Fig. 5

An example of comprehensive molecular staging in a clinically localized prostate cancer patient using RT-PCR detection of PSA and PSMA transcripts in PB and BM as developed by the clinical prerequisites previously described (74,75). This example represents the case of patient with PSA = 5.6 ng/ml; Gleason’s score = 7 (4 + 3) prostatic adenocarcinoma (transrectal ultrasound-guided biopsy); negative evaluation for metastasis as assessed by bone scan, metastatic survey (x-rays) and CT; who tested positive for both PSA and PSMA in PB and BM. He underwent immediate radical prostatectomy (RP) and experienced early biochemical failure (PSA = 1.5 ng/ml) 6 months after RP. Then he was prescribed local irradiation therapy plus temporary combined androgen blockade (CAB; for 3 months). Twelve months after irradiation therapy, PSA was 9.0 ng/ml, and the bone scan revealed the presence of multiple sites of bone lesions throughout the spine and pelvis. The latter were confirmed by CT. Notably, RT-PCR-based indications for probable extraprostatic disease and bone involvement were given approximately 2 years before the final diagnosis of stage D2 disease.