When PSA, MRI and biopsy do not tell the whole story — using CTCs to watch activity and to choose the next systemic option.
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Hong Kong context Prostate cancer was the fourth most common cancer in Hong Kong in 2023, with 3,031 new cases, and the third most common cancer in men. Incidence has risen by more than 80% over a decade as the population ages and testing becomes more common. |
Why this cancer is hard to manage with a single protocol
Many prostate cancers are indolent. Some are not. PSA is a useful but blunt instrument: it rises with benign enlargement, falls with androgen deprivation even when a lethal clone is emerging, and can be uninformative in neuroendocrine or poorly differentiated disease.
Once the disease is castration-resistant, the menu is long — abiraterone, enzalutamide, docetaxel, cabazitaxel, PARP inhibitors in selected HRR-mutated men, lutetium-PSMA, radium-223 — and the cost of choosing the wrong next line is both clinical and financial.
Tissue from a decade-old prostatectomy does not represent the cells circulating today. A fresh blood-based profile of those cells is often the only live sample the team can get without another invasive procedure.
What circulating tumor cells add
Oncotrail RGCC includes a prostate panel. It reports CTC concentration and immunophenotype tailored to this diagnosis, and can be repeated to watch treatment and remission. RGCC sample reports use a prostate-specific reference range, which is not interchangeable with the breast or colon cut-offs.
Stemness and phenotype markers help separate a man whose PSA is noisy but whose circulating burden is quiet, from a man whose PSA looks controlled while more aggressive, less androgen-dependent cells are expanding.
The RGCC pathway for this cancer
A typical sequence is screening or baseline first, then a comprehensive profile when treatment choices matter, then serial follow-up. The exact panel is chosen by the accredited practitioner.
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Clinical question |
RGCC test to consider |
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Elevated PSA or family risk, no confirmed cancer |
Onco-D-clare as an adjunct to PSA / MRI / biopsy — it does not replace urological work-up |
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Confirmed prostate cancer; baseline and monitoring, including during ADT or ARPI |
Oncotrail RGCC (prostate panel) |
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Castration-resistant or metastatic disease; choosing the next agent |
Onconomics Plus |
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Need mutational / HRR / immunotherapy context |
CAMBISeq |
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Interval CTC count only |
Oncocount |
What the report can change in practice
In localised disease the main use is a baseline and then surveillance after prostatectomy or radiotherapy, especially when PSA is detectable but imaging is clear. In metastatic hormone-sensitive disease, serial Oncotrail results can sit beside PSA and PSMA PET.
In castration-resistant disease, Onconomics Plus is the page that ranks remaining cytotoxics and other agents against the cells that are circulating now. Combined with CAMBISeq or tissue NGS, the team can see both the target and the functional response.
Men exploring integrative care after or alongside ADT often ask about supplements. The Extracts panel gives the practitioner a laboratory result to work from instead of a catalogue.
Who this article is for
• Men with a new diagnosis who want a CTC baseline before systemic therapy.
• Rising PSA after prostatectomy or radiotherapy with negative or equivocal imaging.
• Metastatic or castration-resistant disease facing a new line.
• Men who cannot or do not wish to repeat a prostate biopsy.
• Higher-risk men discussing screening — always with PSA and, when indicated, MRI, not instead of them.
Next step
Take your latest PSA trend, MRI or PSMA PET, and biopsy Gleason / Grade Group to an RGCC-accredited practitioner. They will advise whether Oncotrail alone is enough at this step, or whether Onconomics Plus should be drawn at the same time.
Disclaimer. This article is educational and is intended for patients, families, and referring practitioners. RGCC tests are laboratory investigations that support clinical decision-making. They do not replace imaging, tissue diagnosis, or a treating oncologist’s judgement. Results must be interpreted by an RGCC-accredited practitioner in the context of the full medical history. RGCC circulating tumor cell (CTC) assays are not designed to detect primary cancers of the brain or central nervous system. Always discuss findings with your own doctor before changing any treatment.