Shariat Shahrokh F, Kattan Michael W, Song Weitao, Bernard David, Gottenger Emanuel, Wheeler Thomas M, Slawin Kevin M
Matsunaga-Conte Prostate Cancer Research Center, Scott Department of Urology, Baylor College of Medicine and The Methodist Hospital, Houston, Texas 77030, USA.
Cancer Res. 2003 Sep 15;63(18):5874-8.
Preoperative peripheral blood reverse transcription-PCR (RT-PCR) for prostate-specific antigen (PSA) [RT-PCR-PSA] is not associated with an increased risk of progression after radical prostatectomy. We tested the hypothesis that early postoperative peripheral blood RT-PCR-PSA would detect prostate cancer cells persisting in the circulation that would be associated with disease progression. The study group consisted of 145 consecutive patients who underwent radical prostatectomy for clinically localized disease (median follow-up, 54.5 months) for whom pre- and postoperative peripheral blood samples were available. RT-PCR-PSA was performed on preoperative and postoperative peripheral blood specimens. Pre- and postoperative RT-PCR-PSA were positive in 27% and 12%, respectively, of patients. Most (64%) preoperative RT-PCR-PSA-positive patients converted to a negative RT-PCR-PSA status after prostate removal (P < 0.001). Whereas preoperative RT-PCR-PSA was not associated with prostate cancer characteristics or outcome, a positive postoperative RT-PCR-PSA assay was associated with extracapsular extension (P = 0.044) and seminal vesicle involvement (P = 0.024). Furthermore, postoperative RT-PCR-PSA was an independent predictor of disease progression (P = 0.027). In patients who experienced disease progression, postoperative RT-PCR-PSA was associated with a more aggressive pattern of failure (P = 0.005). Whereas a significant number of patients with clinically localized prostate cancer have prostate cells detectable preoperatively by RT-PCR-PSA circulating in their blood, most of these cells are clinically insignificant because the majority of these patients convert to RT-PCR-PSA-negative status and maintain disease-free status after prostate removal. In contrast, postoperative RT-PCR-PSA detection of prostate cells in the peripheral blood is associated with established markers of aggressive prostate cancer and is an early independent predictor of disease progression, presumably because of an association with established micrometastatic disease.
术前外周血前列腺特异性抗原逆转录聚合酶链反应（RT-PCR-PSA）与根治性前列腺切除术后疾病进展风险增加无关。我们检验了这样一个假设，即术后早期外周血RT-PCR-PSA能够检测到循环中持续存在的前列腺癌细胞，而这些癌细胞与疾病进展相关。研究组由145例连续接受根治性前列腺切除术治疗临床局限性疾病的患者组成（中位随访时间为54.5个月），这些患者术前和术后均有外周血样本。对术前和术后外周血标本进行RT-PCR-PSA检测。患者术前和术后RT-PCR-PSA阳性率分别为27%和12%。大多数（64%）术前RT-PCR-PSA阳性患者在前列腺切除术后转为RT-PCR-PSA阴性状态（P<0.001）。术前RT-PCR-PSA与前列腺癌特征或预后无关，而术后RT-PCR-PSA检测阳性与包膜外侵犯（P=0.044）和精囊受累（P=0.024）相关。此外，术后RT-PCR-PSA是疾病进展的独立预测因素（P=0.027）。在经历疾病进展的患者中，术后RT-PCR-PSA与更具侵袭性的失败模式相关（P=0.005）。虽然大量临床局限性前列腺癌患者术前可通过RT-PCR-PSA检测到血液中循环的前列腺细胞，但这些细胞大多在临床上无意义，因为大多数此类患者在前列腺切除术后转为RT-PCR-PSA阴性状态并保持无病状态。相比之下，术后外周血中RT-PCR-PSA检测到前列腺细胞与侵袭性前列腺癌的既定标志物相关，并且是疾病进展的早期独立预测因素，这可能是因为与既定的微转移疾病有关。
