Wood D P, Beaman A, Banerjee M, Powell I, Pontes E, Cher M L
Genitourinary Program of the Karmanos Cancer Institute, Department of Urology, Wayne State University, Detroit, Michigan 48201, USA.
Clin Cancer Res. 1998 Sep;4(9):2119-23.
Our objective was to determine the effect of neoadjuvant hormonal therapy on the presence of circulating prostate cells in patients undergoing radical prostatectomy for prostate cancer. A total of 60 patients at high risk for extraprostatic disease were analyzed for the presence of circulating prostate cells using reverse transcriptase PCR (RTPCR) amplification of the prostate-specific antigen mRNA. Twenty-nine patients underwent radical prostatectomy for a clinical T2b-c tumor or a stage T1c-T2a tumor and a serum prostate-specific antigen level > or =10ng/ml (radical prostatectomy alone), and 31 similarly staged patients received neoadjuvant hormonal therapy before radical prostatectomy (neoadjuvant). Bone marrow samples were used for RTPCR analysis. Twenty-four percent and 58% of the radical-prostatectomy-alone patients and neoadjuvant patients had organ-confined disease, respectively (P = 0.007). In the radical-prostatectomy-alone group, 77% and 14% of patients with extraprostatic and organ-confined disease were RTPCR positive, respectively (P = 0.03). However, in the neoadjuvant group, 46% and 28% of patients with extraprostatic and organ-confined disease were RTPCR positive, respectively (P = 0.29). For patients that were RTPCR positive, 45 % of the neoadjuvant patients had organ-confined disease compared with 6% in the radical-prostatectomy-alone patients (P = 0.018). These data suggest that a subset of the neoadjuvant patients are converted to organ confined disease without eliminating the prostate cells in the bone marrow. Our data suggest that hormonal therapy before radical prostatectomy decreases the occurrence of extraprostatic disease but, to a lesser degree, the incidence of circulating prostate cells. This may partially explain why hormonal therapy before radical prostatectomy has not improved disease-free survival.
我们的目的是确定新辅助激素治疗对接受前列腺癌根治术患者循环前列腺细胞存在情况的影响。使用逆转录酶聚合酶链反应（RTPCR）扩增前列腺特异性抗原mRNA，对总共60例有前列腺外疾病高风险的患者进行循环前列腺细胞检测。29例临床T2b - c期肿瘤或T1c - T2a期肿瘤且血清前列腺特异性抗原水平≥10 ng/ml的患者接受了前列腺癌根治术（单纯前列腺癌根治术组），31例分期相似的患者在前列腺癌根治术前接受了新辅助激素治疗（新辅助治疗组）。骨髓样本用于RTPCR分析。单纯前列腺癌根治术组和新辅助治疗组分别有24%和58%的患者患有器官局限性疾病（P = 0.007）。在单纯前列腺癌根治术组中，前列腺外疾病和器官局限性疾病患者的RTPCR阳性率分别为77%和14%（P = 0.03）。然而，在新辅助治疗组中，前列腺外疾病和器官局限性疾病患者的RTPCR阳性率分别为46%和28%（P = 0.29）。对于RTPCR阳性的患者，新辅助治疗组中有45%的患者患有器官局限性疾病，而单纯前列腺癌根治术组中这一比例为6%（P = 0.018）。这些数据表明，新辅助治疗组中的一部分患者转变为器官局限性疾病，但并未消除骨髓中的前列腺细胞。我们的数据表明，前列腺癌根治术前的激素治疗可降低前列腺外疾病的发生率，但在一定程度上也降低了循环前列腺细胞的发生率。这可能部分解释了为什么前列腺癌根治术前的激素治疗未能改善无病生存期。
