Cormac Farrelly MD, Presenter: Research Grant, F. Hoffmann-La Roche Ltd

Priti Lal MD, Abstract Co-Author: Nothing to Disclose

Scott O. Trerotola MD, Abstract Co-Author: Royalties, Cook Group Incorporated Consultant, Medical Components, Inc Consultant, C. R. Bard, Inc Consultant, Teleflex Incorporated Consultant, W. L. Gore & Associates, Inc Consultant, B. Braun Melsungen AG Consultant, Medical Components, Inc Royalties, Teleflex Incorporated Research Grant, Vascular Pathways, Inc

Gregory Jon Nadolski MD, Abstract Co-Author: Nothing to Disclose

Micah M. Watts MD, Abstract Co-Author: Nothing to Disclose

Catherine Mc Gorrian MRCPI, Abstract Co-Author: Nothing to Disclose

Thomas J. Guzzo MD, MPH, Abstract Co-Author: Nothing to Disclose

To correlate prostate specific antigen(PSA) values and free to protein-bound PSA ratios(fPSA/PSA) in specimens taken from peripheral upper limb, internal iliac and deep branch internal iliac veins bilaterally to prostatectomy specimens in patients with prostate adenocarcinoma and borderline elevation of PSA.

7 patients with biopsy proven prostate cancer had venous sampling procedure prior to prostatectomy(mean 3.2 days, range: 1-7). All had borderline elevation of PSA on prior peripheral venous sampling(4-10 ng/mL). Sampling procedure involved peripheral vein sample(PVS) taken from a 5 Fr sheath in right basilic vein. Pelvic vein samples were taken through a 5Fr catheter fluoroscopically guided into right internal iliac vein(RIV), deep right internal iliac vein branch(dRIV), left internal iliac vein(LIV), and deep left internal iliac vein branch(dLIV). Venous sampling results were compared to prostatectomy surgical specimens.

Mean PVS PSA was 3.9, range 2.3-6 ng/mL. Total PSA in PVS did not differ significantly from internal iliac or deep internal iliac vein samples(P>0.05). Total PSA in RIV and dRIV did not differ significantly from LIV or dLIV samples(P>0.05). fPSA/PSA was significantly higher in internal iliac and deep internal iliac vein samples compared to PVS(p<0.05). Compared to contralateral internal iliac and contralateral deep branch internal iliac vein fPSA/PSA did not correlate positively with the side of highest tumor volume(p>0.05). On pathology, 6 patients had tumor in both sides of the prostate. fPSA/PSA was highest on the side ipsilateral to the highest grade of tumor in all 7 patients. 1 of 7 patients had unilateral left sided prostate cancer. This patient had a fPSA/PSA ratio of 6% from PVS, 6% from RIV and 14% from LIV samples. There were no procedural complications.

Free PSA, unlike total PSA, is significantly higher in pelvic vein compared to peripheral vein samples when prostate cancer is present. This prospective pilot study suggests that fPSA/PSA is higher in pelvic veins ipsilateral to highest grade tumor. Larger studies including patients with higher PSA values are warranted to further investigate this counterintuitive finding.

This new minimally invasive procedure could help localize prostate cancer within the pelvis thus helping to guide biopsies, select patients for new localized therapies and detect local recurrence post surgery.

Farrelly, C, Lal, P, Trerotola, S, Nadolski, G, Watts, M, Mc Gorrian, C, Guzzo, T, Correlation of Prostate Specific Antigen Levels Obtained by Internal Iliac Venous Sampling to Radical Prostatectomy Specimens in Patients with Prostate Cancer: A Pilot Study.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14009684.html