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- Prostate Cancer Disseminated Tumor Cells are Rarely Detected in the Bone Marrow of Localized Patients Undergoing Radical Prostatectomy Across Multiple Rare Cell Detection Platforms

# Prostate Cancer Disseminated Tumor Cells are Rarely Detected in the Bone Marrow of Localized Patients Undergoing Radical Prostatectomy Across Multiple Rare Cell Detection Platforms

Chalfin HJ, Glavaris SA, Malihi PD, Sperger JM, Gorin MA, Lu C, et al.

The Journal of Urology . 2018;199(6):1494-1501. DOI [10.1016/j.juro.2018.01.033](https://doi.org/10.1016/j.juro.2018.01.033). PMID 29339080. PMCID PMC5964005.

How to cite

### AMA

Chalfin HJ, Glavaris SA, Malihi PD, Sperger JM, Gorin MA, Lu C, et al. Prostate Cancer Disseminated Tumor Cells are Rarely Detected in the Bone Marrow of Localized Patients Undergoing Radical Prostatectomy Across Multiple Rare Cell Detection Platforms. J Urol . 2018;199(6):1494-1501. doi:10.1016/j.juro.2018.01.033

### APA

Chalfin, H. J., Glavaris, S. A., Malihi, P. D., Sperger, J. M., Gorin, M. A., Lu, C., et al. (2018). Prostate Cancer Disseminated Tumor Cells are Rarely Detected in the Bone Marrow of Localized Patients Undergoing Radical Prostatectomy Across Multiple Rare Cell Detection Platforms. The Journal of Urology , 199(6), 1494-1501. https://doi.org/10.1016/j.juro.2018.01.033

### BibTeX

@article{chalfin2018prostate,
title = {Prostate Cancer Disseminated Tumor Cells are Rarely Detected in the Bone Marrow of Localized Patients Undergoing Radical Prostatectomy Across Multiple Rare Cell Detection Platforms},
author = {Chalfin, H. J. and Glavaris, S. A. and Malihi, P. D. and Sperger, J. M. and Gorin, M. A. and Lu, C. and others},
journal = {The Journal of Urology},
volume = {199},
number = {6},
pages = {1494--1501},
year = {2018},
doi = {10.1016/j.juro.2018.01.033},
pmid = {29339080}
}

Disseminated tumor cells are thought to seed the bone marrow early in prostate cancer, before any metastasis is visible on imaging. How often that actually happens in localized disease has been unclear, in part because earlier work leaned on epithelial markers that turn out to be common in normal marrow.

This multi-center study screened bone marrow from 208 patients with localized prostate cancer, plus controls and metastatic patients, using four separate rare-cell detection platforms and a mix of epithelial and prostate-specific markers. Two platforms interrogated the whole sample without enrichment; two enriched by antibody first.

The answer was consistent across methods: disseminated tumor cells were rarely found in localized disease, and epithelial markers such as EpCAM proved too non-specific in the marrow to be reliable on their own.

[Read publication at The Journal of Urology](https://pmc.ncbi.nlm.nih.gov/articles/PMC5964005/)

## Key findings

- On the RareCyte platform, only 1 of 41 localized patients carried a disseminated tumor cell. Two slides from each patient were scored for a 4P+/AR+/CK+/EpCAM+/CD45- signature; a single cell in one patient (pT2N0) met it, and the remaining 40 patients had none.

- Three cell clusters were detected but held back from the tumor-cell count. The clusters showed large nuclei, strong cytokeratin and no CD45, yet lacked the androgen receptor and 4P staining required by the 5-marker definition, so the single-cell scoring excluded them.

- Epithelial markers were too non-specific in the bone marrow to define tumor cells. EpCAM-expressing cells appeared in 98% (125 of 127) of marrow samples and only 1 localized patient was positive for the prostate-specific marker PSA, supporting the conclusion that disseminated tumor cells are genuinely rare in localized prostate cancer.

## AccuCyte in the methods

“Two immunofluorescence-based assays were employed at two separate centers, the High-Definition Single Cell Assay (HD-SCA) at the University of Southern California (USC), and the Accucyte ® System at the Fred Hutchinson Cancer Research Center (FHCRC).”

— Chalfin et al., The Journal of Urology (2018), Materials and Methods, “DTC and CTC Detection Assays”

## Why it matters for AccuCyte users

If you are weighing AccuCyte for rare-cell work, this study is a useful picture of what a null result looks like when it is trustworthy. The question was whether tumor cells had already reached the bone marrow in men with localized prostate cancer, a setting where any such cells are vanishingly rare. AccuCyte deposits every nucleated cell from the sample onto slides without an enrichment step, so nothing is thrown away before scoring; that whole-sample approach is what let the team read two slides per patient and still trust a count of zero. It also carried a five-marker, single-cell readout, which mattered here: three cell clusters that looked epithelial were correctly set aside because they lacked the prostate-specific markers. For your own work the lesson is about specificity, not only sensitivity. When a marker like EpCAM shows up in nearly every marrow sample, finding more events is not the goal; resolving which single cells carry a full, co-localized signature is, and that is the measurement AccuCyte was asked to make here.

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