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Urology Service, Department of Surgery and the George M. O'Brien Urology Research Center for Prostate Cancer, Memorial Sloan-Kettering Cancer Center, New York, New York 10021 [R. S. I., S. L. S., C. T. P., W. R. F., R. F. H., A. D., E. T. E., W. D. W. H.]; Division of Urology, Maimonides Medical Center, Brooklyn, New York 11219 [R. S. I., G. J. W.]; Lady Davis Institute for Medical Research, McGill University, Montreal, Canada H3T1E2 [W. H. M.]; and The Johns Hopkins University School of Medicine, Baltimore, Maryland 21210 [D. S. S.]
A highly sensitive nested reverse transcriptase-PCR assay, with primers derived from the prostate-specific antigen (PSA) and prostate-specific membrane antigen (PSM) cDNA sequences, has been used to detect occult hematogenous micrometastatic prostate cells. In 77 patients with prostate cancer, PSM and PSA primers detected circulating prostate cells in 48 (62.3%) and 7 (9.1%) patients, respectively. In treated stage D disease patients, PSM primers detected cells in 16 of 24 patients (66.7%), while PSA primers detected cells in 6 of 24 (25%). In post-radical prostatectomy patients with negative serum PSA values, PSM primers detected metastases in 21 of 31 patients (67.7%), whereas PSA primers detected cells in only 1 of 33 (3.0%), indicating that micrometastatic spread may be a relatively early event in prostate cancer. The analysis of 40 individuals without known prostate cancer provides evidence that this assay is highly specific and suggests that PSM expression may predict the development of cancer in patients without clinically apparent prostate cancer. Using PSM primers, we detected micrometastases in 4 of 40 controls, 2 of whom had known benign prostatic hyperplasia and were later found to have previously undetected prostate cancer. The clinical significance of detection of hematogenous micrometastatic prostate cells using PSM primers and potential applications of this molecular assay, as well as the assay for PSA, merit further study.
1 This work was supported in part by NIH Grants DK-CA47650 and CA58192. R. S. I. received partial support through NIH Training Grant CA-09501. W. H. M. received a Terry Fox development grant from the National Institute of Cancer of Canada.
2 To whom requests for reprints should be addressed, at Memorial Sloan- Kettering Cancer Center, 1275 York Avenue Box 334, New York, NY 10021.
Received 9/26/94. Accepted 11/10/94.
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