Positive prostate-specific antigen circulating cells detected by reverse transcriptase-polymerase chain reaction does not imply the presence of prostatic micrometastases

• Published in: Urology (Ridgewood, N.J.) N.J.), 1997-08, Vol.50 (2), p.245-250
• Main Authors: THIOUNN, N, SAPORTA, F, FLAM, T. A, PAGES, F, ZERBIB, M, VIEILLEFOND, A, MARTIN, E, DEBRE, B, CHEVILLARD, S
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Female; Humans; Male; Medical sciences; Middle Aged; Neoplasm Staging; Neoplastic Cells, Circulating - chemistry; Nephrology. Urinary tract diseases; Polymerase Chain Reaction - methods; Predictive Value of Tests; Prostate-Specific Antigen - analysis; Prostate-Specific Antigen - genetics; Prostatic Hyperplasia - blood; Prostatic Hyperplasia - pathology; Prostatic Neoplasms - blood; Prostatic Neoplasms - pathology; RNA, Messenger - analysis; Sensitivity and Specificity; Tumors of the urinary system; Urinary tract. Prostate gland
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/S0090-4295(97)00272-0

Detection of circulating tumor cells may improve the preoperative local staging of prostate cancers. The aim of this study was to perform enhanced reverse transcriptase-polymerase chain reaction (RT-PCR) of prostate-specific antigen (PSA) mRNA to define the predictive value of PSA-positive circulating cells in a large series of patients. The study included 46 patients with Stage T1 to T2 prostate cancer, 94 with benign prostatic hyperplasia (BPH), and 51 (including 9 women) with nonprostatic disease. PSA-positive cells from peripheral blood samples were detected by Southern blot analysis of the RT-PCR products. Original oligonucleotide primers were defined to exclusively detect the three PSA mRNA splices. Circulating PSA-positive cells were observed in 8 (8.5%) of 94 patients with BPH, 10 (22%) of 46 with Stage T1 to T2 prostate cancer, and 9 (17.6%) of 51 with nonprostatic disease. The detection rate of PSA-positive circulating cells was significantly increased in patients with prostate cancer versus patients with BPH (P = 0.03). Among clinically localized prostate cancers with a Gleason score less than 8, a correlation was observed between PSA-positive circulating cells and Stage pT3 cancer (P = 0.038), capsular penetration (P = 0.04), and a positive margin (P = 0.038). The specificity of the assay for Stage pT3 cancer detection was 84.6%, with a positive predictive value of 60%. Although RT-PCR assay may have a role in preoperative local staging, this study demonstrated the absence of tissue and tumor specificity of PSA-positive circulating cells, accounting for the weak positive predictive value of this technique.