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Vlaeminck-Guillem V. When Prostate Cancer Circulates in the Bloodstream. Diagnostics (Basel) 2015; 5:428-74. [PMID: 26854164 PMCID: PMC4728468 DOI: 10.3390/diagnostics5040428] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 10/14/2015] [Accepted: 10/22/2015] [Indexed: 12/14/2022] Open
Abstract
Management of patients with prostate cancer is currently based on imperfect clinical, biological, radiological and pathological evaluation. Prostate cancer aggressiveness, including metastatic potential, remains difficult to accurately estimate. In an attempt to better adapt therapeutics to an individual (personalized medicine), reliable evaluation of the intrinsic molecular biology of the tumor is warranted, and particularly for all tumor sites (primary tumors and secondary sites) at any time of the disease progression. As a consequence of their natural tendency to grow (passive invasion) or as a consequence of an active blood vessel invasion by metastase-initiating cells, tumors shed various materials into the bloodstream. Major efforts have been recently made to develop powerful and accurate methods able to detect, quantify and/or analyze all these circulating tumor materials: circulating tumors cells, disseminating tumor cells, extracellular vesicles (including exosomes), nucleic acids, etc. The aim of this review is to summarize current knowledge about these circulating tumor materials and their applications in translational research.
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Affiliation(s)
- Virginie Vlaeminck-Guillem
- Cancer Research Centre of Lyon, U1052 INSERM, CNRS 5286, Léon Bérard Centre, Lyon I University, 28 rue Laennec, Lyon 69008, France.
- Medical Unit of Molecular Oncology and Transfer, Department of Biochemistry and Molecular Biology, University Hospital of Lyon-Sud, Hospices Civils of Lyon, Lyon 69008, France.
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Alapont Alacreu JM, Navarro Rosales S, Budía Alba A, España Furió F, Morera Martínez F, Jiménez Cruz JF. [PSA and hK2 in the diagnosis of prostate cancer]. Actas Urol Esp 2008; 32:575-88. [PMID: 18655340 DOI: 10.1016/s0210-4806(08)73891-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Serum markers for prostate carcinoma are widely applied for the purpose of early detection of cancer and the differentiation between benign and malignant disease, for the pre-treatment staging of detected prostatic cancers, and for the monitoring of prostate cancer after curative or palliative therapies. Since its discovery in 1979, serum PSA has been the most powerful marker of prostate cancer, but, when used alone, PSA is not sufficiently sensitive or specific to consider it an ideal tool for the early detection or staging of prostate cancer. To optimize the use of PSA, the concepts of PSA velocity, PSA density, and age-related PSA values were developed. Moreover, the molecular forms of PSA, especially the percentage of free PSA, seem to be useful tools for the detection of prostate cancer in men with slightly elevated total PSA. Human kallikrein 2 (hK2), a serine protease closely related to PSA that also is expressed predominantly in the prostate, is a new complementary marker to PSA for early detection of prostate cancer. In this review, we examine PSA testing and its effectiveness in the diagnosis of prostate cancer. Further, we also evaluate recent literature regarding the use of hk2.
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Maitland NJ. The Search for Genes Which Influence Prostate Cancer Metastasis: A Moving Target? ACTA ACUST UNITED AC 2008. [DOI: 10.1007/978-1-4020-5847-9_3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
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Cho KS, Oh HY, Lee EJ, Hong SJ. Identification of enhancer of zeste homolog 2 expression in peripheral circulating tumor cells in metastatic prostate cancer patients: a preliminary study. Yonsei Med J 2007; 48:1009-14. [PMID: 18159594 PMCID: PMC2628187 DOI: 10.3349/ymj.2007.48.6.1009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Enhancer of zeste homolog 2 (EZH2), a kind of transcriptional repressor, is reportedly over-expressed in metastatic prostate cancer. In this study, we analyzed EZH2 mRNA in circulating tumor cells (CTCs) in peripheral blood as a biomarker in patients with metastatic prostate cancer. PATIENTS AND METHODS Ber-EP4 coated immunomagnetic beads were used to harvest CTCs, and mRNA was isolated by oligo- dT conjugated immunomagnetic beads. Reverse transcriptase- polymerase chain reaction for EZH2 mRNA was performed and the expression density was measured. The sensitivity of this test for detection of EZH2 mRNA was determined by serial dilutions of a human prostate cancer cell line. Blood samples were collected from 20 patients each with metastatic or localized prostate cancer and 10 healthy volunteers. RESULTS Sensitivity experiments showed that the test was highly sensitive as it could detect 10 tumor cells per 5 mL. EZH2 mRNA expression was obtained from peripheral blood samples of patients and control subjects. EZH2 mRNA expression density in the metastatic prostate cancer group was significantly higher than in the control (p=0.023) and localized prostate cancer groups (p=0.019). There was no difference between the control and localized prostate cancer groups (p > 0.05). CONCLUSION EZH2 mRNA expression in circulating epithelial cells represents a promising marker for detecting early metastasis in prostate cancer. However, more specific and sensitive techniques for detection of CTCs are needed to avoid mononuclear cell contamination.
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Affiliation(s)
- Kang Su Cho
- Department of Urology, Urological Science Institute, Brain Korea 21 Project for Medical Science, College of Medicin, Korea
| | - Hea Young Oh
- Department of Urology, Urological Science Institute, Brain Korea 21 Project for Medical Science, College of Medicin, Korea
- Department of Food and Nutrition, Yonsei University, Seoul, Korea
| | - Eun Jin Lee
- Department of Urology, Urological Science Institute, Brain Korea 21 Project for Medical Science, College of Medicin, Korea
| | - Sung Joon Hong
- Department of Urology, Urological Science Institute, Brain Korea 21 Project for Medical Science, College of Medicin, Korea
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Fizazi K, Morat L, Chauveinc L, Prapotnich D, De Crevoisier R, Escudier B, Cathelineau X, Rozet F, Vallancien G, Sabatier L, Soria JC. High detection rate of circulating tumor cells in blood of patients with prostate cancer using telomerase activity. Ann Oncol 2007; 18:518-21. [PMID: 17322541 DOI: 10.1093/annonc/mdl419] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Circulating tumor cells (CTCs) cannot be readily detected with currently available methods in the majority of patients with prostate cancer. Telomerase activation, one of the major immortalization events, is found in most cases of prostate cancer. We attempted to develop a method using telomerase activity to isolate CTCs in patients with prostate cancer. PATIENTS AND METHODS Peripheral blood mononuclear cells (PBMCs) were isolated from whole blood using Ficoll-Hypaque. Immunomagnetic beads coated with an epithelial cell-specific antigen antibody (BerEP4) were used to harvest epithelial cells from PBMCs. Telomerase activity was detected in harvested epithelial cells using the telomerase-PCR-enzyme-linked immunosorbent assay method. RESULTS Blood samples from 107 patients with prostate cancer were studied. CTCs were detected in 19 of 24 (79%) patients with advanced prostate cancer. In contrast, CTCs were not detected in blood samples from 22 healthy male volunteers. CTCs were even identified in patients with an undetectable (<0.1 ng/ml) serum prostate-specific antigen (PSA). CTCs were detected in 55 of 70 (79%) patients with localized prostate cancer before radical prostatectomy (n = 30) or brachytherapy (n = 40). CTCs were also detected in 3 of 13 patients (23%) with an undetectable serum PSA measured at least 1 year after radical prostatectomy, which is consistent with the expected relapse rate in this setting. CONCLUSION CTCs can be detected using telomerase activity in a large majority and a wide variety of patients with prostate cancer, including those with localized disease.
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Affiliation(s)
- K Fizazi
- Department of Medicine, Institut Gustave Roussy, Villejuif, France.
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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, Scher HI. Circulating tumor cell analysis in patients with progressive castration-resistant prostate cancer. Clin Cancer Res 2007; 13:2023-9. [PMID: 17404082 DOI: 10.1158/1078-0432.ccr-06-2701] [Citation(s) in RCA: 269] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To better direct targeted therapies to the patients with tumors that express the target, there is an urgent need for blood-based assays that provide expression information on a consistent basis in real time with minimal patient discomfort. We aimed to use immunomagnetic-capture technology to isolate and analyze circulating tumor cells (CTC) from small volumes of peripheral blood of patients with advanced prostate cancer. EXPERIMENTAL DESIGN Blood was collected from 63 patients with metastatic prostate cancer. CTCs were isolated by the Cell Search system, which uses antibodies to epithelial cell adhesion marker and immunomagnetic capture. CTCs were defined as nucleated cells positive for cytokeratins and negative for CD45. Captured cells were analyzed by immunofluorescence, Papanicolau staining, and fluorescence in situ hybridization. RESULTS Most patients (65%) had 5 or more CTCs per 7.5 mL blood sample. Cell counts were consistent between laboratories (c = 0.99) and did not change significantly over 72 or 96 h of storage before processing (c = 0.99). Their identity as prostate cancer cells was confirmed by conventional cytologic analysis. Molecular profiling, including analysis of epidermal growth factor receptor (EGFR) expression, chromosome ploidy, and androgen receptor (AR) gene amplification, was possible for all prostate cancer patients with >or=5 CTCs. CONCLUSIONS The analysis of cancer-related alterations at the DNA and protein level from CTCs is feasible in a hospital-based clinical laboratory. The alterations observed in EGFR and AR suggest that the methodology may have a role in clinical decision making.
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Affiliation(s)
- David R Shaffer
- Genitourinary Oncology Service, Immunicon Corporation, Huntingdon Valley, Pennsylvania, USA
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Sung SY, Hsieh CL, Wu D, Chung LWK, Johnstone PAS. Tumor microenvironment promotes cancer progression, metastasis, and therapeutic resistance. Curr Probl Cancer 2007; 31:36-100. [PMID: 17362788 DOI: 10.1016/j.currproblcancer.2006.12.002] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Shian-Ying Sung
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
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Llanes L, Ferruelo A, Luján M, Pascual C, García-Mediero JM, Berenguer A. Quantitative real-time reverse transcription: polymerase chain reaction of prostate-specific antigen (PSA) for detection of circulating prostatic cells in patients with clinically localized prostate cancer. Prostate Cancer Prostatic Dis 2005; 8:248-52. [PMID: 15897916 DOI: 10.1038/sj.pcan.4500801] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the clinical utility of using the real-time reverse transcriptase-polymerase chain reaction (RT-PCR) to quantify prostate-specific antigen (PSA) mRNA in peripheral blood samples from patients with prostate cancer as a predictor of extraprostatic extension of the disease and to assess any correlations with known predictive markers of this condition. METHODS Immediately before radical prostatectomy, peripheral blood samples were taken from 42 men with clinically localized prostate cancer and analysed for PSA and 18S ribosomal (endogenous control) genes using real-time RT-PCR (with gene expression assays and the comparative CT-cycle threshold-method for quantifying). A total of 30 healthy male blood donors aged <50 y was taken as a control group. The relationships between PSA mRNA values, pathological and clinical features were analysed. PSA mRNA value, PSA level and biopsy Gleason score were then compared as predictors of extraprostatic extension. RESULTS PSA gene expression was 3.73 times significantly higher in patients with clinically localized prostate cancer than in healthy men (P<0.05). There was no relationship between PSA real-time RT-PCR values and pathological stage pT2 or pT3 (P=0.5), and no association between PSA mRNA value and serum PSA level (P=0.9) or the Gleason score of the preoperative biopsy (P=0.9). CONCLUSION There was no significant advantage in using the real-time RT-PCR assay of PSA mRNA before surgery to stage prostate cancer and to discriminate between organ-confined and extraprostatic extension.
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Affiliation(s)
- L Llanes
- Department of Urology, Hospital Universitario de Getafe, Madrid, Spain
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Loberg RD, Fridman Y, Pienta BA, Keller ET, McCauley LK, Taichman RS, Pienta KJ. Detection and isolation of circulating tumor cells in urologic cancers: a review. Neoplasia 2005; 6:302-9. [PMID: 15256052 PMCID: PMC1502117 DOI: 10.1593/neo.03484] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
The American Cancer Society has estimated that in 2003, there will be approximately 239,600 new cases of urologic cancer diagnosed and 54,600 urologic cancer-related deaths in the United States. To date, the majority of research and therapy design have focused on the microenvironment of the primary tumor site, as well as the microenvironment of the metastatic or secondary (target) tumor site. Little attention has been placed on the interactions of the circulating tumor cells and the microenvironment of the circulation (i.e., the third microenvironment). The purpose of this review is to present the methods for the detection and isolation of circulating tumor cells and to discuss the importance of circulating tumor cells in the biology and treatment of urologic cancers.
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Affiliation(s)
- Robert D Loberg
- Department of Urology, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI 48109-0946, USA.
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Duplex RT-PCR and chemiluminometric hybridization assay for combined screening of the mRNAs of prostate-specific antigen and prostate-specific membrane antigen in peripheral blood. Anal Chim Acta 2005. [DOI: 10.1016/j.aca.2004.10.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Wu F, Wang ZB, Jin CB, Zhang JP, Chen WZ, Bai J, Zou JZ, Zhu H. Circulating tumor cells in patients with solid malignancy treated by high-intensity focused ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2004; 30:511-517. [PMID: 15121253 DOI: 10.1016/j.ultrasmedbio.2003.12.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2003] [Revised: 12/04/2003] [Accepted: 12/20/2003] [Indexed: 05/24/2023]
Abstract
The theoretical possibility that exposure of a solid malignancy to high-intensity focused ultrasound (US), or HIFU, could lead to an increased rate of metastasis still remains. Using reverse transcriptase polymerase chain reaction (RT-PCR), the potential risk of hematogenous dissemination was assessed in HIFU-treated patients with solid malignancy. RT-PCR can demonstrate the presence or absence of specific RNA fragments. On the day before HIFU ablation, 5-mL peripheral blood samples were collected, and again 5 to 7 days after HIFU, from 26 enrolled patients (hepatocellular carcinoma, HCC: 10; osteosarcoma: 16). Total RNA was isolated and RT-PCR was performed to analyze the mRNA expression of (alpha-fetoprotein (AFP) and bone-specific alkaline phosphatase (BALP) genes. Positive AFP mRNA expression was preoperatively detected in 8 of 10 patients with HCC. In the postoperative specimens, positive expression was also detected in 8 of 10 patients. In 2 patients, circulating tumor cells were found preoperatively, but not postoperatively. Conversely, 2 patients with no circulating tumor cells preoperatively were found to have circulating tumor cells after HIFU. Of 16 osteosarcoma patients, 12 patients had circulating tumor cells and 4 had none. After HIFU treatment, 2 of the 12 patients had converted from presence to absence of circulating cells and the remaining 4 patients remained negative. It is concluded that patients undergoing complete HIFU ablation may demonstrate conversion from presence to absence of circulating tumor-specific marker mRNA, and that HIFU would not enhance the potential risk of metastasis in patients with malignant diseases.
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Affiliation(s)
- Feng Wu
- Clinical Center for Tumor Therapy of 2nd Affiliated Hospital, and Institute of Ultrasonic Engineering in Medicine, Chongqing University of Medical Sciences, Chongqing, China.
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Ady N, Morat L, Fizazi K, Soria JC, Mathieu MC, Prapotnich D, Sabatier L, Chauveinc L. Detection of HER-2/neu-positive circulating epithelial cells in prostate cancer patients. Br J Cancer 2004; 90:443-8. [PMID: 14735191 PMCID: PMC2409539 DOI: 10.1038/sj.bjc.6601532] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
HER-2/neu may play a role in prostate carcinogenesis. The aim of this study was to use the expression of HER-2/neu as a molecular marker for the detection of circulating tumour cells (CTCs) in the blood of patients with prostate cancer (PC). Blood samples were collected from 42 patients with PC and nine healthy volunteers. Immunomagnetic beads were used to harvest epithelial cells from peripheral blood mononuclear cells. Total RNA was extracted and reverse transcribed before analysis by real-time PCR with HER-2/neu-specific primers. CTCs were HER-2/neu positive in six out of 11 (54%) patients with metastatic disease and in three out of 31 (9.6%) patients with localised PC (P=0.004). In blood samples from nine healthy volunteers, we detected no expression of HER-2/neu. The present method appears to be minimally invasive, highly sensitive and a specific approach for detecting CTCs in PC. Furthermore, it may help better target HER-2/neu in advanced PC.
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Affiliation(s)
- N Ady
- CEA, Laboratoire de Radiobiologie et Oncologie, DRR/DSV, 92265 Fontenay-aux-Roses, France
| | - L Morat
- CEA, Laboratoire de Radiobiologie et Oncologie, DRR/DSV, 92265 Fontenay-aux-Roses, France
| | - K Fizazi
- Département de Médecine, Institut Gustave Roussy, 94805 Villejuif, France
| | - J-C Soria
- CEA, Laboratoire de Radiobiologie et Oncologie, DRR/DSV, 92265 Fontenay-aux-Roses, France
- Département de Médecine, Institut Gustave Roussy, 94805 Villejuif, France
| | - M-C Mathieu
- Département d'Anatomopathologie, Institut Gustave Roussy, 94805 Villejuif, France
| | - D Prapotnich
- Service d'Urologie, Institut Mutualiste Montsouris, 75014 Paris, France
| | - L Sabatier
- CEA, Laboratoire de Radiobiologie et Oncologie, DRR/DSV, 92265 Fontenay-aux-Roses, France
- CEA, Laboratoire de Radiobiologie et Oncologie, DRR/DSV, 92265 Fontenay-aux-Roses, France. E-mail:
| | - L Chauveinc
- CEA, Laboratoire de Radiobiologie et Oncologie, DRR/DSV, 92265 Fontenay-aux-Roses, France
- Département de Radiothérapie, Institut Curie, 75005 Paris, France
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Affiliation(s)
- Victoria L Robinson
- Section of Urology, Department of Surgery, The University of Chicago, IL 60637, USA
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Tombal B, Van Cangh PJ, Loric S, Gala JL. Prognostic value of circulating prostate cells in patients with a rising PSA after radical prostatectomy. Prostate 2003; 56:163-70. [PMID: 12772185 DOI: 10.1002/pros.10237] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND To predict poor outcome in patients with a biochemical recurrence (rising PSA) after radical prostatectomy (RP), urologists rely primarily on Gleason score, PSA doubling time, and time from surgery to biochemical (i.e., PSA) recurrence. In the present study, we assess the value of RT-PCR detection circulating prostate cells in blood of patients with a rising PSA. METHODS RNA from blood samples was obtained from 55 patients with a rising PSA and from 45 patients without evidence of biochemical failure (PSA < 0.1 ng/ml). Both groups were matched for age, Gleason score, pT stage, and interval between radical prostatectomy and PCR testing. RESULTS PSA positive cells were detected in 1/45 (2%) patients without a PSA recurrence and 19/55 (34%) patients with a PSA recurrence. In the rising PSA group, mean PSA doubling time was significantly shorter in patients with positive RT-PCR (5 months) than in patients with negative RT-PCR (16 months; P = 0.001). An earlier onset of recurrence was also detected in patients with a positive RT-PCR (31 months for positive RT-PCR vs. 50 months for negative RT-PCR) but this result did not achieve statistical significance (P = 0.102). Salvage radiation therapy was administered in 15 patients. Three of the five patients with a positive RT-PCR progressed during radiotherapy whereas 7 of the 10 patients with a negative RT-PCR obtained a complete response and none have progressed. CONCLUSIONS These preliminary results suggest that RT-PCR detection of prostate cells in blood of patients after RP correlates with rapidly progressing biochemical failure after RP.
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Affiliation(s)
- Bertrand Tombal
- Division of Urology, Saint-Luc University Hospital, Brussels, Belgium
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Kauffman EC, Robinson VL, Stadler WM, Sokoloff MH, Rinker-Schaeffer CW. Metastasis suppression: the evolving role of metastasis suppressor genes for regulating cancer cell growth at the secondary site. J Urol 2003; 169:1122-33. [PMID: 12576866 DOI: 10.1097/01.ju.0000051580.89109.4b] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The prevention and treatment of prostate cancer metastasis continue to provide a significant clinical challenge. Identification of the rate limiting steps of metastasis and their underlying molecular mechanisms may lead to new therapeutic targets and also allow more accurate risk stratification for clinical metastases. We review the literature supporting growth of disseminated tumor cells at the secondary site as a key rate limiting step in metastasis. We also reviewed the definition, identification and characterization of metastasis suppressor genes, and discuss their evolving role in regulating this step. MATERIALS AND METHODS We performed MEDLINE searches and manual bibliographic reviews on the specific steps of metastasis, including growth at the secondary site. In addition, we performed a comprehensive literature review to identify genes fitting the classic definition of a metastasis suppressor gene. The literature was also searched to assess the status of each gene in clinical cancer and evaluate functional support for the potential involvement of each gene in regulating growth at the secondary site. RESULTS Clinical studies in prostate cancer and other cancer types suggest that dissemination to the secondary site is often an early clinical event. However, not all patients with tumor cells at the secondary site have overt metastatic lesions even in the absence of therapy, suggesting that growth at the secondary site may be highly inefficient. Complimentary approaches have allowed researchers to document and quantify the inefficiency of cancer cell growth at the secondary site. Regarding the mechanism of growth control, many studies support a role for the interaction of a cancer cell and the microenvironment at the secondary site influencing whether growth into metastasis may occur. The 7 genes that suppress metastasis without affecting primary tumor growth that have been identified are KAI1, CD44, mitogen activated protein kinase (MAPK) kinase 4, nm23-H1, nm23-H2, KiSS1 and BrMS1. Three of these genes (KAI1, CD44 and MAPK kinase 4) act as metastasis suppressor genes of prostate cancer, while the remainder have yet to be tested in this cancer type. Loss of expression has been demonstrated for most of these genes during the clinical progression of prostate cancer to metastasis. MAPK kinase 4 and KiSS1 appear to suppress metastasis by inhibiting cancer cell growth at the secondary site. Interestingly many metastasis suppressor genes have common roles in growth control, adhesion and cytoskeletal reorganization, suggesting a common mechanism of metastasis suppression. Proposed candidate pathways include signaling through Src kinase and Rac GTPase. CONCLUSIONS The findings discussed support growth at the secondary site as a clinical target for metastasis treatment and prevention. Metastasis suppressor genes may offer valuable mechanistic insight for guiding specific therapeutic strategies, which may include drug induced reactivation of metastasis suppressor genes and their signaling pathways. Clinical assessment of metastasis suppressor gene product status in disseminated cancer cells may improve the accuracy of predicting the prognosis in patients with clinically localized disease.
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Affiliation(s)
- Eric C Kauffman
- Section of Urology, Department of Surgery, University of Chicago Comprehensive Cancer Research Center, Illinois 60637, USA
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Roddiger SJ, Renneberg H, Martin T, Tunn UW, Zamboglou N, Kurek R. Human kallikrein 2 (hK2) mRNA in peripheral blood of patients with thyroid cancer: a novel molecular marker? J Cancer Res Clin Oncol 2003; 129:29-34. [PMID: 12618898 DOI: 10.1007/s00432-002-0401-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2002] [Accepted: 11/12/2002] [Indexed: 10/25/2022]
Abstract
PURPOSE To elucidate whether hK2 mRNA can be detected in peripheral blood of patients with thyroid disease using reverse transcription polymerase chain reaction (RT-PCR). METHODS A nested RT-PCR protocol for the detection of hK2 mRNA was established, and blood samples of 72 patients with a history of thyroid cancer, 10 patients with current metastases of thyroid cancer, and 32 volunteers were tested. RESULTS hK2-transcripts were significantly more often detected in patients with thyroid cancer (20/72=28%) than in the control group (2/32=6%, P = 0.03, chi-square analysis). CONCLUSIONS This is the first study reporting on hK2 as a potential molecular marker for patients with thyroid cancer. We could demonstrate a correlation between diagnosis of thyroid cancer and the positive signal for hK2 in the RT-PCR assay. Future studies are necessary to prove the clinical value of hK2 as a molecular marker regarding recurrence and outcome.
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Affiliation(s)
- Sandra J Roddiger
- Department of Radiation Oncology, Academic Hospital, Starkenburgring 66, 63069, Offenbach, Germany
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Ylikoski A, Pettersson K, Nurmi J, Irjala K, Karp M, Lilja H, Lövgren T, Nurmi M. Simultaneous Quantification of Prostate-specific Antigen and Human Glandular Kallikrein 2 mRNA in Blood Samples from Patients with Prostate Cancer and Benign Disease. Clin Chem 2002. [DOI: 10.1093/clinchem/48.8.1265] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background: Detection or quantification of circulating cancer cells has been proposed as an aid in detection and monitoring of several solid tumors. We investigated the classification accuracy of prostate-specific antigen (PSA) and human glandular kallikrein 2 (hK2) mRNA copy numbers in blood for the differentiation of patients with prostate cancer (PC) and benign disease.
Methods: PSA and hK2 mRNA expression was studied in blood samples from 51 men with PC and 19 men with benign disease. Among the PC patients, 10 had organ-confined disease (pT1–pT2). We used a multiplexed reverse transcription-PCR assay with two highly target-like mRNA internal standards for the simultaneous quantification of PSA and hK2 mRNA. An external calibration curve covered the range of 102–106 mRNA copies.
Results: PSA and hK2 mRNA were detected in 41 of 51 (median, 1200 copies/0.5 mL of blood) and 43 of 51 (median, 3800 copies/0.5 mL of blood) patients with PC, respectively, whereas only 1 of 19 men with benign disease was positive for both mRNAs (1500 PSA and 3100 hK2 mRNA copies/0.5 mL of blood; P <0.0001, Mann–Whitney U-test). Of the 10 patients with organ-confined PC, only 3 with low Gleason scores (≤5) were negative for both PSA and hK2 (P = 0.02, Mann–Whitney U-test).
Conclusions: The presence of PC cells in the blood circulation is an early event in PC progression, and quantitative assays for PSA and hK2 mRNA discriminate benign from PC cases. Further studies are needed to determine the diagnostic accuracy and prognostic value of the assays.
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Affiliation(s)
- Alice Ylikoski
- Department of Biotechnology, University of Turku, 20520 Turku, Finland
| | - Kim Pettersson
- Department of Biotechnology, University of Turku, 20520 Turku, Finland
| | - Jussi Nurmi
- Department of Biotechnology, University of Turku, 20520 Turku, Finland
| | - Kerttu Irjala
- Departments of Clinical Chemistry, Turku University Hospital, 20520 Turku, Finland
| | - Matti Karp
- Department of Biotechnology, University of Turku, 20520 Turku, Finland
| | - Hans Lilja
- Department of Laboratory Medicine, Division of Clinical Chemistry, Lund University, University Hospital, 20502 Malmö, Sweden
| | - Timo Lövgren
- Department of Biotechnology, University of Turku, 20520 Turku, Finland
| | - Martti Nurmi
- Departments of Urology, Turku University Hospital, 20520 Turku, Finland
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19
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Bianco FJ, Powell IJ, Cher ML, Wood DP. Presence of circulating prostate cancer cells in African American males adversely affects survival. Urol Oncol 2002; 7:147-52. [PMID: 12474530 DOI: 10.1016/s1078-1439(02)00179-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
African-Americans (AAM) with prostate cancer are more likely to relapse than Caucasian-Americans (CAM) despite controlling for known prognostic factors. One explanation may be that micrometastatic disease in AAM behaves more aggressively than in CAM. We tested this hypothesis by comparing the reverse transcriptase polymerase chain reaction amplification of the Prostatic Specific Antigen-mRNA (RTPCR PSA-mRNA) results from peripheral blood samples of AAM and CAM with respect to disease outcome. We evaluated the peripheral blood of 246 consecutive patients at the time of radical prostatectomy. The RTPCR PSA-mRNA test for determination of circulating prostate cancer cells was performed. The results were stratified by races and correlated with standard clinico-pathological variables and disease free survival. 27% and 23% of AAM and CAM patients were RTPCR PSA-mRNA positive, respectively. The RTPCR PSA-mRNA status correlated with the pathologic stage in CAM but not in AAM, (p = 0.05). There was no association with Gleason score, PSA level, or clinical stage with the RTPCR PSA-mRNA status in either group. AAM with organ-confined prostate cancer were marginally more likely to have circulating prostate cells than similarly staged CAM (24% vs. 17%). In AAM but not CAM who had prostate cancer, the RTPCR PSA-mRNA status correlated with and was an independent predictor of disease-free survival. Our data suggests that, though the likelihood of having circulating prostate cells is the same in AAM and CAM, the presence of circulating prostate cells in AAM is predictive of a worse outcome. This may partially explain the worse prognosis in AAM vs. CAM with clinically localized prostate cancer.
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Affiliation(s)
- Fernando J Bianco
- Department of Urology, Wayne State University School of Medicine, Detroit, MI 48201.
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20
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Llanes L, Ferruelo A, Páez A, Gómez JM, Moreno A, Berenguer A. The clinical utility of the prostate specific membrane antigen reverse-transcription/polymerase chain reaction to detect circulating prostate cells: an analysis in healthy men and women. BJU Int 2002; 89:882-5. [PMID: 12010232 DOI: 10.1046/j.1464-410x.2002.02774.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the overall specificity of nested reverse transcriptase-polymerase chain reaction (RT-PCR) to detect prostate-specific membrane antigen (PSM) mRNA in peripheral blood samples of healthy donors. SUBJECTS AND METHODS Peripheral blood samples were taken from 60 healthy blood-donors (30 men and 30 women aged < 50 years) and analysed for PSM-mRNA using nested RT-PCR (in 'hot-start' conditions and confirmed using nested EcoRI restriction enzyme). Intron-spanning primer pairs specific for human PSM were deduced from the GenBank sequence (M99487) using gene software. The outer primer pair for PSM was: fwd: 1368 5'-TCACCGGGACTCATGGGTGT-3'; reverse: 1860 5'-GCCTGAAGCAATTCCAAGTCGG-3'. Inner primer pair for PSM was: fwd: 1480 5'-AAGGAAGGGTGGAGACCTAG-3'; reverse: 5-ACTGAACTCTGGGGAAGGAC-3'. The integrity of cDNAs was checked using primer pairs specific for the housekeeping gene beta-actin. The specificity and false-positive rate were calculated assuming that the underlying prostate cancer incidence was nil. RESULTS The first PCR was negative for all samples (100% specificity; 0% false-positive rate). The nested PCR detected 23 positive samples (23/60, 38%) with an overall specificity of 62% (false positive rate, 38%). CONCLUSION Nested RT-PCR of PSM-mRNA in peripheral blood is highly unspecific. Its clinical utility in the management of prostate cancer must be low. Further development is needed of quantitative RT-PCR, primers that identify prostatic PSM or another prostate-specific marker gene to differentiate PSM mRNA from circulating prostate cells and from non-prostatic tissues.
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Affiliation(s)
- L Llanes
- Department of Urology, Hospital Universitario de Getafe, Madrid, Spain
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21
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Fisher TL, Nocera M, Willis RA, Turner MJ, Abdul Alim CS, Brown DM, Bourne PA, di Sant'Agnese PA, Messing EM, Lord EM, Frelinger JG. Generation of monoclonal antibodies specific for human kallikrein 2 (hK2) using hK2-expressing tumors. Prostate 2002; 51:153-65. [PMID: 11967950 DOI: 10.1002/pros.10071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Human kallikrein 2 (hK2) and prostate-specific antigen (PSA) are serine proteases in the human kallikrein gene family that are 80% identical at the protein level. Like PSA, hK2 is expressed primarily in the prostate, making it an attractive bio-marker for prostate cancer development. In addition, its potent enzymatic activity may functionally affect the biology of prostate cancer. In order to further elucidate the possible roles of hK2 in prostate cancer, we have generated a panel of hK2-specific, non-PSA cross-reactive monoclonal antibodies. METHODS A novel tumor-immunization strategy was used to produce monoclonal antibodies. Human hK2 cDNA was transfected into a BALB/c tumor cell line and used to immunize both BALB/c and PSA-expressing BALB/c.PSA transgenic mice. Because the BALB/c.PSA transgenic mouse showed a biased response towards hK2, a B cell fusion was performed using spleen cells from a transgenic mouse immunized in this fashion. RESULTS A panel of monoclonal antibodies was produced and shown to be hK2-specific using newly developed hK2-specific sandwich ELISA and ELIspot assays. One of the monoclonal antibodies (6B7) was used to detect hK2 in human prostate by immunohistochemistry. Interestingly, two of the antibodies affected the function of hK2. The 1F8 antibody enhanced the enzymatic activity of hK2 whereas the 3C7 antibody inhibited its function. CONCLUSIONS These hK2-specific antibodies illustrate a novel approach for constructing B-cell hybridomas and provide useful reagents to examine the role of hK2 in the biology and detection of prostate cancer.
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Affiliation(s)
- Terrence L Fisher
- Department of Microbiology and Immunology, School of Medicine and Dentistry, University of Rochester Cancer Center, 575 Elmwood Avenue, Rochester, NY 14642, USA
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22
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Ylikoski A, Karp M, Pettersson K, Lilja H, Lövgren T. Simultaneous quantification of human glandular kallikrein 2 and prostate-specific antigen mRNAs in peripheral blood from prostate cancer patients. J Mol Diagn 2001; 3:111-22. [PMID: 11486050 PMCID: PMC1906957 DOI: 10.1016/s1525-1578(10)60660-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We present a multiplexed and internally calibrated quantitative reverse transcription-PCR (QRT-PCR) assay to detect human glandular kallikrein 2 (hK2) and prostate-specific antigen (PSA) transcripts in blood samples from healthy subjects and prostate cancer (PC) patients. The assay detected 50 copies of hK2 and PSA mRNA, and 1 PSA- and 10 hK2-expressing LNCaP cells in the presence of 2.5 x 10(6) PSA- and hK2-negative cells. In PC patients, 20 of 25 and 19 of 25 gave detectable PSA and hK2 mRNAs, respectively. Number of hK2 mRNA copies was significantly higher than that of PSA mRNA copies in patients with biochemically progressive (P = 0.02) PC, and with locally advanced and metastasized (P = 0.004) PC. Patients with rapidly progressive and hormone refractory PC gave detectable hK2 mRNA only in 2 of 8 and PSA mRNA in 3 of 8 patients. Neither PSA nor hK2 mRNAs were detected in 16 healthy subjects. PSA and hK2 discriminated PC patients with biochemically progressive and advanced disease from the controls and from the aggressive distant metastatic disease. The assay provides a reliable quantification of the number of hK2 and PSA mRNA copies, allows to discriminate PC cases from healthy subjects, and offers a tool for further studies on molecular staging of PC.
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Affiliation(s)
- A Ylikoski
- Department of Biotechnology, University of Turku, Turku, Finland
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23
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Ghossein RA, Bhattacharya S. Molecular detection and characterisation of circulating tumour cells and micrometastases in solid tumours. Eur J Cancer 2000; 36:1681-94. [PMID: 10959054 DOI: 10.1016/s0959-8049(00)00152-0] [Citation(s) in RCA: 111] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The detection and molecular characterisation of circulating tumour cells (CTC) and micrometastases may have important prognostic and therapeutic implications. Because their numbers are very small, these tumour cells are not easily detected using conventional methods. In the last decade, numerous groups have attempted to detect occult tumour cells in solid malignancies using the highly sensitive reverse transcriptase polymerase chain reaction (RT-PCR). These assays were in the vast majority directed against tissue-specific markers. PCR was shown to be superior to conventional techniques in detecting occult tumour cells allowing the identification of one malignant cell mixed with 1-10 million normal cells. In some tumours like melanoma and prostatic carcinoma, tissue-specific transcripts were detected with high specificity in the blood of patients with localised and advanced disease. In some reports, PCR was shown to be a strong predictor of poorer outcome. However, due to the many limitations of PCR (e.g false-positives), many groups are developing new approaches for the detection of occult tumour cells. The most attractive technique involves immunomagnetic isolation of CTC and micrometastases prior to downstream analysis. The tumour-rich magnetic fraction can be subjected to RT-PCR, immunocytochemistry and in situ hybridisation. This will lead to better quantification and molecular characterisation of these tumour cells. In conclusion, the molecular detection and characterisation of occult tumour cells offer a great opportunity for better stratifying patients with solid tumours and for developing new prognostic markers and targeted therapies.
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Affiliation(s)
- R A Ghossein
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10021, USA
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Zippelius A, Pantel K. RT-PCR-based detection of occult disseminated tumor cells in peripheral blood and bone marrow of patients with solid tumors. An overview. Ann N Y Acad Sci 2000; 906:110-23. [PMID: 10818606 DOI: 10.1111/j.1749-6632.2000.tb06600.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Despite recent progress in early detection and local curative therapy, patients with primary epithelial cancer quite frequently relapse with incurable metastasis. Early disseminated tumor cells that may be seminal for distant failure and are undetectable by current diagnostic methods have been identified by immunocytochemical techniques in bone marrow of cancer patients using monoclonal antibodies against cytokeratins. Recently, promising new molecular approaches, namely, reverse transcriptase--polymerase chain reaction (RT-PCR) assays, have been suggested as a potential technique for the detection of minimal residual tumor burden by targeting mRNA transcribed from epithelial genes in bone marrow, peripheral blood, or lymph nodes. Several studies using RT-PCR thus far indicate a highly sensitive and specific staging tool, although the prognostic value is still controversial. However, limitations may arise from ectopic expression of marker mRNA in hematopoietic cells and deficient expression in circulating tumor cells. The present review focuses on the relevant literature and demonstrates the range of current applications of RT-PCR-based assays for detecting disseminated tumor cells in peripheral blood and bone marrow of patients with solid tumors. We will both summarize technical evaluations of published molecular approaches and discuss the widely disparate results on PCR findings in clinical studies.
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Affiliation(s)
- A Zippelius
- Medizinische Klinik III, Klinikum Grosshadern, München, Germany.
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25
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Su SL, Boynton AL, Holmes EH, Elgamal AA, Murphy GP. Detection of extraprostatic prostate cells utilizing reverse transcription-polymerase chain reaction. SEMINARS IN SURGICAL ONCOLOGY 2000; 18:17-28. [PMID: 10617893 DOI: 10.1002/(sici)1098-2388(200001/02)18:1<17::aid-ssu4>3.0.co;2-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This article reviews the utility of reverse transcription-polymerase chain reaction (RT-PCR) in prostate cancer. RT-PCR aims to detect occult micrometastases in non-prostatic sites. Due to its exquisite analytical sensitivity, RT-PCR is able to amplify and detect even low-level, prostate-specific messages present at these extraprostatic sites. In recent years, a fair amount of data on the clinical utility of the technique had been reported. The target tissues under investigation are peripheral blood, bone marrow aspirate, and lymph nodes. Favorite markers of choice are prostate-specific antigen (PSA), prostate-specific membrane antigen (PSMA), and human glandular kallikrein-2 (hK2). False positives among negative controls are low. For the most part, RT-PCR is inadequate in detecting tumor cells in the peripheral blood from patients who are known to have metastatic prostate cancer. All studies showed that RT-PCR could detect PSA, PSMA or hK2 mRNAs in the circulation of patients who have organ-confined or extraprostatic disease. Most studies showed that RT-PCR utilizing current markers could not be used as a prospective test to diagnose prostate cancer. However, a few studies also showed that the detection rate could be predictive and sensitive enough to differentiate patients with organ-confined disease from those with extraprostatic disease. Data from PSA- or PSMA-RT-PCR using lymph nodes as the tissue source is more encouraging. RT-PCR was able to detect PSA and/or PSMA positive samples that have not been detected by conventional pathology.
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Affiliation(s)
- S L Su
- Northwest Biotherapeutics, Inc., Seattle, Washington 98125, USA.
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26
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de la Taille A, Olsson CA, Buttyan R, Benson MC, Bagiella E, Cao Y, Burchardt M, Chopin DK, Katz AE. Blood-based reverse transcriptase polymerase chain reaction assays for prostatic specific antigen: long term follow-up confirms the potential utility of this assay in identifying patients more likely to have biochemical recurrence (rising PSA) following radical prostatectomy. Int J Cancer 1999; 84:360-4. [PMID: 10404086 DOI: 10.1002/(sici)1097-0215(19990820)84:4<360::aid-ijc5>3.0.co;2-e] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Reverse transcriptase polymerase chain reaction (RT-PCR) assay is a sensitive technique to detect circulating cells expressing prostate-specific antigen (PSA) in blood or bone marrow from patients with prostate cancer. When applied to prostate cancer patients at our institution, this technique identifies those patients with a greater likelihood of extra-prostatic disease. We evaluated RT-PCR PSA as a predictor of PSA recurrence and compared it with pre-operative (serum PSA, digital rectal examination, Gleason score on biopsy) and post-operative parameters (pathological findings). Three hundred nineteen men scheduled for radical prostatectomy had an enhanced RT-PCR PSA assay before surgery. The enhanced RT-PCR PSA protocol has been previously described. PSA recurrence was defined as any serum PSA value above 0.2 microgram/l. Forty-six patients had PSA recurrence. The mean follow-up was 25.4 months. Recurrence free survival was 53% for patients with positive RT-PCR PSA vs. 84% if RT-PCR PSA was negative. By using multivariate analyses, RT-PCR PSA status was not an independent predictor of PSA recurrence compared to pathological stage pT3, Gleason score on prostate specimen and serum PSA. If only pre-operative parameters were studied, serum PSA and RT-PCR PSA status were 2 independent pre-operative predictors of PSA recurrence compared with Gleason score on biopsy and digital rectal examination. Int. J. Cancer (Pred. Oncol.) 84:360-364, 1999.
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Affiliation(s)
- A de la Taille
- Department of Urology, The Squier Urological Clinic, Columbia University College of Physicians and Surgeons, Columbia-Presbyterian Medical Center, New York, New York, USA
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DETECTION OF CIRCULATING PROSTATE SPECIFIC ANTIGEN EXPRESSING PROSTATIC CELLS IN THE BONE MARROW OF RADICAL PROSTATECTOMY PATIENTS BY SENSITIVE REVERSE TRANSCRIPTASE POLYMERASE CHAIN REACTION. J Urol 1999. [DOI: 10.1097/00005392-199904000-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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Gao CL, Maheshwari S, Dean RC, Tatum L, Mooneyhan R, Connelly RR, McLeod DG, Srivastava S, Moul JW. Blinded evaluation of reverse transcriptase-polymerase chain reaction prostate-specific antigen peripheral blood assay for molecular staging of prostate cancer. Urology 1999; 53:714-21. [PMID: 10197846 DOI: 10.1016/s0090-4295(98)00608-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The reverse transcriptase-polymerase chain reaction (RT-PCR)-prostate-specific antigen (PSA) assay to detect presumed occult micrometastatic prostate cancer has been controversial, and this molecular staging has been thought to be clinically useful by some groups but not others. METHODS We used a sensitive nested RT-PCR assay with specific primers derived from the PSA sequence and a very stringent two-step PCR protocol with denaturing temperature of 94 degrees C annealing and extension temperature of 68 degrees C. This method enabled us to detect PSA-expressing LNCaP prostate cancer (PC) cells as low as one cell of 10 million lymphocytes (1/10(7)). Ninety-six patients with PC were studied, including 85 before radical prostatectomy (RP), and 22 controls, including healthy men and women and men with benign prostatic hyperplasia. RESULTS In 85 patients undergoing RP, a minimum of two independent RT-PCR-PSA assays detected circulating prostate cells preoperatively in 27 patients (31.8%). Of 12 patients with locally advanced or advanced stage cancer, RT-PCR-PSA was positive in 5 (41.7%); of the 22 controls, no patient was RT-PCR-PSA positive. In 10 randomly selected cases, the RT-PCR product was confirmed as PSA by DNA sequencing. Of the 27 patients undergoing RP who were RT-PCR positive, 11 (40.7%) had non-organ-confined disease (pT3a or greater), and of the 58 patients who were RT-PCR negative, 32 (55.2%) had non-organ-confined disease. Patients with RT-PCR positive results also had lower margin positivity (9 of 27, 33.3%) than did patients with RT-PCR negative results (21 of 58, 36.2%). Finally, at a mean follow-up of 25.7 months, 5 (18.5%) of 27 RT-PCR positive patients had recurrence (PSA) compared with 14 (24.1%) of 58 RT-PCR negative patients. CONCLUSIONS On the basis of this blinded study, RT-PCR for PSA-expressing cells in 85 patients before RP is not related to clinical stage, age, race, grade, Gleason sum, serum PSA or prostatic acid phosphatase, tumor volume, or tumor multifocality. RT-PCR positivity did not predict pathologic stage or early PSA recurrence. A standardized RT-PCR assay needs to be developed to account for interlaboratory discrepancies.
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Affiliation(s)
- C L Gao
- Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814-4799, USA
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29
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DETECTION OF CIRCULATING PROSTATE SPECIFIC ANTIGEN EXPRESSING PROSTATIC CELLS IN THE BONE MARROW OF RADICAL PROSTATECTOMY PATIENTS BY SENSITIVE REVERSE TRANSCRIPTASE POLYMERASE CHAIN REACTION. J Urol 1999. [DOI: 10.1016/s0022-5347(01)61592-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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30
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Murphy GP, Elgamal AAA, Su SL, Bostwick DG, Holmes EH. Current evaluation of the tissue localization and diagnostic utility of prostate specific membrane antigen. Cancer 1998. [DOI: 10.1002/(sici)1097-0142(19981201)83:11%3c2259::aid-cncr5%3e3.0.co;2-t] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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31
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Murphy GP, Elgamal AAA, Su SL, Bostwick DG, Holmes EH. Current evaluation of the tissue localization and diagnostic utility of prostate specific membrane antigen. Cancer 1998. [DOI: 10.1002/(sici)1097-0142(19981201)83:11<2259::aid-cncr5>3.0.co;2-t] [Citation(s) in RCA: 136] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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32
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Moreno JG, Gomella LG. Circulating Prostate Cancer Cells Detected by Reverse Transcription-Polymerase Chain Reaction (RT-PCR): What Do They Mean? Cancer Control 1998; 5:507-512. [PMID: 10761099 DOI: 10.1177/107327489800500603] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND: Molecular techniques have been developed recently to assess for circulating tumor cells. This "molecular staging" of prostate cancer uses the reverse transcription-polymerase chain reaction (RT-PCR) to detect cells that contain PSA or PSMA in the bloodstream. Currently, the clinical application of this concept is controversial. METHODS: The authors discuss the current status of molecular biologic methods to detect circulating prostate cancer cells. They report on the limitations of the technology and the advances that will allow the quantification of these circulating cells. RESULTS: Studies generally indicate an increasing level of PSA RT-PCR positivity as disease advances. However, reports have been significantly diverse, and there is no clear explanation for this disparity. CONCLUSIONS: The determination of the "circulating prostate cancer cell load" by RT-PCR or other techniques may prove to be useful in the management of patients with prostate cancer, but questions remain to be answered before we can develop and assess new therapeutic strategies that will advance the treatment of prostate cancer before metastasis becomes evident. A better understanding of the biology of tumor cells present in the circulatory system is also needed.
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Affiliation(s)
- JG Moreno
- Department of Urology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pa 19107, USA
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33
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Mannello F, Luchetti F, Lancioli D, Battistelli S, Papa S, Gazzanelli G. Prostate-specific Antigen Expression in Neoplastic Human Myeloid Cell Lines. Clin Chem 1998. [DOI: 10.1093/clinchem/44.9.1991] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ferdinando Mannello
- Instituto di Istologia ed Analisi di Laboratorio, Facoltà di Scienze, MFN Università, Via E. Zeppi, 61029 Urbino, Italy
| | - Francesca Luchetti
- Instituto di Scienze Morfologiche, Università Studi, 61029 Urbino, Italy; Laboratorio Analisi, Ospedale Civile, 61029 Urbino, Italy
| | | | - Serafina Battistelli
- Instituto di Istologia ed Analisi di Laboratorio, Facoltà di Scienze, MFN Università, Via E. Zeppi, 61029 Urbino, Italy
| | - Stefano Papa
- Instituto di Scienze Morfologiche, Università Studi, 61029 Urbino, Italy; Laboratorio Analisi, Ospedale Civile, 61029 Urbino, Italy
| | - Giancarlo Gazzanelli
- Instituto di Istologia ed Analisi di Laboratorio, Facoltà di Scienze, MFN Università, Via E. Zeppi, 61029 Urbino, Italy
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34
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Daher R, Beaini M. Prostate-specific antigen and new related markers for prostate cancer. Clin Chem Lab Med 1998; 36:671-81. [PMID: 9804390 DOI: 10.1515/cclm.1998.120] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although prostate-specific antigen (PSA), or human kallikrein 3, is the most valuable tool available for the diagnosis and management of prostate cancer, as currently used it is insufficiently sensitive and specific for early detection or staging of the malignancy. Many new concepts have been introduced in order to optimize the clinical use of PSA measurements, but each one has its own drawbacks. The molecular forms of PSA, especially the free PSA, seem to be useful for the detection of prostate cancer in men with PSA concentrations falling in the 4-10 microg/l range. New molecular techniques, such as reverse transcriptase polymerase chain reaction for the detection of minimal amounts of PSA messenger RNA and prostate-specific membrane antigen, offer new promise for the prognosis and possibly staging of prostate cancer. On the other hand, human kallikrein 2, a serine protease closely related to PSA that is also expressed predominantly in the prostate, may be a new adjuvant marker for prostate cancer. As for its biological functions, PSA can no longer be regarded as a specific prostate molecule associated mainly with semen liquefaction when it has a possible role as a prognostic indicator in female breast cancer. The biological role of PSA in normal tissues and tumors may be much more complex than previously thought and requires further investigation.
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Affiliation(s)
- R Daher
- Department of Pathology and Laboratory Medicine, American University of Beirut, Lebanon.
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35
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Corey E, Corey MJ. Detection of disseminated prostate cells by reverse transcription-polymerase chain reaction (RT-PCR): technical and clinical aspects. Int J Cancer 1998; 77:655-73. [PMID: 9688296 DOI: 10.1002/(sici)1097-0215(19980831)77:5<655::aid-ijc1>3.0.co;2-u] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- E Corey
- Genitourinary Research Cancer Laboratory of the Urology Department, the School of Medicine of the University of Washington, Seattle 98195, USA.
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36
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37
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Rittenhouse HG, Finlay JA, Mikolajczyk SD, Partin AW. Human Kallikrein 2 (hK2) and prostate-specific antigen (PSA): two closely related, but distinct, kallikreins in the prostate. Crit Rev Clin Lab Sci 1998; 35:275-368. [PMID: 9759557 DOI: 10.1080/10408369891234219] [Citation(s) in RCA: 227] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Recent studies on human kallikrein 2 (hK2) have revealed striking similarities and significant differences with the closely related kallikrein PSA. Both PSA and hK2 are primarily localized to the prostate and share close structural similarities. Although both kallikreins are produced by the same secretory epithelial cells in the prostate, hK2 is associated more with prostate tumors than PSA and is highly expressed in poorly differentiated cancer cells. The potent trypsin-like activity of hK2 contrasts with the weak chymotrypsin-like activity of PSA. The inactive precursor form of PSA, proPSA, is converted rapidly to active PSA by hK2, suggesting an important in vivo regulatory function by hK2 on PSA activity. The high homology between hK2 and PSA results in significant cross-reactivity to hK2 by polyclonal and some monoclonal antibodies to PSA. Future studies on both PSA and hK2 need to take into account this potential for cross-reactivity. Specific monoclonal antibodies to hK2 have now demonstrated that serum levels of hK2, like PSA, are correlated with prostate cancer. The production of hK2 protein in active protease form and specific monoclonal antibodies to the hK2 antigen will allow extensive future studies delineating the physiological and clinical utility of this new prostate antigen.
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Affiliation(s)
- H G Rittenhouse
- Research and Development Department, Hybritech Incorporated, Beckman Coulter, Inc., San Diego, California, USA.
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38
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RE: REVERSE TRANSCRIPTASE POLYMERASE CHAIN REACTION FOR PROSTATE SPECIFIC ANTIGEN IN THE MANAGEMENT OF PROSTATE CANCER. J Urol 1998. [DOI: 10.1097/00005392-199805000-00080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Racila E, Euhus D, Weiss AJ, Rao C, McConnell J, Terstappen LW, Uhr JW. Detection and characterization of carcinoma cells in the blood. Proc Natl Acad Sci U S A 1998; 95:4589-94. [PMID: 9539782 PMCID: PMC22534 DOI: 10.1073/pnas.95.8.4589] [Citation(s) in RCA: 492] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/1998] [Indexed: 02/07/2023] Open
Abstract
A highly sensitive assay combining immunomagnetic enrichment with multiparameter flow cytometric and immunocytochemical analysis has been developed to detect, enumerate, and characterize carcinoma cells in the blood. The assay can detect one epithelial cell or less in 1 ml of blood. Peripheral blood (10-20 ml) from 30 patients with carcinoma of the breast, from 3 patients with prostate cancer, and from 13 controls was examined by flow cytometry for the presence of circulating epithelial cells defined as nucleic acid+, CD45(-), and cytokeratin+. Highly significant differences in the number of circulating epithelial cells were found between normal controls and patients with cancer including 17 with organ-confined disease. To determine whether the circulating epithelial cells in the cancer patients were neoplastic cells, cytospin preparations were made after immunomagnetic enrichment and were analyzed. Epithelial cells from patients with breast cancer generally stained with mAbs against cytokeratin and 3 of 5 for mucin-1. In contrast, no cells that stained for these antigens were observed in the blood from normal controls. The morphology of the stained cells was consistent with that of neoplastic cells. Of 8 patients with breast cancer followed for 1-10 months, there was a good correlation between changes in the level of tumor cells in the blood with both treatment with chemotherapy and clinical status. The present assay may be helpful in early detection, in monitoring disease, and in prognostication.
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Affiliation(s)
- E Racila
- Cancer Immunobiology Center, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75235, USA
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