Prognostic usefulness of serum acid phosphatase levels in carcinoma of the prostate

Carcinoma of the prostate: pathology, staging, and treatment

Prostate cancer is the most common malignancy affecting American men over the age of 50. Its incidence increases with each decade. It is usually discovered by rectal examination performed during physical examination or incidentally found on histologic sections of a prostate removed to alleviate urinary obstructive symptoms. About 50% of patients have clinically localized disease at presentation. The majority of prostate cancers grow slowly, metastasize late, and are not the primary cause of death. Before recommending treatment to a patient with prostate cancer, the treating physician should assess the extent of malignancy and determine which therapy, if any, would favorably influence the course of disease with the least influence on the general quality of life. Patients with disease limited to the prostate are offered curative therapy with either radical prostatectomy or radiation therapy. Those with locally extensive disease are treated with external beam irradiation or with androgen ablation. Metastatic disease is treated by androgen ablation. Chemotherapy is reserved for those patients who fail hormonal treatment.

Acid phosphatase in prostatic tissue homogenates from patients with benign prostatic hyperplasia and prostatic carcinoma

Acid phosphatase activity biochemically in the primary tumor of 20 patients with prostatic carcinoma, was studied in an attempt to understand the basis for a correlation or lack of correlation between serum and/or bone marrow acid phosphatase levels and the presence and/or clinical behavior of prostatic carcinoma. The enzyme activity was similarly measured in 19 patients with benign prostatic hyperplasia as controls. On the average, enzyme activities were lower (P less than 0.002) in the tissues from patients with carcinoma. There was no correlation of enzyme activity in tumor with the age of the patient, stage of disease, degree of differentiation of the tumor, or serum acid phosphatase activity.

Serial spot hydroxyproline/creatinine ratios in metastatic prostatic cancer

Analysis of urinary hydroxyproline levels offers a marker to monitor osseous involvement in patients with metastatic malignancies. Such a marker is needed in patients with prostatic cancer when bone metastases predominate. Thirty-two men with stage D2 prostatic cancer were monitored by bone scan, acid and alkaline phosphatase values, and urinary hydroxyproline, beginning from 4 to 36 months after initiation of hormonal manipulation and/or systemic chemotherapy. In patients with disease progression determined by bone scan serial urinary hydroxyproline values progressively increased and were significantly elevated compared to urinary values obtained from patients with a stable or improving scan (p less than 0.001). Simultaneous alkaline phosphatase determinations showed less significant differences between patient groups. Acid phosphatase did not reliably indicate osseous response to therapy. These data suggest that urinary hydroxyproline values are predictive as an early objective sign of osseous response in patients receiving therapy for stage D2 prostatic cancer.

Serum prostatic antigen measurement in localized prostatic cancer: correlation with clinical course

Serial serum prostatic antigen measurements were performed on patients treated for localized prostatic carcinoma. There was good correlation of mean serum prostatic antigen levels and the surgical stage of the disease. Among patients treated by radical prostatectomy there was good correlation of an elevated serum prostatic antigen and the development of metastatic disease. It appears that serum prostatic antigen is a good indicator and predictor of the development of distant metastasis in this group of patients.

Effective treatment of hormonally-unresponsive metastatic carcinoma of the prostate with adriamycin and cyclophosphamide: methods of documenting tumor response and progression

Combination chemotherapy with Adriamycin and cyclophosphamide was administered to 22 men with progressive tumor following hormonal treatment for metastatic carcinoma of the prostate. Objective partial response was documented in 7 patients (32%); an additional four (18%) had stable disease for a minimum of four months, and 11 (50%) were non-responders. Patients with partial response had a median survival of 14 months and lived significantly longer than those with no response (median five months); survival of men with stable disease approximated that of partial responders. Serial utilization of multiple staging procedures during chemotherapy demonstrated that although no single test allowed identification of all patients with objective tumor response or progression, improvement in median of five parameters could be documented in responding patients. In patients adequately studied at the time of disease progression, deterioration in a median of six tests was found. Serum acid phosphatase radionuclide bone scan, and plasma carcinoembryonic antigen were the most sensitive procedures which detected both objective tumor response and progression. Toxicity of chemotherapy was acceptable except in patients with prior radiation therapy. Administration of Adriamycin and cyclophosphamide was associated with clinical benefit in half of our patients with hormone-resistant prostatic cancer. Tumor response and progression can best be objectively assessed if several staging procedures are serially employed during treatment.

Overview of past and current philosophy of prostatic cancer

Carcinoma of the prostate is the second most common cancer in men, yet no significant change in overall survival has occurred since the original description of the results of castration by Huggins and Hodges. Many important questions about the disease remain unanswered. The cause of prostatic cancer is unknown, and few specific environmental or viral agents have been linked with the tumor. Increased recognition of the importance of frequent digitial rectal examination has resulted in more tumors being diagnosed in early stages. Developments in sonography suggest that it may be useful in detecting the presence of prostatic cancer and whether extraprostatic extension has occurred. Recent inprovements in the sensitivity of prostatic acid phosphatase assays have been made, but their use as a screening tool remains limited. In patients with clinical stage B lesions that are microscopically confined to the prostate, treatment by radical prostatectomy appears to confer greatest survival. The exact role of radiotherapy remains to be defined. However, when the tumor extends beyond the prostate and is localized to the pelvis, external beam ro interstitial radiation is appropriate. Pelvic lymphadenectomy has significant morbidity, but less invasive methods of pelvic nodal evaluation are less accurate. Lymphadenectomy has not been shown to have any therapeutic effect. Whether hormonal therapy improves survival needs further investigation, and efforts must continue to develop means of predicting hormonal responsiveness. Those patients unlikely to respond to hormonal therapy should be treated with early chemotherapy.