前立腺癌における血清前立腺性酸フォスファターゼの腫瘍マーカーとしての意義

Abstract

正常女子14例, 正常男子56例, 前立腺炎25例, 前立腺肥大症74例, 前立腺癌129例, 前立腺以外の悪性疾患50例および膀胱前立腺全摘除後男子16例の合計364例について, RIA-Quant PAP test kitを用いRIにより血清前立腺性酸フォスファターゼ(PSAP)を測定した.前立腺癌の診断にはPSAP 3.0 ng/ml以上を陽性とすると, 前立腺炎0%, 前立腺肥大症5.4%, 未治療前立腺癌80.6%, 前立腺以外の悪性疾患2%であった.前立腺肥大症において, 尿道留置カテーテル例はPSAP高値を示したが有意差はなかった.未治療前立腺癌のStage別には, high stage例の陽性率が高く, GradeとPSAPの関係は同一Stage間では分化癌ほどPSAP高値であった.前立腺癌の治療経過観察の血清マーカーとしては, PSAP 2.0 ng/ml以上を陽性とした.前立腺癌患者の内腸骨静脈血中PAPは大腿静脈や肘静脈のそれより高値の傾向を示す

The levels of prostatic serum acid phosphatase (PSAP) were determined by radioimmunoassay using RIA-Quant PAP test kit on 14 normal females, 56 normal males, 25 patients with prostatitis, 74 patients with benign prostate hypertrophy, 129 patients with prostatic cancer, 50 patients with nonprostatic malignancies, and 16 post radical cystectomized males, making 364 cases in all. To diagnose prostatic cancer, a PSAP level of over 3.0 ng/ml was determined positive for differential diagnosis of prostatitis, benign prostate hypertrophy, and prostatic cancer. According to this criterium, the positive rate for each type of disease was: 0% for prostatitis, 5.4% for benign prostate hypertrophy, 80.6% for untreated prostatic cancer, and 2% for nonprostatic malignancies. In benign prostate hypertrophy, the cases with urethral catheters showed a tendency of high PSAP level, but no significant difference was observed. PSAP positive rates of untreated prostatic cancer by stage are 0% for Stage A, 57.1% for Stage B, 85.7% for Stage C, 100% for Stage D1, and 94.1% for Stage D2 cases at a high stage showing high positive rates. However, there seems to be a limit for the diagnosis of early prostatic cancer. As for the relationship between the grade of untreated prostatic cancer and PSAP, well differentiated tumors showed higher levels of PSAP in the study with cases of the same stage. However, with all the cases, less well differentiated tumors showed higher levels of PSAP. As a tumor marker for prostatic cancer in the observation of treatment response, the PSAP level of over 2.0 ng/ml was determined positive. The relationship between the judgement of treatment response and PSAP was: Objective stable for its increase or decrease within the normal range; progressive disease for its elevation from normal to positive level, or increase or decrease of PSAP level within the positive range; Objective partial regression or objective stable for normalization from positive level. The PSAP level in the internal iliac vein of the patients with prostatic cancer tended to be higher than that in the femoral vein or antecubital vein.