title: Primary circulating prostate cells are not detected in men with low grade small volume prostate cancer.
abstract: Objective. To determine if primary circulating prostate cells (CPCs) are found in all men with prostate cancer. Methods and Patients. A prospective study, to analyze all men with an elevated PSA between 4.0 and 10.0 ng/mL undergoing initial biopsy. Primary CPCs were obtained by differential gel centrifugation and detected using standard immunocytochemistry using anti-PSA; positive samples underwent a second process with anti-P504S. A malignant primary CPC was defined as PSA (+) P504S (+) and a test positive if 1 cell/4 mL was detected. Biopsy results were registered as cancer/no-cancer, number of cores positive, and percent infiltration of the cores. Results. 328/1123 (29.2%) of the study population had prostate cancer diagnosed on initial biopsy, and 42/328 (12.8%) were negative for primary CPCs. CPC negative men were significantly older, and had lower PSA levels, lower Gleason scores, and fewer positive cores and with infiltration by the cancer. 38/42 (91%) of CPC negative men complied with the criteria for active surveillance in comparison with 34/286 (12%) of CPC positive men. Conclusions. Using primary CPC detection as a sequential test to select men with an elevated PSA for biopsy, the risk of missing clinically significant prostate cancer is minimal when the patient is primary CPC negative; less than 0.5% of all primary CPC negative men had a clinically significant prostate cancer.
authors.affiliation: Hospital Carabineros of Chile, Nunoa, 7770199 Santiago, Chile ; Circulating Tumor Cell Unit, Faculty of Medicine, University Mayor, Las Condes, 7550224 Santiago, Chile ; Institute of Bio-Oncology, Providencia, 7500710 Santiago, Chile.
authors.forename: Nigel P
authors.initials: NP
authors.lastname: Murray
authors.affiliation: Hospital Carabineros of Chile, Nunoa, 7770199 Santiago, Chile ; Faculty of Medicine, Diego Portales University, Manuel Rodríguez Sur 415, 8370179 Santiago, Chile.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Reyes
authors.affiliation: Hospital Carabineros of Chile, Nunoa, 7770199 Santiago, Chile.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Fuentealba
authors.affiliation: Hospital Carabineros of Chile, Nunoa, 7770199 Santiago, Chile.
authors.forename: Nelson
authors.initials: N
authors.lastname: Orellana
authors.affiliation: Hospital Carabineros of Chile, Nunoa, 7770199 Santiago, Chile.
authors.forename: Omar
authors.initials: O
authors.lastname: Jacob