DETECTION OF CIRCULATING TUMOR-CELLS IN MEN WITH LOCALIZED PROSTATE-CANCER

Purpose: Using prostate-specific antigen (PSA) mRNA as a marker for pr ostatic epithelial cells, we have developed a sensitive technique that involves reverse transcription and polymerase chain reaction (RT-PCR) to detect circulating tumor cells in the peripheral blood of men with prostatic carcinoma (Cap). Patients and Methods: A sensitive RT-PCR a ssay was used to evaluate the peripheral blood of 135 men with a histo ry of Cap. Fourteen men with benign prostate disease, many of whom had elevated serum PSA levels, were used as a control group. Results: All patients with benign prostate disease had a negative result in the RT -PCR assay. Of particular interest was a subgroup of 65 patients with clinically localized Cap evaluated before definitive local therapy. Fi ve of these patients had detectable PSA mRNA by RT- PCR, suggesting ci rculating tumor cells. Within this group, systemic disease was detecte d by RT-PCR in some men with PSA levels less than 10 ng/mL and clinica l stage B disease. Blood from men with hormone-refractory and progress ive Cap demonstrated a higher frequency of PSA mRNA detectable by RT-P CR (10 of 20 patients). In contrast, none of seven patients with newly diagnosed metastatic prostate cancer and only one of seven patients w ith metastatic, hormone-responsive disease had blood that wets positiv e for PSA mRNA by RT-PCR. Conclusion: Circulating tumor cells can be d etected in the blood aa subset of patients with clinically localized C ap and a larger subset of patients with progressive metastatic disease . (C) 1994 by American Society of Clinical Oncology.