British JournalofUrology (1990), 66, 188-192
0007-1 33 1/90/0066al88/$10.00
01990 British Journal of Urology
Serum Acid Phosphatase in Patients with Localised Prostatic Cancer, Benign Prostatic Hyperplasia or Normal Prostates J. 0. SALO, S. RANNIKKO and R. HAAPIAINEN Second Department of Surgery, Urological Unit. Helsinki University Central Hospital, Helsinki, Finland
Summary-Serum acid phosphatase levels were determined in 247 men with surgically confirmed intracapsular prostatic cancer (30 patients), benign prostatic hyperplasia (BPH) (1 14 patients) or palpably normal prostates (103 men). Both radioimmunoassay (245 cases) and an enzymatic method (2 18 cases) were used. Using radioimmunoassay, the mean serum prostatic acid phosphatase (PAP) level was significantly higher in patients with BPH than in patients with intracapsular cancer or men with normal prostates. The weight of hyperplastic tissue removed during operation in the BPH group correlated closely with PAP concentrations. Age or the presence (or absence) of an indwelling catheter had no effect on PAP concentrations. Using the enzymatic method, the highest levels of acid phosphatase were also detected in patients with BPH but the difference was less marked. It was concluded that intracapsular cancer does not elevate serum acid phosphatase levels as determined by radioimmunoassay or an enzymatic method. BPH alone leads to significant rises in PAP concentrations. The degree of BPH correlates with PAP levels.
Acid phosphatases are exocrine products of the normal prostate. They form a group of non-specific enzymes that hydrolyse phosphate esters under acid conditions to yield inorganic phosphate. Their physiological function has not been clarified but they have been found useful for staging and monitoring prostatic cancer. They were the first tumour marker to be studied in urology (Gutman et al., 1936; Huggins and Hodges, 1941). Both enzymatic and radioimmunoassay techniques have been used to measure acid phosphatases. There is disagreement over whether or not immunochemical techniques are any better than enzymatic methods 1984; Vihko (Quinones et al., 1981;Samuel1 et d., et al., 1985). Until recently it has not been clear whether serum acid phosphatase levels in localised prostatic cancer differ from those in benign prostatic hyperplasia and in subjects with normal prostates (Bruce et al., 1981). Accepted for publication 8 January 1990
In this study we compared serum levels of acid phosphatase, measured by both enzymatic and radioimmunoassay techniques, in patients with histologically verified BPH, in patients with surgically staged intraprostatic cancer and in men with clinically normal prostatic glands.
Patients and Methods Acid phosphatase levels were determined in 247 patients whose mean age was 62.5 years (range 1888). Thirty patients (mean age 66 years, range 5375) had intracapsular prostatic cancer, confirmed by histological examination of radical prostatectomy and pelvic lymphadenectomy specimens. The tumours were well differentiated (Grade 1) in 12 cases, moderately differentiated (Grade 2) in 16 and poorly differentiated (Grade 3) in 2 cases; 114 patients (mean age 70 years, range 54-86) had BPH, verified by histological examination of material obtained either through transurethral resection of
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SERUM ACID PHOSPHATASE IN PATIENTS WITH LOCALISED PROSTATIC CANCER
the prostate (1 10 cases) or by transvesical prostatectomy (4 cases). Thirty-seven of these BPH patients (32%) had had a pre-operative indwelling catheter because of urinary retention. Weights of tissue obtained during operation were recorded. Acid phosphatase levels were also determined in 103 patients (mean age 54 years, range 18-88) with various non-prostatic diseases and palpably normal prostates (controls). An enzymatic method was used in 218 cases and radioimmunoassay (RIA, Farmos, Oulunsalo, Finland) in 245 cases to measure acid phosphatase levels. The x2 test, analysis of variance and regression analysis were used for statistical analysis of the results. Natural logarithmic transformations were used in calculations to reduce skewness when appropriate.
significantly higher than the levels in the other groups (P
0007-1 33 1/90/0066al88/$10.00
01990 British Journal of Urology
Serum Acid Phosphatase in Patients with Localised Prostatic Cancer, Benign Prostatic Hyperplasia or Normal Prostates J. 0. SALO, S. RANNIKKO and R. HAAPIAINEN Second Department of Surgery, Urological Unit. Helsinki University Central Hospital, Helsinki, Finland
Summary-Serum acid phosphatase levels were determined in 247 men with surgically confirmed intracapsular prostatic cancer (30 patients), benign prostatic hyperplasia (BPH) (1 14 patients) or palpably normal prostates (103 men). Both radioimmunoassay (245 cases) and an enzymatic method (2 18 cases) were used. Using radioimmunoassay, the mean serum prostatic acid phosphatase (PAP) level was significantly higher in patients with BPH than in patients with intracapsular cancer or men with normal prostates. The weight of hyperplastic tissue removed during operation in the BPH group correlated closely with PAP concentrations. Age or the presence (or absence) of an indwelling catheter had no effect on PAP concentrations. Using the enzymatic method, the highest levels of acid phosphatase were also detected in patients with BPH but the difference was less marked. It was concluded that intracapsular cancer does not elevate serum acid phosphatase levels as determined by radioimmunoassay or an enzymatic method. BPH alone leads to significant rises in PAP concentrations. The degree of BPH correlates with PAP levels.
Acid phosphatases are exocrine products of the normal prostate. They form a group of non-specific enzymes that hydrolyse phosphate esters under acid conditions to yield inorganic phosphate. Their physiological function has not been clarified but they have been found useful for staging and monitoring prostatic cancer. They were the first tumour marker to be studied in urology (Gutman et al., 1936; Huggins and Hodges, 1941). Both enzymatic and radioimmunoassay techniques have been used to measure acid phosphatases. There is disagreement over whether or not immunochemical techniques are any better than enzymatic methods 1984; Vihko (Quinones et al., 1981;Samuel1 et d., et al., 1985). Until recently it has not been clear whether serum acid phosphatase levels in localised prostatic cancer differ from those in benign prostatic hyperplasia and in subjects with normal prostates (Bruce et al., 1981). Accepted for publication 8 January 1990
In this study we compared serum levels of acid phosphatase, measured by both enzymatic and radioimmunoassay techniques, in patients with histologically verified BPH, in patients with surgically staged intraprostatic cancer and in men with clinically normal prostatic glands.
Patients and Methods Acid phosphatase levels were determined in 247 patients whose mean age was 62.5 years (range 1888). Thirty patients (mean age 66 years, range 5375) had intracapsular prostatic cancer, confirmed by histological examination of radical prostatectomy and pelvic lymphadenectomy specimens. The tumours were well differentiated (Grade 1) in 12 cases, moderately differentiated (Grade 2) in 16 and poorly differentiated (Grade 3) in 2 cases; 114 patients (mean age 70 years, range 54-86) had BPH, verified by histological examination of material obtained either through transurethral resection of
188
189
SERUM ACID PHOSPHATASE IN PATIENTS WITH LOCALISED PROSTATIC CANCER
the prostate (1 10 cases) or by transvesical prostatectomy (4 cases). Thirty-seven of these BPH patients (32%) had had a pre-operative indwelling catheter because of urinary retention. Weights of tissue obtained during operation were recorded. Acid phosphatase levels were also determined in 103 patients (mean age 54 years, range 18-88) with various non-prostatic diseases and palpably normal prostates (controls). An enzymatic method was used in 218 cases and radioimmunoassay (RIA, Farmos, Oulunsalo, Finland) in 245 cases to measure acid phosphatase levels. The x2 test, analysis of variance and regression analysis were used for statistical analysis of the results. Natural logarithmic transformations were used in calculations to reduce skewness when appropriate.
significantly higher than the levels in the other groups (P
