Circulating Tumor Cells - Article about them as an indicator of metastatic disease

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Redwing57
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Date Joined Apr 2013
Total Posts : 2292
   Posted 9/12/2017 8:29 AM (GMT -7)   
This study was mentioned in the Uroalert email I get periodically. The link here is for the free full-text version of the article. It explores the idea of using Circulating Tumor Cells (CTCs) as indicators of metastatic disease status. They find various cancers are better or worse about releasing CTCs. Prostate cancer is more prone to exhibiting CTCs, according to this.

From the article:
In a disease-to-disease comparison when reviewing the percentage of patients exhibiting CTCs, CTCs are seen in a higher percentage of breast and prostate cancer patients than in colorectal cancer patients. Pancreatic and ovarian cancers, regardless of their stage and aggressiveness, rarely reveal CTCs.

The smart guys can comment on this, I'm sure. It's at least an interesting research avenue, and may one day be good enough to help people make better treatment choices up front. This is one aspect of the "liquid biopsy" idea we sometimes hear about.

Also from the article (cfDNA is "cell free DNA"):
Can CTCs and cfDNA be combined in such a manner to aid in the cure of metastatic disease? Yes, and used in combination and including a control of whole blood to detect somatic mutations, CTCs—the “silent” predictor of metastatic disease—and cfDNA can serve to monitor the progression of primary disease to a metastatic state and this combination can be used for every tumor type.

Circulating tumor cells: silent predictors of metastasis
55@Dx 4/16/13
Bx: 6/12 pos, G9=5+4 (80%, 60%), 4+5 (2@100%, 80%, 10%), PNI+
cT3a (3T mpMRI: Bilateral EPE, NVB+, SV-, LN-)

Pre:
Date PSA fPSA
9/12 4.1 15%
3/13 5.2 12% PCA3=31

Tx:
IGRT by IMRT, 44 done 8/28/13: 50.4 Gy pelvic nodes, 79.2 Gy prostate
ADT2 3 yrs: Lupron/Casodex, ended 3/16

PSA <0.1 : 8/13 - 5/16;
steadying? - 0.2-8/16, 0.5-12/16, 0.7-3/17, 0.8-5/17, 0.8-7/17

JNF
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Date Joined Dec 2010
Total Posts : 3389
   Posted 9/12/2017 9:29 AM (GMT -7)   
Dr. Snuffy Myers addresses this in one of his books and my urologist has also discussed it with me. They both report that PCa is very blood born compared to other cancers. My uro says that 1/2 the men at age 50 will have PCa cells in their blood. But we also know that most PCa is unable to live outside the prostate. So just because the cells are circulating doesn't mean they will do anything, as most will not be a problem.

Hopefully these blood tests can be developed to the point of identifying the cells that may cause a problem to both help direct men to treatment options and to help identify recurrence and metastasis.
PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.
Eligard and Jalyn started on 10-7-2010. IMRT to prostate and lymph nodes started on 11-8-2010, HDR Brachytherapy December 6 and 13, 2010.
PSA < .1 since February 2011

Redwing57
Veteran Member


Date Joined Apr 2013
Total Posts : 2292
   Posted 9/12/2017 10:44 AM (GMT -7)   
Another article on the "liquid biopsy" topic. It would appear they're working on distinguishing simply circulating cells from those that are actually related to the cancer. The example used in this article is actually for colorectal, a type specifically identified in the first study as not having many circulating cells. They're even looking at how the tumors change over time, how the DNA "evolves".

Obviously they'll need to be able to identify circulating tumor cells, not just circulating prostate cells.

From the article:
Panels that are capable of tracking tumor evolution, for instance, can help determine when a patient may need to change treatments and what the next option should be.

Cancer’s Circulating Secrets
55@Dx 4/16/13
Bx: 6/12 pos, G9=5+4 (80%, 60%), 4+5 (2@100%, 80%, 10%), PNI+
cT3a (3T mpMRI: Bilateral EPE, NVB+, SV-, LN-)

Pre:
Date PSA fPSA
9/12 4.1 15%
3/13 5.2 12% PCA3=31

Tx:
IGRT by IMRT, 44 done 8/28/13: 50.4 Gy pelvic nodes, 79.2 Gy prostate
ADT2 3 yrs: Lupron/Casodex, ended 3/16

PSA <0.1 : 8/13 - 5/16;
steadying? - 0.2-8/16, 0.5-12/16, 0.7-3/17, 0.8-5/17, 0.8-7/17

Almost a 10
Veteran Member


Date Joined Mar 2014
Total Posts : 871
   Posted 9/12/2017 1:49 PM (GMT -7)   
The idea of learning the changes in time is very interesting and could lead to some great advances.
11/13 psa 240
DX 10/2013 PSA 187.5
PSA HIST 07/11,3.31;3/10,1.87,3/06,.87
Biopsy 10/28/13; 11/12 cores positive gs 9 (4+5)
BNSCN 12/09/2013 2 hot spots in spine
ADT 12/17/2013 22mg lupr, 50 mg Cas
BN biopsy 01/09/2013 neg
RALP 2/19/14 NN,LVI,Path T3BNX,MX, pros size 4.2 X 4 X 3 cm, 31 grm.Post Op PSA 3/14 .6, 6/14<.1;9/8,;.6;12/8, 1.2;3/9/15 3.9;6/2/15 23
12/14 CT SCAN; 1/15 BNSC

Michael_T
Veteran Member


Date Joined Sep 2012
Total Posts : 2512
   Posted 9/12/2017 3:51 PM (GMT -7)   
CTCs are addressed in the New Yorker article I posted the other day. (And was re-posted in another thread today as well.) As part of the author's premise that certain patients have host tissue that is more conducive to picking up mets, he talks about the large quantity of CTCs that some cancers can produce. Yet for many people, the cancer doesn't spread, while for some it does.

His point is that we need to understand why that is to more effectively design treatments.
Age 56, Diagnosed at 51
PSA 9.6, Gleason: 9 (5+4), three 7s (3+4)
Chose triple play of HDR brachy, IMRT and HT (Casodex, Lupron and Zytiga)
Completed HT (18 months) in April 2014
3/17: T = 167, PSA = 0.13
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