title: Value of the serum prostate-specific antigen-alpha 1-antichymotrypsin complex and its density as a predictor for the extent of prostate cancer.
abstract: OBJECTIVE
  To determine whether serum levels of the prostate-specific antigen-alpha1-antichymotrypsin complex (PSA-ACT) and its density (ACTD) in patients scheduled to undergo radical prostatectomy for clinically localized prostate cancer can predict organ-confined vs extraprostatic disease.
  
  
  METHODS
  Serum samples were obtained from 62 patients with clinically localized prostate cancer before they underwent radical prostatectomy. PSA and PSA-ACT were measured using immunofluorometric techniques with different monoclonal antibodies against PSA and ACT, respectively. Furthermore, the PSA and PSA-ACT densities of the whole prostate (PSAD and ACTD, respectively) were calculated. The relationships of serum PSA, PSA-ACT, PSAD, ACTD and the pathological stage of the prostatectomy specimens were analysed.
  
  
  RESULTS
  The disease was organ-confined or extraprostatic in 30 and 32 men, respectively. In men with organ-confined cancer, the mean PSA and PSA-ACT levels were significantly lower than in those with extraprostatic disease. Furthermore, there were significantly higher mean PSAD and ACTD levels in men with extraprostatic than with organ-confined disease. There were also significant differences in PSA, PSA-ACT, PSAD and ACTD levels at each pathological stage, whereas there was no significant association between these variables and the Gleason score. Receiver-operating characteristic curve analysis for detecting organ-confined disease showed that PSA-ACT and ACTD had a larger area under the curve than PSA and PSAD, respectively, but these differences were not significant. Furthermore, PSA-ACT and ACTD provided significantly better sensitivity for detecting organ-confined disease than PSA and PSAD, respectively.
  
  
  CONCLUSIONS
  Measuring PSA-ACT and ACTD may improve the preoperative evaluation of patients scheduled to undergo radical prostatectomy, because these factors better differentiate extraprostatic from organ-confined disease than PSA and PSAD.
authors.affiliation: Department of Urology, Kobe University School of Medicine, Kobe, Japan.
authors.forename: I
authors.initials: I
authors.lastname: Hara
authors.forename: H
authors.initials: H
authors.lastname: Miyake
authors.forename: S
authors.initials: S
authors.lastname: Hara
authors.forename: N
authors.initials: N
authors.lastname: Yamanaka
authors.forename: Y
authors.initials: Y
authors.lastname: Ono
authors.forename: H
authors.initials: H
authors.lastname: Eto
authors.forename: Y
authors.initials: Y
authors.lastname: Takechi
authors.forename: S
authors.initials: S
authors.lastname: Arakawa
authors.forename: S
authors.initials: S
authors.lastname: Kamidono
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D006801:Humans; D008297:Male; D009367:Neoplasm Staging / Q000379:methods; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D012372:ROC Curve; D012680:Sensitivity and Specificity; D000514:alpha 1-Antichymotrypsin / Q000097:blood*
chemical_list: D014408:Biomarkers, Tumor; D000514:alpha 1-Antichymotrypsin; D017430:Prostate-Specific Antigen