DETECTION OF CIRCULATING PROSTATE CARCINOMA-CELLS VIA AN ENHANCED REVERSE TRANSCRIPTASE-POLYMERASE CHAIN-REACTION ASSAY IN PATIENTS WITH EARLY-STAGE PROSTATE CARCINOMA - INDEPENDENCE FROM OTHER PRETREATMENT CHARACTERISTICS

BACKGROUND. Circulating prostate cells can be detected in the venous b lood of patients with clinically localized prostate carcinoma by apply ing reverse transcriptase-polymerase chain reaction (RT-PCR) technique s using primers specific for the prostate specific antigen (PSA) gene. This study evaluates whether the detection of circulating cells corre lates with established prognostic factors, treatment, and pathologic s tage. METHODS. Two hundred and twenty-seven patients with clinically l ocalized adenocarcinoma of the prostate had an RT-PCR assay performed as part of their staging evaluation. No treatment decisions were made on the basis of the RT-PCR results. Of these, 156 patients were treate d with radical prostatectomy (RP) and 71 with radical external beam ra diotherapy (EBRT). Forty-eight patients were treated with hormonal the rapy prior to RP (n = 39) or EBRT (n = 9). The prognostic factors anal yzed for their relationship to RT-PCR were clinical stage, pretreatmen t serum PSA levels, Gleason score of the biopsy specimen, and Gleason score of the surgical specimen. An analysis of the relationship betwee n treatment and RT-PCR results was also performed. Multivariate logist ic regression analysis of predictors of RT-PCR positivity was performe d as well. In addition, univariate and multivariate analyses of predic tors of pathologic stage, including RT-PCR, were performed. RESULTS. S ixty-one patients (26.9%) had a positive RT-PCR assay. There was no re lationship between clinical stage, pretreatment PSA, biopsy Gleason sc ore, or surgical Gleason score and RT-PCR positivity. In univariate an alysis, patients treated with RP had a higher rate of RT-PCR positivit y than patients treated with EBRT (P = 0.054). However, in multivariat e logistic regression analysis no factor, including treatment with RP, was a significant predictor of RT-PCR positivity. RT-PCR and pretreat ment PSA predicted pathologic stage in univariate and multivariate ana lyses (P < 0.0001 and P = 0.002, respectively). CONCLUSIONS. The detec tion of circulating prostate cells using RT-PCR occurs in approximatel y 25% of early stage prostate carcinoma patients and is independent of other established prognostic factors. In addition, a positive RT-PCR assay is a strong predictor of pathologic upstaging in patients with c linically organ-confined disease. (C) 1997 American Cancer Society.