New U.S. study below [1].
It used to be that a prostatectomy [RP] would be halted if the cancer was not confined to the prostate. The man my surgeon operated on after me was stapled back up due to lymph node involvement. I think that today, he would have a good chance of having his prostate removed anyway.
From the new paper:
"Circulating tumor cells (CTCs) are thought to represent the earliest form of metastases".
That's a stretch, IMO, but perhaps some would say that an RP is inappropiate when there are CTCs.
In the study of men with Gleason score 8-10: "CTCs were detected in 81.1% (30/37) of samples with a median of 2.4 CTCs/ml (range: 0-22.9)."
It seems as though the Gleason score was the final score (as determined by the pathologist after surgery). (The Gleason score from a biopsy might differ from the final score.)
81.1% suggests that there might have been CTCs in men with lesser disease. Would have been interesting to see the numbers for Gleason score 3+4 & Gleason score 4+3 (my case).
"There was a high incidence of CTC detection after RP and shorter time to BCR in those with higher CTC burden and more CTC CNAs {copy number aberrations}."
The body is very good at zapping CTCs, but could perhaps use a little help. This is why some men use modified citrus pectin [MCP] &/or nattokinase (to remove micro clots that CTCs might dock on & be protected.)
-Patrick
[1] ncbi.nlm.nih.gov/pubmed/312...
J Urol. 2019 Jun 19:101097JU0000000000000393. doi: 10.1097/JU.0000000000000393. [Epub ahead of print]
Identification and Characterization of Circulating Tumor Cells in Men Who Have Undergone Prostatectomy for Clinically Localized, High - Risk Prostate Cancer.
Friedlander TW1, Welty C, Anantharaman A1, Schonhoft JD2, Jendrisak A2, Lee J2, Li P1, Hough J1, Stromlund A1, Kobayashi Y3, Simko J4, Farrokhian N3, Lindquist K3, Greene S2, Ontiveros P2, Graf R2, Rodriquez A2, Suraneni M2, Wang Y2, Landers M2, Carroll P3, Cooperberg MR3, Dittamore R2, Paris PL1,3.
Author information
1
Division of Hematology-Oncology, Helen Diller Family Comprehensive Cancer Center, University of California at San Francisco , San Francisco , CA .
2
Epic Sciences . San Diego , CA.
3
Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California at San Francisco , San Francisco , CA.
4
Department of Pathology, University of California at San Francisco , San Francisco , CA.
Abstract
BACKGROUND:
Approximately 15% of men with newly diagnosed prostate cancer have high-risk features that increase the risk of recurrence and metastasis. Better predictive biomarkers could allow for earlier detection of biochemical recurrence (BCR) and change surveillance and adjuvant treatment paradigms. Circulating tumor cells (CTCs) are thought to represent the earliest form of metastases, however their role as biomarkers in men with high-risk localized prostate cancer (HRLPCa) is not well defined.
METHODS:
Blood samples from 37 patients with HRLPCa (Stage T3a or higher, Gleason score ≥8, or PSA ≥20 ng/ml), were obtained 2-5 months post prostatectomy. CTCs were enumerated using the Epic Sciences platform. Matched tumor and single CTC sequencing was performed.
RESULTS:
CTCs were detected in 81.1% (30/37) of samples with a median of 2.4 CTCs/ml (range: 0-22.9). Patients with detectable CTCs exhibited a trend towards shorter recurrence times (p=0.12) and all patients with BCR had detectable CTCs. AR over-expression was detected in 18.9% (7/37) of patients. Patients with BCR had more CTC copy number aberrations (CNAs, p=0.027). Matched tumor tissue and single CTC sequencing reveals heterogeneity.
CONCLUSION:
There was a high incidence of CTC detection after RP and shorter time to BCR in those with higher CTC burden and more CTC CNAs. Genomic alterations consistent with established CNAs in prostate cancer were detectable in CTCs, but often discordant with cells analyzed in bulk from primary lesions. With further testing in appropriately powered cohorts, early CTC detection could be an informative biomarker to assist with adjuvant treatment decisions.
KEYWORDS:
Biomarkers; Circulating Tumor Cells; Genomics; Prostate Cancer
PMID: 31216253 DOI: 10.1097/JU.0000000000000393
Post RP No RT Allowed :(
