Ellis W J, Vessella R L, Corey E, Arfman E W, Oswin M M, Melchior S, Lange P H
Department of Urology, University of Washington, Seattle, USA.
J Urol. 1998 Apr;159(4):1134-8.
The reverse transcriptase polymerase chain reaction (RT-PCR) assay is an extremely sensitive technique of detecting cells expressing prostate specific antigen (PSA). Controversy exists regarding the ability of peripheral blood PSA RT-PCR testing to reflect pathological staging or treatment outcome. We examine the phenomenology of RT-PCR results in patients with prostate cancer, with particular emphasis on the RT-PCR test before and after radical prostatectomy, and correlations with pathological staging and treatment outcome.
Peripheral blood was obtained from a wide variety of patients with and without prostate cancer, including before and after radical prostatectomy. After ribonucleic acid isolation, complementary deoxyribonucleic acid was generated and amplified with a hot-start technique. RT-PCR results were compared with pathological stage, Gleason score, tumor volume and disease-free status. Correlations between preoperative and postoperative RT-PCR tests were also made.
The RT-PCR test was positive in 1 of 56 controls (1.8%) without suspicion of prostate cancer. A positive test was obtained in 12 of 65 men (18.5%) with a suspicion of prostate cancer but a negative biopsy. Before radical prostatectomy a positive test was obtained in 13 of 75 men (17.3%) with pT2 disease versus 10 of 46 (21.7%) with pT3 disease. There was no significant difference in serum PSA, Gleason score or tumor volume between the men with positive or negative results. With repetitive testing an increasing percentage of men had at least 1 positive test preoperatively. With a median followup of 8 months 6 of the 7 patients in whom radical prostatectomy failed had had negative RT-PCR before treatment. Of patients with known metastatic disease or failed primary treatment a positive test was obtained in 32 to 75%. Radical prostatectomy and prostate needle biopsy appeared to have a negligible effect on RT-PCR tests immediately following these procedures. Following radical prostatectomy results were variable but many men who are RT-PCR positive preoperatively become RT-PCR negative postoperatively.
The PSA RT-PCR test in our laboratory cannot be used preoperatively to predict pathological stage of prostate cancer or treatment failure. Most cases that are positive preoperatively become negative postoperatively. While increasing tumor burden increases the likelihood of positive tests, there appears to be significant sampling error associated with the use of this test in the peripheral blood.
逆转录聚合酶链反应（RT-PCR）检测是一种检测表达前列腺特异性抗原（PSA）细胞的极其敏感的技术。外周血PSA RT-PCR检测反映病理分期或治疗结果的能力存在争议。我们研究了前列腺癌患者RT-PCR结果的现象学，特别关注根治性前列腺切除术前和术后的RT-PCR检测，以及与病理分期和治疗结果的相关性。
从包括根治性前列腺切除术前和术后在内的各种有或无前列腺癌的患者中获取外周血。分离核糖核酸后，采用热启动技术生成并扩增互补脱氧核糖核酸。将RT-PCR结果与病理分期、Gleason评分、肿瘤体积和无病状态进行比较。还对术前和术后的RT-PCR检测进行了相关性分析。
56名无前列腺癌怀疑的对照者中有1名（1.8%）RT-PCR检测呈阳性。65名怀疑前列腺癌但活检阴性的男性中有12名（18.5%）检测呈阳性。根治性前列腺切除术前，75名pT2期男性中有13名（17.3%）检测呈阳性，而46名pT3期男性中有10名（2l.7%）检测呈阳性。检测结果为阳性或阴性的男性在血清PSA、Gleason评分或肿瘤体积方面无显著差异。随着重复检测，术前至少有1次检测呈阳性的男性比例增加。中位随访8个月，7例根治性前列腺切除失败的患者中有6例在治疗前RT-PCR检测为阴性。在已知有转移性疾病或初始治疗失败的患者中，32%至75%的检测呈阳性。根治性前列腺切除术和前列腺穿刺活检在这些操作后立即对RT-PCR检测的影响似乎可以忽略不计。根治性前列腺切除术后结果各不相同，但许多术前RT-PCR检测呈阳性的男性术后变为阴性。
我们实验室的PSA RT-PCR检测不能在术前用于预测前列腺癌的病理分期或治疗失败。大多数术前呈阳性的病例术后变为阴性。虽然肿瘤负荷增加会使检测呈阳性的可能性增加，但在外周血中使用该检测似乎存在显著的抽样误差。
