Molecular Detection of Prostate Epithelial Cells from the Surgical Field and Peripheral Circulation during Radical Prostatectomy

Oefelein, Michael G.; Kaul, Karen L.; Herz, Barbara; Blum, Michael D.; Holland, James M.; Keeler, Thomas C.; Cook, William A.; Ignatoff, Jeffrey M.

doi:10.1097/00005392-199601000-00082

Cited by 17 publications

(22 citation statements)

References 17 publications

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“…Tumor cells have been detected in expressed seminal secretion from patients with pathologic T3 disease [23]. Using more sensitive assays such as RT–PCR to detect PSA–producing cells, investigators have shown 20 of 22 patients with pathologic T2 disease to have evidence of ‘tumor spillage’ in the operative field and 10 of 22 patients had evidence of PSA producing cells in the peripheral blood during surgery [24]. Similarly, older studies of men undergoing channel TURP have demonstrated transient circulating cancer cells [25]though well–matched studies of men undergoing TURP prior to radical prostatectomy have not demonstrated an increase in local or distant failure rates when compared to men diagnosed by traditional biopsy [26].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Radical Prostatectomy

Hoznek¹,

Salomon²,

Olsson³

et al. 2001

Eur Urol

167

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Section: Discussionmentioning

confidence: 99%

Laparoscopic Radical Prostatectomy

Hoznek¹,

Salomon²,

Olsson³

et al. 2001

Eur Urol

167

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“…Using a reverse transcriptase–polymerase chain reaction PSA assay method, Oefelein et al [20]found positive cells in operative field blood of 20 of 22 (91%) men undergoing radical retropubic prostatectomy. But the study by Oefelein et al [20]used RT–PCR assay [21]which at this time showed discordant results, and no follow–up information was available on the 22 men studied. There is a very low rate of tumor implantation in transrectal and transperineal needle biopsy tracts [22].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Radical Prostatectomy: Preliminary Results

Jacob¹,

Salomon²,

Hoznek³

et al. 2000

European Urology

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Background: Retropubic and perineal radical prostatectomy are used for curative treatment of localized prostate cancer. More complex urological procedures are now being done with laparoscopy. We present our initial results of transperitoneal laparoscopic radical prostatectomy.Materials and Methods: Twenty laparoscopic radical prostatectomies were performed between May 1998 and May 1999. The mean age at the time of surgery was 64.2 years. There were 14 stage T1c, 5 stage T2a and 1 stage T2b tumors. The preoperative PSA was 9.3 ng/ml (normal <4 ng/ml). The Gleason score for positive specimens in 6 random echo–guided endorectal biopsies was 5.7. Four trocars were used. Insufflation pressure was 15 mmHg. The seminal vesicles were first dissected. The prostate was dissected free from the anterior face of the rectum to the prostate apex. Then the peritoneum was incised to find the apex of the prostate. The puboprostatic ligaments were isolated and cut, and the dorsal vein complex was ligated and cut to expose the urethra. The bladder neck was opened and dissected free from the prostate. The lateral pedicles were coagulated before sectioning the urethra. The radical prostatectomy specimen was left along the sigmoid colon, the bladder neck was reconstructed, and a urethrovesical anastomosis was performed with 6 interrupted sutures. The prostatectomy specimen was removed intact in a sack by enlarging the umbilical trocar port. All the prostatectomy specimens were processed according to the Standford protocol. Prostate weight, tumor weight, the Gleason score, and the tumor status of the capsule, seminal vesicles, lymph nodes and surgical margins were studied.Results: The operating time was 385 min. Two patients were transfused. The mean hospital stay was 7.8 days. The Foley catheter was removed 10.7 days after the operation. Specimen weight was 61 (28–126) g, the Gleason score was 5.9, and tumor volume was 1.4 ml. There were 18 stage pT2, 1 stage pTa (capsular effraction) and 1 stage pT3b (seminal vesicle invasion) tumors. There were four positive surgical margins (2 at the apex and 2 at the bladder neck). All the patients had a postoperative PSA level <0.1 ng/ml at 1 month. The first patient had urethrovesical anastomotic leakage, and required Foley catheterization for 21 days. There was 1 colostomy for rectal injury and 1 urinoma because of urethrovesical anastomotic leakage that required an open surgical procedure. One month after surgery, 15 (75%) patients were fully continent. Six patients had erections, and 5 stated having sexual intercourse.Conclusion: These preliminary results show that radical prostatectomy can be performed laparoscopically. Laparoscopy offered excellent vision of all the anatomical structures of the pelvis, permitting precise dissection. Long–term follow–up and further studies are required to confirm and improve these results.

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“…These undifferentiated tumor cells are able to create all the step of the metastasis cascade. This may also explain why following radical prostatectomy, distant metastases are relatively infrequent despite hematogenous cell dissemination during the surgical procedure detected by RT–PCR [20, 21]. …”

Section: Discussionmentioning

confidence: 99%