Extended use of P504S Positive Primary Circulating Prostate Cell Detection to Determine the Need for Initial Prostate Biopsy in a Prostate Cancer Screening Program in Chile

Abstract

Background: To determine the frequency of primary circulating prostate cells (CPC) detection according to age and serum PSA levels in a cohort of men undergoing screening for prostate cancer and to determine the diagnostic yield in those men complying with the criteria for prostate biopsy. Materials and Methods: A prospective study was carried out to analyze all men evaluated in a hospital prostate cancer screening program. Primary CPCs were obtained by differential gel centrifugation and detected using standard immunocytochemistry using anti-PSA, positive samples undergoing a second process with anti-P504S. A malignant primary CPC was defined as PSA+ P504S+, and a test positive if 1 cell/4ml was detected. The frequency of primary CPC detection was compared with age and serum PSA levels. Men with a PSA >4.0ng/ml and/or abnormal rectal examination underwent 12 core prostate biopsy, and the results were registered as cancer/no-cancer and compared with the presence/absence of primary CPCs to calculate the diagnostic yield. Results: A total of 1,117 men participated; there was an association of primary CPC detection with increasing age and increasing serum PSA. Some 559 men underwent initial prostate biopsy of whom 207/559 (37.0%) were positive for primary CPCs and 183/559 (32.0%) had prostate cancer detected. The diagnostic yield of primary CPCs had a sensitivity of 88.5%, a specificity of 88.0%, and positive and negative predictive values of 78.3% and 94.9%, respectively. Conclusions: The use of primary CPCs for testing is recommended, since its high negative predictive value could be used to avoid prostate biopsy in men with an elevated PSA and/or abnormal DRE. Men positive for primary CPCs should undergo prostate biopsy. It is a test that could be implemented in the routine immunocytochemical laboratory.

Comparison of the Formula of PSA, Age, Prostate Volume and Race Versus PSA Density and the Detection of Primary Malignant Circulating Prostate Cells in Predicting a Positive Initial Prostate Biopsy in Chilean Men with Suspicion of Prostate Cancer

“…Normal or benign cells do not express P504S, whereas cells arising from prostatic intraepithelial neoplasia (PIN) or cancer are positive (Beach et al, 2002). The use of primary mCPC detection has been reported to have a high negative predictive value, decrease the number of PB and does not detect low grade small volumen tumors (Murray et al, 2014;Murray et al 2014a).…”

Human Kallikrein-2, Prostate Specific Antigen and Free-Prostate Specific Antigen in Combination to Discriminate Prostate Cancer from Benign Diseases in Syrian Patients

“…But the most important disadvantage of the PSA test is its low specificity which means that a high percentage of the men are negative on initial biopsy (Jansen et al, 2009). This lack of specificity of PSA warrants the use of new biomarkers to diagnose prostate cancer more accurately and decreases the number of unnecessary biopsies (Madu et al, 2010;Murray et al, 2014;Esfahani et al, 2015).…”

Outcome of radical prostatectomy in primary circulating prostate cell negative prostate cancer

“…The concept of primary CPCs, those disseminating prior to primary therapy has been reported to be useful as a sequential test to detect prostate cancer [19]. It is recognised that not all primary CPCs will survive; the majority being eliminated by host defense mechanisms.…”