Dynamic Profiling of Circulating Tumor Cells and MYC/PTEN Alterations in Prostate Cancer Patients Undergoing Radical Prostatectomy in Amazon Population.

Prostate cancer (PCa) is the second most frequently diagnosed malignancy among men and the sixth leading cause of cancer-related mortality worldwide. Radical prostatectomy remains the standard treatment for localized disease; however, approximately one-third of patients develop biochemical recurrence within 10 years. Although prostate-specific antigen (PSA) is the primary biomarker used for diagnosis and monitoring, additional molecular markers such as PTEN loss and MYC amplification have been investigated to improve prognostic stratification. Liquid biopsy has emerged as a promising tool in oncology, yet the clinical significance of circulating tumor cells (CTCs) in early-stage PCa remains uncertain. This prospective, single-center study included 50 patients with localized prostate cancer from the Brazilian Amazon region who underwent radical prostatectomy in 2023. Peripheral blood samples were collected preoperatively and postoperatively for CTC enumeration and molecular characterization using Cytelligen SET-iFISH and the CellSearch system. PTEN and MYC status were evaluated to further characterize the detected CTC population. CTCs were detected in all patients prior to surgery, with a significant reduction observed after radical prostatectomy (p < 0.001); 88% of patients had no detectable CTCs postoperatively. PTEN loss was identified in 12% of patients, all of whom presented with ISUP grade ≥ 2 disease. MYC amplification was rare, observed in only one patient with Gleason score 7 and concomitant PTEN deletion. These findings suggest that perioperative CTC detection may provide clinically relevant prognostic information in localized PCa. PTEN loss appears to represent an early molecular alteration associated with adverse pathological features. Longer follow-up is needed to determine the predictive value of these biomarkers for recurrence and long-term outcomes.