gms | German Medical Science

27. Deutscher Krebskongress

Deutsche Krebsgesellschaft e. V.

22. - 26.03.2006, Berlin

RT-PCR for PSA mRNA improves the detection of metastases in pelvic lymph nodes of prostate cancer patients

Meeting Abstract

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  • corresponding author presenting/speaker Hans Krause - Charité Universitätsmedizin Berlin, Deutschland
  • Martin Schostak - Charité Universitätsmedizin Berlin
  • Mark Schrader - Charité Universitätsmedizin Berlin
  • Kurt Miller - Charité Universitätsmedizin Berlin

27. Deutscher Krebskongress. Berlin, 22.-26.03.2006. Düsseldorf, Köln: German Medical Science; 2006. DocPE320

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dkk2006/06dkk430.shtml

Veröffentlicht: 20. März 2006

© 2006 Krause et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Approximately 50% of all prostate cancer (PCA) patients can be cured by either radical prostatectomy (RPX) or radiation treatment. For long term prognosis a proper staging at the time of diagnosis is of critical importance. Detection of micrometastatic disease in pelvic lymph nodes, which points to a systemic and unfavorable disease spread, still represents a major challenge for the uropathologist. Supplementing standard pathological grading and staging through methods detecting disease with high specificity and sensitivity on the molecular level might overcome these circumstances. The current study reports initial results obtained by the detection of minimal numbers of PSA expressing cells by means of RT-PCR. Total RNA of 457 pelvic lymph nodes representing 70 patients who underwent RPX (n=53) or laparoscopic lymphadenectomy (n=17) in our clinic in late 1999 and the first half of 2000 were analyzed for PSA mRNA expression either by conventional or quantitative RT-PCR. For this alternate sections of lymph node tissue were either snap frozen for later RNA isolation or underwent standard histopathological examination. The mean age at PCA diagnosis was 65.1 years, the mean initial PSA level was 10.7ng/ml. 20 out of 57 (35%) prostatectomy specimens indicated positive surgical margins, two of these cases (3,5%) were classified pT2. As of May 2005 (5 years of observation time) follow-up data of 57 patients were available. 21 patients showed biochemical PSA recurrence or otherwise detected clinical progress, and 36 patients had no signs for disease recurrence. Two patients died of prostate cancer. Within the “progression group” 7 patients were initially diagnosed with pN+ stage, and all of them were positive for PSA RT-PCR signals, too. Among the pN0 patients we detected PSA mRNA in 10 out of 14 patients of whom 3 belong to a group without obvious signs of established risk factors for disease progression (PSA ≥ 10ng/ml, ≥pT3, Gleason score ≥7, R+, N+). 32 patients in the group with no signs for disease progression (n=36) were classified pN0. Among these 15 patients showed positive PSA RT-PCR signals, and 13 of them fit into the high-risk group for disease progression, leading to speculations about the aggressiveness of disseminated prostatic cells. Our preliminary data (with respect to disease progression), when added to the pathological classification improve the detection rate of primary lymphatically disseminated disease. Despite low specificity, patients with absent established risk factors for disease progression and positive for PSA mRNA expression in pelvic lymph nodes (in this study n=7) should be considered for more stratified therapeutic concepts once PSA levels start to rise.