
                 14 
                 98 
               
               
                   
                 grp 81 
                 19 
                 86 
               
               
                   
                 grp 82 
                 20 
                 46 
               
               
                   
                 grp 83 
                 22 
                 29 
               
               
                   
                 grp 84 
                 31 
                 32 
               
               
                   
                 grp 85 
                 31 
                 86 
               
               
                   
                 grp 86 
                 46 
                 104 
               
               
                   
                 grp 87 
                 62 
                 69 
               
               
                   
                 grp 88 
                 69 
                 98 
               
               
                   
                 grp 89 
                 76 
                 89 
               
               
                   
                 grp 90 
                 7 
                 8 
               
               
                   
                 grp 91 
                 7 
                 20 
               
               
                   
                 grp 92 
                 8 
                 16 
               
               
                   
                 grp 93 
                 8 
                 17 
               
               
                   
                 grp 94 
                 8 
                 20 
               
               
                   
                 grp 95 
                 8 
                 100 
               
               
                   
                 grp 96 
                 8 
                 106 
               
               
                   
                 grp 97 
                 12 
                 97 
               
               
                   
                 grp 98 
                 16 
                 19 
               
               
                   
                 grp 99 
                 16 
                 45 
               
               
                   
                 grp 100 
                 19 
                 27 
               
               
                   
                   
               
             
          
         
       
     
         [0021]    The invention also relates to a nucleic acid molecule that hybridizes under stringent conditions in the vicinity of one of the genomic regions according to SEQ ID NO. 1 to SEQ ID NO. 110, wherein said vicinity is any position having a distance of up to 500 nt from the 3′ or 5′ end of said genomic region, wherein said vicinity includes the genomic region itself. 
         [0022]    The invention further relates to the use of nucleic acids for the diagnosis of prostate cancer. 
         [0023]    The present invention also comprises the use of an antibody for the diagnosis of prostate cancer. 
         [0024]    Another subject of the present invention is a composition and a kit comprising one or more of said nucleic acids and/or antibody for the diagnosis of prostate cancer. 
         [0025]    The following detailed description of the invention refers, in part, to the accompanying drawings and does not limit the invention. 
       DEFINITIONS 
       [0026]    The following definitions are provided for specific terms which are used in the following. 
         [0027]    The articles “a” and “an” are used herein to refer to one or to more than one (i.e. to at least one) of the grammatical object of the article. By way of example, “an element” means one element or more than one element. In contrast, “one” is used to refer to a single element. 
         [0028]    As used herein, the term “amplified”, when applied to a nucleic acid sequence, refers to a process whereby one or more copies of a particular nucleic acid sequence is generated from a nucleic acid template sequence, preferably by the method of polymerase chain reaction. Other methods of amplification include, but are not limited to, ligase chain reaction (LCR), polynucleotide-specific based amplification (NSBA), or any other method known in the art. 
         [0029]    As used herein, the term “biomarker” refers to (a) a genomic region that is differentially methylated, particularly hypermethylated, or (b) a gene that is differentially expressed, wherein the status (hypo-/hypermethylation and/or up-/downrcgulated expression) of said biomarker can be used for diagnosing PC or a stage of PC as compared with those not having PC. Within the context of the invention, a genomic region or parts thereof or fragment thereof are used as a biomarker for PC. Within this context “parts of a genomic region” or a “fragment of a biomarker” means a portion of the genomic region or a portion of a biomarker comprising 1 or more CpG positions. 
         [0030]    As used herein, the term “composition” refers to any mixture. It can be a solution, a suspension, liquid, powder, a paste, aqueous, non-aqueous or any combination thereof. 
         [0031]    The term “CpG position” as used herein refers to a region of DNA where a cytosine nucleotide is located next to a guanine nucleotide in the linear sequence of bases along its length. “CpG” is shorthand for “C-phosphate-G”, that is, cytosine and guanine separated by a phosphate, which links the two nucleosides together in DNA. Cytosines in CpG dinucleotides can be methylated to form 5-methylcytosine. This methylation of cytosines of CpG positions is a major epigenetic modification in multicellular organisms and is found in many human diseases including prostate cancer. 
         [0032]    As used herein, the term “diagnosis” refers to the identification of the disease (PC) at any stage of its development, and also includes the determination of predisposition of a subject to develop the disease. In a preferred embodiment of the invention, diagnosis of PC occurs prior to the manifestation of symptoms. Subjects with a higher risk of developing the disease are of particular concern. The diagnostic method of the invention also allows confirmation of PC in a subject suspected of having PC. 
         [0033]    As used herein, the term “differential expression” refers to a difference in the level of expression of the RNA and/or protein products of one or more biomarkers, as measured by the amount or level of RNA or protein. In reference to RNA, it can include difference in the level of expression of mRNA, and/or one or more spliced variants of mRNA and/or the level of expression of small RNA (miRNA) of the biomarker in one sample as compared with the level of expression of the same one or more biomarkers of the invention as measured by the amount or level of RNA, including mRNA, spliced variants of mRNA or miRNA in a second sample or with regard to a threshold value. “Differentially expressed” or “differential expression” can also include a measurement of the protein, or one or more protein variants encoded by the inventive biomarker in a sample as compared with the amount or level of protein expression, including one or more protein variants of the biomarker in another sample or with regard to an threshold value. Differential expression can be determined, e.g. by array hybridization, next generation sequencing, RT-PCR or an immunoassay and as would be understood by a person skilled in the art. 
         [0034]    As used herein, the term “differential methylation” or “aberrant methylation” refers to a difference in the level of DNA/cytosine methylation in a prostate cancer (PC) positive sample as compared with the level of DNA methylation in a PC negative sample. The “DNA methylation status” is interchangeable with the term “DNA methylation level” and can be assessed by determining the ratio of methylated and non-methylated DNA of a genomic region or a portion thereof and is quoted in percentage. For example, the methylation status of a sample is 60% if 60% of the analyzed genomic region of said sample is methylated and 40% of the analyzed genomic region of said sample is unmethylated. 
         [0035]    The methylation status can be classified as increased (“hypermethylated”), decreased (“hypomethylated”) or normal as compared to a benign sample. The term “hypermethylated” is used herein to refer to a methylation status of at least more than 10% methylation in the tumour in comparison to the maximal possible methylation value in the normal, most preferably above 15%, 20%, 25% or 30% of the maximum values. For comparison, a hypomethylated sample has a methylation status of less than 10%, most preferably below 15%, 20%, 25% or 30% of the minimal methylation value in the normal. 
         [0036]    The percentage values can be estimated from bisulphite mass spectrometry data (Epityper). Being obvious to the skilled person, the measurement error of the method (ca 5%) and the error coming from preparation of the sample must be considered. Particularly, the aforementioned values assume a sample which is not contaminated with other DNA (e.g. micro dissected sample) than those coming from prostate cells. As would be understood to the skilled person the values must be recalculated for contaminated samples (e.g. macro dissected samples). If desired, other methods can be used, such as the methods described in the following for analyzing the methylation status. However, the skilled person readily knows that the absolute values as well as the measurement error can differ for different methods and he knows how to compensate for this. 
         [0037]    The term, “analyzing the methylation status” or “measuring the methylation”, as used herein, relates to the means and methods useful for assessing and quantifying the methylation status. Useful methods are bisulphite-based methods, such as bisulphite-based mass spectrometry, bisulphite-based sequencing methods or enrichment methods such as MeDIP-Sequencing methods. Likewise, DNA methylation can also be analyzed directly via single-molecule real-time sequencing, single-molecule bypass kinetics and single-molecule nanopore sequencing. 
         [0038]    As used herein, the term “genomic region” refers to a sector of the genomic DNA of any chromosome that can be subject to differential methylation, in particular to a DNA hypermethylation, within said sector and may be used as a biomarker for the diagnosis of PC according to the invention. For example, each sequence listed in Table 1 and Table 2 with the corresponding SEQ ID No. 1 to 110 is a genomic region according to the invention. A genomic region can comprise the full sequence or parts thereof provided that at least one CpG position is comprised by said part. Preferably, said part comprises between 1-15 CpG positions. In another embodiment, the genomic region can comprise at least 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, or 15 CpG positions. 
         [0039]    A combination of two genomic regions selected from Table 1 is named “genomic region pair” with some examples are given in Table 2. Genomic regions that occur in the vicinity of genes may be associated with the names of those genes for descriptive purpose. This may not mean, that the genomic region comprises all or a part of that gene or functional elements of it. In case of doubt, solely the locus and/or the sequence shall be used. 
         [0040]    As used herein, the term “in the vicinity of a genomic region” refers to a position outside or within said genomic region. As would be understood to a person skilled in the art the position may have a distance up to 500 nucleotides (nt), 400 nt, 300 nt, 200 nt, 100 nt, 50 nt, 20 nt or 10 nt from the 5′ or 3′ end of the genomic region. Alternatively, the position is located at the 5′ or 3′ end of said genomic region, or, the position is within said genomic region. 
         [0041]    The term “genomic region specific primers” as used herein refers to a primer pair hybridizing to a flanking sequence of a target sequence to be amplified. Such a sequence starts and ends in the vicinity of a genomic region. In one embodiment, the target sequence to be amplified comprises the whole genomic region and its complementary strand. In a preferred embodiment, the target sequence comprises 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15 or even more CpG positions of the genomic region and the complementary strand thereof. In general, the hybridization position of each primer of the primer pair can be at any position in the vicinity of a genomic region provided that the target sequence to be amplified comprises at least one CpG position of said genomic region. As would be obvious to the skilled person, the sequence of the primer depends on the hybridization position and on the method for analyzing the methylation status, e.g. if a bisulphite based method is applied, part of the sequence of the hybridization position may be converted by said bisulphite. Therefore, in one embodiment, the primers may be adapted accordingly to still enable or disable hybridization (e.g. in methylation specific PCR). 
         [0042]    The term “genomic region specific probe” as used herein refers to a probe that selectively hybridizes to a genomic region. In one embodiment a genomic region specific probe can be a probe labelled, for example with a fluorophore and a quencher, such as a TagMan® probe or a Molecular Beacons probes. In a preferred embodiment, the probe can hybridize to a position of the genomic region that can be subject to hypermethylation according to the inventive method. Hereby, the probe hybridizes to positions with either a methylated CpG or a unmethylated CpG in order to detect methylated or unmethylated CpGs. In a preferred embodiment, two probes are used, e.g. in a methylight (qPCR assay) assay. The first probe hybridizes only to positions with a methylated CpG, the second probe hybridizes only to positions with a unmethylated CpG, wherein the probes are differently labelled and, thus, allow for discrimination between unmethylated and methylated sites in the same sample. 
         [0043]    As used herein, the terms “hybridizing to” and “hybridization” are interchangeable used with the term “specific for” and refer to the sequence specific non-covalent binding interactions with a complementary nucleic acid, for example, interactions between a target nucleic acid sequence and a target specific nucleic acid primer or probe. In a preferred embodiment a nucleic acid, which hybridizes is one which hybridizes with a selectivity of greater than 70%, greater than 80%, greater than 90% and most preferably of 100% (i.e. cross hybridization with other DNA species preferably occurs at less than 30%, less than 20%, less than 10%). As would be understood to a person skilled in the art, a nucleic acid, which “hybridizes” to the DNA product of a genomic region of the invention can be determined taking into account the length and composition. 
         [0044]    As used herein, “isolated” when used in reference to a nucleic acid means that a naturally occurring sequence has been removed from its normal cellular (e.g. chromosomal) environment or is synthesised in a non-natural environment (e.g. artificially synthesised). Thus, an “isolated” sequence may be in a cell-free solution or placed in a different cellular environment. 
         [0045]    As used herein, a “kit” is a packaged combination optionally including instructions for use of the combination and/or other reactions and components for such use. 
         [0046]    As used herein, “nucleic acid(s)” or “nucleic acid molecule” generally refers to any ribonucleic acid or deoxyribonucleic acid, which may be unmodified or modified DNA. “Nucleic acids” include, without limitation, single- and double-stranded nucleic acids. As used herein, the term “nucleic acid(s)” also includes DNA as described above that contain one or more modified bases. Thus, DNA with backbones modified for stability or for other reasons are “nucleic acids”. The term “nucleic acids” as it is used herein embraces such chemically, enzymatically or metabolically modified forms of nucleic acids, as well as the chemical forms of DNA characteristic of viruses and cells, including for example, simple and complex cells. 
         [0047]    The term “primer”, as used herein, refers to an nucleic acid, whether occurring naturally as in a purified restriction digest or produced synthetically, which is capable of acting as a point of initiation of synthesis when placed under conditions in which synthesis of a primer extension product, which is complementary to a nucleic acid strand, is induced, i.e., in the presence of nucleotides and an inducing agent such as a DNA polymerase and at a suitable temperature and pH. The primer may be either single-stranded or double-stranded and must be sufficiently long to prime the synthesis of the desired extension product in the presence of the inducing agent. The exact length of the primer will depend upon many factors, including temperature, source of primer and the method used. For example, for diagnostic applications, depending on the complexity of the target sequence, the nucleic acid primer typically contains 15-25 or more nucleotides, although it may contain fewer nucleotides. The factors involved in determining the appropriate length of primer are readily known to one of ordinary skill in the art. In general, the design and selection of primers embodied by the instant invention is according to methods that are standard and well known in the art, see Dieffenbach, C. W., Lowe, T. M. J., Dveksler, G. S. (1995) General Concepts for PCR Primer Design. In: PCR Primer, A Laboratory Manual (Eds. Dieffenbach, C. W, and Dveksler, G. S.) Cold Spring Harbor Laboratory Press, New York, 133-155; Innis, M. A., and Gelfand, D. H. (1990) Optimization of PCRs. In: PCR protocols, A Guide to Methods and Applications (Eds. Innis, M. A., Gelfand, D. H., Sninsky, J. J, and White, T. J.) Academic Press, San Diego, 3-12; Sharrocks, A. D. (1994) The design of primers for PCR. In: PCR Technology, Current Innovations (Eds. Griffin, H. G., and Griffin, A. M, Ed.) CRC Press, London, 5-11. 
         [0048]    As used herein, the term “probe” means nucleic acid and analogs thereof and refers to a range of chemical species that recognise polynucleotide target sequences through hydrogen bonding interactions with the nucleotide bases of the target sequences. The probe or the target sequences may be single- or double-stranded DNA. A probe is at least 8 nucleotides in length and less than the length of a complete polynucleotide target sequence. A probe may be 10, 20, 30, 50, 75, 100, 150, 200, 250, 400, 500 and up to 2000 nucleotides in length. Probes can include nucleic acids modified so as to have a tag which is detectable by fluorescence, chemiluminescence and the like (“labelled probe”). The labelled probe can also be modified so as to have both a detectable tag and a quencher molecule, for example Taqman® and Molecular Beacon® probes. The nucleic acid and analogs thereof may be DNA, or analogs of DNA, commonly referred to as antisense oligomers or antisense nucleic acid. Such DNA analogs comprise but are not limited to 2-′O-alkyl sugar modifications, methylphosphonate, phosphorothiate, phosphorodithioate, formacetal, 3′-thioformacetal, sulfone, sulfamate, and nitroxide backbone modifications, and analogs wherein the base moieties have been modified. In addition, analogs of oligomers may be polymers in which the sugar moiety has been modified or replaced by another suitable moiety, resulting in polymers which include, but are not limited to, morpholino analogs and peptide nucleic acid (PNA) analogs (Egholm, et al. Peptide Nucleic Acids (PNA)-Oligonucleotide Analogues with an Achiral Peptide Backbone, (1992)). 
         [0049]    The term “sample” or “biological sample” is used herein to refer to prostate tissue, blood, urine, semen, prostatic secretions or isolated prostate cells originating from a subject, preferably to prostate tissue, prostatic secretions or isolated prostate cells, most preferably to prostate tissue. 
         [0050]    As used herein, the term “DNA sequencing” or “sequencing” refers to the process of determining the nucleotide order of a given DNA fragment. As known to those skilled in the art, sequencing techniques comprise sanger sequencing and next-generation sequencing, such as 454 pyrosequencing, Illumina (Solexa) sequencing and SOLiD sequencing. 
         [0051]    The term “bisulphite sequencing” refers to a method well-known to the person skilled in the art comprising the steps of (a) treating the DNA of interest with bisulphite, thereby converting non-methylated cytosines to uracils and leaving methylated cytosines unaffected and (b) sequencing the treated DNA, wherein the existence of a methylated cytosine is revealed by the detection of a non-converted cytosine and the absence of a methylated cytosine is revealed by the detection of a thymine. 
         [0052]    As used herein, the terms “subject” and “patient” are used interchangeably to refer to an animal (e.g., a mammal, a fish, an amphibian, a reptile, a bird and an insect). In a specific embodiment, a subject is a mammal (e.g., a non-human mammal and a human). In another embodiment, a subject is a primate (e.g., a chimpanzee and a human). In another embodiment, a subject is a human. In another embodiment, the subject is a male human with or without prostate cancer. 
       DETAILED DESCRIPTION OF THE INVENTION 
       [0053]    The practice of the present invention employs in part conventional techniques of molecular biology, microbiology and recombinant DNA techniques, which are within the skill of the art. Such techniques are explained fully in the literature. See, e.g., Sambrook, Fritsch &amp; Maniatis, 1989, Molecular Cloning: A Laboratory Manual, Second Edition; Oligonucleotide Synthesis (M. J. Gait, ed., 1984); Nucleic Acid Hybridization (B. D. Harnes &amp; S. J. Higgins, eds., 1984); A Practical Guide to Molecular Cloning (B. Perbal, 1984); and a series, Methods in Enzymology (Academic Press, Inc.); Short Protocols In Molecular Biology, (Ausubel et al., ed., 1995). All patents, patent applications, and publications mentioned herein, both supra and infra, are hereby incorporated by reference in their entireties. 
         [0054]    The invention as disclosed herein identifies genomic regions that are useful in diagnosing prostate cancer (PC). By definition, the identified genomic regions are biomarkers for PC. In order to use these genomic regions (as biomarkers), the invention teaches the analysis of the DNA methylation status of said genomic regions. The invention further encompasses genomic region specific nucleic acids. The invention further contemplates the use of said genomic region specific nucleic acids to analyze the methylation status of a genomic region, either directly or indirectly by methods known to the skilled person and explained herein. The invention further discloses a composition and kit comprising said nucleic acids for the diagnosis of PC. 
         [0055]    To address the need in the art for a more reliable diagnosis of prostate cancer (PC), the peculiarities of the DNA methylation status across the whole genome of PC positive samples were examined in comparison to PC negative samples. The inventors found genomic regions, that are subject to an aberrant methylation status. Tumour associations were found stronger for hypermethylated than for hypomethylated genomic regions. Therefore, the invention teaches the analysis of those genomic regions that are differentially methylated in samples from patients having prostate cancer. Superior to current diagnostic methods, the invention discloses genomic regions, wherein most astonishingly a combination of two genomic regions (genomic region pair) is able to diagnose prostate cancer with a reliability of 100%. If both genomic regions of a genomic region pair are hypermethylated, the sample can be designated as prostate cancer positive. 
         [0056]    Accordingly, the invention relates to a method for diagnosis of prostate cancer, comprising the steps of analyzing in a sample of a subject the DNA methylation status of the genomic regions of at least one genomic region pair selected from the group of Table 2, wherein, if at least one genomic region pair is hypermethylated, the sample is designated as prostate cancer positive. 
         [0057]    In one embodiment of the present invention is a method for diagnosis of prostate cancer, comprising the steps of obtaining a biological sample of a subject suspected of having prostate cancer; measuring in said biological sample the DNA methylation status of at least one genomic region pair comprising a first biomarker and a second biomarker selected from the group consisting of:
       1. SEQ ID NO. 29 and SEQ ID NO. 86;   2. SEQ ID NO. 8 and SEQ ID NO. 13;   3. SEQ ID NO. 8 and SEQ ID NO. 27;   4. SEQ ID NO. 8 and SEQ ID NO. 39;   5. SEQ ID NO. 8 and SEQ ID NO. 86;   6. SEQ ID NO. 6 and SEQ ID NO. 95;   7. SEQ ID NO. 3 and SEQ ID NO. 31;   8. SEQ ID NO. 19 and SEQ ID NO. 62;   9. SEQ ID NO. 6 and SEQ ID NO. 7;   10. SEQ ID NO. 8 and SEQ ID NO. 90;   11. SEQ ID NO. 7 and SEQ ID NO. 62;   12. SEQ ID NO. 8 and SEQ ID NO. 22;   13. SEQ ID NO. 23 and SEQ ID NO. 95; 14, SEQ ID NO. 8 and SEQ ID NO. 12;   15. SEQ ID NO. 8 and SEQ ID NO. 50;   16. SEQ ID NO. 8 and SEQ ID NO, 95;   17. SEQ ID NO. 31 and SEQ ID NO. 98;   18. SEQ ID NO. 3 and SEQ ID NO. 8;   19. SEQ ID NO. 8 and SEQ ID NO. 9;   20. SEQ ID NO. 6 and SEQ ID NO. 86;   21. SEQ ID NO. 14 and SEQ ID NO. 95;   22. SEQ ID NO. 8 and SEQ ID NO. 47;   23. SEQ ID NO. 16 and SEQ ID NO. 23;   24. SEQ ID NO. 21 and SEQ ID NO. 98;   25. SEQ ID NO. 22 and SEQ ID NO, 95;   26. SEQ ID NO. 6 and SEQ ID NO. 16;   27. SEQ ID NO. 12 and SEQ ID NO. 19;   28. SEQ ID NO. 13 and SEQ ID NO, 19;   29. SEQ ID NO. 16 and SEQ ID NO. 41;   30. SEQ ID NO. 27 and SEQ ID NO. 44;   31. SEQ ID NO. 31 and SEQ ID NO, 95;   32. SEQ ID NO. 46 and SEQ ID NO. 62;   33. SEQ ID NO. 55 and SEQ ID NO. 86;   34. SEQ ID NO. 62 and SEQ ID NO. 86;   35. SEQ ID NO, 4 and SEQ ID NO. 8;   36. SEQ ID NO. 7 and SEQ ID NO. 98;   37. SEQ ID NO. 8 and SEQ ID NO. 19;   38. SEQ ID NO. 8 and SEQ ID NO. 43;   39. SEQ ID NO. 19 and SEQ ID NO. 65;   40. SEQ ID NO. 22 and SEQ ID NO. 86;   41. SEQ ID NO. 27 and SEQ ID NO. 31;   42. SEQ ID NO. 95 and SEQ ID NO. 98;   43. SEQ ID NO. 8 and SEQ ID NO. 30;   44. SEQ ID NO. 8 and SEQ ID NO. 33;   45. SEQ ID NO. 8 and SEQ ID NO. 108;   46. SEQ ID NO. 9 and SEQ ID NO. 59;   47. SEQ ID NO. 20 and SEQ ID NO. 95;   48. SEQ ID NO. 26 and SEQ ID NO. 47;   49. SEQ ID NO. 31 and SEQ ID NO. 33;   50. SEQ ID NO. 42 and SEQ ID NO. 95;   51. SEQ ID NO. 60 and SEQ ID NO. 97;   52. SEQ ID NO. 88 and SEQ ID NO. 95;   53. SEQ ID NO. 6 and SEQ ID NO. 57;   54. SEQ ID NO. 8 and SEQ ID NO. 21;   55. SEQ ID NO. 8 and SEQ ID NO. 45;   56. SEQ ID NO. 8 and SEQ ID NO. 46;   57. SEQ ID NO. 20 and SEQ ID NO. 86;   58. SEQ ID NO. 47 and SEQ ID NO. 62;   59. SEQ ID NO. 12 and SEQ ID NO. 21;   60. SEQ ID NO. 19 and SEQ ID NO. 37;   61. SEQ ID NO. 27 and SEQ ID NO. 101;   62. SEQ ID NO. 29 and SEQ ID NO. 95;   63. SEQ ID NO. 31 and SEQ ID NO, 37;   64. SEQ ID NO. 46 and SEQ ID NO. 59;   65. SEQ ID NO. 55 and SEQ ID NO. 95;   66. SEQ ID NO. 59 and SEQ ID NO. 95;   67. SEQ ID NO. 3 and SEQ ID NO. 47;   68. SEQ ID NO. 6 and SEQ ID NO. 98;   69. SEQ ID NO. 8 and SEQ ID NO. 65;   70. SEQ ID NO. 9 and SEQ ID NO. 98;   71. SEQ ID NO. 13 and SEQ ID NO. 95;   72. SEQ ID NO. 23 and SEQ ID NO. 86;   73. SEQ ID NO. 25 and SEQ ID NO. 95;   74. SEQ ID NO. 31 and SEQ ID NO. 57;   75. SEQ ID NO. 33 and SEQ ID NO. 95;   76. SEQ ID NO. 62 and SEQ ID NO. 98;   77. SEQ ID NO. 4 and SEQ ID NO. 95;   78. SEQ ID NO. 8 and SEQ ID NO. 68;   79. SEQ ID NO. 12 and SEQ ID NO. 16;   80. SEQ ID NO. 14 and SEQ ID NO. 98.   81. SEQ ID NO. 19 and SEQ ID NO. 86;   82. SEQ ID NO. 20 and SEQ ID NO. 46;   83. SEQ ID NO. 22 and SEQ ID NO. 29;   84. SEQ ID NO. 31 and SEQ ID NO. 32;   85. SEQ ID NO. 31 and SEQ ID NO. 86.   86. SEQ ID NO. 46 and SEQ ID NO. 104;   87. SEQ ID NO. 62 and SEQ ID NO. 69;   88. SEQ ID NO. 69 and SEQ ID NO. 98;   89. SEQ ID NO. 76 and SEQ ID NO. 89;   90. SEQ ID NO. 7 and SEQ ID NO. 8;   91. SEQ ID NO. 7 and SEQ ID NO. 20;   92. SEQ ID NO. 8 and SEQ ID NO. 16;   93. SEQ ID NO. 8 and SEQ ID NO. 17;   94. SEQ ID NO. 8 and SEQ ID NO. 20;   95. SEQ ID NO. 8 and SEQ ID NO. 100;   96. SEQ ID NO. 8 and SEQ ID NO. 106;   97. SEQ ID NO. 12 and SEQ ID NO. 97;   98. SEQ ID NO. 16 and SEQ ID NO. 19;   99. SEQ ID NO. 16 and SEQ ID NO. 45; and   100. SEQ ID NO. 19 and SEQ ID NO. 27;
 
determining the presence of hypermethylation of each of said biomarkers in the biological sample; and correlating the presence of hypermethylation of both of said biomarkers in said at least one genomic region pair with a positive indication of prostate cancer in said subject. In another embodiment, the genomic region pair is selected from the group of: SEQ ID NO. 29 and SEQ ID NO. 86; SEQ ID NO. 8 and SEQ ID NO. 13; SEQ ID NO. 8 and SEQ ID NO. 27; SEQ ID NO. 8 and SEQ ID NO. 39; and SEQ ID NO. 8 and SEQ ID NO. 86. In yet another embodiment, the genomic region pair is SEQ ID NO. 29 and SEQ ID NO. 86.
       
 
         [0157]    In another embodiment of the inventive method, the methylation status of only one genomic region selected from Table 1 is analyzed. 
         [0158]    The method is particularly useful for early diagnosis of PC. The method is useful for further diagnosing patients having an identified prostate mass or symptoms associated with prostate cancer, e.g. abnormally high levels of PSA. The method of the present invention can further be of particular use with patients having an enhanced risk of developing prostate cancer (e.g., patients having a familial history of prostate cancer and patients identified as having a mutant oncogene). The method of the present invention may further be of particular use in monitoring the efficacy of treatment of a prostate cancer patient (e.g. the efficacy of chemotherapy). 
         [0159]    In one embodiment of the method, the sample comprises cells obtained from a patient. The cells may be found in a prostate tissue sample collected, for example, by a prostate tissue biopsy or histology section, or a bone marrow biopsy if metastatic spreading has occurred. In another embodiment, the patient sample is a prostate-associated body fluid. Such fluids include, for example, blood fluids, lymph, urine, prostatic fluid and semen. From the samples cellular or cell free DNA is isolated using standard molecular biological technologies and then forwarded to the analysis method. 
         [0160]    In order to analyze the methylation status of a genomic region, conventional technologies can be used. 
         [0161]    Either the DNA of interest may be enriched, for example by methylated DNA immunoprecipitation (MeDIP) followed by real time PCR analyses, array technology, or next generation sequencing. Alternatively, the methylation status of the DNA can be analyzed directly or after bisulphite treatment. 
         [0162]    In one embodiment, bisulphite-based approaches are used to preserve the methylation information. Therefore, the DNA is treated with bisulphite, thereby converting non-methylated cytosine residues into uracil while methylated cytosines are left unaffected. This selective conversion makes the methylation easily detectable and classical methods reveal the existence or absence of DNA (cytosine) methylation of the DNA of interest. The DNA of interest may be amplified before the detection if necessary. Such detection can be done by mass spectrometry or, the DNA of interest is sequenced. Suitable sequencing methods are direct sequencing and pyrosequencing. In another embodiment of the invention the DNA of interest is detected by a genomic region specific probe that is selective for that sequence in which a cytosine was either converted or not converted. Other techniques that can be applied after bisulphite treatment are for example methylation-sensitive single-strand conformation analysis (MS-SSCA), high resolution melting analysis (HRM), methylation-sensitive single-nucleotide primer extension (MS-SnuPE), methylation specific PCR (MSP) and base-specific cleavage. 
         [0163]    In an alternative embodiment the methylation status of the DNA is analyzed without bisulphite treatment, such as by methylation specific enzymes or by the use of a genomic region specific probe or by an antibody, that is selective for that sequence in which a cytosine is either methylated or non-methylated. 
         [0164]    In a further alternative, the DNA methylation status can be analyzed via single-molecule real-time sequencing, single-molecule bypass kinetics and single-molecule nanopore sequencing. These techniques, which are within the skill of the art, are fully explained in: Flusberg et al. Direct detection of DNA methylation during single-molecule, real-time sequencing. Nature methods 7(6): 461-467. 2010; Summerer. High-Througput DNA Sequencing Beyond the Four-Letter Code: Epigenetic Modifications Revealed by Single-Molecule Bypass Kinetics. Chem Bio Chem 11: 2499-2501. 2010; Clarke et al. Continuous base identification for single-molecule nanopore DNA sequencing. Nature Nanotechnology 4: 265-270. 2009; Wallace et al. Identification of epigenetic DNA modifications with a protein nanopore. Chemical Communication 46:8195-8197, which are hereby incorporated by reference in their entireties. 
         [0165]    To translate the raw data generated by the detection assay (e.g. a nucleotide sequence) into data of predictive value for a clinician, a computer-based analysis program can be used. The profile data may be prepared in a format suitable for interpretation by a treating clinician. For example, rather than providing raw nucleotide sequence data or methylation status, the prepared format may represent a diagnosis or risk assessment (e.g. likelihood of cancer being present or the subtype of cancer) for the subject, along with recommendations for particular treatment options. 
         [0166]    In one embodiment of the present invention, a computing device comprising a client or server component may be utilized.  FIG. 4  is an exemplary diagram of a client/server component, which may include a bus  210 , a processor  220 , a main memory  230 , a read only memory (ROM)  240 , a storage device  250 , an input device  260 , an output device  270 , and a communication interface  280 . Bus  210  may include a path that permits communication among the elements of the client/server component. 
         [0167]    Processor  220  may include a conventional processor or microprocessor, or another type of processing logic that interprets and executes instructions. Main memory  230  may include a random access memory (RAM) or another type of dynamic storage device that stores information and instructions for execution by processor  220 . ROM  240  may include a conventional ROM device or another type of static storage device that stores static information and instructions for use by processor  220 . Storage device  250  may include a magnetic and/or optical recording medium and its corresponding drive. 
         [0168]    Input device  260  may include a conventional mechanism that permits an operator to input information to the client/server component, such as a keyboard, a mouse, a pen, voice recognition and/or biometric mechanisms, etc. Output device  270  may include a conventional mechanism that outputs information to the operator, including a display, a printer, a speaker, etc. Communication interface  280  may include any transceiver-like mechanism that enables the client/server component to communicate with other devices and/or systems. For example, communication interface  280  may include mechanisms for communicating with another device or system via a network. 
         [0169]    As will be described in detail below, the client/server component, consistent with the principles of the invention, may perform certain measurement determinations of methylation, calculations of methylation status, and/or correlation operations relating to the diagnosis of prostate cancer. It may further optionally output the presentation of status results as a result of the processing operations conducted. The client/server component may perform these operations in response to processor  220  executing software instructions contained in a computer-readable medium, such as memory  230 . A computer-readable medium may be defined as a physical or logical memory device and/or carrier wave. 
         [0170]    The software instructions may be read into memory  230  from another computer-readable medium, such as data storage device  250 , or from another device via communication interface  280 . The software instructions contained in memory  230  may cause processor  220  to perform processes that will be described later. Alternatively, hardwired circuitry may be used in place of or in combination with software instructions to implement processes consistent with the principles of the invention. Thus, implementations consistent with the principles of the invention are not limited to any specific combination of hardware circuitry and software. 
         [0171]      FIG. 5  is a flowchart of exemplary processing of methylation status for pairs of biomarkers present in biological samples according to an implementation consistent with the principles of the present invention. Processing may begin with quantifying the methylation  510  and non-methylation  520  of the DNA of a biological sample for a first and second biomarker constituting a genomic region pair of Table 2. The processor may then quantify the methylation status  530 , as described above, as the ratio of methylated DNA to non-methylated of the biological sample for the first and second biomarkers. The methylation status may then be evaluated either via a computing device  540  or by human analysis to determine if both the first and second biomarkers of the genomic region pair meet or exceed a predetermined methylation threshold. If the threshold is met or exceeded, then the computing device may then, optionally, present a status result indicating a positive diagnosis of prostate cancer  550 . Alternatively, if the threshold is not met, then the computing device may, optionally, present a status result indicating that the threshold is not satisfied  560 . It is noted that the output displaying results may differ depending on the desired presentation of results. For example, the output may be quantitative in nature, e.g., displaying the measurement values of each of the biomarkers in relation to the predetermined methylation threshold value. The output may be qualitative, e.g., the display of a color or notation indicating a positive result for prostate cancer, or a negative results for prostate cancer, as the case may be. Notably, this process may be repeated multiple times using different genomic region pairs, as set forth in Table 2. The computing device may alternatively be programmed to permit the analysis of more than one genomic region pair at one time. 
         [0172]    In some embodiments, the results are used in a clinical setting to determine a further diagnostic (e.g., additional further screening (e.g., PSA or other markers) or diagnostic biopsy) course of action. In other embodiments, the results are used to determine a treatment course of action (e.g., choice of therapies or watchful waiting). 
         [0173]    Table 2 shows examples of genomic region pairs most preferably to be analyzed regarding their methylation status. In one embodiment any genomic region pair can be analyzed. 
         [0174]    In a preferred embodiment, the genomic region pair is selected from the group of: 
         [0000]    
       
         
               
               
               
               
             
               
               
               
               
             
           
               
                   
                   
               
               
                   
                 Genomic region 
                 Genomic region 1 
                 Genomic region 2 
               
               
                   
                 pair (grp) 
                 [SEQ ID NO.] 
                 [SEQ ID NO.] 
               
               
                   
                   
               
             
             
               
                   
               
             
          
           
               
                   
                 grp 1 
                 29 
                 86 
               
               
                   
                 grp 2 
                 8 
                 13 
               
               
                   
                 grp 3 
                 8 
                 27 
               
               
                   
                 grp 4 
                 8 
                 39 
               
               
                   
                 grp 5 
                 8 
                 86 
               
               
                   
                   
               
             
          
         
       
     
         [0175]    Table 3 shows examples of genomic region pairs most preferably to be analyzed regarding their methylation status. In one embodiment any genomic region pair can be analyzed. 
         [0000]    
       
         
               
               
               
               
             
               
               
               
               
             
           
               
                   
                   
               
               
                   
                 Genomic region 
                 Genomic region 1 
                 Genomic region 2 
               
               
                   
                 pairs 
                 [SEQ ID NO.] 
                 [SEQ ID NO.] 
               
               
                   
                   
               
             
             
               
                   
               
             
          
           
               
                   
                 grp 101 
                 1 
                 59 
               
               
                   
                 grp 102 
                 1 
                 9 
               
               
                   
                 grp 103 
                 1 
                 6 
               
               
                   
                 grp 104 
                 1 
                 29 
               
               
                   
                 grp 104 
                 1 
                 10 
               
               
                   
                 grp 105 
                 1 
                 50 
               
               
                   
                 grp 106 
                 1 
                 56 
               
               
                   
                 grp 107 
                 1 
                 12 
               
               
                   
                 grp 108 
                 1 
                 8 
               
               
                   
                 grp 109 
                 1 
                 16 
               
               
                   
                 grp 110 
                 1 
                 86 
               
               
                   
                 grp 111 
                 1 
                 21 
               
               
                   
                 grp 112 
                 1 
                 23 
               
               
                   
                 grp 113 
                 1 
                 45 
               
               
                   
                 grp 114 
                 1 
                 58 
               
               
                   
                 grp 115 
                 1 
                 83 
               
               
                   
                   
               
             
          
         
       
     
         [0176]    In a more preferred embodiment, the genomic region pair is SEQ ID NO. 29 and SEQ ID NO. 86. 
         [0177]    Significantly, the inventors found that a minimum of one genomic region pair is sufficient to accurately discriminate between malignant and benign tissues. The extension with additional sites even increases the discriminatory potential of the marker set. Thus, in another embodiment, the invention relates to a method, wherein the methylation status of a further genomic region and/or a further biomarker is analyzed. 
         [0178]    In one embodiment of the invention, a known prostate cancer biomarker is additionally analyzed. Such PC biomarkers can be a gene, e.g. encoding for GSTP1, multidrug resistance protein 1 (MDR1), O-6-methylguanine-DNA methyltransferase (MGMT), Ras association domain family member 1 (RASSF1), retinoic acid receptor beta (RARB), adenomatous polyposis coli (APC), androgen receptor (AR), cyclin-dependent kinase inhibitor 2A (CDKN2A), E-cadherin (CDH1) and/or CD44. Such biomarkers can also be based on gene expression, e.g. of said encoding genes. In a preferred embodiment, the concentration or activity of prostate specific antigen (PSA) is determined by means of an immunoassay. The analysis of the biomarkers within this context can be the analysis of the methylation status, the analysis of the gene expression (mRNA), or the analysis of the amount or concentration or activity of protein. 
         [0179]    In another embodiment a further genomic region and/or a further genomic region pair according to the invention is analyzed. 
         [0180]    The inventors surprisingly found that the methylation status within a genomic region according to the invention is almost constant, leading to a uniform distribution of either hyper- or hypomethylated CpG positions within said genomic region. In one embodiment of the invention, all CpG positions of a genomic region are analyzed. In a specific embodiment, CpG positions in the vicinity of the genomic region may be analyzed. In an alternative embodiment, a subset of CpG positions of a genomic region is analyzed. Ideally, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 GpG positions of a genomic region are analyzed. Therefore, a preferred embodiment of the invention relates to a method, wherein analyzing the methylation status of a genomic region means analyzing the methylation status of at least one CpG position per genomic region. 
         [0181]    In a preferred embodiment the invention relates to a method, wherein the methylation status is analyzed by non-methylation-specific PCR based methods followed by sequencing, methylation-based methods such as methylation sensitive PCR, EpiTyper and Methylight assays or enrichment-based methods such as MeDIP-Seq. In an alternative embodiment of the present invention, the DNA methylation is assessed by methylation-specific restriction analysis. 
         [0182]    In a preferred embodiment of the invention Epityper® and Methylight® assays may be used for the analysis of the methylation status. 
         [0183]    The invention also relates to a nucleic acid molecule that hybridizes under stringent conditions in the vicinity of one of the genomic regions according to SEQ ID NO. 1 to SEQ ID NO. 110, wherein said vicinity relates to a position as defined above. 
         [0184]    In one embodiment said nucleic acid is 15 to 100 nt in length. In a preferred embodiment said nucleic acid is 15 to 50 nt, in a more preferred embodiment 15 to 40 nt in length. 
         [0185]    In another embodiment said nucleic acid is a primer. The inventive primers being specific for a genomic region can be used for the analysis methods of the DNA methylation status. Accordingly, they are used for amplification of a sequence comprising the genomic region or parts thereof in the inventive method for the diagnosis of PC. Within the context of the invention, the primers selectively hybridizes in the vicinity of the genomic region as defined above. 
         [0186]    Primers may be prepared using any suitable method, such as, for example, the phosphotriester and phosphodiester methods or automated embodiments thereof. In one such automated embodiment diethylophosphoramidites are used as starting materials and may be synthesized as described by Beaucage et al., Tetrahedron Letters, 22:1859-1862 (1981), which is hereby incorporated by reference. One method for synthesizing oligonucleotides on a modified solid support is described in U.S. Pat. No. 4,458,006, which is hereby incorporated by reference. It is also possible to use a primer which has been isolated from a biological source (such as a restriction endonuclease digest). 
         [0187]    The methylation status of a genomic region may be detected indirectly (e.g. by bisulphite sequencing) or directly by using a genomic region specific probe, e.g. in a methylight assay. Thus, the present invention also relates to said nucleic acid being a probe. In a preferred embodiment of the present invention the probe is labelled. 
         [0188]    Said probes can also be used in techniques such as quantitative real-time PCR (qRT-PCR), using for example SYBR®Green, or using TaqMan® or Molecular Beacon techniques, where the nucleic acids are used in the form of genomic region specific probes, such as a TaqMan labelled probe or a Molecular Beacon labelled probe. Within the context of the invention, the probe selectively hybridizes to the genomic region as defined above. Additionally, in qRT-PCR methods a probe can also hybridize to a position in the vicinity of a genomic region. 
         [0189]    Current methods for the analysis of the methylation status require a bisulphite treatment a priori, thereby converting non-methylated cytosines to uracils. To ensure the hybridization of the genomic region specific nucleic acid of the invention to the bisulphite treated DNA, the nucleotide sequence of the nucleic acid may be adapted. For example, if it is desired to design nucleic acids being specific for a sequence, wherein a cytosine is found to be differentially methylated, that genomic region specific nucleic acid may have two sequences: the first bearing an adenine, the second bearing an guanine at that position which is complementary to the cytosine nucleotide in the sequence of the genomic region. The two forms can be used in an assay to analyze the methylation status of a genomic region such that they are capable of discriminating between methylated and non-methylated cytosines. Depending on the analysis method and the sort of nucleic acid (primer/probe), only one form or both forms of the genomic region specific nucleic acid can be used within the assay. Thus, in an alternative embodiment of the present invention the nucleic acid hybridizes under stringent conditions in said vicinity of one of the genomic regions after a bisulphite treatment. 
         [0190]    The present invention also relates to the use of genomic region specific nucleic acids for the diagnosis of prostate cancer. 
         [0191]    The present invention also comprises the use of an antibody that is specific for a genomic region for the diagnosis of prostate cancer. 
         [0192]    Such antibody may preferably bind to methylated nucleotides. In another embodiment the antibody preferably binds to non-methylated nucleotides. The antibody can be labelled and/or used in an assay that allows the detection of the bound antibody, e.g. ELISA. 
         [0193]    The nucleic acid or antibody for performing the method according to the invention is advantageously formulated in a stable composition. Accordingly, the present invention relates to a composition for the diagnosis of prostate cancer comprising said nucleic acid or antibody. 
         [0194]    The composition may also include other substances, such as stabilizers. 
         [0195]    The invention also encompasses a kit for the diagnosis of prostate cancer comprising the inventive nucleic acid or antibody as described above. 
         [0196]    The kit may comprise a container for a first set of genomic region specific primers. In a preferred embodiment, the kit may comprise a container for a second set of genomic region specific primers. In a further embodiment, the kit may also comprise a container for a third set of genomic region specific primers. In a further embodiment, the kit may also comprise a container for a forth set of genomic region specific primers, and so forth. 
         [0197]    The kit may also comprise a container for bisulphite, which may be used for a bisulphite treatment of the genomic region of interest. 
         [0198]    The kit may also comprise genomic region specific probes. 
         [0199]    The kit may comprise containers of substances for performing an amplification reaction, such as containers comprising dNTPs (each of the four deoxynucleotides dATP, dCTP, dGTP, and dTTP), buffers and DNA polymerase. 
         [0200]    The kit may also comprise nucleic acid template(s) for a positive control and/or negative control reaction. In one embodiment, a polymerase is used to amplify a nucleic acid template in PCR reaction. Other methods of amplification include, but are not limited to, ligase chain reaction (LCR), or any other method known in the art. 
         [0201]    The kit may also comprise containers of substances for performing a sequencing reaction, for example pyrosequencing, such as DNA polymerase, ATP sulfurylase, luciferase, apyrase, the four deoxynucleotide triphosphates (dNTPs) and the substrates adenosine 5′ phosphosulfate (APS) and luciferin. 
     
    
     
       FIGURE CAPTIONS 
         [0202]      FIG. 1 : Overview of the MeDIP-Seq technology and validation experiments. (A) Schematics of the MeDIP-Seq protocol. Genomic DNA is sheared to a size of 100-200 bp, end repaired and sequencing adapters carrying a distinct barcode are ligated. After denaturation the libraries are incubated with antibodies targeting 5-methylcytosine coupled to magnetic beads. The enriched libraries are amplified and analysed on a SOLiD3+ NGS system using 35 bp fragment sequencing chemistry. (B) Coverage plots of uniquely mapped reads for eight samples (four normal and four tumour) for the CAV2 promoter region (left) and the GSTP1 promoter region (right). Top lane: location of the CpG-island, second lane with CAV2 and GSTP1 labels: coding regions, dark grey: normal, light grey: tumour samples. (C) Bisulphite conversion and mass spectrometry analyses were used for the validation of the MeDIP-Seq results. Left: hypomethylated, promoter associated region in the KLK4-gene (chr19:51411401-51412100), right: hypermethylated intronic region in the PTPRN2-gene (chr7:157360901-157361600). Top 3 samples are derived from tumour DNA, sample 4 to 6 from normal tissues. Line 7: Completely methylated control DNA, line 8: water control. Dark grey circles: no methylation, light grey circles: 100% methylation, white circles mark CpG dinucleotides not accessible for analysis or failed in analysis. 
           [0203]      FIG. 2 : Separation of normal (dark grey) and tumour (light grey) samples based on DMRs. (A) Principal component analyses were performed by using the rpm-values of either all bins (upper left corner) or restrictions to either chromosome 8 (bottom row) or the promoter regions (right column) were applied. (B) PAM analyses enabled a selection of seven marker regions used for unsupervised cluster analyses. 
           [0204]      FIG. 3 : Differential methylations are due to alterations in tumour cells. Bisulphite analyses of microdissected tumour material. Normal and tumour tissue materials were prepared with macrodissections (light grey bars) or laser captured microdissections (dark grey bars) and bisulphite-MS analyses were performed for 35 differentially methylated regions. Correlation analyses between microdissected and macrodissected samples (A) and unsupervised cluster analyses (B) are shown. 
           [0205]      FIG. 4  is an exemplary diagram of a computing device comprising a client and/or server according to an implementation consistent with the principles of the invention. 
           [0206]      FIG. 5  is a flowchart of exemplary processing of methylation status for pairs of biomarkers present in biological samples according to an implementation consistent with the principles of the present invention. 
       
    
    
     EXAMPLES 
       [0207]    Aberrant cytosine methylation is among the earliest and most frequent events in the development of prostate cancer. Herein, an immunocapturing approach followed by next generation sequencing was used to generate genome-wide methylation profiles of 51 prostate tumour and 53 normal prostate tissues. Machine-learning techniques identified several sets of differentially methylated genomic regions which enabled a correct classification (100%) of tumour and normal samples. 
         [0208]    It should be noted, that gene names are merely used to constrict the localization of the identified genomic regions. This means that the genomic region must not necessarily form a part of the gene, but lies in the vicinity of that gene. Genomic locations are given in Hg19 annotation. 
       Experimental Procedure 
       [0209]    Prostate tissue samples were obtained from the University Medical Center Hamburg Eppendorf. Approval for the study was obtained from the local ethics committee and all patients agreed to provide additional tissue sampling for scientific purposes. Tissue samples from 51 prostate cancer and 53 normal prostate tissues were included. None of the patients had been treated with neo-adjuvant radio-, cytotoxic- or endocrine therapy. 
         [0210]    Tumour or normal tissue materials are further processed for DNA extraction. For the validation screen matched normal and tumour tissues are extracted from two patients, each with standard macrodissection and microdissection technologies. 
         [0211]    Identification screen: During radical prostatectomy, tissue samples from the peripheral zone of the prostate were taken with a 6 mm punch biopsy instrument immediately after surgical removal of the prostate from tumerous and non-tumerous areas as described before. The punches were immersed in RNAlater (Qiagen) and subsequently stored at −80° C. To confirm the presence of tumour, all punches were sectioned, and tumour cell content was determined in every 10th section. Only sections containing at least 70% tumour cells were included in the study. Normal prostate tissue samples were obtained from 53 patients who underwent radical prostatectomy for prostate cancer. Only sections containing only normal tissue material with epithelial cell content between 20 and 40% were included in the study. Simultaneous DNA and RNA isolation from the tumour and normal tissue sections was performed using the Allprep kit (Qiagen) according to the manufacturer&#39;s instructions. 
         [0212]    Validation screen: In order to exclude a possible bias in the identification screen because i) normal and tumour samples were taken from different patients and ii) epithelial cells were not microdissected from the stroma background, the validation study was performed on two patients with matched normal and tumour samples where the effect of epithelial cell microdissection versus whole section analysis was compared. Ten tissue sections (4-μm) were taken from each tissue block for DNA isolation from non-microdissected tissues. For Laser Capture Microdissection (LCM, Zeiss, Germany) of epithelial cells, 16-μm tissue sections were mounted on special LCM slides and briefly stained with hematoxilin and eosin to facilitate localization of epithelial cells. Epithelial cells were collected by LCM from 10 tissue sections each. DNA was isolated using the DNA mini kit (Qiagen) according to the manufacturer&#39;s instructions. 
         [0213]    Primary samples from prostate tissues after radical prostatectomies were obtained from the University Hospital Eppendorf (Hamburg). 
         [0214]    Clinical data obtained for each sample includes: age of the patient, PSA values, Gleason score, TNM classifications, TMPRESS-ERG-fusion status. 
         [0215]    Methylation profiling by MeDIP-Seq: SOLiD sequencing libraries are prepared following the SOLiD v3 fragment multiplex library preparation protocol (Life Technologies) with slight modifications. Libraries are used for a methylated DNA immunoprecipitation using an anti-5-methyl cytosine antibody (Eurogentec) followed by SOLiD 3+ barcoded sequencing. 
         [0216]    In detail, 2.5 μg of genomic DNA were fragmented to 100 to 200 bp using the Covaris S2 system and end repaired with End Repair mix (Enzymatics) followed by a purification step (Qiagen DNA purification kit). Barcoded sequencing adapters were ligated followed by nick translation with DNA polymerase I (NEB, 10U). 
         [0217]    For the enrichment step of the methylated DNA immunoprecipitation (MeDIP) 5 μg of an anti-5-methyl cytosine antibody (Eurogentec) coupled to magnetic beads were used (coupling was performed by incubation overnight in 1×PBS+0.5% BSA). The libraries were incubated with the beads for 4 hours in IP Buffer (10 mM sodium phosphate buffer pH 7, 140 mM NaCl, 0.25% Triton X100). Beads were washed three times with IP buffer and DNA was eluted in elution buffer (50 mM Tris-HCl pH 7.5, 10 mM EDTA, 1% SDS) by incubation for 15 min at 65° C. After two hours of incubation with proteinase K, the DNA was phenol/chloroform extracted and ammonium acetate/ethanol precipitated. Enrichment controls were performed with real time PCRs targeting methylated as well as unmethylated regions. Libraries were amplified with multiplex_PCR_primers 1 having a sequence according to SEQ ID NO. 111 and multiplex_PCR_primers 2 with a sequence of SEQ ID NO. 112, size-selected and quantified using qPCRs with primers Quant_PCR_primer 1 with the sequence of SEQ ID NO. 113 and primers Quant_PCR_primer 2 with the sequence of SEQ ID NO. 114. Libraries were diluted to 100 pg/μl, requantified by qPCR and pooled (up to 8 libraries/pool). Libraries were then coupled to P1-beads in an emulsion PCR reaction following the manufacturer&#39;s protocol. Approximately 500 million enriched beads were deposited per slide and sequencing was performed on a SOLiD 3+ machine using barcode sequencing chemistry (5+35 bp) (Lifetech). 
         [0218]    Alignment and peak detection: Reads are aligned to HG19 using Applied Biosystem&#39;s Bioscope Alignment module in seed and extend mode taking the first 25 bp of the reads as seeds allowing 2 mismatches and a mismatch penalty score of −2 for extension. Then the aligned reads are elongated to 200 bp in a strand-oriented manner. Redundant reads and reads with no CpGs in the elongated sequence are excluded from further analyses. Next, the HG19 reference genome is split into adjacent 500 bp bins and the amount of reads per bin is counted. Reads are assigned to a bin when their centre is located within the bin. For sample wise normalizations total read counts are related to the total read count of each sample (reads per million=rpm). For the identification of differentially methylated regions a Mann-Whitney-test is performed using the rpm-values of all tumour and all normal samples in each bin. Resulting p-values are corrected for multiple testing using the Benjamini-Hochberg-approach. A binomial distribution of the reads (null hypothesis) is assumed and thus a probability value for the mean tumour and mean normal read count in each bin to appear solely by chance is assigned. 
         [0219]    Principal component analyses (PCA): Principal component analyses are performed with the prcomp-function in R using the rpm-values of all 104 samples. Additional information like tissue type and copy number variation (chr8 q-arm) is visualized by colours. 
         [0220]    PAM (Prediction Analysis of Microarrays): This supervised algorithm performs sample classification by applying the nearest shrunken centroid method and cross-validation and is here used to obtain loci which discriminate normal and tumour samples (Tibshirani et al. Diagnosis of multiple cancer types by shrunken centroids of gene expression. Proc Natl Acad Sci USA 99, 6567-6572, 2002). A set of 8 loci is chosen, classifying the two subsets with no miss-classifications in 100-fold cross-validation. 
         [0221]    Mass spectrometry analyses: For DNA methylation analyses, 1 μg DNA is bisulphite (BS)-converted to preserve methylation information, and this is subsequently amplified with specific primer pairs carrying a T7-promoter that are designed using the Epidesigner tool (www.epidesigner.com) with standard criteria (amplicon length: 400-600 bp). In vitro transcription is performed and the transcripts are cleaved and subsequently analysed using MALDI-TOF mass spectrometry on a MassARRAY Analyser 4 at the Sequenom facility in Hamburg. 
       Results 
       [0222]    Genome-wide profiles of cytosine methylation in prostate cancer: We prepared genomic DNA from human primary tissues and enriched methylated regions using a methylated DNA immunoprecipitation (MeDIP) methodology in combination with next generation SOLiD sequencing ( FIG. 1A ). All tumours selected for this study were staged pT2a or greater, Gleason 6 or greater, and had PSA levels between 1.9 and 100 ng/ml. Of the tumours, 17 contained chromosomal rearrangements involving TMPRESS-ERG loci and nine showed amplifications on chromosome 8q. 
         [0223]    We performed 15 full slide runs with 8 barcoded samples/slide on a SOLiD 3+ machine and obtained an average sequencing depth of 20 million uniquely mappable reads per sample (0.7 billion bases). To determine the success of our MeDIP approach we counted the number of extended 200 bp reads bearing different numbers of CpGs and compared it to the distribution of CpGs in the genome. We found a significant enrichment of reads with at least three CpGs, with a maximum enrichment of reads with approximately 10 CpGs. In addition, we determined the number of reads without any CpGs for each sample (5-15%). We assume that reads without CpG result from unspecific binding of DNA to the beads because differentiated cells contain only very small amounts of non CpG-cytosine-methylation methylation (Lister and Ecker, 2009). 
         [0224]    We discarded all reads without any CpG from further analyses. We next divided the genome into 500 bp genomic intervals (bins) and counted the number of reads located within each bin. To test whether a bin is covered by chance rather than by an underlying methylation we assumed a binomial distribution of the read counts per bin (null hypothesis) and assigned a probability value to each bin. We identified 682,510 bins with significant read counts (p&lt;0.05) in tumour or normal samples. On the average, 39% of all reads are located within the significant bins and were assumed to represent the underlying methylation patterns. 
         [0225]    We tested each bin for association to prostate cancer using a Mann-Whitney-test and corrected for multiple testing using the Benjamini-Hochberg approach. We identified approximately 147,000 differentially methylated regions (false detection rate (FDR)&lt;0.05), examples of which are visualized in  FIG. 1B . 
         [0226]    To validate our findings we used mass spectrometry-based analyses of bisulphite-converted DNA (Epityper) (see Radpour et al. High-throughput hacking of the methylation patterns in breast cancer by in vitro transcription and thymidine-specific cleavage mass array on MALDI-TOF silico-chip. Mol Cancer Res 6, 1702-1709, 2008), which, as an independent technology, yields methylation values for single cytosine residues. Altogether, we analyzed 83 regions in 14 samples. We observed a fairly uniform methylation rate of the CpGs within most of the target regions for all samples ( FIG. 1C ). To compare mass spectrometry data to the MeDIP sequencing data we adjusted the former by utilizing the number of CpGs in the underlying bin. This roughly takes into account that regions with more CpGs might have a higher enrichment in MeDIP experiments. An average Pearson&#39;s correlation coefficient of 0.73 was achieved, showing that MeDIP-Seq can be used for genome-wide screening purposes. We did not expect perfect correlation since bisulphite conversion experiments do not discriminate between 5-methyl-cytosine and 5-hydroxymethyl-cytosine, but MeDIP experiments enrich only for 5-methyl-cytosine. 
         [0227]    Tumour-specific differential methylations: Among the 682,510 genomic intervals (bins) with significant read-count distributions, we found 85,406 bins with significant hypermethylations and 61,308 bins with significant hypomethylations in tumour samples (FDR&lt;0.05). Interestingly, we found tumour associations to be stronger for hypermethylated than for hypomethylated bins (lower p-values). 
         [0228]    Differentiation between normal and tumour samples: To investigate whether it is possible to separate normal and tumour tissue samples using the MeDIP-Seq approach we performed principal component analyses (PCA) on methylation levels for the whole genome and on chromosome 8, a chromosome with frequent copy number variations in PC ( FIG. 2A ). We found a separation of tumour and normal samples for both data sets which could also be shown by calculating self organizing maps. The methylation patterns for normal samples were found to be more uniform since they are less scattered than the tumour samples. Interestingly, when we restricted the PCA to chromosome 8 we found samples with 8q amplifications separate from samples without, indicating an influence of copy number variations on methylation values. 
         [0229]    Identification of biomarkers: One of the aims of our study was the identification of biomarkers for prostate cancer diagnostics based on the epigenetic cancer profiles. To extract one or a combination of a few regions out of our data set of 147,000 differentially methylated regions we used the ‘nearest shrunken centroid’ method (PAM). 
         [0230]    For the ‘nearest shrunken centroid’ method we followed the PAM (prediction analysis for microarrays) classification protocol (see Tibshirani et al. Diagnosis of multiple cancer types by shrunken centroids of gene expression. Proc Natl Acad Sci USA 99, 6567-6572, 2002). PAM was originally developed to analyse gene expression microarray data, but as we show here it is also applicable to other data where a large set of quantitative information has to be scaled down to the most significant classifiers. We identified seven features which allow a complete separation of tumour and normal samples in a self organizing map and in unsupervised clustering ( FIG. 2B ). These markers scored within the top 60 most significant promoter associated bins. 
         [0231]    To reduce the marker set even further, we used the two most significantly differentially methylated regions for the classification analyses and were able to clearly separate the samples, albeit with lower discriminatory power than for the other marker sets. To evaluate our marker sets against a known classifier, we used differentially methylated bins within the GSTP1 promoter and found three samples incorrectly classified, showing that our marker sets have the potential to discriminate between benign and tumour tissues with a higher accuracy than GSTP1. 
         [0232]    Since it is not feasible to use MeDIP-Seq with extensive statistical analyses for every tumour patient we also investigated the applicability of the bisulphite-based mass spectrometry (BS-MS) approach (Sequenom) as a potential technology for routine diagnostic usage. Similar to the validation experiments described earlier the regions selected covered a broad spectrum of CpG content with a peak of 20 to 35 CpGs. Using cluster analyses we were able to perfectly discriminate between tumour and normal samples based on the mass spectrometry data, either with all data points ( FIG. 3B ), or subsets of markers. 
         [0233]    Differential methylations are specific for tumour cells: All experiments performed so far have used macrodissected preparations from tumour and benign tissue samples. To exclude the possibility that the observed differential methylations are due to an overrepresentation of epithelial or stromal cells within the tumour samples we also performed bisulphite analyses on micro- and macro-dissected samples of two additional patients: From each patient we used normal and tumour tissues, each after macrodissection and after laser-microdissection. Correlation analysis of methylation values comparing both dissection techniques reached values of 0.91 ( FIG. 3 ), showing that our identified differential methylations are tumour-cell specific alterations. Comparing matched normal and tumour tissues from the same patients we identified clear differences between the sample types, proving that our methylation profiles are indeed tumour specific and are not due to inter-individual differences. 
         [0234]    Our study revealed approximately 147,000 differentially methylated regions in prostate cancer. Most of these differential methylations were also confirmed if neoplastic and non-neoplastic epithelium was microdissected. This suggests that these patterns are likely to be tumour cell-specific and may not result from connective tissue specific methylations ( FIG. 3 ). Systematic genomic screening efforts have often focused primarily on gene-coding regions to identify “driver” mutations, but identified markedly less somatic mutations per megabase in prostate cancer as compared to many other tumour types. In contrast, high numbers of epigenetic alterations emphasize the relative importance of methylation changes for this tumour type. 
         [0235]    This comprehensive analysis of cytosine methylation in a large set of normal and tumour prostate samples provides a unique catalogue of genes with differential methylation and may identify most significant marker regions dysregulated by methylation in prostate cancer development. 
         [0236]    Earlier studies have only investigated the methylation status of several preselected gene regions in prostate cancer. 
         [0237]    More than 30% of the differentially methylated regions hypermethylated in tumours belong to CpG-islands, CpG island shores and gene promoter regions. 
         [0238]    Outside of gene regions we detected significant hypermethylations in evolutionary conserved regions and micro RNAs. Although 17% of the conserved regions with differential methylation were promoter regions, our data suggests that the non-promoter regions might carry an additional function for tumour formation as they might represent hot spots for long range transcriptional regulation mechanisms. 
         [0239]    In contrast to hypermethylation of distinct positions hypomethylated regions result in less stringent p-values. 
         [0240]    In addition, hypomethylations are less frequently found within specific regions such as promoters or conserved regions. In particular the correlation between hypermethylation and conserved regions, tumour suppressor genes and homeobox genes suggests that hypermethylation might be a directed process necessary in tumour evolution whereas hypomethylation is more unspecific. Most hypomethylation occurred in repetitive regions such as LINE1-elements and satellite DNA. Taking also non-uniquely mappable reads into account, the association of hypomethylations with satellite regions becomes even stronger. 
         [0241]    We have used diverse machine-learning techniques and statistical approaches to identify signatures of differential methylation which correctly differentiate between tumour and normal samples based on our MeDIP-Seq results. Significantly, we found that a minimum of two genomic regions is sufficient to accurately discriminate between malignant and benign tissues (Table 1; Table 2). The extension with additional sites even increases the discriminatory potential of the marker set. The marker sets are independent of the technology used, since bisulphite-based approaches are similarly applicable. Based on our ability to clearly separate prostate cancer from benign prostate specimens by aid of only a few marker regions, we are now in the progress of extending our analyses to diverse body fluids—such as blood and urinary samples—with the goal of establishing the differentially methylated regions as biomarkers for the early detection of prostate cancer.