The clinical implications of postoperative detection of circulating tumor cells (CTCs) in prostate cancer are largely unknown. This study aimed to investigate the association between postoperative CTC detection after radical prostatectomy and disease recurrence in prospectively enrolled patients with prostate cancer.
A total of 203 patients with undetectable prostate-specific antigen (PSA) who had undergone radical prostatectomy for prostate cancer were prospectively enrolled. CTC sampling was performed at a median of 4.5 months after surgery. The primary endpoint was biochemical recurrence-free survival. Detection of CTCs in the blood of patients was performed using a novel approach with a replication competent adenovirus controlled by PSA/prostate-specific membrane antigen transcription regulatory elements (Ad5/35E1aPSESE4).
CTCs were detected in 73 (36.0%) patients with undetectable PSA concentrations after surgery. The 3-year biochemical recurrence-free survival rate from the time of surgery was significantly higher in CTC-negative patients than in CTC-positive patients (81.6% vs 48.9%, log rank p<0.001). Multivariable analysis showed that postoperative CTC detection was independently associated with an increased risk of biochemical recurrence (HR=5.42; 95% CI, 3.24-9.06; p<0.001). C-index was increased in the combination of multivariable model and postoperative CTC detection compared with multivariable model alone.
CTCs in the blood were frequently detected in patients with undetectable PSA levels after radical prostatectomy for localized prostate cancer. Furthermore, CTC detection was associated with an increased risk of biochemical recurrence, suggesting that CTC detection precedes PSA rise after surgery in case of prostate cancer recurrence. Large-scale validation is needed in the future.
The Journal of urology. 2019 Dec 17 [Epub ahead of print]
Sahyun Pak, Yoon Seok Suh, Dong-Eun Lee, Sung Han Kim, Jae Young Joung, Weon Seo Park, Sang-Jin Lee, Kang Hyun Lee
Department of Urology, Center for Urologic Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea., Biostatistics Collaboration Team, Research Core Center, Research Institute and Hospital, National Cancer Center, Goyang, Korea., Department of Pathology, Research Institute and Hospital, National Cancer Center, Goyang, Korea., Division of Cancer Immunology, Research Institute and Hospital, National Cancer Center, Goyang, Korea.