title: Prognostic role of serum prostatic acid phosphatase for 103Pd-based radiation for prostatic carcinoma.
abstract: OBJECTIVE
  To establish the prognostic role of serum enzymatic prostatic acid phosphatase (PAP) in patients treated with palladium (103Pd) and supplemental external beam irradiation (EBRT) for clinically localized, high-risk prostate carcinoma.
  
  
  METHODS
  One hundred twenty-four consecutive patients with Stage T2a-T3 prostatic carcinoma were treated from 1992 through 1995. Each patient had at least one of the following risk factors for extracapsular disease extension: Stage T2b or greater (100 patients), Gleason score 7-10 (40 patients), pretreatment prostate specific antigen (PSA) >15 ng/ml (32 patients), or elevated serum PAP (25 patients). Patients received 41 Gy conformal EBRT to a limited pelvic field, followed 4 weeks later by a 103Pd boost (prescription dose 80 Gy). Biochemical failure was defined as a PSA greater than 1 ng/ml (normal <4 ng/ml).
  
  
  RESULTS
  The overall, actuarial freedom from biochemical failure at 4 years after treatment was 79%. In Cox-proportional hazard multivariate analysis, the strongest predictor of failure was elevated pretreatment acid phosphatase (p = 0.02), followed by Gleason score (p = 0.1), and PSA (p = 0.14).
  
  
  CONCLUSIONS
  PAP was the strongest predictor of long-term biochemical failure. It may be a more accurate indicator of micrometastatic disease than PSA, and as such, we suggest that it be reconsidered for general use in radiation-treated patients.
authors.affiliation: Department of Radiology, University Community Hospital, Tampa, FL 33613, USA.
authors.forename: M
authors.initials: M
authors.lastname: Dattoli
authors.forename: K
authors.initials: K
authors.lastname: Wallner
authors.forename: L
authors.initials: L
authors.lastname: True
authors.forename: R
authors.initials: R
authors.lastname: Sorace
authors.forename: J
authors.initials: J
authors.lastname: Koval
authors.forename: J
authors.initials: J
authors.lastname: Cash
authors.forename: R
authors.initials: R
authors.lastname: Acosta
authors.forename: M
authors.initials: M
authors.lastname: Biswas
authors.forename: M
authors.initials: M
authors.lastname: Binder
authors.forename: B
authors.initials: B
authors.lastname: Sullivan
authors.forename: E
authors.initials: E
authors.lastname: Lastarria
authors.forename: N
authors.initials: N
authors.lastname: Kirwan
authors.forename: D
authors.initials: D
authors.lastname: Stein
mesh_terms: D000135:Acid Phosphatase / Q000097:blood*; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009363:Neoplasm Proteins / Q000097:blood*; D009367:Neoplasm Staging; D010165:Palladium / Q000627:therapeutic use*; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood* / Q000473:pathology / Q000532:radiotherapy*; D011868:Radioisotopes / Q000627:therapeutic use*; D017211:Treatment Failure
chemical_list: D009363:Neoplasm Proteins; D011868:Radioisotopes; D010165:Palladium; D000135:Acid Phosphatase; D017430:Prostate-Specific Antigen