Fig. 5

Possible mechanism of how CTC-CAF cluster migration promotes cancer recurrence and the proposed use of TRAIL therapy as an adjuvant therapy to prevent this cancer recurrence during surgery. During the primary tumor resection, CTCs are released into the bloodstream due to the disruption of the tumor microenvironment. The CTCs can migrate as clusters along with other CTCs or stromal cells such as CAFs to facilitate the survival and growth in distant tissues. After radical prostatectomy, the CTC cluster and CAF numbers in blood correlate with cancer recurrence in PC patients. Thus, we propose the use of TRAIL therapy as an adjuvant therapy that could be administered during the peri-operative window to neutralize newly released CTCs caused by surgical procedures. Ex vivo, this approach killed over 75% single CTCs and clustered CTCs, respectively. We believe that the eradication of most of the single and clustered CTCs in the bloodstream could prevent cancer recurrence and progression