Despite the absence of local prostate cancer recurrence, some patients develop

Despite the absence of local prostate cancer recurrence, some patients develop distant metastases after prostate brachytherapy. intraoperative, = 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. = 0.012). Open in a separate window Figure 1 Comparison of circulating tumor cell (CTC) detection rates between pre- and intraoperative blood specimens in all patients undergoing high-dose-rate or low-dose-rate brachytherapy (= 59). Table 1 Patient characteristics (= 59). = 30)= 29)= 59)= 0.112) or in the LDR brachytherapy group (= 0.236). Open in a separate window Figure 2 Comparison of circulating tumor cell (CTC) detection rates between Meropenem distributor pre- and intraoperative blood specimens in patients undergoing high-dose-rate (A, = 30) and low-dose-rate (B, = 29) brachytherapy. Table 2 lists the characteristics of the 7 patients who became positive for CTCs intraoperatively. The intraoperative CTC count was 1 CTC in 3 patients and 2 CTCs in 1 patient treated with HDR brachytherapy, and 1 CTC was detected in 3 patients who underwent LDR brachytherapy. Table 2 Characteristics of seven patients who changed to positive status for intraoperative circulating tumor cells (CTCs). = 59). = 0.02). Several investigators then measured perioperative CTCs and reported the possibility of hematogenous spillage of cancer cells during radical prostatectomy in clinically nonmetastatic cancer patients [20,21,22,23,24]. Eschwege et al. investigated Meropenem distributor the dissemination of malignant prostatic cells Ly6a during open radical prostatectomy [20], and they confirmed prostate-specific membrane antigen (PSMA) using reverse-transcription nested PCR for CTC detection. The incidence of positive CTC status increased from 21% before the surgery to 86% immediately afterward, supporting the possibility of intraoperative hematogenous dissemination during the open radical prostatectomy. They concluded that surgeons should minimize prostate manipulation to avoid seeding from the gland for the prevention of metastatic disease. Prostate needle biopsy is one of the most similar procedures to prostate Meropenem distributor brachytherapy in that needles being inserted into prostate tissue directly penetrate the cancer lesions. Hara et al. examined PSA-mRNA-bearing cells in peripheral blood of the 108 patients before and after prostate biopsy [25]. Of 46 patients who were diagnosed with prostate cancer, the incidence of positive PSA-mRNA-bearing cells increased from 3% before the biopsy to 45% immediately afterward. In addition, the incidence of positive PSA-mRNA status after prostate biopsy in patients diagnosed with prostate cancer were higher than those without prostate cancer (45% vs. 25%, 0.001). This study supported the possibility of tumor spreading by prostate biopsy. While we detected intraoperative hematogenous spillage of prostate cancer cells during brachytherapy procedures, it is still controversial whether the CTCs spilled iatrogenically into circulation have the biological capability to implant into distant sites and Meropenem distributor subsequently develop metastatic foci. Most studiesincluding the present study that detected the intraoperative CTC increase during radical treatment for primary lesion and prostate biopsyhad a small sample size and lacked a long follow-up period. Thus, the clinical significance of intraoperative CTC increase remains unclear, and we still have the question of whether this kind of iatrogenic CTC is clinically metastable. Eschwege et al. evaluated the cancer-cell seeding impact on recurrence-free survival [23]. Hematogenous spread of prostate cells was assessed by a dual PSA/PSMA PCR assay using very specific PSMA and PSA primers. Ninety-eight patients with negative status for preoperative CTC were divided into two groups according to status for intraoperative CTC: 53 (54%) remained negative and 45 (46%) became positive. Median biological and clinical recurrence-free time did not significantly differ between the two groups (69.6 vs. 65 months). The authors concluded that intraoperative hematogenous spillage of prostate cancer cells does.