Does the immunocytochemical detection of epithelial cells in bone marrow (micrometastasis) influence the time to biochemical relapse after radical prostatectomy?
D. Weckermann et al., Does the immunocytochemical detection of epithelial cells in bone marrow (micrometastasis) influence the time to biochemical relapse after radical prostatectomy?, UROL RES, 27(5), 1999, pp. 285-290
The detection of cytokeratin-positive bone marrow cells has been considered
a prognostic factor in numerous malignant tumors. We investigated whether
this was also valid for localized prostate cancer. Bone marrow aspirates we
re taken prior to radical prostatectomy from 169 consecutive patients with
pT1/2 pN0 G1-3 adenocarcinoma of the prostate. The immunocytochemical detec
tion of cytokeratin no. 18 (CK 18) positive cells using monoclonal antibody
CK 2 was interpreted as micrometastasis. Repeat marrow aspirations were pe
rformed at 6 months postoperatively and once a year thereafter. The patient
s were re-examined over a period of at least 10 and a maximum of 72 months
(median 32 months). An increase in prostate specific antigen greater than o
r equal to 0.5 ng/ml was considered a biochemical "relapse". One hundred an
d fifty-four patients had evaluable bone marrow aspirates, of which 74.7% w
ere CK 18-negative and 25.3% positive. The latency period for biochemical r
elapse was 1481 days (median) in the CK 18-negative group and 1106 days (me
dian:) in the CK 18-positive group. This difference was not statistically s
ignificant. The CK 18-positive aspirates (n = 39) showed one positive cell
in 20 cases, two positive: cells in 8 and three or more positive cells in 1
1 cases. The pre-operative number of cells had no statistically significant
effect upon the onset of biochemical relapse. Only patients with three or
more CK 18-positive cells tended to have a poorer prognosis. One hundred an
d thirteen patients had evaluable bone marrow aspirates pre- and postoperat
ively. Postoperative persistence or occurrence of CK 18-positive cells did
not affect the outcome of the disease. The detection of CK 18-positive cell
s in bone marrow does not influence the prognosis of patients with localize
d prostate cancer within a period of 32 months (median). Solely a subgroup
of patients showing a large preoperative number of CK 18-positive cells see
ms to tend to an unfavorable course of the disease. Thus, further studies a
re necessary aiming at a more detailed characterization of these cells.