Measuring Circulating Tumor Cells[CTC]

An issue has been festering, for awhile. This entails men who have low PSA's and wind up one day with Bone Pain, and scans showing that the Pca reached the Bone, even though the PSA, was not considered dangerous and AS was the mode of treatment.

Also there are people like myself, who have a rare form of Ductal Pca, and all Ductal's kind of understate PSA, as it is estimated that 30% of what is left after initial treatment were non-PSA refractive Pca cells. And then when you look at men who have had what appears to be a durable remission, all of a sudden 6-10 years later they have a Biochemical relapse.

Add to this Micro-Metastasis, CTC---circulating Pca cells that have not landed. Many here have low or undetectable PSA's, with circulating Dormant Pca cells until they wake up.

Well wouldn't it be nice to know what is floating in our blood, instead of just relying on a PSA test. I am very interested, for I am told all my Pca, that is whatever is left, is in my blood, with no landings, yet. Well I want to know what is left. I could have 2 types left, Dormant, and Refractive Pca cells, that cannot yet land.

So in speaking with my Geneticist We have 2 methods of measuring cells left in the blood, and giving it a number per 7.5 ml of blood---and a table that predicts overall survival based on active cancer cells, and this table may not be accurate for Dormant cells. But anyway, How many do I have, or anyone here have.

The 2 methods are Nano Chip technology, where they put a micro sized chip in a vessel, that can capture cancer cells and measure them per 7.5 ml's--which is the standard for those doing testing. In this method, the cancer cell is bigger than the blood cell and gets captured and the rate of capture is measured. I know you are looking for less than 5 Cancer cells per 7.5 ml of blood for the result to be considered good for those with active Cancer cells.

The other method, that has a Medicare coding, can be obtained thru, CellSearch. You can go to CellSearchctc,com, and do some reading. Quest Labs is one laboratory that does the test. Blood is collected and sent overnight refrigerated, Through staining methods they can give you a count of Pca cells circulating per 7.5 ml's.

I contacted them and ask if they can measure Dormant Pca cells, they said they could not communicate on technical subjects, with patients, according to FDA rules[F--- the FDA],. So I p[an to have one of my Docs. contact, and if they can measure dormant cells, I will go forth with the test. I may be loaded with these, or it is possible we killed a bunch of my Pca. This CTC measuring, can very well offer patients certain lines of preferred treatment, instead of just relying on PSA, and scans when your PSA hits a specific number.

Anyway those interested in CTC's can go to the sight and discuss with their Docs. I am going to move on this for myself--for many reasons, some scientific to prove my ADT and Supplement Programs affect.


16 Replies

  • What a fact finding mission you are going to be launched on for the benefit of many of us! The same question which has gripped your mind has dwelled in my mind too for long with no definite answer or solution. What you have said about the belief in stable remission is absolutely true and can be illusionary on account of the presence of any hormone refractive and PSA negative cancer cells in our body, after or during various treatments. When you succeed in your efforts, please let us know again how we can get this blood test CTC ( circulating tumor cells ) done for prostate cancer and the effectiveness of the test etc.

    Posting your research information for us is always appreciated.


  • This .pdf from the company has numerous references in it related to using the test for Prostate Cancer for various cancers lines, including advanced Prostate Cancers.

    This paper was also mentioned at the very end of the above, in regards to Prostate Cancer circulating tumor cells.

    Shaffer DR, Leversha MA, Danila DC, Lin O, Gonzalez-Espinoza R, Gu B, Anand A, Smith K, Maslak, P, Doyle GV, Terstappen LWMM, Lilja H, Heller G, Fleisher M and Scher HI. “Circulating Tumor Cell Analysis in Patients with Progressive Castration-Resistant Prostate Cancer”, Clinical Cancer Research, Vol 13 No.7: 2023-2029, (2007).


    Gee Whiz,


  • Makes a lot of sense to me. I look forward to updates from you as you proceed.

  • I asked my oncologist why this was not done on us PC patients as a normal procedure. He says it is VERY expensive. Well, If it were done more, the cost would surely come down. Measuring ctc's would have to be a more reliable measurement than anything we presently use. I really think you are onto something worthwhile. Let us know how it goes.


  • Well if its so important, then perhaps some should simply pay for it. Often, I found things weren't covered but if we wanted it, we found a way to make it a priority. Many of the tests and treatments are costly and mainly big profit so it's pushed and often unnecessary or if it doesn't test everything, I would have to question if it is worth the cost.

  • I believe since there is a Medicare Code--and people like me who have a Supplemental Plan, might make it viable for us that are over 65. Now the Code exists so far just for the CellSearch process. There were over a dozen Insurance companies that offer some coverage, on their site.

    In speaking with a representative I got enough info, to indicate there is a s--- load of profit in the CellSearch Process, that is/can be done by a large testing organization, such as Quest Labs. Basically the process starts with your Doc. One that has the means to draw a certain amount of blood, refrigerate and send overnight. Something a Red Cross might do if they could Mail. Hospitals all have the capability at their Internal Labs to do this.

    Then when a Lab like Quest gets the sample---they stain a portion of the blood, which is then put into a machine, kind of how they do PSA's today--but in this case the computer in the machine reads cancer cells that were stained, and reports a number based on cells per 7.5 ml as I initially reported. I do not see a lot of cost other than paying back the Labs initial costs for an expensive reader[Amortization].

    The biggest question, is can it measure all circulating cells, weather they are active, or dormant. I can understand the difficulty if you have both, how do you determine what % is active or dormant[that can later become active].

    I have a personal interest, as mine right now are supposedly all dormant. So a number to me or my Docs. would have great meaning. Anyone with an undetectable, or under the 0.2 PSA range, might find the same benefit. Telling Docs. what the load is and what can be expected later, and to determine treatment modalities in advance. Those with higher than 0.2 can have an indication of best treatment modalities also, but I assume a Good Onc. would take into account the Pathology, and Mutation types one would have, while having a count--or load factor/7.5 mls. Another tool--cannot hurt here!

    Anyway my Geneticist, is encouraging me to pursue, even though she does not have all the answers I seek.


  • Nal,

    The Mayo Clinic does they own PSA tests by mailing out a kit with instructions and a cold pack for overnight delivery. For the blood draw and separation process most hospitals will, upon the written order from Mayo, perform the blood draw at no cost. So a hospital would be your best bet.


  • Hi N.

    I am about to meet today (first time) with the doctor who is to perform HDR brachytherapy as part three of a treatment for a Gleason 9, "locally advanced" p ca. I would like to get the CTC cell search prior to the HDR to aid if need be the addition of early chemo. I just read last night a study of 59 men having HDR and LDR who had the circulating tumor cells tested before and after the needle or catheter insertions. All 59 showed 0% CTCs before insertion. Immediately following CTC blood tests taken and 11.8% showed CTCs. or search perioperative search for circulating tumor cells

    Any advice on how to present this to the doctor other than saying I will pay for it, show him the links, and say my thoughts about early chemo? I will probably get all of ten minutes with a lot of other questions

    I only have two weeks before HDR is scheduled after pelvic radiation is complete. I see my other option is to cancel the HDR and try SBRT which does not have the invasive risk.

    Many thanks in advance. D

  • I am not a doctor--so it is hard to give advise here. Since you have pelvic mets, you are I assume castrate resistant. So what is in your blood circulating might be interesting to know, as it may offer other choices if this information was available and either was positive or negative. My medicare with supplemental paid for mine. I do not have an issue presenting what I want from my Doctors. I run my own show. What I mean is I am the final decider about anything. And they do not argue, as they were all told up front if you cannot handle me being in control, i will find other Doctors that allow patients to make decisions. And they all have to be integrative, allowing for Drugs, and Supplementation to be used along with any other modalities or tests. I called for my Genetic profile from Foundation one. We looked at 340 genes and we found the 2 that had mutated. So we now know what targeted drugs we might be able to use later.

    So bring your papers on the subjects and if you want something, because your gut or your own research, shows it might be important---then argue for it. I am not in a position to assure you, that anything meaningful, will be brought forth. My Best To You,


  • Thank you. I have had 3 months of 2yr. adt so far and and no mets on imaging to begin with. My doctor calls it locally advanced I think because of the high Gleason/t2b. I am one who wants as much info up front. Just had my appt and the hdr doctor has a lot of confidence in the odds of success and thinks CTC may be premature. I feel pretty good about going forward with the hdr now. But very good knowing how to get info in CTCs if needed in future. Thanks again D

  • My Best to you again,


  • My PSA was quite low and normal looking at 2.7 when I showed up with a very palpable Gleason 8 tumor. I certainly have concerns about PSA providing a useful measure of my condition. Thanks for the post; this is certainly an area of interest for me.

  • Nalakrats,

    As you know the key is can they tell the % of active versus dormant PCa cells. When you find out; everyone will want to know this information. I would go for the test if the information is positive.


  • I am stuck until my next Doc. appointments, as I need them to communicate--directly. I will be at the Levine Institute of Cancer[they do Prostate Cancer Research], they should know for sure, or get to the bottom of it.

    In my case, since all my Pca cells as of today are in dormancy---it would be very important to measure. They were put there by my drug/supplement program. So I want to know if the cell count is low enough to take a vacation, assuming they are still dormant over the next 2 months. I plan to email my Onc. at Levine in advance, to get things rolling.

    Those that are castrate resistant--I am led to understand, can benefit by determining the load, of active tumor cells, that can determine what treatments that might be best.

    Here is where there is a problem just with PSA, in my opinion. Take 2 men, both castrate resistant, no Mets, both have the same PSA, lets say it is 10, for argument sake. Without considering Pathology and Mutations---which should be---one man weighs 250 lbs, and the other 150 lbs.

    So which of the 2 has a more critical situation? Knowing the CTC for each would go along with PSA, to determine best treatment, and they may be very different.

    Just thinking out loud.


  • I Have major concerns withy husbands treatment. Finished oxfigo March 28. PSA continues to rise went from 63 to 68 in 2 weeks. Taken off zitiga 4 weeks ago approx) never done test to see testosterone level or if AR-V7 positive. He is 5 years out- MCRPC. 4 years MCRPC. Feeling pretty bad - bone scan & CT SCAN ON may 17. What comes next - do you think He is getting the best care?? PLEASE RESPOND. I am feeling pretty out there not trusting our oncologist! Concerned about low PSA with aggressive cancer.

  • Charlesd, Sorry to hear your feeling bad. I think a Testosterone Test, will tell us something. If above 40 ng/dl, might indicate something. Over 40 your husband is not castrated. Was your husband ever initially treated with Lupron, and Casodex. You are starting the story 5 years out. What were the initial treatments? Did your husband Initially have Surgery, or Radiation, or seeds. Then put on ADT[Lupron/Casodex]? Coming off Radium 223, there is a slight rise in PSA. After, the Radium, the drug of choice is many times Xtandi, which is like a super Hormone Receptor Blocker that can dramatically bring down PSA. Many times Lupron is given with the Xtandi, after the bone scans show that the radium did its job.

    All I can say to comfort you, is that there are many options, especially with the new targeted Drug therapies. But in order to know what might work later, Gene Mapping, would indicate what mutations your husband has. Medicare Pays for Gene Mapping, and can be gotten at Foundation if you are looking to do something between now and the 17th of May, talk to the people at the Foundation. Also get an Advocate, a Prostate Cancer Advocate--you can call/find number on Web----the PRCI--Prostate Research Cancer Institute. Then you will have someone to speak with that has knowledge and resources all over this country. They really helped me in the beginning of my Journey.

    Since you are short of knowledge in the vast Universe of Prostate Cancer, You seem to be uncomfortable with your Oncologist. If you got that uneasy feeling get a second opinion. Better yet if you live near one of the Great Centers for Pca---like MD Anderson--Houston. Sloan Memorial--NYC, John Hopkins in Maryland, or any of the Mayo Centers, I would consider using them. I use the Levine Cancer Institute In Charlotte. I want a group that is doing research, and clinical trials, as well as regular Pca work. This is just my opinion. Just giving you my thinking.

    You may at this time have to wait for the scans, as nobody at this time can predict anything--but you could make those contacts I mentioned above.


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