title: Disseminated tumor cells in prostate cancer patients after radical prostatectomy and without evidence of disease predicts biochemical recurrence.
abstract: OBJECTIVE
  Men with apparently localized prostate cancer often relapse years after radical prostatectomy. We sought to determine if epithelial-like cells identified from bone marrow in patients after radical prostatectomy, commonly called disseminated tumor cells (DTC), were associated with biochemical recurrence.
  
  
  METHODS
  We obtained bone marrow aspirates from 569 men prior to radical prostatectomy and from 34 healthy men with prostate-specific antigens <2.5 ng/mL to establish a comparison group. Additionally, an analytic cohort consisting of 98 patients with no evidence of disease (NED) after radical prostatectomy was established to evaluate the relationship between DTC and biochemical recurrence. Epithelial cells in the bone marrow were detected by magnetic bead enrichment with antibodies to CD45 and CD61 (negative selection) followed by antibodies to human epithelial antigen (positive selection) and confirmation with FITC-labeled anti-BerEP4 antibody.
  
  
  RESULTS
  DTC were present in 72% (408 of 569) of patients prior to radical prostatectomy. There was no correlation with pathologic stage, Gleason grade, or preoperative prostate-specific antigens. Three of 34 controls (8.8%) had DTC present. In patients with NED after radical prostatectomy, DTC were present in 56 of 98 (57%). DTC were detected in 12 of 14 (86%) NED patients after radical prostatectomy who subsequently suffered biochemical recurrence. The presence of DTC in NED patients was an independent predictor of recurrence (hazard ratio 6.9; 95% confidence interval, 1.03-45.9).
  
  
  CONCLUSIONS
  Approximately 70% of men undergoing radical prostatectomy had DTC detected in their bone marrow prior to surgery, suggesting that these cells escape early in the disease. Although preoperative DTC status does not correlate with pathologic risk factors, persistence of DTC after radical prostatectomy in NED patients was an independent predictor of recurrence.
authors.affiliation: Department of Urology, University of Washington School of Medicine, 1959 NE Pacific, BB-1115, Box 356510, Seattle, WA 98195, USA. tmorgan2@u.washington.edu
authors.forename: Todd M
authors.initials: TM
authors.lastname: Morgan
authors.forename: Paul H
authors.initials: PH
authors.lastname: Lange
authors.forename: Michael P
authors.initials: MP
authors.lastname: Porter
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Lin
authors.forename: William J
authors.initials: WJ
authors.lastname: Ellis
authors.forename: Ian S
authors.initials: IS
authors.lastname: Gallaher
authors.forename: Robert L
authors.initials: RL
authors.lastname: Vessella
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001854:Bone Marrow Cells / Q000378:metabolism; D015331:Cohort Studies; D018450:Disease Progression; D006801:Humans; D039661:Integrin beta3 / Q000096:biosynthesis; D017493:Leukocyte Common Antigens / Q000096:biosynthesis; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000096:biosynthesis; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D012008:Recurrence
chemical_list: D039661:Integrin beta3; D017493:Leukocyte Common Antigens; D017430:Prostate-Specific Antigen