Document Type: Research Articles
CTC Unit, Faculty of Medicine, University Finis Terrae, Chile.
Urology Service, Hospital de Carabineros de Chile, Santiago, Chile.
Faculty of Medicine University Diego Portales Santiago, Chile.
Introduction: The use of pre- and post-surgery variables has been used to create nomograms in order to identify
patients at high risk of treatment failure. The PRIX nomogram is one such device; we compare the PRIX nomogram
with the presence of secondary circulating prostate cells to predict those men who will undergo treatment failure.
Methods and Patients: Men who underwent radical prostatectomy for prostate cancer entered the study. The PRIX
score was calculated from the total serum PSA pre-surgery, the biopsy Gleason score and clinical stage. Circulating
prostate cells were detected from venous blood one month after surgery, using differential gel centrifugation and standard
immunocytochemistry with anti-PSA. A test was considered positive when 1 CPC/blood sample was detected. Patients
were followed up for five years and biochemical failure was defined as a serum PSA >0.2ng/ml. Kaplan-Meier and
Cox proportional models were used to calculate survival curves. Results: 321 men participated, of whom 131 (40.8%)
underwent biochemical failure within 5 years. A higher PRIX score was associated with increased failure risk, as was
the presence of CPCs. The predictive power of CPCs was significantly higher than the PRIX score. Combining the
two methods, for equal PRIX scores, scores but CPC positive had a worse biochemical failure free survival than men
with high PRIX scores but CPC negative. For men with PRIX scores of ≥4 the use of CPC detection did not aid in the
clinical decision making process. For those with PRIX scores of 0 and 1, CPC detection identified men with a high risk
of treatment failure. Conclusions: The combined PRIX/CPC score improved the predictive values of men at high risk
of biochemical failure. Both are simple systems that could be incorporated in a general hospital. Further multicenter
studies are warranted to confirm these results.