To investigate the prediction effect of ultrasound-guided prostate puncture combined with circulation tumor cells (CTCs) enumeration on prognosis of prostate cancer.

83 patients with prostate cancer admitted to our hospital from January 2011 to December 2017 were enrolled for the study. All patients were diagnosed as prostate cancer by ultrasound-guided transrectal prostate biopsy, and the expression of immune markers including CK34BE12, p63 and α-methylacyl CoA racemase (AMACR) in pathological specimens were detected. Cell Search system was performed to detect the number of CTCs in peripheral blood, which was divided into positive group (> 5/7.5 ml) and negative group (< 5/7.5 ml) . The correlations of the expression of immune markers in biopsy tissues, the number of CTCs in peripheral blood and the clinicopathological features and survival status of patients were analyzed. The number of positive cases of each marker, the proportion of Gleason score > 7 points, TNM stage and other qualitative data were compared by χ² test, and the quantitative data such as age, blood routine test, coagulation function, liver function and PSA level were compared by t test. Kaplan Meier method was used for survival analysis, and multivariate Cox proportional risk regression model was used to analyze the prognostic factors.

(1) The positive rates of CTCs in peripheral blood, CK34BE12, p63 and AMACR in biopsy tissues were 31.33﹪, 3.61﹪, 3.61﹪ and 86.75﹪ respectively. The positive rate of AMACR in CTCs positive group was 100.00﹪, and significantly higher than 80.70﹪ in CTCs negative group (χ²= 4.227, P < 0.05) . (2) Hemoglobin (HB) of AMACR positive group was significantly lower than that in AMACR negative group[ (123.66±13.33) g/L vs (134.89±20.08) g/ L, t = 2.420, P = 0.018]. Platelet (PLT) , serum levels of alanine aminotransferase, D-dimer (DD) , prostate specific antigen (PSA) and proportion of Gleason score > 7 in AMACR positive group were significantly higher than those in AMACR negative group [ (197.23±36.98) ×10⁹/ L vs (172.83±33.33) ×10⁹/ L, t = 2.062, P = 0.042; (38.80±10.03) U/L vs (31.46±7.83) U/ L, t = 2.317, P = 0.023; (255.00±38.80) μg/ L vs (220.81±30.99) μg/L, t = 2.785, P = 0.007; (26.60±12.23) ng/ml vs (17.90±8.88) ng/ml, t = 2.263, P = 0.026; 45.83﹪ vs 9.09﹪, χ² = 3.916, P = 0.048]. HB of CTCs positive group was significantly lower than that of CTCs negative group [ (121.69±15.89) g/ L vs (132.73±18.85) g/ L, t = 2.767, P = 0.007]. Serum levels of alkaline phosphatase, DD, PSA, proportions of Gleason score > 7, T3-T4 stage and M1 stage in CTCs positive group were significantly higher than those in CTCs negative group [ (105.69±30.56) U/L vs (88.89±35.58) U/ L, t = 2.205, P = 0.030; (256.63±35.86) μg/L vs (236.98±33.30) μg/L, t = 2.368, P = 0.020; (30.09±11.89) ng/ ml vs (23.33±10.99) ng/ml, t = 2.533, P = 0.013; 57.69﹪vs 33.33﹪, χ²= 4.381, P = 0.036; 30.77﹪ vs 8.77﹪, χ² = 4.981, P = 0.026; 50.00﹪ vs 17.54﹪, χ² = 9.390, P = 0.002]. (3) The median survival time of all patients was 58.33 months, and the 1, 3 and 5-year survival rates were 88.95﹪, 51.81﹪ and 30.12﹪ respectively. The median survival time of AMACR positive group and CTCs positive group were 40.93 and 36.93 months, which were significantly lower than 66.66 and 69.56 months of AMACR negative group and CTCs negative group respectively (P < 0.05) . (4) Multivariate Cox proportional regression analysis showed that Gleason score > 7, M1 stage, AMACR positive and CTCs positive were the independent risk factors for death (HR =1.883, 3.666, 2.009, 2.923, P < 0.05) .

Ultrasound-guided prostate puncture combined with CTCs enumeration in peripheral blood exert important predictive value for the prognosis of prostate cancer patients, and the prognosis could be comprehensively analyzed according to AMACR expression level in biopsy tissue and CTCs count in peripheral blood.