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Senior Citizen Health & Medicine
Potential of Prostate Cancer Spread Detected Early
by New Test
Test works even if surrounding lymph nodes
initially appear negative
June 21, 2006 - A new prognostic test can help
determine whether a prostate cancer patient will go on to have a
recurrence of the disease, even if surrounding lymph nodes initially
appear negative for cancer, according to a study by University of
Southern California researchers.
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The test, developed at USC, "appears to be a very
powerful test and better than anything else we know of for predicting
recurrence," says Richard Cote, professor of pathology and urology at
the Keck School of Medicine of USC. Current trials are also using the
test to find hidden metastases in lymph nodes and bone marrow for breast
and lung cancers.
The study, "Detection of Occult Lymph Node
Metastases in Patients with Local Advanced (pT3) Node-Negative Prostate
Cancer" appears this week in the Journal of Clinical Oncology.
Prostate cancer is the most common non-skin cancer
in America, according to the Prostate Cancer Foundation. One in six
American men will be diagnosed with prostate cancer, making men 35
percent more likely to be diagnosed with prostate cancer than women are
to be diagnosed with breast cancer.
"Thanks to greater awareness, as well as increased
and improved screening, we see men increasingly diagnosed with prostate
cancer in its early stages," Cote says. "Most of these patients will do
very well and will not require treatment beyond surgery or radiation
therapy to cure their disease."
But a proportion of these patients have metastases
of the prostate cancer appear later, even when the lymph nodes removed
at the time of the cancer surgery appeared negative for cancer, he says.
Cote and his colleagues looked at 3,914 lymph nodes
from 180 patients who were staged as having lymph nodes negative for
cancer based on standardized histologic evaluation (visual scan under a
microscope). The lymph nodes were then evaluated for occult (hidden)
metastases using new specific immunohistochemistry tests that can detect
cancer on a cell-by-cell level.
Their new analysis checks for cells that react with
antibodies to cytokeratins and PSA. The team's testing found occult
tumor cells in the lymph nodes of 24 of the patients whose lymph nodes
had been previously been diagnosed as cancer-free.
The test used to detect the occult tumor cells is
more sensitive than any clinical, pathologic or radiographic techniques,
Cote says.
The group then compared cancer recurrence and
survival in those patients with the hidden tumor cells versus those
without the cells. The presence of occult tumor cells was associated
with increased prostate cancer recurrence and decreased survival. In
fact, "the outcome for patients with occult tumor cells was similar to
those who were identified as having positive lymph nodes at the time of
the surgery," Cote says.
"We have shown that occult tumor spread in lymph
nodes is a significant predictor of disease recurrence," he says. "Once
surgery is performed, the primary form of treatment is adjuvant systemic
therapy. In patients with no evidence of metastasis, success of such
therapy is assumed to be due to killing of occult tumor before it
becomes clinically evident. Therefore, the ability to detect occult
metastasis is pivotal to identification of patients who would most
benefit from systemic therapy and also identify patients who may be
spared from unnecessary therapy."
About study:
Vincenzo Pagliarulo, Debra Hawkes, Frank Brands,
Susan Groshen, Jie Cai, John P. Stein, Gary Lieskovsky, Donald G.
Skinner, Richard J. Cote, "Detection of Occult Lymph Node Metastases in
Patients with Locally Advanced (pT3) Node Negative Prostate Cancer,"
Journal of Clinical Oncology, 24: 2735-2741, 2006.
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