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Circulating prostate-specific antigen mRNA during radical prostatectomy in patients with localized prostate cancer:
1Department of Urology, Akita University School of Medicine, Hondo 1-1-1, Akita 010-5432, Japan.
Abstract:
To determine the potential risk of hematogenous dissemination of prostate cancer cells during radical prostatectomy (RP), we investigated the pre- and intraoperative circulating prostate-specific antigen (PSA) mRNA in patients with clinically localized prostate cancer, with special reference to neoadjuvant hormonal therapy (NHT). Using a nested reverse transcriptase (RT) polymerase reaction (PCR) assay, PSA mRNA in the peripheral blood was evaluated pre- and postoperatively in a total of 23 patients, 10 of whom received NHT with antiandrogens. The RT-PCR assay employed detected one LNCaP cell in 10(7) mononuclear blood cells, and showed no positive signal in the blood samples from all 15 healthy controls. Pre- and intraoperative circulating PSA mRNA was positive in 11 (48%) and 18 patients (78%), respectively. All 11 patients with positive preoperative PSA mRNA continued to be positive during RP, and seven (58%) of 12 patients with negative preoperative PSA mRNA had a positive conversion. Although the patients' ages, preoperative serum PSA values and clinical or pathological stages were not associated with the pre- and intraoperative PSA mRNA results, the NHT group showed a significantly lower incidence of preoperative PSA mRNA positivity (2/10) than the group receiving RP alone (9/13) (20% vs 69%, P = 0.036). NHT, however, showed no suppressive effect on either intraoperative positivity or positive conversion of circulating PSA mRNA. The present study suggests that a substantial number of patients receiving RP are at risk of hematogenous dissemination, and NHT with antiandrogens has a minimal or no suppressive effect on the circulating PSA mRNA during surgical manipulation of the prostate. Because the clinical significance of circulating cancer cells remains to be determined, long-term follow-up in association with the circulating cancer cells assessed by the RT-PCR is essential in order to establish the role of molecular staging as well as NHT.
Insights
Radical prostatectomy may risk prostate cancer cell spread via blood. Neoadjuvant hormonal therapy (NHT) reduced preoperative cancer cell markers but not intraoperative spread. Further research is needed.
Area of Science:
- Oncology
- Molecular Biology
- Urology
Background:
- Radical prostatectomy (RP) is a common treatment for localized prostate cancer.
- Understanding the risk of cancer cell dissemination during RP is crucial for patient outcomes.
- Neoadjuvant hormonal therapy (NHT) is sometimes used before RP, but its effect on intraoperative cancer cell spread is unclear.
Purpose of the Study:
- To assess the risk of hematogenous dissemination of prostate cancer cells during RP.
- To investigate the presence of circulating prostate-specific antigen (PSA) mRNA before and during RP.
- To evaluate the impact of NHT on circulating PSA mRNA levels.
Main Methods:
- Nested reverse transcriptase (RT) polymerase reaction (PCR) assay used to detect PSA mRNA in peripheral blood.
- Blood samples collected preoperatively and intraoperatively from 23 patients undergoing RP.
- 10 patients received NHT prior to RP; 15 healthy controls were included for baseline comparison.
Main Results:
- Circulating PSA mRNA was detected preoperatively in 48% and intraoperatively in 78% of patients.
- NHT group showed significantly lower preoperative PSA mRNA positivity (20%) compared to the no-NHT group (69%).
- NHT did not suppress intraoperative PSA mRNA positivity or positive conversion during RP.
Conclusions:
- A significant number of patients undergoing RP are at risk for hematogenous cancer cell dissemination.
- NHT has a limited effect on suppressing circulating PSA mRNA during the surgical manipulation of the prostate.
- Long-term follow-up is essential to determine the clinical significance of circulating cancer cells and the role of molecular staging with RT-PCR.