CIRCULATING TUMOR CELL DIAGNOSTICS FOR IDENTIFICATION OF RESISTANCE TO ANDROGEN RECEPTOR TARGETED THERAPIES

1 . A method of predicting de novo resistance to androgen receptor (AR) targeted therapy in a tumor of a prostate cancer patient comprising

(a) performing a direct analysis comprising immunofluorescent staining and morphological characteristization of nucleated cells in a blood sample obtained from the patient to generate circulating tumor cell (CTC) data, wherein the analysis comprises determining a measurable feature of a panel of traditional and non-traditional CTC biomarkers for de novo resistance to androgen receptor (AR) targeted therapy, and

(c) evaluating the CTC data to determine the probability of de novo resistance to the AR targeted therapy in the tumor of the prostate cancer patient.

2 . The method of claim 1 , wherein the immunofluorescent staining comprises wherein the immunofluorescent staining of nucleated cells comprises pan cytokeratin, cluster of differentiation (CD) 45, diamidino-2-phenylindole (DAPI) and AR.

3 . The method of claim 1 , wherein the biomarkers comprise (1) CTC heterogeneity, (2) frequency of cytokeratin positive (CK+), AR N-terminal positive CTCs with prominent nucleoli morphology, and (3) frequency of AR C-terminal truncated CTCs.

4 . The method of claim 3 , wherein the CTC heterogeneity further comprises biomarkers selected from the group consisting of traditional CTCs, CTC clusters, CK− CTCs, small CTCs, nucleoli + CTCs, CK speckled CTCs and the biomarkers listed in Table 1.

5 . The method of claim 1 comprising an initial step of depositing the nucleated cells as a monolayer onto a slide.

6 . The method of claim 1 , wherein the prostate cancer is metastatic castration resistant prostate cancer (mCRPC).

7 . The method of claim 1 , wherein the CTC data is generated by fluorescent scanning microscopy.

8 . The method of claim 7 , wherein the microscopy provides a field of view comprising both CTCs and at least 200 surrounding white blood cells (WBCs).

9 . The method of claim 1 , wherein the CTC data is generated by assessing at least 4 million of the nucleated cells.

10 . The method of claim 8 , wherein the CTCs comprise distinct immunofluorescent staining from surrounding nucleated cells.

11 . The method of claim 8 , wherein the CTCs comprise distinct morphological characteristics compared to surrounding nucleated cells.

12 . The method of claim 11 , wherein the morphological characteristics comprise one or more of the group consisting of nucleus size, nucleus shape, presence of holes in nucleus, cell size, cell shape and nuclear to cytoplasmic ratio, nuclear detail, nuclear contour, presence or absence of nucleoli, quality of cytoplasm and quantity of cytoplasm.

13 . The method of claim 1 , wherein the identification of CTCs further comprises comparing intensity of pan cytokeratin fluorescent staining to surrounding nucleated cells.

14 . The method of claim 1 , further comprising an initial step of obtaining a white blood cell (WBC) count for the blood sample.

15 . The method of claim 1 , further comprising an initial step of lysing erythrocytes in the blood sample.

16 . The method of claim 1 , further comprising an initial step of depositing nucleated cells from the blood sample as a monolayer on a glass slide.

17 . The method of claim 16 , further comprising depositing between about 2 million and about 3 million cells onto the glass slide.

18 . The method of claim 1 , wherein the generation of the CTC data comprises enumeration of CTCs in the blood sample.

19 . The method of claim 1 , wherein the measurable features are analyzed using a predictive model.

20 . The method of claim 19 , wherein the model is a multivariate model.