Psm molecular no diagnóstico e estadiamento do câncer da próstata

Abstract

Molecular markers have been investigated to improve prostate câncer diagnostics. Therefore, PSM mRNA leveis were investigated through Nested RT-PCR in peripheral blood mononuclear cells of patients submitted to radical prostatectomy to evaluate its association to the TNM 92 histological staging and to the total PSA serum leveis in the post-surgery follow-up, in order to establish a molecular diagnostic for the prostate câncer and to avaliate the clinicai prognostic aiming the cure after surgery. Patients and methods: A group of patients with prostate câncer (PCa) consisted of 32 individuais that were submitted to radical prostatectomy with the following criteria: Gleason score lower than 8, total PSA (tPSA) serum leveis lower or equal to 20 ng/mL (IMMULITE®), negative bone mapping and X-rays image analysis for tPSA greater than 10 ng/mL, rectal examination compatible with organ confined câncer, age limit up to 80 years old with a life expectancy of 10 years or more. PSM mRNA was also detected through nested RT-PCR in pre-surgery blood samples, and positivity was associated to the TNM 92 histological staging, and to the diagnostic of organ confined and extracapsular invasion or metastatic disease, based on total tPSA serum leveis measured after surgery. For the post-surgery follow-up, the tPSA cutoff limit of 0.04 ng/mL was used to separate the organ confined from extracapsular invasion or metastatic disease. The control group consisted of 14 patients with benign prostate hyperplasia (BPH) that were submitted to either transurethral resections or to open prostatectomies (trans-vesical or retro pubic) according to the following inclusion criteria: histopathological results of BPH and tPSA serum leveis pre-biopsies lower or equal to 20 ng/mL. RT-PCR was also realized in pre-surgery blood samples. Results: TNM 92 staging was accomplished based on the inclusion criteria, and 18 patients (56 3%) presented organ confined câncer (pTl and pT2) and 14 (43.7%) had a possible local invasion or a metastatic disease (pT3, pT4 and pNl). RT-PCR-PSM was positive in 4 of 6ABSTRACT BPH patients (66.7%), in 10 of 11 organ confined PCa patients (90.9%), and in 3 of 7 local invasion or metastatic PCa patients (42.9%). Considering only patients diagnosed with extracapsular câncer invasion or metastasis and BPH, the molecular detection had a sensitivity, specifícity, positive and negative predictive values, and accuracy of 43%, 33%, 43%, 33% and 38%, respectively. From those patients with organ confined disease, the post-surgeiy tPSA cutoff limit have detected positive surgical margins in 38.9% (7 of 18) while for those patients with extracapsular disease 15.4% (2 o f 13) have presented laboratorial cure, with a final result of 58.1% of patients with extracapsular câncer invasion or metastasis. During follow-up with tPSA serum leveis, the RT-PCR-PSM was positive for 100% of organ confined disease and 90% for extracapsular PCa invasion or metastasis, with a sensitivity, specifícity, positive and negative predictive values, and accuracy of 90%, 0 %, 56,0%, 0 % and 53%, respectively, for extracapsular câncer invasion or metastasis, in relation to the organ confined disease, Conclusions: Positive results of RT-PCR-PSM in pre-surgery blood samples were not able to separate disease stages; however, this molecular marker detected most of the organ confined disease patients, suggesting that it may be used as a PCa early detection marker.