Clinical and molecular followup after radical retropubic prostatectomy

• Published in: The Journal of urology Vol. 162; no. 2; p. 307
• Main Authors: Oefelein, M G, Ignatoff, J M, Clemens, J Q, Watkin, W, Kaul, K L
• Format: Journal Article
• Language: English
• Published: United States 01.08.1999
• Subjects: Adenocarcinoma - blood; Adenocarcinoma - pathology; Adenocarcinoma - surgery; Adult; Aged; Follow-Up Studies; Humans; Male; Middle Aged; Neoplastic Cells, Circulating; Prospective Studies; Prostate-Specific Antigen - blood; Prostatectomy; Prostatic Neoplasms - blood; Prostatic Neoplasms - pathology; Prostatic Neoplasms - surgery; Reverse Transcriptase Polymerase Chain Reaction
• ISSN: 0022-5347
• DOI: 10.1016/S0022-5347(05)68544-8

We previously reported evidence of hematogenous dissemination of prostate cells during radical retropubic prostatectomy, and we now provide clinical and molecular reverse transcriptase-polymerase chain reaction (RT-PCR) followup of that patient cohort. A total of 101 men with clinically localized prostate cancer were prospectively enrolled in the study. The prostate specific antigen (PSA) RT-PCR assay was performed on peripheral venous blood samples preoperatively in 101, during surgery in 29, during and up to 12 weeks after surgery in 50 and at least 1 year postoperatively in 65 patients. Correlation with clinical (PSA) indicators of recurrence was performed. Of the 101 patients 9 demonstrated biochemical evidence of prostate cancer progression (median followup 22 months). Of the 50 men with perioperative molecular results the RT-PCR positive rate increased from 22% preoperatively in 11 to 48% in 24 (p = 0.02) and then decreased to 10% in 4 of 40 men at 1 year postoperatively (p = 0.07). Molecular followup at a minimum of 1 year after radical retropubic prostatectomy was obtained in 65 men, of whom the RT-PCR positive rate decreased from 23% preoperatively in 14 to 9.2% in 6 (p = 0.05). No significant correlation was observed between a persistently positive RT-PCR result and biochemical failure. Although a significant proportion of men have molecular evidence of hematogenous prostate cell dissemination intraoperatively, longitudinal molecular and clinical followup demonstrates reconversion to a negative status as the predominant trend. At relatively short followup no significant correlation was identified between the RT-PCR result and the PSA progression-free survival.