Blood-based reverse transcriptase polymerase chain reaction assays for prostatic specific antigen: Long term follow-up confirms the potential utilityof this assay in identifying patients more likely to have biochemical recurrence (rising PSA) following radical prostatectomy

Reverse transcriptase polymerase chain reaction (RT-PCR) assay is a sensiti ve technique to detect circulating cells expressing prostate-specific antig en (PSA) in blood or bone marrow from patients with prostate cancer. When a pplied to prostate cancer patients at our institution, this technique ident ifies those patients with a greater likelihood of extraprostatic disease. W e evaluated RT-PCR PSA as a predictor of PSA recurrence and compared it wit h pre-operative (serum PSA, digital rectal examination, Gleason score on bi opsy) and post-operative parameters (pathological findings). Three hundred nineteen men scheduled for radical prostatectomy had an enhan ced RT-PCR PSA assay before surgery. The enhanced RT-PCR PSA protocol has b een previously described. PSA recurrence was defined as any serum PSA value above 0.2 mu g/l. Forty-six patients had PSA recurrence. The mean follow-up was 25.4 months. Recurrence free survival was 53% for patients with positive RT-PCR PSA vs. 84% if RT-PCR PSA was negative. By using multivariate analyses, RT-PCR PSA status was not an independent predictor of PSA recurrence compared to patho logical stage pT3, Gleason score on prostate specimen and serum PSA. If onl y pre-operative parameters were studied, serum PSA and RT-PCR PSA status we re 2 independent pre-operative predictors of PSA recurrence compared with G leason score on biopsy and digital rectal examination. Int. J. Cancer (Pred . Oncol.) 84:360-364, 1999. (C) 1999 Wiley-Liss, Inc.