ACT-PSA and complexed PSA elimination kinetics in serum after radical retropubic prostatectomy: proof of new complex forming of PSA after release into circulation.
OBJECTIVE
To study the elimination kinetics of alpha(1)-antichymotrypsin (ACT)-prostate-specific antigen (PSA) and complexed PSA (cPSA) in comparison to the biexponential decrease of total PSA and free PSA after radical prostatectomy.


METHODS
Serum total PSA, free PSA, ACT-PSA, and cPSA values and the corresponding ratios were determined in venous blood from 12 patients with prostate cancer. The samples were taken before surgery, immediately after surgery, 1, 2, 3, 4, 5, and 6 hours after surgery, and then once daily for the next 10 days. Total PSA and cPSA were analyzed by using Immuno 1 PSA assays (Bayer Corporation); free PSA was measured using the AxSym test kit (Abbott Diagnostics). For ACT-PSA, the ES analyzer system was used (Roche Diagnostics). Statistical calculations were performed with the analysis of variance and Wilcoxon tests.


RESULTS
During the first 6 hours after radical retropubic prostatectomy, we found nearly constant levels of ACT-PSA and cPSA, in contrast to the rapid elimination of free PSA and significant decrease in total PSA. From days 1 to 10, a continuous and nearly identical decrease of ACT-PSA and cPSA occurred compared with total PSA; free PSA was eliminated more rapidly.


CONCLUSIONS
In addition to the opinion that the first PSA decrease might be an effect of the operation itself or caused by renal elimination alone, our findings indicate that the initial rapid decrease of free PSA immediately after surgery could be caused by new complex forming of PSA with ACT and other serum protease inhibitors.
Stephan
C
C
Department of Urology, University Hospital Charité, Humboldt University Berlin, Berlin, Germany.
Jung
K
K
Brux
B
B
Lein
M
M
Sinha
P
P
Schnorr
D
D
Loening
S A
SA
D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D006801:Humans; D008297:Male; D008657:Metabolic Clearance Rate / Q000502:physiology; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis / Q000601:surgery*; D011485:Protein Binding / Q000502:physiology; D000514:alpha 1-Antichymotrypsin / Q000097:blood*
D014408:Biomarkers, Tumor; D000514:alpha 1-Antichymotrypsin; D017430:Prostate-Specific Antigen