Value of reverse transcription polymerase chain reaction assay in pathological stage T3N0 prostate cancer

BACKGROUND. We tested the ability of the nested reverse transcription polym erase chain reaction (RT-PCR) assay to detect signs of biochemical recurren ce of prostate cancer in the lymph nodes and peripheral blood of patients w ith pT3N0 prostate cancer. METHODS. Using lymph nodes and pre- and postoperative peripheral blood diss ected from 30 patients with pT3N0 prostate cancer treated by radical prosta tectomy, we used RT-PCR for prostate-specific membrane antigen (PSM) and se rum prostate-specific antigen (PSA) to determine the presence of prostate c ancer. Results of the nested RT-PCR assay were compared with pathological s tages and biochemical recurrence. RESULTS. Two of 13 patients with capsular penetration (15%), 6 of 10 patien ts with invasion of seminal vesicles (60%), and 3 of patients with a positi ve surgical margin (43%) were RT-PCR-positive for PSM and/or PSA in the lym ph nodes. Results of preoperative RT-PCRs of peripheral blood for PSM and f or PSA significantly differed between positive and negative results of RT-P CR in lymph nodes (P < 0.001 and P < 0.001, respectively). Results of posto perative RT-PCRs of peripheral blood for PSM and for PSA. also significantl y different between positive and negative results of RT-PCR in lymph nodes (P = O.M1 and P = 0.001, respectively). Nine of 11 patients with positive n ested RT-PCR for PSM and/or PSA in the lymph nodes (82%) experienced bioche mical recurrence. Significant difference in Kaplan-Meier recurrence-free ac tuarial curves was noted between patients who nested positive and negative on RT-PCR in the lymph nodes, pre- and postoperative peripheral blood, biop sy and prostatectomy Gleason score, and preoperative PSA values. In multiva riate analysis, biopsy and prostatectomy Gleason score (P = 0.026, P = 0.02 0, respectively), pre- and postoperative RT-PCR for PSM in peripheral blood (P = 0.030 and P = 0.040, respectively), and RT-PCR fur PSM in lymph nodes (P = 0.035) were independent prognostic factors. CONCLUSIONS. Nested RT-PCR assay of the lymph nodes or peripheral blood sig nificantly predicted biochemical recurrence after surgery. It may help iden tify patients at risk for recurrence and progression of prostate cancer. (C ) 2000 Wiley-Liss, Inc.