PROGNOSTIC-SIGNIFICANCE OF DETECTION OF PROSTATE-SPECIFIC ANTIGEN TRANSCRIPTS IN THE PERIPHERAL-BLOOD OF PATIENTS WITH METASTATIC ANDROGEN-INDEPENDENT PROSTATIC-CARCINOMA

Objectives. To evaluate the prognostic significance of reverse transcr iptase polymerase chain reaction (RT PCR) detection of prostate-specif ic antigen (PSA) mRNA in relation to survival in patients with metasta tic androgen-independent prostatic carcinoma (AIPC). Methods. Peripher al blood from 122 men (64 from Memorial Sloan-Kettering Cancer Center [MSKCC] and 58 from the Dana Farber Cancer Institute [DFCI]) with meta static (Stage D2) AIPC was analyzed for PSA mRNA using RT PCR. Forty-o ne controls without prostatic carcinoma were also evaluated. Results. RT PCR positivity for PSA mRNA was present in 24 of the 64 (38%) patie nts seen at MSKCC and in 26 of the 58 (45%) patients followed at DFCI. All control individuals were PSA PCR negative. There was a significan t correlation between RT PCR positivity and decreased survival in each of the Memorial and Dana Farber populations (P = 0.028 and 0.039, res pectively). Serum PSA (at time of blood collection for PCR) was not pr edictive of survival as a continuous variable in the MSKCC (P = 0.31) and the DFCI (P = 0.09) groups. RT PCR for PSA mRNA was found to be in dependent from and superior to serum PSA in predicting survival in bot h the MSKCC and DFCI populations (P = 0.048 and P = 0.027, respectivel y). Conclusions. The detection of PSA mRNA in the peripheral blood by RT PCR is a predictor of survival in patients with metastatic AIPC, an d PCR is superior to a single serum PSA measurement. Further studies a re needed to test the value of this factor in comparison to and couple d with other prognostic parameters. (C) 1997, Elsevier Science Inc. Al l rights reserved.