Molecular detection of prostate epithelial cells from the surgical field and peripheral circulation during radical prostatectomy.
OBJECTIVE
Prostate cancer progression despite organ confined pathological assessment has been reported in a variable number of men after radical retropubic prostatectomy. To study this phenomenon, we used the prostate specific antigen (PSA) reverse transcriptase-polymerase chain reaction assay.


METHODS
We prospectively assayed the peripheral venous blood before, during and after surgical manipulation as well as the intraoperative field blood for PSA reverse transcriptase-polymerase chain reaction-positive cells in 22 men undergoing radical retropubic prostatectomy.


RESULTS
PSA reverse transcriptase-polymerase chain reaction-positive cells were identified in 20 of the 22 operative field samples (91%) and 4 of 16 (25%) had evidence of intraoperative hematogenous dissemination (p = 0.046). No significant association was identified among Gleason score, pathological stage and the PSA reverse transcriptase-polymerase chain reaction result.


CONCLUSIONS
Our results suggest that tumor cell spillage and less frequently hematogenous dissemination may be associated with operative manipulation of the prostate during radical retropubic prostatectomy and may potentially represent mechanisms of failure after radical retropubic prostatectomy.
D000230:Adenocarcinoma / Q000473:pathology* / Q000556:secondary / Q000601:surgery*; D016022:Case-Control Studies; D004848:Epithelium / Q000473:pathology; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D009366:Neoplasm Seeding; D016133:Polymerase Chain Reaction / Q000379:methods; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000032:analysis*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D012334:RNA, Neoplasm / Q000032:analysis*
D012334:RNA, Neoplasm; D017430:Prostate-Specific Antigen