Molecular staging of XXXX with the use of an enhanced reverse transcriptase-PCR assay.

@entity1 @entity263 @entity5 @entity1067 @entity1859 @entity189 @entity1486
OBJECTIVE: Because up to 40 percent of surgically treated @entity1 with @entity263 are subsequently found to be clinically understaged, a more sensitive staging modality to identify extraprostatic disease prior to surgery is required. METHODS: We describe an enhanced reverse transcriptase [RT] polymerase chain reaction (PCR) assay utilizing oligonucleotide primers specific for the @entity1 @entity1486 ( @entity1486 ). This assay identifies @entity1486 -synthesizing cells from reverse transcribed mRNA. This assay was applied to RNAs extracted from the peripheral blood lymphocytes of 65 @entity1 with clinically @entity263 . In addition, blood from 20 @entity1 , 20 young @entity1 , 25 age-matched control @entity1 under treatment for @entity1067 ( @entity1067 ), and 18 @entity1 with established, untreated @entity263 was tested. RESULTS: An RT-PCR assay for @entity1486 can recognize one @entity1486 -expressing cell diluted into one hundred thousand lymphocytes. The sensitivity of this assay can be enhanced by the addition of @entity1859 -modified nucleotides to the PCR reaction and this assay was applied to RNAs extracted from the peripheral lymphocyte fraction of 148 @entity263 @entity1 and controls at this institution. Although no specimen from @entity1 or @entity1 without @entity5 was positive in this assay, 14 of 18 @entity263 @entity1 were positive (77.8%). Additionally, 25 of 65 (38.5%) @entity1 with clinically localized disease (T1-2b) were positive from blood specimens obtained prior to surgery. Final pathologic results from this group of @entity1 identified a correlation between positivity on this assay and the presence of capsular @entity5 penetration (sensitivity, 68%; specificity, 84%) as well as strong correlation with the finding of @entity189 at the surgical margin (sensitivity, 87%; specificity, 76%). Logarithmic regression analysis of the results of the RT-PCR assay indicates its remarkable superiority to digital rectal examination, computed tomography scan, endorectal coil magnetic resonance imaging, @entity1486 , @entity1486 density, or Gleason score for predicting the true pathologic stage of @entity263 in these surgically treated @entity1 . CONCLUSIONS: An RT-PCR assay using @entity1486 primers to detect prostate cells in the peripheral circulation of surgical-candidate @entity1 is significantly correlated with capsular penetration and @entity5 -positive surgical margins. This molecular assay provides a sensitive and specific means to stage correctly apparent @entity263 prior to radical prostatectomy.
