The serine protease urokinase-type plasminogen activator (uPA) and its receptor (uPAR) are known to be involved in the invasion and metastasis of many solid tumors. In this study, we analyzed the role of the uPAR/uPA system in both the development and progression of pancreatic cancer in invasive ductal adenocarcinomas of the pancreas (PDA) and their premalignant precursors (PanIN lesions) in 50 patients with long-term clinical follow-up. We found overexpression of the uPAR in 48 of 50 invasive carcinomas as well as in a large proportion of high-grade PanIN lesions by immunohistochemistry and in situ hybridization. Fluorescence in situ hybridization analysis showed both high-and low-level amplification of the uPAR gene in ϳ50% of cases with strictly identical patterns between invasive cancers and their accompanying precursor lesions. These results suggest that PDA may develop from PanIN lesions along an alternative rather than a sequential molecular pathway. The detection of the gene amplification of uPAR was a highly significant, adverse prognostic parameter (P < 0.001) because it likely renders the tumors more sensitive to uPA and its proproliferative and anti-apoptotic signals. We conclude that the activation of the uPAR/uPA system is an early event in the development of PDA and that uPAR gene amplifications identify a subgroup of particularly aggressive tumors, making the uPAR/uPA system a critical and highly promising target for therapeutic in- Invasive ductal adenocarcinoma of the pancreas (PDA) represents the fourth most common cause of cancerrelated death and its incidence is still increasing.1 With an estimated number of 232,000 new cases per year, pancreatic cancer is among the most common malignancies worldwide.2 Moreover, it is one of the most lethal cancers, as indicated by a mortality incidence ratio of 98%.2 Once pancreatic cancer is clinically evident, it progresses at a rapid rate, and metastasis is often present already at the time of diagnosis.3 The mechanisms that regulate this aggressive growth behavior in pancreatic cancer are still poorly understood.Several studies indicate that during cancer cell invasion and metastasis proteolytic enzymes participate in the degradation of extracellular matrix components. The serine protease urokinase-type plasminogen activator (uPA) and its receptor (uPAR, CD87) are involved in the control of extracellular matrix turnover, cell migration, invasion, and cell signaling leading to a variety of different responses under both physiological and pathological conditions. 4 -6 uPAR is a highly glycosylated 45-to 60-kDa protein that is attached to the cell membrane via glycosylphosphatidylinositol anchor. It consists of three