title: Preoperative reverse transcriptase polymerase chain reaction for prostate specific antigen predicts treatment failure following radical prostatectomy.
abstract: OBJECTIVE
  We previously demonstrated than an enhanced reverse transcriptase-polymerase chain reaction assay for prostate specific antigen (PSA) can predict final pathological stage in radical prostatectomy patients. The potential role of the assay in predicting serum PSA recurrence after radical prostatectomy was explored.
  
  
  METHODS
  We evaluated 100 radical prostatectomy candidates by reverse transcriptase polymerase chain reaction preoperatively, and status was compared to serum PSA, Gleason score and final pathological results. Potential surgical failure was defined as tumor at the surgical margin or extending into the seminal vesicle. Patients were monitored postoperatively by serum PSA every 4 months. Kaplan-Meier analysis was used to evaluate the correlation between reverse transcriptase polymerase chain reaction and disease recurrence, defined as a PSA of 0.2 ng/ml. or greater.
  
  
  RESULTS
  Enhanced reverse transcriptase polymerase chain reaction for PSA had a stronger correlation with potential surgical failure than preoperative serum PSA or Gleason score (relative risks 15.2, 5.9 and 3.2, respectively). The correlation between these modalities and PSA recurrence was evaluated during a mean followup of 13.6 months (range 5 to 26). Of 36 patients with positive reverse transcriptase polymerase chain reactions 9 had failure by PSA compared to 3 of 64 (4.7%) with negative polymerase chain reactions (p<0.0286). The relative risk for failure by reverse transcriptase polymerase chain reaction was 3.6. Gleason score and serum PSA had higher correlations with postoperative PSA elevations (relative risk 13.2 and 7.6, respectively). A Cox regression analysis model demonstrated that reverse transcriptase polymerase chain reaction for PSA can be used in conjunction with Gleason score and provides statistically significant risk information.
  
  
  CONCLUSIONS
  Enhanced reverse transcriptase polymerase chain reaction for PSA is a statistically significant predictor of potential failure by pathological analysis and of disease recurrence by PSA. Longer followup data are required to define further the role of the assay in the management of patients with prostate cancer.
authors.affiliation: Department of Urology, College of Physicians and Surgeons, Columbia University, New York, USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Olsson
authors.forename: G M
authors.initials: GM
authors.lastname: de Vries
authors.forename: A J
authors.initials: AJ
authors.lastname: Raffo
authors.forename: M C
authors.initials: MC
authors.lastname: Benson
authors.forename: K
authors.initials: K
authors.lastname: O'Toole
authors.forename: Y
authors.initials: Y
authors.lastname: Cao
authors.forename: R E
authors.initials: RE
authors.lastname: Buttyan
authors.forename: A E
authors.initials: AE
authors.lastname: Katz
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood*; D009367:Neoplasm Staging; D016133:Polymerase Chain Reaction / Q000379:methods*; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood* / Q000473:pathology / Q000601:surgery*; D012194:RNA-Directed DNA Polymerase; D017211:Treatment Failure
chemical_list: D012194:RNA-Directed DNA Polymerase; D017430:Prostate-Specific Antigen