Fig. 5: Representative H&E, immunohistochemistry, and RNAscope images demonstrating changes in the overall and cell-type-specific expression of MCT1, MCT4, LDHA, and LDHB in Gleason pattern 3, 4, and 5 disease.

a–c Digitised haematoxylin-and-eosin images (H&E) showing GP3, GP4, and GP5 adenocarcinoma of the prostate, respectively. d–f MCT1 immunohistochemical staining of the same glands demonstrated expression which is predominantly in tumour epithelium and is consistent across GP3, GP4, and GP5 glands. g–i Conversely, MCT4 immunohistochemical staining showed predominantly stromal expression in GP3 and GP4 glands, and a shift towards tumour expression in GP5 glands, an observation reflected in the increased epithelium-to-stroma MCT4 ratio detailed in the text. j–l RNAscope immunofluorescent staining for LDHA mRNA (spectrum gold) demonstrated the gradual increase in the intensity of staining in the progression to GP5 disease. m–o Conversely, RNAscope immunofluorescent staining for LDHB mRNA (spectrum white) revealed its decreasing expression in the progression to GP5 disease, while the combined LDH expression increased. Scale bars on images (a, b, d, e, g, h), (c, f, i, l, o), and (j, k, m, n), denote 200 μm, 100 μm, and 10 μm, respectively.