Clinical and molecular followup after radical retropubic prostatectomy

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.