Prostatic acid phosphatase in 1993: Its limited clinical utility

Franklin C. Lowe, S. J. Trauzzi

Research output: Contribution to journalArticle

56 Citations (Scopus)

Abstract

The principal role of PAP determinations in 1993 with the ready availability of reproducible serum PSA determinations would be in the identification of those patients with clinically localized prostate cancer who will not be candidates for surgical cure because of the high likelihood of having pathologic stage C or D disease. However, if you believe that radical prostatectomy offers good local control and palliation for clinically localized but pathologic stage C or D disease, then preoperative PAP determinations are not necessary. Also, if you believe that radical prostatectomy in conjugation with androgen deprivation therapy is appropriate for clinically localized but pathologic stage D1 disease, then, again, preoperative PAP determinations are not necessary. However, if you believe that radical prostatectomy is indicated only for those patients with organ- confined cancer, then ordering a preoperative staging Roy enzymatic PAP assay is indicated. Therefore, every urologist must know the type of assay and the substrate being used by his/her laboratory to interpret the PAP results properly; otherwise, patients with potentially curable cancer will not be offered a radical prostatectomy. In conclusion, PSA is superior to PAP for diagnosis, screening, and monitoring prostate cancer. Even though there are three assays for PSA, there is less confusion in interpreting the results than for PAP. The only specific area where the enzymatic PAP assay can be useful is in the identification of those patients with clinically localized disease but pathologically extensive disease; this is not important if you believe that radical prostatectomy offers good local control and palliation for pathologic stage C and D1 disease. The result is helpful only if elevated (abnormal); if normal, it does not add any information. The more sensitive immunologic and radioimmune PAP assays are of no significant clinical value. In addition, the overall usefulness of the Roy enzymatic assay in the United States is obviously reduced by its limited availability. Difficulties in interpreting the results of the other enzymatic assays are potentially another serious problem in using PAP determinations. Thus, less than half of the urologists in the United States are even able to order the only PAP assay-the Roy enzymatic assay-that provides any unique or useful information over PSA values alone. Enzymatic PAP determinations should be performed only for preoperative evaluation of those patients with biopsy-proved localized disease; there is no need to do a 'screening' or 'monitoring' PAP, because PSA is the appropriate marker to follow and use for these purposes.

Original languageEnglish (US)
Pages (from-to)589-595
Number of pages7
JournalUrologic Clinics of North America
Volume20
Issue number4
StatePublished - 1993
Externally publishedYes

Fingerprint

Enzyme Assays
Prostatectomy
Prostatic Neoplasms
prostatic acid phosphatase
Androgens
Neoplasms
Biopsy
Serum
Urologists

ASJC Scopus subject areas

  • Urology

Cite this

Prostatic acid phosphatase in 1993 : Its limited clinical utility. / Lowe, Franklin C.; Trauzzi, S. J.

In: Urologic Clinics of North America, Vol. 20, No. 4, 1993, p. 589-595.

Research output: Contribution to journalArticle

@article{4f0da544478947faa489c0c902dd7968,
title = "Prostatic acid phosphatase in 1993: Its limited clinical utility",
abstract = "The principal role of PAP determinations in 1993 with the ready availability of reproducible serum PSA determinations would be in the identification of those patients with clinically localized prostate cancer who will not be candidates for surgical cure because of the high likelihood of having pathologic stage C or D disease. However, if you believe that radical prostatectomy offers good local control and palliation for clinically localized but pathologic stage C or D disease, then preoperative PAP determinations are not necessary. Also, if you believe that radical prostatectomy in conjugation with androgen deprivation therapy is appropriate for clinically localized but pathologic stage D1 disease, then, again, preoperative PAP determinations are not necessary. However, if you believe that radical prostatectomy is indicated only for those patients with organ- confined cancer, then ordering a preoperative staging Roy enzymatic PAP assay is indicated. Therefore, every urologist must know the type of assay and the substrate being used by his/her laboratory to interpret the PAP results properly; otherwise, patients with potentially curable cancer will not be offered a radical prostatectomy. In conclusion, PSA is superior to PAP for diagnosis, screening, and monitoring prostate cancer. Even though there are three assays for PSA, there is less confusion in interpreting the results than for PAP. The only specific area where the enzymatic PAP assay can be useful is in the identification of those patients with clinically localized disease but pathologically extensive disease; this is not important if you believe that radical prostatectomy offers good local control and palliation for pathologic stage C and D1 disease. The result is helpful only if elevated (abnormal); if normal, it does not add any information. The more sensitive immunologic and radioimmune PAP assays are of no significant clinical value. In addition, the overall usefulness of the Roy enzymatic assay in the United States is obviously reduced by its limited availability. Difficulties in interpreting the results of the other enzymatic assays are potentially another serious problem in using PAP determinations. Thus, less than half of the urologists in the United States are even able to order the only PAP assay-the Roy enzymatic assay-that provides any unique or useful information over PSA values alone. Enzymatic PAP determinations should be performed only for preoperative evaluation of those patients with biopsy-proved localized disease; there is no need to do a 'screening' or 'monitoring' PAP, because PSA is the appropriate marker to follow and use for these purposes.",
author = "Lowe, {Franklin C.} and Trauzzi, {S. J.}",
year = "1993",
language = "English (US)",
volume = "20",
pages = "589--595",
journal = "Urologic Clinics of North America",
issn = "0094-0143",
publisher = "W.B. Saunders Ltd",
number = "4",

}

TY - JOUR

T1 - Prostatic acid phosphatase in 1993

T2 - Its limited clinical utility

AU - Lowe, Franklin C.

AU - Trauzzi, S. J.

PY - 1993

Y1 - 1993

N2 - The principal role of PAP determinations in 1993 with the ready availability of reproducible serum PSA determinations would be in the identification of those patients with clinically localized prostate cancer who will not be candidates for surgical cure because of the high likelihood of having pathologic stage C or D disease. However, if you believe that radical prostatectomy offers good local control and palliation for clinically localized but pathologic stage C or D disease, then preoperative PAP determinations are not necessary. Also, if you believe that radical prostatectomy in conjugation with androgen deprivation therapy is appropriate for clinically localized but pathologic stage D1 disease, then, again, preoperative PAP determinations are not necessary. However, if you believe that radical prostatectomy is indicated only for those patients with organ- confined cancer, then ordering a preoperative staging Roy enzymatic PAP assay is indicated. Therefore, every urologist must know the type of assay and the substrate being used by his/her laboratory to interpret the PAP results properly; otherwise, patients with potentially curable cancer will not be offered a radical prostatectomy. In conclusion, PSA is superior to PAP for diagnosis, screening, and monitoring prostate cancer. Even though there are three assays for PSA, there is less confusion in interpreting the results than for PAP. The only specific area where the enzymatic PAP assay can be useful is in the identification of those patients with clinically localized disease but pathologically extensive disease; this is not important if you believe that radical prostatectomy offers good local control and palliation for pathologic stage C and D1 disease. The result is helpful only if elevated (abnormal); if normal, it does not add any information. The more sensitive immunologic and radioimmune PAP assays are of no significant clinical value. In addition, the overall usefulness of the Roy enzymatic assay in the United States is obviously reduced by its limited availability. Difficulties in interpreting the results of the other enzymatic assays are potentially another serious problem in using PAP determinations. Thus, less than half of the urologists in the United States are even able to order the only PAP assay-the Roy enzymatic assay-that provides any unique or useful information over PSA values alone. Enzymatic PAP determinations should be performed only for preoperative evaluation of those patients with biopsy-proved localized disease; there is no need to do a 'screening' or 'monitoring' PAP, because PSA is the appropriate marker to follow and use for these purposes.

AB - The principal role of PAP determinations in 1993 with the ready availability of reproducible serum PSA determinations would be in the identification of those patients with clinically localized prostate cancer who will not be candidates for surgical cure because of the high likelihood of having pathologic stage C or D disease. However, if you believe that radical prostatectomy offers good local control and palliation for clinically localized but pathologic stage C or D disease, then preoperative PAP determinations are not necessary. Also, if you believe that radical prostatectomy in conjugation with androgen deprivation therapy is appropriate for clinically localized but pathologic stage D1 disease, then, again, preoperative PAP determinations are not necessary. However, if you believe that radical prostatectomy is indicated only for those patients with organ- confined cancer, then ordering a preoperative staging Roy enzymatic PAP assay is indicated. Therefore, every urologist must know the type of assay and the substrate being used by his/her laboratory to interpret the PAP results properly; otherwise, patients with potentially curable cancer will not be offered a radical prostatectomy. In conclusion, PSA is superior to PAP for diagnosis, screening, and monitoring prostate cancer. Even though there are three assays for PSA, there is less confusion in interpreting the results than for PAP. The only specific area where the enzymatic PAP assay can be useful is in the identification of those patients with clinically localized disease but pathologically extensive disease; this is not important if you believe that radical prostatectomy offers good local control and palliation for pathologic stage C and D1 disease. The result is helpful only if elevated (abnormal); if normal, it does not add any information. The more sensitive immunologic and radioimmune PAP assays are of no significant clinical value. In addition, the overall usefulness of the Roy enzymatic assay in the United States is obviously reduced by its limited availability. Difficulties in interpreting the results of the other enzymatic assays are potentially another serious problem in using PAP determinations. Thus, less than half of the urologists in the United States are even able to order the only PAP assay-the Roy enzymatic assay-that provides any unique or useful information over PSA values alone. Enzymatic PAP determinations should be performed only for preoperative evaluation of those patients with biopsy-proved localized disease; there is no need to do a 'screening' or 'monitoring' PAP, because PSA is the appropriate marker to follow and use for these purposes.

UR - http://www.scopus.com/inward/record.url?scp=0027878069&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0027878069&partnerID=8YFLogxK

M3 - Article

C2 - 8273267

AN - SCOPUS:0027878069

VL - 20

SP - 589

EP - 595

JO - Urologic Clinics of North America

JF - Urologic Clinics of North America

SN - 0094-0143

IS - 4

ER -