Do Circulating Tumor Cell Numbers Increase in Prostate Cancer Patients after Attentive DRE or Robot Assisted Prostatectomy?
Abstract
Circulating tumor cells (CTCs) are thought to be present in all patients diagnosed with cancer. In addition to lymph nodes, disseminated dormant tumor cells (DTCs) are present in the pelvic aspirates of the majority of men diagnosed with prostate cancer. Since it is known that an attentive Digital Rectal Exam (DRE) mobilizes both PSA and prostate cancer specific biomarkers like TMPRSS2:ERG, we asked whether or not DRE increased the basal level of CTCs in patients diagnosed with prostate cancer. Here we report that while attentive DRE appears to double the observed CTC count, the result yields a p value of 0.105 in a generalized estimating equation data analysis. Further, we note that the CTC count appears to be doubled after robotic radical prostatectomy, although here again the p value of 0.109 suggests lack of significance. Our results agree with published results on CTC levels before and after surgery, but suggest that the existing experimental data on this topic is underpowered. It remains possible that an attentive DRE prior to liquid biopsy for prostate cancer could improve the sensitivity of tests based on CTC count.
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Nagrath S, Sequist LV, Maheswaran S, Bell DW, Irimia D, Ulkus L, et al. Isolation of rare circulating tumour cells in cancer patients by microchip technology. Nature. 2007 Dec 20;450(7173):1235-9.
Tan SJ, Lakshmi RL, Chen P, Lim WT, Yobas L, Lim CT. Versatile label free biochip for the detection of circulating tumor cells from peripheral blood in cancer patients. Biosens Bioelectron. 2010 Dec 15;26(4):1701-5.
Norton L, Massague J. Is cancer a disease of self-seeding? Nat Med. 2006 Aug;12(8):875-8.
Kim MY, Oskarsson T, Acharyya S, Nguyen DX, Zhang XH, Norton L, et al. Tumor self-seeding by circulating cancer cells. Cell. 2009 Dec 24;139(7):1315-26.
Morgan TM, Lange PH, Porter MP, Lin DW, Ellis WJ, Gallaher IS, et al. Disseminated tumor cells in prostate cancer patients after radical prostatectomy and without evidence of disease predicts biochemical recurrence. Clin Cancer Res. 2009 Jan 15;15(2):677-83.
Heller G, Fizazi K, McCormack R, Molina A, MacLean D, Webb IJ, et al. The Added Value of Circulating Tumor Cell Enumeration to Standard Markers in Assessing Prognosis in a Metastatic Castration-Resistant Prostate Cancer Population. Clin Cancer Res. 2017 Apr 15;23(8):1967-73.
Vogelzang NJ, Fizazi K, Burke JM, De Wit R, Bellmunt J, Hutson TE, et al. Circulating Tumor Cells in a Phase 3 Study of Docetaxel and Prednisone with or without Lenalidomide in Metastatic Castration-resistant Prostate Cancer. Eur Urol. 2017 Feb;71(2):168-71.
Daskalakis M, Mavroudis D, Sanidas E, Apostolaki S, Askoxylakis I, de Bree E, et al. Assessment of the effect of surgery on the kinetics of circulating tumour cells in patients with operable breast cancer based on cytokeratin-19 mRNA detection. Eur J Surg Oncol. 2011 May;37(5):404-10.
Hermansson U, Konstantinov IE, Aren C. Tumor dissemination after video-assisted thoracic surgery: What does it mean? J Thorac Cardiov Sur. 1997 Aug;114(2):300-2.
Kienle P, Koch M, Autschbach F, Benner A, Treiber M, Wannenmacher M, et al. Decreased detection rate of disseminated tumor cells of rectal cancer patients after preoperative chemoradiation - A first step towards a molecular surrogate marker for neoad juvant treatment in colorectal cancer. Ann Surg. 2003 Sep;238(3):324-30.
Eschwege P, Dumas F, Blanchet P, Lemaire V, Benoit G, Jardin A, et al. Hematogenous Dissemination of Prostatic Epithelial-Cells during Radical Prostatectomy. Lancet. 1995 Dec 9;346(8989):1528-30.
Koch M, Kienle P, Sauer P, Willeke F, Buhl K, Benner A, et al. Hematogenous tumor cell dissemination during colonoscopy for colorectal cancer. Surg Endosc. 2004 Apr;18(4):587-91.
Koch M, Antolovic D, Kienle P, Horstmann J, Herfarth C, Doeberitz MV, et al. Increased detection rate and potential prognostic impact of disseminated tumor cells in patients undergoing endorectal ultrasound for rectal cancer. Int J Colorectal Dis. 2007 Apr;22(4):359-65.
Clark JP, Munson KW, Gu JW, Lamparska-Kupsik K, Chan KG, Yoshida JS, et al. Performance of a Single Assay for both Type III-Type VI TMPRSS2:ERG fusions in Non-Invasive Prediction of Prostate Biopsy Outcome. Clinical Chemistry. 2008;54:2007-17.
Whelan C, Kawachi M, Smith DD, Linehan J, Babilonia G, Mejia R, et al. Expressed Prostatic Secretion Biomarkers Improve Stratification of National Comprehensive Cancer Network Active Surveillance Candidates: Performance of Secretion Capacity and TMPRSS2:ERG Models. J Urol. 2013 May 10.
Tomlins SA, Aubin SM, Siddiqui J, Lonigro RJ, Sefton-Miller L, Miick S, et al. Urine TMPRSS2:ERG fusion transcript stratifies prostate cancer risk in men with elevated serum PSA. Sci Transl Med. 2011 Aug 3;3(94):94ra72.
Park EC, Shin YS, Zhang LT, Kim DS, Kim SZ, Park NC, et al. Prospective investigation of change in the prostate-specific antigens after various urologic procedures. Clin Interv Aging. 2015;10:1213-8.
Polascik TJ, Wang ZP, Shue M, Di SJ, Gurganus RT, Hortopan SC, et al. Influence of sextant prostate needle biopsy or surgery on the detection and harvest of intact circulating prostate cancer cells. J Urology. 1999 Sep;162(3):749-52.
Scheumann N, Gorges T, Penkalla N, Nowack B, Schalk T, Riethdorf S, et al. 50P Enumeration And Molecular Characterization Of Circulating Tumor Cells In Lung Cancer Patients Using The Gilupi Cellcollector™, An Effective In Vivo Device For Capturing CTCs.. Ann Oncol. 2015;26(Suppl_1):i14.
Kauffman EC, Lee MJ, Alarcon SV, Lee S, Hoang AN, Walton Diaz A, et al. Lack of Impact of Robotic Assisted Laparoscopic Radical Prostatectomy on Intraoperative Levels of Prostate Cancer Circulating Tumor Cells. J Urol. 2016 Apr;195(4 Pt 1):1136-42.2
Davis JW, Nakanishi H, Kumar VS, Bhadkamkar VA, McCormack R, Fritsche HA, et al. Circulating Tumor Cells in Peripheral Blood Samples from Patients with Increased Serum Prostate Specific Antigen: Initial Results in Early Prostate Cancer. J. Urol. 2008 Jun;179(6):2187-91.
DOI: http://dx.doi.org/10.18103/imr.v3i6.484
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