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Abstract
Cancer of the prostate is one of the principal medical problems facing the male population. It is the second most common cancer in males worldwide after lung cancer.
Although the specific causes of prostate cancer initiation and progression are not yet known, classical and molecular epidemiology studies have identified a number of potential risk factors associated with the development of prostate cancer. They include hereditary factors, gene polymorphism, increased level of androgens and increased fat consumption.
Prostate cancer rarely causes symptoms early as it arises from the periphery of the gland. This made screening for prostate cancer of great use. The American Cancer Society has recommended that screening could be offered annually at the age of 50 years and perhaps earlier for high risk. It is done by digital rectal examination and prostate specific antigen.
PSA testing has revolutionized the detection of prostate cancer and the monitoring of its treatment. It is organ specific but not cancer-specific, and serum levels may be elevated in the presence of benign prostatic hypertrophy, prostatitis and other non-malignant conditions like ejaculation, , instrumentation of prostatic urethra and prostatic biopsy. Its expression has also been reported in non-prostate tissue such as pancreas, breast, endometrium and salivary gland.
Percent fPSA, PSA velocity, PSA density, PSA density of the transition zone and Age-specific reference ranges are modifications of PSA that may help to distinguish between prostate cancer and benign disorders of the prostate. These modifications are important in the intermediate PSA range (4-10 ng/ml).
The development of metastasis is a complex, multi-staged process in which the hematogenous spreading of tumor cells is considered to be an intermediate and essential step for the spread of the disease beyond the prostate.
Circulating tumour cells (CTCs) consistute the hematogenous route of metastasis, and are of utmost clinical importance during the metastatic cascade for the establishment of distant metastasis. If these CTCs could be traced in the bloodstream of prostate cancer patients, they could potentially provide useful clinical information as regards to evaluation of tumour progression, prediction of long-term prognosis, identification of patients who are likely to respond to therapies with curative intent, and assessment of recurrence.
In the present study we aimed to detect the CTCs that express prostate specific antigen in peripheral blood of prostate cancer patients using reverse transcriptase polymerase chain reaction (RT-PCR) technique. This study was conducted on 69 patients admitted to the Genito-Urinary Surgery Department and the out-patient clinic at Alexandria Main University Hospital. These patients were divided into five groups:
Group I included: Fifteen patients with metastatic prostate cancer according to clinico-pathological staging. .
Group II included: Nineteen patients with non metastatic prostate cancer according to clinico-pathological staging. .
Group III included: Fifteen patients with benign prostatic hyperplasia according to histopathological records.
Group IV included: Ten patients with prostatitis.
Group V included: Ten healthy volunteers as normal control subjects.
In this study we found that 80% of the metastatic group and 26.3% of the non metastatic group were positive for the CTCs, while none of the BPH, prostatitis or the normal subjects was positive for the CTCs. We also found that there was a statistically significant relation between CTCs and t-PSA, Gleason’s score and the imaging studies.
In the current study we defined a cut-off value for t- PSA at which we could start searching for CTCs. This cut-off was 36.5 ng/ml. This cut-off is of clinical importance. Patients below this cut-off will not benefit from bone scan while those above this cut-off will.