Comparison of the Walz Nomogram and Presence of Secondary Circulating Prostate Cells for Predicting Early Biochemical Failure after Radical Prostatectomy for Prostate Cancer in Chilean Men

  • Murray, Nigel P (Hematology, Medicine, Faculty Medicine, University Finis Terrae) ;
  • Reyes, Eduardo (Faculty of Medicine University Diego Portales, Hospital DIPRECA) ;
  • Orellana, Nelson (Hospital DIPRECA) ;
  • Fuentealba, Cynthia (Hospital de Carabineros de Chile, Faculty Medicine, University Finis Terrae) ;
  • Jacob, Omar (Hospital de Carabineros de Chile, Faculty Medicine, University Finis Terrae)
  • Published : 2015.11.04


Purpose: To determine the utility of secondary circulating prostate cells for predicting early biochemical failure after radical prostatectomy for prostate cancer and compare the results with the Walz nomagram. Materials and Methods: A single centre, prospective study of men with prostate cancer treated with radical prostatectomy between 2004 and 2014 was conducted, with registration of clinical-pathological details, total serum PSA pre-surgery, Gleason score, extracapsular extension, positive surgical margins, infiltration of lymph nodes, seminal vesicles and pathological stage. Secondary circulating prostate cells were obtained using differential gel centrifugation and assessed using standard immunocytochemistry with anti-PSA. Biochemical failure was defined as a PSA >0.2ng/ml, predictive values werecalculated using the Walz nomagram and CPC detection. Results: A total of 326 men participated, with a median follow up of 5 years; 64 had biochemical failure within two years. Extracapsular extension, positive surgical margins, pathological stage, Gleason score ${\geq}8$, infiltration of seminal vesicles and lymph nodes were all associated with higher risk of biochemical failure. The discriminative value for the nomogram and circulating prostate cells was high (AUC >0.80), predictive values were higher for circulating prostate cell detection, with a negative predictive value of 99%, sensitivity of 96% and specificity of 75%. Conclusions: The nomagram had good predictive power to identify men with a high risk of biochemical failure within two years. The presence of circulating prostate cells had the same predictive power, with a higher sensitivity and negative predictive value. The presence of secondary circulating prostate cells identifies a group of men with a high risk of early biochemical failure. Those negative for secondary CPCs have a very low risk of early biochemical failure.


Prostate cancer;biochemical failure;circulating prostate cells;nomogram


  1. Borgen E, Naume B, Nesland JM, et al (1999). Standardization of the immunocytochemical detection of cancer cells in BM and blood. I. Establishment of objective criteria for the evaluation of immunostained cells. Cytotherapy, 1, 377-88.
  2. Brodsky AS, Fischer A, Miller DH, et al (2014). Expression profiling of primary and metastatic ovarian tumors reveals differences indicative of aggressive disease. PLoS One, 14, 94476
  3. Dillioglugil O, Leibman BD, Kattan MW, et al (1997). Hazard rates for progression after radical prostatectomy for clinically localized prostate cancer. Urology, 50, 93
  4. Freedland SJ, Humphreys EB, Mangold LA, et al (2005). Risk of prostate cancer specific mortality following biochemical recurrence after radical prostatectomy. JAMA, 294, 433
  5. Goranova TE, Ohue M, Shimoharu Y, et al (2011). Dynamics of cancer cell subpopulations in primary and metastatic colorectal tumors. Clin Exp Metastasis, 28, 427-35
  6. Hull GW, Rabanni F, Abbas F, et al (2002). Cancer control with radical prostatectomy alone in 1,000 consecutive patients. J Urol, 167, 528
  7. Messing EM, Manola J, Yao J, et al (2006). Immediate versus delayed androgen depreviation treatment in patients with node positive prostate cancer after radical prostatectomy and pelvic lymphadenectomy. Lancet Oncol, 7, 472
  8. Mitchell RE, Chang SS (2008). Current controversies in the treatment of high risk prostate cancer. Curr Opin Urol, 18, 263
  9. Murray NP, Badinez L, Duenas R, et al (2011). Positive HER-2 expression in circulating prostate cells and micrometastasis. Resistent to androgen suppression but not DES. Ind J Urol, 27, 200-206.
  10. Murray NP, Reyes E, Orellana N, et al (2013). Secondary circulating prostate cells predict biochemical failure after radical prostatectomy and without evidence of disease. The Scientific World J;
  11. Partin AW, Mangold LA, Lamm DM, et al (2001). Contemporary update of prostate cancer staging nomograms (Partin tables) for the new millennium. Urol, 58, 843
  12. Porter CR, Kodama K, Gibbons RP, et al (2006). 25 year prostate cancer control and survival outcomes, a 40 year radical prostatectomy single institution series. J Urol, 176, 569
  13. Pound CR, Partin AW, Eisenberger MA, et al (1999). Natural history of progression after PSA elevation following radical prostatectomy. JAMA, 281, 1591
  14. The MRC Prostate Cancer Working Party Investigators Group (1997). Immediate versus deffered treatment for advanced prostate cancer; initial results of the MRC Trial. Br J Urol, 79, 235
  15. Walz J, Chun FK, Klein EA, et al (2009). Nomogram predicting the probability of early recurrence after radical prostatectomy for prostate cancer. J Urol, 181, 601-8.
  16. Zeijlemaker W, Gratama JW, Schuurhuis GJ (2014). Tumor heterogeneity makes AML a “moving target” for detection of residual disease. Cytometry B Clin Cytom, 86, 3-14

Cited by

  1. Contemporary approach to predict early biochemical recurrence after radical prostatectomy: update of the Walz nomogram vol.21, pp.3, 2018,
  2. Minimal residual disease in prostate cancer patients after primary treatment: theoretical considerations, evidence and possible use in clinical management vol.51, pp.1, 2018,