Fluorescence in situ hybridization aneuploidy as a predictor of clinical disease recurrence and prostate-specific antigen level 3 years after radicalprostatectomy

Objective: To determine if fluorescence in situ hybridization (FISH) analys is of fresh-tissue biopsy specimens obtained at the time of radical prostat ectomy is able to predict prospectively clinical disease progression or pro state-specific antigen (PSA) level in patients 3 to 4 Sears after surgery. Materials and Methods: FISH analysis was performed on fresh-tissue touch pr eparations obtained from 90 randomly selected radical prostatectomy specime ns. Cut surface touch preparations from 40 specimens resected in 1992 were analyzed with DNA probes for chromosomes 4, 6-12, 17, 18, X, and Y. Needle- biopsy specimens were obtained from 50 tumors resected in 1993, and touch p reparations from these specimens were studied with DNA probes for chromosom es 7, 8, 11, and 12, Serum PSA levels and clinicopathologic data were recor ded, and each patient was followed up from the time of surgery to determine cancer progression. Results: Of 90 patients undergoing radical prostatectomy in 1992 and 1993, 89 returned for follow-up. Three patients received preoperative hormonal th erapy, and in 2 patients, antiandrogen therapy was continued postoperativel y. Fifteen patients underwent intraoperative orchiectomy immediately after radical prostatectomy while 9 patients had postoperative adjuvant hormonal therapy. Six patients underwent postoperative radiation therapy. Fourteen p atients (15.7%) demonstrated systemic. local, or PSA progression. Only 2 (4 .7%) of 43 patients with FISH diploid tumors demonstrated cancer progressio n, Conversely, 10 (30.3%) of 33 FISH aneuploid and 12 (26.1%) of 46 FISH no ndiploid tumors demonstrated cancer progression (P=.004 and P=.006, respect ively). Unlike FISH, flow cytometric aneuploidy was not associated with ear ly cancer progression. Elevated preoperative PSA concentration, increased p reoperative and postoperative Gleason score, and increased preoperative and postoperative T or N stage were not statistically significantly associated with cancer progression. while chromosome 7 and 8 ancusomies were not stat istically associated with cancer progression, 2 of 5 (P=.04) chromosome 12 aneusomic turners demonstrated cancer progression. Conclusion: Early (within 4 Sears) local, systemic, or PSA progression occu rred more frequently (P<.05) in radical prostatectomy patients with FISH an euploid, nondiploid, and chromosome 12 aneusomic tumors. Flow cytometric pl oidy status, preoperative serum PSA concentration, and clinical or patholog ic grade or stage, including seminal vesicle involvement, margin status, an d capsular perforation status, were not associated with early prostate canc er progression in this group of 89 patients, FISH analysis appears to be a useful preoperative tool for predicting aggressive vs indolent prostate can cer.