Clinical strategies in the management of biochemical recurrence after radical prostatectomy

Identification of prostate cancer mRNA markers by averaged differential expression and their detection in biopsies, blood, and urine

The advent of serum prostate-specific antigen (PSA) as a biomarker has enabled early detection of prostate cancer and, hence, improved clinical outcome. However, a low PSA is not a guarantee of disease-free status, and an elevated PSA is frequently associated with a negative biopsy. Therefore, our goal is to identify molecular markers that can detect prostate cancer with greater specificity in body fluids such as urine or blood. We used the RT-PCR differential display method to first identify mRNA transcripts differentially expressed in tumor vs. patient-matched nontumor prostate tissue. This analysis led to the identification of 44 mRNA transcripts that were expressed differentially in some but not all tumor specimens examined. To identify mRNA transcripts that are differentially expressed in most tumor specimens, we turned to differential display of pooled tissue samples, a technique we name averaged differential expression (ADE). We performed differential display of mRNA from patient-matched nontumor vs. tumor tissue, each pooled from 10 patients with various Gleason scores. Differentially expressed mRNA transcripts identified by ADE were fewer in number, but were expressed in a greater percentage of tumors (>75%) than those identified by differential display of mRNA from individual patient samples. Differential expression of these mRNA transcripts was also detected by RT-PCR in mRNA isolated from urine and blood samples of prostate cancer patients. Our findings demonstrate the principle that specific cDNA probes of frequently differentially expressed mRNA transcripts identified by ADE can be used for the detection of prostate cancer in urine and blood samples.

Patterns of care for men with prostate cancer after failure of primary treatment

BACKGROUND

This study sought to determine trends in patterns of care after failure of primary prostate cancer treatment and to determine whether nonclinical factors influenced the receipt of secondary treatment.

METHODS

The authors identified individuals treated for nonmetastatic prostate cancer in the years 1991-1999 from the linked databases of Medicare and the National Cancer Institute's Surveillance, Epidemiology, and End Results registry. The outcome of interest was receipt of secondary therapy. They performed Cox proportional hazard analyses to investigate the link between demographic and clinical characteristics and the likelihood of receiving secondary treatment after either surgery or radiation.

RESULTS

Of 65,716 subjects who met our inclusion criteria, 10,200 (15%) received some form of secondary therapy. For men undergoing initial surgical or radiation therapy, tumor grade, year of diagnosis, and geographic region were associated with secondary therapy. No socioeconomic factors such as education, ethnicity, or income level were associated with secondary therapy.

CONCLUSIONS

Patterns of care after primary prostate cancer therapy continue to vary regionally. Standardized clinical algorithms and utilization of prostate-specific antigen testing appear to have influenced secondary therapy rates.