The individual risk to progression is unclear for intermediate risk prostate cancer patients.
To assess their risk to progression, we examined the level of genomic instability in circulating
tumor cells (CTCs) using quantitative three-dimensional (3D) telomere analysis. Data of CTCs from
65 treatment-naïve patients with biopsy-confirmed D’Amico-defined intermediate risk prostate cancer
were compared to radical prostatectomy pathology results, which provided a clinical endpoint to the
study and confirmed pre-operative pathology or demonstrated upgrading. Hierarchical centroid cluster
analysis of 3D pre-operative CTC telomere profiling placed the patients into three subgroups with different
potential risk of aggressive disease. Logistic regression modeling of the risk of progression estimated
odds ratios with 95% confidence interval (CI) and separated patients into “stable” vs. “risk of aggressive”
disease. The receiver operating characteristic (ROC) curve showed an area under the curve (AUC) of 0.77,
while prostate specific antigen (PSA) (AUC of 0.59) and Gleason 3 + 4 = 7 vs. 4 + 3 = 7 (p > 0.6) were
unable to predict progressive or stable disease. The data suggest that quantitative 3D telomere profiling
of CTCs may be a potential tool for assessing a patient’s prostate cancer pre-treatment risk.