Abstract
BackgroundWe assessed the incidence of micro-metastases at surgical margins (SM) and pelvic lymph nodes (LN) in patients submitted to radical retropubic prostatectomy (RP) after neoadjuvant therapy (NT) or to RP alone. We compared traditional staging to molecular detection of PSA using Taqman-based quantitative real-time PCR (qrt-PCR) never used before for this purpose.Methods29 patients were assigned to NT plus RP (arm A) or RP alone (arm B). Pelvic LN were dissected for qrt-PCR analysis, together with right and left lateral SM.Results64,3% patients of arm B and 26.6% of arm A had evidence of PSA mRNA expression in LN and/or SM. 17,2% patients, all of arm B, had biochemical recurrence.ConclusionsQrt-PCR may be more sensitive, compared to conventional histology, in identifying presence of viable prostate carcinoma cells in SM and LN. Gene expression of PSA in surgical periprostatic samples might be considered as a novel and reliable indicator of minimal residual disease after NT.
Highlights
We assessed the incidence of micro-metastases at surgical margins (SM) and pelvic lymph nodes (LN) in patients submitted to radical retropubic prostatectomy (RP) after neoadjuvant therapy (NT) or to RP alone
Patients were randomly assigned to neoadjuvant hormonal therapy plus radical prostatectomy or radical prostatectomy alone
Radical Prostatectomy is widely performed in early prostate cancer and it may lead to cure as long as the cancer is confined to the prostate and all neoplastic cells are removed [10]
Summary
We assessed the incidence of micro-metastases at surgical margins (SM) and pelvic lymph nodes (LN) in patients submitted to radical retropubic prostatectomy (RP) after neoadjuvant therapy (NT) or to RP alone. Prostatic carcinoma has an unpredictable clinical behavior. This cancer is widespread in males with 1/5 of men being affected throughout life. Prostate cancer remains the second cause of oncologic death in males in Europe and in the USA [1]. Because of patient-to-patient heterogeneity in the clinical behavior of this disease, prognostic markers that may help tailor therapeutic strategies to individual clinical situations are continuously re-assessed. This frequent reassessment leads to modifications of clinical criteria utilized for the selection of therapeutic strategies which, in turn, make difficult the comparison and interpretation of clinical results among different therapeutic strategies
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