Prognostic value of circulating prostate cells in patients with a rising PSA after radical prostatectomy.
BACKGROUND
To predict poor outcome in patients with a biochemical recurrence (rising PSA) after radical prostatectomy (RP), urologists rely primarily on Gleason score, PSA doubling time, and time from surgery to biochemical (i.e., PSA) recurrence. In the present study, we assess the value of RT-PCR detection circulating prostate cells in blood of patients with a rising PSA.


METHODS
RNA from blood samples was obtained from 55 patients with a rising PSA and from 45 patients without evidence of biochemical failure (PSA < 0.1 ng/ml). Both groups were matched for age, Gleason score, pT stage, and interval between radical prostatectomy and PCR testing.


RESULTS
PSA positive cells were detected in 1/45 (2%) patients without a PSA recurrence and 19/55 (34%) patients with a PSA recurrence. In the rising PSA group, mean PSA doubling time was significantly shorter in patients with positive RT-PCR (5 months) than in patients with negative RT-PCR (16 months; P = 0.001). An earlier onset of recurrence was also detected in patients with a positive RT-PCR (31 months for positive RT-PCR vs. 50 months for negative RT-PCR) but this result did not achieve statistical significance (P = 0.102). Salvage radiation therapy was administered in 15 patients. Three of the five patients with a positive RT-PCR progressed during radiotherapy whereas 7 of the 10 patients with a negative RT-PCR obtained a complete response and none have progressed.


CONCLUSIONS
These preliminary results suggest that RT-PCR detection of prostate cells in blood of patients after RP correlates with rapidly progressing biochemical failure after RP.
Tombal
Bertrand
B
Division of Urology, Saint-Luc University Hospital, Brussels, Belgium.
Van Cangh
Paul J
PJ
Loric
Sylvain
S
Gala
Jean-Luc
JL
D004273:DNA, Neoplasm / Q000032:analysis; D006801:Humans; D008297:Male; D009367:Neoplasm Staging / Q000379:methods*; D009360:Neoplastic Cells, Circulating; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000235:genetics / Q000473:pathology* / Q000601:surgery*; D020133:Reverse Transcriptase Polymerase Chain Reaction; D016896:Treatment Outcome
D004273:DNA, Neoplasm; D017430:Prostate-Specific Antigen