MOLECULAR-DETECTION OF PROSTATE EPITHELIAL-CELLS FROM THE SURGICAL FIELD AND PERIPHERAL-CIRCULATION DURING RADICAL PROSTATECTOMY

Purpose: Prostate cancer progression despite organ confined pathologic al assessment has been reported in a variable number of men after radi cal retropubic prostatectomy. To study this phenomenon, we used the pr ostate specific antigen (PSA) reverse transcriptase-polymerase chain r eaction assay. Materials and Methods: We prospectively assayed the per ipheral venous blood before, during and after surgical manipulation as well as the intraoperative field blood for PSA reverse transcriptase- polymerase chain reaction-positive cells in 22 men undergoing radical retropubic prostatectomy. Results: PSA reverse transcriptase-polymeras e chain reaction-positive cells were identified in 20 of the 22 operat ive field samples (91%) and 4 of 16 (25%) had evidence of intraoperati ve hematogenous dissemination (p = 0.046). No significant association was identified among Gleason score, pathological stage and the PSA rev erse transcriptase-polymerase chain reaction result. Conclusions: Our results suggest that tumor cell spillage and less frequently hematogen ous dissemination may be associated with operative manipulation of the prostate during radical retropubic prostatectomy and may potentially represent mechanisms of failure after radical retropubic prostatectomy .