PAP (Prostatic Acid Phosphatase) tests

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Does anyone have information on changes in PAP values over time?

As part of my Active Surveillance monitoring I have had periodic PAP tests (Life Extension Foundation/LabCorp, DCP Immulite 2000). Results have been: 11/13/06 1.69/28/09 2.110/19/09 1.75/11/10 1.53/29/11 1.77/20/11 1.55/25/12 2.9

The most recent result of 2.9 is of some concern as it is near or above the suggested thresholds for indication of micro metastasis. See below

The Best to You and Yours!Jon in Nevada

PS- LEF is now offering PAP tests in their standard catalog (LC004747, $41.34 non members, $23.25 members). It used to be a special order at $96.

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PAP references:PAP CONCERN POINTS FOR EARLY METASTASISMoul et al.1998 PAP > 3.0Dattoli et al.2003 PAP > 2.5Saito et al, 2006 PAP > 3.0Fang et al, 2008 PAP > 2.5

Merrick et al, 2005 Cut point for positive bone scans: PAP > 15.0; PSA >50--------------------------------------------------------------------------

Moul JW, Connelly RR, Perahia B, et al, 1998, The contemporary value of pretreatment prostatic acid phosphatase to predict pathological stage and recurrence in radical prostatectomy cases., J Urol 159:935-40

Dattoli M, Wallner K, True L, et al, 1999, Prognostic role of serum prostatic acid phosphatase for 103Pd-based radiation for prostatic carcinoma. Int J Radiat Oncol Biol Phys 45:853-856, 1999.

Han M, Piantadosi S, Zahurak ML, et al, 2001,Serum acid phosphatase level and biochemical recurrence following radical prostatectomy for men with clinically localized prostate cancer. Urology 57:707-11, 2001.

Dattoli M, Wallner K, True L, Cash J, Sorace R, 2003, Long-term outcomes after treatment with external beam radiation therapy and palladium 102 for patients with higher risk prostate carcinoma, Cancer 97:979-983, 2003.

Merrick GS, WM, Wallner K, et al, 2005, Enzymatic prostatic acid phosphatase in the clinical staging of patients diagnosed with prostate cancer. W V Med J 101:116-119, 2005.

Saito T, Kitamura Y, Komatsubara S, 2006, Prognosis of prostate cancer with elevated prostatic acid phosphatase, Hinyokika Kiyo. 2006 Mar;52(3):177-80

Dattoli M, Wallner K, True L, et al: Long-term prostate cancer control using palladium-103 brachytherapy and external beam radiotherapy in patients with a high likelihood of extracapsular cancer extension. Urology 69:334-337, 2007.

Fang LC, Dattoli M, Wallner K, et al, 2007, Prostatic acid phosphatase predicts cancer-specific survival after palladium-103 brachytherapy for prostate cancer. Brachytherapy 6:79-80, 2007.

Taira A, Merrick G, Wallner K, Dattoli M, 2007, Commentary: Reviving the Acid Phosphatase Test for Prostate Cancer, ONCOLOGY. Vol. 21 No. 8, July 1, 2007

Saito T, Hara N, Kitamura Y, Komatsubara S, 2007, Prostate-specific antigen/prostatic acid phosphatase ratio is significant prognostic factor in patients with stage IV prostate cancer, Urology. 2007 Oct;70(4):702-5.

Walner K, Merrick G, Dattoli M, 2007, Prostate Brachytherapy Made Complicated, 3rd Ed.

Fang LC, Dattoli M, Taira A, et al, 2008, Prostatic acid phosphatase adversely affects cause-specific survival in patients with intermediate to high-risk prostate cancer treated with brachytherapy. Urology 71:146-50, 2008.

----------------------------------------------------------------------Fang LC, Dattoli M, Taira A, et al, 2008:OBJECTIVES: To perform a retrospective analysis to assess the utility of pretreatment serum prostatic acid phosphatase (PAP) as a predictor of cause-specific survival (CSS) in patients with higher risk prostate cancer treated with palladium-103 (103Pd) brachytherapy and supplemental external beam radiotherapy (EBRT).

METHODS: From 1992 to 1996, 193 patients with clinically localized prostate adenocarcinoma, a pretreatment PAP level, and Gleason score 7 or more, and/or a prostate-specific antigen (PSA) level of 10 ng/mL or more were treated with 103Pd brachytherapy and supplemental EBRT. The patients underwent EBRT of 41.4 Gy to a limited pelvic field and 103Pd brachytherapy with a prescribed minimum 103Pd dose of 80 Gy. Multivariate analysis was performed to analyze the predictive value of PAP, PSA, and Gleason score on CSS.

RESULTS: The 10-year CSS rate for patients with a PAP level of less than 1.5, 1.5 to 2.4, and 2.5 U/L or more was 93%, 87%, and 75%, respectively (P = 0.013). The 10-year CSS rate for patients with a PSA level of less than 10, 10 to 20, and greater than 20 ng/mL was 92%, 76%, and 83%, respectively (P = 0.393). The 10-year CSS rate for patients with a Gleason score of 6, 7, 8, and 9 was 90%, 89%, 70%, and 68%, respectively (P = 0.002). On multivariate regression analysis, PAP (hazard ratio 1.31, P <0.0001) and Gleason score (hazard ratio 2.37, P =0.0007) were associated with CSS. PSA was not predictive of CSS (P = 0.393).

CONCLUSIONS: The results of this study demonstrated that PAP is a stronger predictor of CSS than PSA or Gleason score in men with higher risk prostate cancer treated with 103Pd brachytherapy and EBRT. Given the findings of this analysis, the use of PAP should be reconsidered in these patients.