Purpose: Hypoxia regulates key biological processes including angiogenesis via the transcription factor, hypoxia-inducible factor (HIF). In prostate cancer, angiogenesis is also influenced by androgens, and recent cell line studies suggest that this effect is partly mediated by HIF.The study aimed to assess whether a relationship exists in human prostate cancer between expression of the androgen receptor, HIFs, and the key angiogenesis factor, vascular endothelial growth factor (VEGF). Experimental Design: A tissue microarray comprised of 149 radical prostatectomy specimens was constructed. Semiquantitative immunohistochemical analysis was used to assess the expression of the androgen receptor, VEGF and HIF-1a and 2a, and their regulatory prolyl hydroxylase enzymes (PHD1, PHD2, and PHD3). Statistical analysis compared these factors with each other and with prostate-specific antigen relapse.Results: There was a significant correlation between HIF-1a and HIF-2a expression (P = 0.02), and with androgen receptor (P = 0.04 and P < 0.001, respectively) and VEGF expression (P = 0.05 and P <0.001, respectively).VEGF was also significantly related to the androgen receptor (P = 0.05), whereas PHD2 was inversely related to HIF-2a expression. No significant association was shown between HIF-1a or HIF-2a and time to prostate-specific antigen recurrence (P = 0.20 and P = 0.94, respectively). Conclusions: These findings confirm the relationship between hypoxia and the androgen receptor in prostate cancer, and show for the first time, the role of HIF-2a in this disease process. They provide clinical evidence to support the recent cell line findings that androgens may regulateVEGF levels through the activation of HIF in androgen-sensitive tumors. Inhibition of both the HIF pathways may provide new therapeutic options in the management of this disease.One of the key pathways involved in the response to hypoxia is the HIF-1 pathway. HIF-1 is an oxygen-dependent transcriptional activator which is composed of two basic helix-loop-helix PAS proteins, HIF-1a and HIF-1b (1). HIF1b (aryl hydrocarbon nuclear translocator) is constitutively expressed and largely unaffected by oxygen tension in contrast to HIF-1a, which is the responsive HIF-1 element (2). Although three a subunits have been identified, most of the studies to date have concentrated on the role of HIF-1a, with those of HIF-2a and HIF-3a remaining less clear (3).The level and activity of the HIF-1a subunit is tightly regulated through a number of posttranslational modifications. In the presence of oxygen, the prolyl hydroxylase enzymes (PHD1, PHD2, and PHD3) cause site-specific hydroxylation of two proline residues, P402 and P564, within the oxygen-dependent degradation domain of HIF-1a. This hydroxylation allows for the recognition of HIF-1a by the tumor suppressor von Hippel-Lindau protein, an E3 ubiquitin ligase complex, which targets HIF-1a for degradation (4). Hydroxylation of a conserved asparagine residue (Asp 803 ) within the caspase-activated DNase domain ...