Staging of prostatic carcinoma; comparative role of prostate specific antigen [PSA] and prostatic acid phosphatase [PAP]

ABSTRACT

OBJECTIVE: 1]. To see the comparative role of serum prostate specific antigen [PSA] and prostatic acid phosphatase [PAP] in the pre-operative staging of prostatic cancer. 2]. Their significance in different grades and different tumor volumes. SETTING: Mayo Hospital Lahore. PERIOD Sep 1993 to Feb 1995. DESIGN Case study. METHODS We evaluated 50 patients with adenocarcinoma of the prostate [Group A]. Fifty benign prostatic hyperplasia [BPH] patients serum PSA and PAP was done in all the cases. Tumour volume was measured by transrectal ultrasonography [TRUS] and were divided into 3 groups [<5cc, 5-10cc,> 10cc]. Grading of the tumour was done [Grade I, II and III] on histopathological examination according to the degree of differentiation. In stage ABC and D prostatic carcinoma patients 33.3%, 56.0%, 87.5% and 100% patients had serum PSA level even more than 10mg/ml respectively. On the other hand serum PAP level was within the normal [3.7 u/l] limits in stage A and B prostatic carcinoma patients, while it was raised above the normal limits in 43.7% and 95.5% patients of stage C and D prostatic carcinoma patients. Serum PSA level was raised above the normal [5ng/ml] in 4.5% normal subjects but it was less than 10 ng/ml and 28% of BPH patients. Serum PAP level was raised above the normal in 2% of the BPH patients. Statistically significant difference [P<0.05] in serum PSA value was seen in stage C and D prostatic carcinoma patients when compared with stage A and B prostatic carcinoma and control groups. This was true only in stage D prostatic carcinoma in case of PAP. Estimation of serum PSA level can better predict variable contributions from tumour differentiation and tumour volume as well as BPH