Perioperative Search for Circulating Tumor Cells in Patients Undergoing Prostate Brachytherapy for Clinically Nonmetastatic Prostate Cancer

Abstract

Despite the absence of local prostate cancer recurrence, some patients develop distant metastases after prostate brachytherapy. We evaluate whether prostate brachytherapy procedures have a potential risk for hematogenous spillage of prostate cancer cells. Fifty-nine patients who were undergoing high-dose-rate (HDR) or low-dose-rate (LDR) brachytherapy participated in this prospective study. Thirty patients with high-risk or locally advanced cancer were treated with HDR brachytherapy after neoadjuvant androgen deprivation therapy (ADT). Twenty-nine patients with clinically localized cancer were treated with LDR brachytherapy without neoadjuvant ADT. Samples of peripheral blood were drawn in the operating room before insertion of needles (preoperative) and again immediately after the surgical manipulation (intraoperative). Blood samples of 7.5 mL were analyzed for circulating tumor cells (CTCs) using the CellSearch System. While no preoperative samples showed CTCs (0%), they were detected in intraoperative samples in 7 of the 59 patients (11.8%; preoperative vs. intraoperative, p = 0.012). Positive CTC status did not correlate with perioperative variables, including prostate-specific antigen (PSA) at diagnosis, use of neoadjuvant ADT, type of brachytherapy, Gleason score, and biopsy positive core rate. We detected CTCs from samples immediately after the surgical manipulation. Further study is needed to evaluate whether those CTCs actually can survive and proliferate at distant sites.

Wedge Resection of Tumor Before Lobectomy for Lung Cancer Could Be a No-touch Isolation Technique

“…that surgical manipulation can promote the dissemination of tumor cells into the circulation (5)(6)(7).…”

“…CTCs are released from the primary tumor into the bloodstream and have the potential to spread to distant sites and develop into micro-metastatic deposits (4). Furthermore, surgical manipulation could promote the dissemination of tumor cells into the circulation (5)(6)(7). Prognosis improvement is expected with the no-touch isolation technique (NTIT) due to preventing surgical manipulation.…”

Contrasting Circulating Tumor Cells and Free Circulating DNA Responses in Men Treated for Prostate Cancer after Primary Versus Salvage Radiotherapy

“…To the best of our knowledge, there are no reports describing CTCs changes following primary external beam RT. A recent study from Japan, reported elevation in CTC numbers after brachytherapy for prostate cancer [26]. However, this was attributable to surgical manipulation of the gland.…”

Advances in Biomarkers for PCa Diagnostics and Prognostics—A Way towards Personalized Medicine

“…This Special Issue also covered studies on seminal plasma biomarkers [ 35 ], improved PET contrast between osteolytic and osteoblastic bone metastatic lesions with fasting [ 36 ] and the impact of the blood collection tube and storage time on CTC-mRNA (AR-V7) analysis [ 37 ]. Two clinical studies on different biomarkers for prostate brachytherapy [ 38 , 39 ] complete the large number of publications.…”

“…The last two studies of this Special issue present data on patients receiving prostate brachytherapy [ 38 , 39 ]. In the sixth study from Germany by PD Ecke et al [ 38 ] PSA, PSA density and other clinical data were evaluated before and after brachytherapy with external beam radiation in 79 high-risk PCa patients treated between 2009 and 2016.…”