Circulating Tumor Cells in Men Who Have Undergone Prostatectomy for Localized, High-Risk Prostate Cancer

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•In this study, blood samples were taken from 37 patients with high-risk, localized prostate cancer at 2 to 5 months following prostatectomy to assess the use of circulating tumor cells (CTCs) as biomarkers. CTCs were detected in 30 of 37 samples. Patients who had detectable CTCs demonstrated a trend toward a shorter time to recurrence, and all patients with biochemical recurrence had detectable CTCs. Additionally, patients with biochemical recurrence had significantly more CTC copy number aberrations.

•Additional studies may confirm the use of early CTC detection as a biomarker to inform adjuvant treatment decisions.

Purpose:

Approximately 15% of men with newly diagnosed prostate cancer have high risk features which increase the risk of recurrence and metastasis. Better predictive biomarkers could allow for earlier detection of biochemical recurrence and change surveillance and adjuvant treatment paradigms. Circulating tumor as biomarkers in men with high risk, localized prostate cancer is not well defined.

Materials and Methods

Two to 5 months after prostatectomy we obtained blood samples from 37 patients with high risk, localized prostate cancer, defined as stage T3a or higher, Gleason score 8 or greater, or prostate specific antigen 20 ng/ml or greater. Circulating tumor cells were enumerated using a commercial platform.Matched tumor and single circulating tumor cell sequencing was performed.

Results:

Circulating tumor cells were detected in 30 of 37 samples (81.1%) with a median of 2.4 circulating tumor cells per ml (range 0 to 22.9). Patients with detectable circulating tumor cells showed a trend toward shorter recurrence time (p[0.12). All patients with biochemical recurrence had detectable circulating tumor cells. Androgen receptor over expression was detected in 7 of 37 patients (18.9%). Patients with biochemical recurrence had more circulating tumor cell copy number aberrations (p[0.027). Matched tumor tissue and single circulating tumor cell sequencing revealed heterogeneity.

Conclusions:

We noted a high incidence of circulating tumor cell detection after radical prostatectomy and shorter time to biochemical recurrence in men with a higher circulating tumor cell burden and more circulating tumor cell copy number aberrations. Genomic alterations consistent with established copy number aberrations in prostate cancer were detectable in circulating tumor cells but often discordant with cells analyzed in bulk from primary lesions. With further testing in appropriately powered cohorts early circulating tumor cell detection could be an informative biomarker to assist with adjuvant treatment decisions.

The Journal of Urology

Identification and Characterization of Circulating Tumor Cells in Men Who Have Undergone Prostatectomy for Clinically Localized, High-Risk Prostate Cancer

J Urol 2019 Oct 01;202(4)732-741, TW Friedlander, C Welty, A Anantharaman, JD Schonhoft, A Jendrisak, J Lee, P Li, J Hough, A Stromlund, Y Kobayashi, J Simko, N Farrokhian, K Lindquist, S Greene, P Ontiveros, R Graf, A Rodriquez, M Suraneni, Y Wang, M Landers, P Carroll, MR Cooperberg, R Dittamore, PL Paris

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