Prostatic Acid Phosphatase Values Research Articles

Correlation of Peripheral Vein Tumour Marker Levels, Internal Iliac Vein Tumour Marker Levels and Radical Prostatectomy Specimens in Patients with Prostate Cancer and Borderline High Prostate-Specific Antigen: A Pilot Study.

To correlate prostate-specific antigen (PSA), free to total PSA percentage (fPSA%) and prostatic acid phosphatase (PAP) levels from peripheral and pelvic venous samples with prostatectomy specimens in patients with prostate adenocarcinoma and borderline elevation of PSA. In this prospective institutional review board approved study, 7 patients with biopsy proven prostate cancer had a venous sampling procedure prior to prostatectomy (mean 3.2 days, range 1-7). Venous samples were taken from a peripheral vein (PVS), the right internal iliac vein, a deep right internal iliac vein branch, left internal iliac vein and a deep left internal iliac vein branch. Venous sampling results were compared to tumour volume, laterality, stage and grade in prostatectomy surgical specimens. Mean PVS PSA was 4.29, range 2.3-6 ng/ml. PSA and PAP values in PVS did not differ significantly from internal iliac or deep internal iliac vein samples (p > 0.05). fPSA% was significantly higher in internal iliac (p = 0.004) and deep internal iliac (p = 0.003) vein samples compared to PVS. One of 7 patients had unilateral tumour only. This patient, with left-sided tumour, had a fPSA% of 6, 6, 6, 14 and 12 in his peripheral, right internal iliac, deep right internal iliac branch, left internal iliac and deep left internal iliac branch samples respectively. There were no adverse events. fPSA%, unlike total PSA or PAP, is significantly higher in pelvic vein compared to peripheral vein samples when prostate cancer is present. Larger studies including patients with higher PSA values are warranted to further investigate this counterintuitive finding.

Elevation of prostate-specific markers after cardiopulmonary resuscitation.

BACKGROUND-Prostate-specific antigen (PSA), acid phosphatase (AP), and prostatic acid phosphatase (PAP) are serum markers for adenocarcinoma of the prostate gland. Previous studies indicated that prostatic ischemia may also produce elevations of PSA. Cardiopulmonary resuscitation (CPR) is frequently associated with profound tissue hypoperfusion. The present study investigated whether PSA, AP, and PAP are influenced by prolonged CPR. METHODS AND RESULTS-PSA, AP, and PAP were assessed immediately, 12 hours, 24 hours, 2 days, 3 days, 5 days, and 7 days after prolonged CPR (>5 minutes) in 14 male and 5 female patients. No changes were noted in women. In men, serum levels increased significantly after CPR and gradually decreased to near baseline values after 7 days. PSA, AP, and PAP values above the normal range were observed in 63%, 71%, and 64% of all patients, respectively. Compared with survivors, nonsurvivors exhibited higher peak serum levels of PSA (98.6+/-14.3 versus 1.1+/-2.2 mcg/L; P<0.03), AP (57.0+/-71 versus 8.6+/-8.8 U/L; P<0.05), and PAP (47.0+/-62 versus 5.7+/-8.0 U/L; P=NS). Patients with poor neurological outcome exhibited higher peak serum levels of PSA (86.4+/-135.5 versus 12.0+/-23.8 mcg/L; P<0.05), AP (50.9+/-68.1 versus 8.7+/-9.6 U/L; P=NS), and PAP (41.6+/-59.5 versus 5.8+/-8.8 U/L; P=NS) than patients with good neurological outcome. CONCLUSIONS-Prolonged CPR is frequently associated with increases of PSA, AP, and PAP serum levels. Therefore, PSA cannot be used for diagnosis of adenocarcinoma of the prostate during the first weeks after CPR. Further evaluation of these parameters as additional prognostic markers after CPR is warranted.

前立腺性酸性フォスファターゼ（PAP）の臨床的有用性の検討 －免疫学的測定系における保存条件に伴う変動－

前立腺性酸性フォスファターゼ（PAP）の臨床的有用性の検討 －免疫学的測定系における保存条件に伴う変動－

DETECTION OF CIRCULATING PROSTATE SPECIFIC ANTIGEN EXPRESSING PROSTATIC CELLS IN THE BONE MARROW OF RADICAL PROSTATECTOMY PATIENTS BY SENSITIVE REVERSE TRANSCRIPTASE POLYMERASE CHAIN REACTION

Purpose The reverse transcriptase polymerase chain reaction (RT-PCR) assay for prostate specific antigen (PSA) expressing cells in the blood circulation has been under intense investigation since 1992. Although it has been suggested that this technology could be used as molecular staging for occult prostatic hematogenous metastases, we have been unable to confirm RT-PCR PSA positivity of peripheral blood to predict stage or recurrence in radical prostatectomy cases. We performed bone marrow RT-PCR PSA assay on a large cohort of radical prostatectomy cases and evaluate the use of this assay in improving prostate cancer staging and detecting early recurrence. Materials and Methods Unilateral anterior iliac crest bone marrow aspirates were performed on 116 patients immediately before radical prostatectomy between February 1995 and September 1997. Radical prostatectomy specimens were processed as whole mounts. A sensitive nested RT-PCR assay with specific primers derived from the PSA sequence was used, which enabled us to detect PSA expressing LNCaP prostate cancer cells at the sensitivity of 1 cancer cell per 10 million lymphocytes (1/10 7). A minimum of 3 RT-PCR PSA reactions were performed on all patients and at least 2 positive tests were required to define positivity. Patients were followed for PSA recurrence (mean followup 14.7 months). Results PSA expressing cells were detected in bone marrow of 51 of 116 patients (44.0%) when at least 2 of 3 RT-PCR PSA assays per patient were positive. A much higher rate of RT-PCR PSA positivity was noted (77/116 patients, 66.3%) when any RT-PCR PSA positivity was considered. In 10 randomly selected cases the RT-PCR product was confirmed as PSA by deoxyribonucleic acid sequencing. Of 51 bone marrow RT-PCR positive cases 25 (49%) had organ confined disease and 26 (51%) had nonorgan confined disease. Similarly, bone marrow RT-PCR PSA was not associated with age, race, grade, pretreatment PSA or prostatic acid phosphatase value, clinical stage or margin status. However, the 2-year disease-free survival was 96.6% in RT-PCR negative patients versus 77.5% in RT-PCR positive patients (p = 0.054), and bone marrow RT-PCR PSA was an independent prognostic factor in multivariate analysis including PSA, Gleason grade and pathological stage. Conclusions Bone marrow RT-PCR PSA positivity in this study did not predict pathological stage, grade or margin positivity as determined from whole mount prostate cancer specimens. Furthermore, no relationship with age, grade or serum markers and bone marrow RT-PCR PSA positivity was noted. However, bone marrow RT-PCR PSA was associated with early disease recurrence. Further studies and longer followup are warranted to define the metastatic potential of the PSA expressing cells in the bone marrow of prostate cancer patients.

Prostatic acid phosphatase and prostate specific antigen in liver disease

Serum concentrations of prostate specific antigen (PSA) and prostatic acid phosphatase (PAP) were measured in 51 liver cirrhosis, 37 chronic active hepatitis (CAH) patients and 26 healthy individuals. Elevated PSA levels have been found in 2 of cirrhotic patients while no increase has been detected in CAH and controls. Serum PAP levels have been observed slightly increased in 2 patients with cirrhosis, 2 patients with CAH and 1 control case. Mean PSA and mean PAP values showed no significant difference between groups (p > 0.05). Serum PSA and PAP levels are reliable in diagnosing and monitoring prostate cancer in chronic liver patients and maintain their specificity in this situation.

Prostate-specific antigen in mass screening for carcinoma of the prostate.

Prostate-specific antigen (PSA) has various advantages over prostatic acid phosphatase (PAP) as a marker for prostate cancer, but its role in prostate cancer mass screening remains controversial. We measured serum PSA in addition to serum PAP determination and digital rectal examination (DRE) in our mass screening program to assess the usefulness of PSA for prostate cancer mass screening. Serum PSA and PAP measurements and DRE were performed in 1249 patients in mass screening for carcinoma of the prostate in 1989 and 1990. Thirteen cancers were diagnosed. We calculated the mean plus standard deviations (2SD) of the PSA and PAP values of men without cancer, and assessed the usefulness of PSA for prostate cancer screening by using these figures as the upper limit of normal. The number positive for PSA, PAP and DRE were 39, 36 and 48, respectively. If our screening had been performed without DRE, three cancers would have remained undetected, and the number would have been the same if performed without PSA. If the screening had been performed without PAP, on the other hand, no cancers would have remained undetected. The sensitivities of PSA and PAP were 54% and 23%, respectively. The screening detection rate with DRE and PSA was 0.88%, and with DRE and PAP was 0.64%. Measurement of serum PSA values with adjustment of the cut-off value was considered more useful than PAP in mass screening for prostate cancer.

Differential suppression of serum prostatic acid phosphatase and prostate‐specific antigen by 5‐alpha‐reductase inhibitor

To evaluate the effect of finasteride (Proscar) on the serum levels of prostatic acid phosphatase (PAP) and prostate-specific antigen (PSA) in patients with benign prostatic hyperplasia (BPH). Thirty patients on finasteride therapy for BPH formed the study group. Serum PSA and PAP levels were monitored for 2 years while the patients were receiving finasteride. During 12 months of finasteride therapy the serum PSA was suppressed but serum PAP was unaffected. The baseline mean PAP value was 1.303 ng/mL prior to finasteride therapy; this changed to 1.510 ng/mL (P = 0.195) at 6 months and 1.166 ng/mL (P = 0.383) at 12 months. The serum PSA was 2.630 ng/mL at baseline, 1.757 ng/mL (P < 0.001) at 6 months and 1.545 ng/mL (P = 0.001) at 12 months. Further studies are warranted to determine if PAP has a role as a tumour marker in patients whose PSA is suppressed as a result of finasteride therapy.

Serum TPS, PSA, and PAP values in relapsing stage D2 adenocarcinoma of the prostate.

Serum tissue polypeptide-specific antigen (TPS), prostate-specific antigen (PSA), and prostatic acid phosphatase (PAP) concentrations were serially measured in 31 prostate cancer patients with bone metastases who had relapsed following hormonal therapy. Of these subjects 7 had well-differentiated cancer (G1), 13 patients were assessed to have moderately differentiated tumor (G2) while in 11 subjects poorly differentiated tumor (C13) was found. With increasing tumor grade (G1 to G3), a proportional increase in mean TPS value was found while the increase in respective PAP serotest values was not linear. Simultaneously measured mean PSA values showed a curved effect. Both PSA and PAP serotest concentrations depend on the respective hormone-dependent gene expressions that gradually decrease with tumor dedifferentiation. Therefore, in progressive hormonally treated stage D2 prostate cancer patients an androgen-independent TPS serotest seems to be a useful clinical addition for monitoring protocols. The combined use of TPS, PSA, and PAP seems to give a better reflection of tumor status. According to the bone scan data metastatic tumor mass in G3 carcinomas was virtually equal to cancer burden in G2 tumors. Hence, the marked elevation of TPS serotest values in G3 adenocarcinomas could not be attributed to greater tumor mass but was most likely due to an increase in proliferation rate. Some authors have recently proposed cytokeratins 8, 18, and 19 to be the origin of TPS serum findings. However, cytokeratin content has been proven to be lower in G3 tumors than in better-differentiated neoplasms.(ABSTRACT TRUNCATED AT 250 WORDS)

Changes in immunohistochemical staining of PSA, PAP, and TURP-27 following irradiation therapy for clinically localized prostate cancer

Objectives. To determine if tissue expression of prostate-specific antigen (PSA), prostatic acid phosphatase (PAP), and a prostate-associated monoclonal antibody (TURP-27) is retained after irradiation therapy and to compare these results with serum levels. Methods. Immunohistochemical tests were performed on prostatic tissue obtained byneedle biopsy or transurethral resection prior to and following definitive irradiation therapy for clinically localized prostatic carcinoma. PSA, PAP, and TURP-27 were studied. Results were compared with serum PSA and PAP values. Results. All 20 preirradiation specimens stained positively for PSA and PAP; 19 of 20stained for TURP-27. All 5 of the initial post-treatment biopsy specimens that showed recurrent tumor stained for all 3 markers. In 2 cases, staining for the 3 markers was greatly diminished. Only 8 of 15 post-treatment biopsy-negative specimens stained for all 3 markers. Six of 15 demonstrated loss of tissue expression for all 3 antigens. One specimen stained for PAP and TURP-27 but failed to stain for PSA. Serum PSA levels paralleled tissue expression in recurrent tumor specimens. However, 3 of the post-treatment biopsy-positive cases with PAP expressing tissue had normal serum PAP levels. Conclusions. No cases of recurrent tumor with marker-negative tissue were identified.However, benign epithelial prostate cells appear to sustain sufficient damage from irradiation to lose the capacity to produce certain proteins. Diminished contribution of benign glands to circulating PSA, in addition to decreased expression in malignant tissues, may explain the lower than anticipated serum PSA levels in patients who progress after irradiation therapy.

Prediction of pelvic lymph node metastases by a prostate-specific antigen and prostatic acid phosphatase in clinical T3/T4M0 prostatic cancer.

Prostate-specific antigen (PSA) and prostatic acid phosphatase (PAP) were determined in the serum of 69 patients with clinical T3/T4M0 prostatic cancer before staging lymphadenectomy. In principle, high-dose radiotherapy was given only to patients of pathological N0 category. Seventeen patients had a prelymphadenectomy PSA level below the normal upper reference limit (10 micrograms/l) and only 3 of them had pelvic lymph node metastases. Fifteen of 52 patients with a preoperative PSA level > or = 10 micrograms/l were of N0 category. Only 8 of the 41 evaluable patients had PAP values above the normal range, and 6 of these 8 patients had pelvic lymph node metastases. Preoperative PSA values, but not preoperative PAP levels, assist the clinician in predicting regional lymph node metastases in patients with clinical T3/T4M0 prostatic cancer. Two-thirds of the patients with T3/T4 tumours and PSA values between 10 and 50 micrograms/l have regional lymph node metastases. About 80% of the patients with PSA levels < 10 micrograms/l belong to the N0 category. About 75% of the patients with PSA > 50 micrograms/l have N+ disease. Taking into account the individual preoperative PSA values, the indication for preradiotherapy staging lymphadenectomy should be balanced between the chance of demonstrating N+ disease, the expected postoperative morbidity and the benefit for the patient found to be of N0 category.

DNA ploidy and prostate-specific antigen as prognostic factors in clinically resectable prostate cancer

Prostate-specific antigen (PSA) and DNA ploidy as measured by flow cytometry were compared with conventional prognostic indicators in 112 patients who underwent radical prostatectomy for clinically resectable prostate cancer. The variables examined included age, race, prostatic acid phosphatase (PAP), Gleason score of the radical prostatectomy specimen, and pathologic stage. No significant relationships were found between DNA ploidy and age, mean PAP value, and absolute PAP value. Of the 112 patients, 65 (58.0%) had disease limited to the prostate (pathologic Stages A and B); 47 (42.0%) had extraprostatic disease (pathologic Stages C and D1). The stage was related to the Gleason score (P less than 0.0001) where extraprostatic disease was associated with a Gleason score of 6 to 10. Nineteen (17.0%) patients had aneuploid tumors, and 93 (83.0%) had diploid tumors. DNA ploidy significantly correlated with pathologic stage (P = 0.04); aneuploidy was identified more frequently in patients with Stages C and D1 tumors. Aneuploid tumors occurred more frequently than diploid tumors in patients with a Gleason score of 6 to 10 (P = 0.034). Mean PSA values were higher in patients with aneuploid tumors (P = 0.078), extraprostatic neoplasms (P = 0.00001), and cancers with a Gleason score of 6 to 10 (P = 0.0004). Furthermore, PSA values greater than 10.0 ng/ml were associated with extraprostatic disease and a Gleason score of 6 to 10 (P less than 0.05 and P less than 0.001, respectively). Significant racial differences were found with respect to DNA ploidy, mean DNA indices, and mean PSA values. The 18 black patients had more DNA aneuploid tumors (P = 0.043), a higher mean DNA index (P = 0.017), and a higher mean PSA value (P = 0.043) than the 94 white patients. Both PSA and DNA ploidy analysis by flow cytometry appear to be valuable indicators in the evaluation of patients with prostatic carcinoma.

The role of prostatic acid phosphatase in the radiotherapeutic management of adenocarcinoma of the prostate

Between 1965 and 1984, 472 patients treated with external beam radiation therapy (EBRT) for adenocarcinoma of the prostate had pretreatment and follow-up serum prostatic acid phosphatase (PAP) measurements performed by the Roy method. All patients were clinically staged (46 A2, 67 B, and 359 C), and none had hormonal manipulation prior to relapse. Four hundred and twenty-five had pretreatment PAP values in the normal range (0.00 0.80 mIU/ml) and had an actuarial 5-year disease-free survival (DFS) of 67% (A 89%, B 93%, and C 59%). Forty-seven patients had elevated pretreatment PAP values. Three of these patients ha have remained disease free. ?l A3 or B disease, and all The remaining 44 patients were in Stage C and had a 5-year D S of 38%. This was significantly worse than the 59% DFS observed in the normal-PAP Stage C group (p 0.4 but <0.8 (P <O.Ol). In Stage C, tumor grade was found to be correlated with initial PAP values so that the higher the grade, the higher the PAP value and the greater was the incidence of elevated PAP values. Of patients with M. D. Anderson grade 4 lesions 8/33 (24%) had elevated PAP values as compared with only 6/89 (7%) elevated PAP values in patients with M. D. Anderson grade 1 tumors (p <O.OZ). Similarly a PAP <0.4 was found in 55/89 (62%) patients with grade 1 lesions while only lo/33 (30%) patients with grade 4 lesions had such low PAP values (p <O.Ol). When corrected for grade, the prognostic significance of low-normal PAP versus high-normal PAP was lost. However, an elevated PAP value was an independent adverse prognostic factor for patients with intermediate (grades 2-3) or high grade (grade 4) tumors. In grades 2 and 3, patients with elevated PAP values had a 5-year DFS of 29% compared with 57% for those with normal values (p <0.05). Patients with grade 4 tumors and elevated PAP values had a 5-year DFS of 13% versus 28% for patients with normal range PAP (p = N.S. due to small patient numbers). The role of post-treatment follow-up PAP measurements was also investigated. Following EBRT mean PAP values decreased significantly within 1 to 3 months. This was true for patients with normal pretreatment values as well as for patients with elevated initial values. For patients with initially normal PAP, the fall in PAP after treatment was of no prognostic significance. For the group of 47 patients with elevated pretreatment PAP, the initial mean PAP was 2.34 and the mean at 1 to 3 months was 0.64 (p <O.Ol). Of these 47 patients, 35 (74%) achieved normal values within 1 to 9 months after treatment and 9 (19%) did not. Of the 35 patients whose PAP normalized, 18 (51%) subsequently relapsed; of the 9 patients whose PAP did not decrease to normal range, 8 (89%) relapsed (p = 0.04). However, the 51% relapse rate of the group whose values normalized was significantly higher than the 33% relapse rate of patients who started with normal PAP (p = 0.04). We conclude that (1) the incidence of elevated PAP correlates with stage; (2) PAP has no prognostic significance in Stage A2 and B; (3) Stage C patients with higher grade tumors are more likely to have high-normal or elevated PAP; (4) even when corrected for grade elevated PAP in Stage C is an adverse factor; and (5) PAP values tend to fall after EBRT and persistent elevation post-EBRT is an especially adverse factor.

Enzyme immunoassay of prostatic acid phosphatase after prostatic examination: Correlation with prostate size and immunopathology

Variation in serum prostatic acid phosphatase (PAP) after prostatic digital examination was studied in 22 patients, 18 with benign prostatic hyperplasia (BPH), and 4 with prostatic carcinoma. Serum PAP was determined by enzyme immunoassay (EIA) and compared with standard enzymatic assay (EA). Prostatic tissue from transurethral resection (TUR) was subjected to routine pathologic examination and stained for PAP. PAP level increased above reference range and up to several fold in 12 of 22 patients (54.5%) by EIA and in 22.7 percent by EA. The increase in PAP correlated positively with the prostate size estimated by digital palpation ( R = 0.82, P < 0.001). There was no definite correlation between the histologic parameters studied and the increase in PAP. No day-to-day variation in PAP level was detected in 8 other patients when samples were taken at 7 AM for three successive days. For proper comparison of PAP value, we suggest that sampling time should be fixed and specimens should be taken before prostatic manipulation.

Daily variability in human serum prostate-specific antigen and prosttic acid phosphatase: A comparative evaluation

The daily variation of serum levels of prostate-specific antigen (PSA) and prostatic acid phosphatase (PAP) was investigated simultaneously in 10 patients with osseous metastatic prostatic cancer, 10 patients with benign prostatic hyperplasia, and 10 volunteers without prostatic disease. Duplicate serum samples were obtained from all patients on the same day at 8 am, 12 pm, 4 pm, and 8 pm. Statistical analysis (two factor analysis of variance comparing time period to disease group) of the mean PSA and PAP levels at the four sampling times on all patient groups demonstrated no evidence of circadian rhythmic variation or any other distinct pattern for the observed sample times. Overall, the variability in PSA levels was significantly less than that observed for PAP. There was no significant difference in mean percent variation between patient groups (cancer, benign, and normal prostate glands) for both the PSA and PAP assays. Our data reveal that serum PSA measurements fluctuate unpredictably over the course of a day in patients with and without prostatic disease, but to a lesser extent than that seen for serum PAP values. These findings illustrate the potential inaccuracy of single determinations of serum PAP or PSA levels for monitoring disease recurrence and treatment response in patients with prostate cancer.

Evaluation of Prostate-Specific Antigen in Prostate Cancer

Prostate-specific antigen (PSA) was assayed retrospectively in 131 prostate cancer patients. Pretreatment levels at primary tumor diagnosis were above 5 ng/ml in 13/16 (81%) of stage B and C patients and in 28/28 (100%) of stage D (D1 and D2) patients. At the discovery of metastasis in treated patients, they were above this value in 12/17 (71%) of patients. To determine the value of PSA assays when physical exams were negative, 52 patients were reevaluated at a maximum interval of 12 months as a function of their initial PSA concentration. When the initial PSA was negative, there was no clinical evolution during the next 6 months; when PSA was positive, patients had a 55% risk of progression in the next 4 months. All PSA assays were coupled with prostatic acid phosphatase (PAP) measurements. No PAP values were positive when PSA was negative.

Prostate-Specific Antigen (PSA) in the Management of 500 Prostatic Patients

Blood samples from 500 patients with clinical prostatic symptoms were radioimmunoassayed with prostate-specific antigen (PSA) and prostatic acid phosphatase (PAP) kits. On the basis of histological data, directed by PSA results and other investigations, 200 prostatic cancers (adenocarcinomas), 276 benign prostatic hypertrophy (BPH), 16 cases of prostatitis, 5 cancers of the bladder, and 3 prostatodynias were diagnosed. All of the serum samples from prostatic cancer patients showed elevated PSA levels at diagnosis, whereas about 70% of these showed normal PAP values. The sensitivity of the PSA assay is 100% when 2.5 ng/ml is taken as the upper limit of normal. However, the specificity and the positive predictive value are better at 10 ng/ml: 99 and 79%, respectively. High PSA values alerted the clinician when diagnosing a cancer without symptoms on rectal or ultrasonographic examination (3%). In BPH, when the PSA level is between 2.5 and 10 ng/ml, a PSA control must be performed within 2 months. If PSA increases above 10 ng/ml, the risk of cancer has to be considered. In the follow-up, PSA is a better marker than PAP to detect disease progression and seems to constitute an evolutive tumor mass index. PSA is the most sensitive, the earliest, and the most prognostically reliable marker for diagnosis and follow-up of prostate cancer patients.

Experience with a new solid phase enzyme immunoassay for prostatic acid phosphatase

In recent years, the value of prostatic acid phosphatase (PAP) as a tumor marker for early prostatic cancer (CaP) has been the subject of controversial discussion. Investigation of sera from patients with pathohistologically proven localized CaP and from those with benign prostatic hyperplasia (BPH) has demonstrated a lack of discrimination between these groups of patients. Earlier investigations have demonstrated that the turnover rate of PAP in a conventional enzyme immunoassay (EIA) was limited by the release of the phosphate from the active center of the enzyme. However, a transfer of the activated phosphate on n-butanol or n-pentanol could increase the turnover rate to about 150%. Based on these observations 1-butanol was added to a solid-phase direct EIA in order to increase the sensitivity. PAP was assayed in 177 healthy male donors, 33 patients with benign prostatic hyperplasia and 33 patients with CaP. In 10 out of 21 patients with localized CaP (T1-3N0M0), the tumor stage was based on pathohistological examination. The upper limit of discriminative normal value was set at 0.65 μg/l. The values of normal donors ranged between 0.07 and 0.6 μg/l (mean 0.27 μg/l), while the values for patients with BPH were slightly higher (mean 0.5 μg/l). Only one patient with BPH had an elevated serum level (0.7 μg/l). Out of 33 patients with CaP, 31 were found to have PAP values higher than 0.65 μg/l. In one patient with CaP, pT2pN0M0 and one other patient with CaP T1N0M0, serum PAP levels were slightly lower than 0.65 μg/l. This study indicates that an increase in the sensitivity of PAP determination might yield a valuable tool even in the diagnosis of early CaP.

Serum half life of prostatic acid phosphatase.

Traumatic manipulation of the prostate can cause elevated prostatic acid phosphatase (PAP) values. To avoid falsely elevated PAP values after prostatic trauma we studied the serum half life of PAP and the time taken to return to preoperative levels in patients undergoing transurethral resection (TUR-P). Although we observed a broad variation in peak PAP values the half life of PAP is fairly constant at about 1.1-2.6 h. Preoperative values were reached within 30 h. We conclude that PAP determinations can safely be carried out 30 h after prostatic trauma without any risk of falsely elevated PAP values.

Analysis of prostatic acid phosphatase in urine voided before and after massage of the prostate in infertile men.

Prostatic acid phosphatase (PAP) - a specific marker of prostatic secretion - has been analyzed by radioimmunoassay in samples of urine voided before and after massage of the prostate. In all patients there was an increase in urine PAP concentration after massage irrespective of the occurrence of expressed prostatic secretion. The mean PAP values increased from 4.9 to 45.8 micrograms/l. No significant change in urine creatinine concentration was observed. No lactoferrin was detected in the urine which should indicate that no secretion from the seminal vesicles was expressed into the urethra during massage of the prostate. Analysis of PAP in urine after massage of the prostate could increase the value of a urine sediment and microbial analysis in the investigation of male infertility.

Prostatic acid phosphatase(PAP)測定用RIAキットの比較検討ならびに測定上の問題点について

Measurement of prostatic acid phosphatase (PAP) concentration is useful for the diagnosis and treatment of prostatic cancer. Fundamental studies of measurement of PAP concentration by radioimmunoassay were performed and values determined by three commercially available kits were compared, those are, PAP EIKEN RIA Kit (E kit), RIA Quant P.A.P. (M kit) and GammaDab PAP RIA Kit (C kit). Upper limits of normal PAP concentration were 3 ng/ml by E and M kits and 2 ng/ml by C kits, respectively. The reproducibility and the recovery studies of three kits were satisfactory. However, dilution curve of some patients was not strait. PAP concentration of 27 patients measured by three kits were correlated well to each other, but the discrepancy of values was noticed in high PAP concentrations. PAP concentration measured by RIA is more reliable than that by enzyme immunoassay. When keeping serum samples, the effect of time, temperature and frreze and thawing on PAP values was obvious. It is recomended that serum is separated at 4℃ as soon as possible after collecting blood and kept frozen until use.