title: Prostatic acid phosphatase adversely affects cause-specific survival in patients with intermediate to high-risk prostate cancer treated with brachytherapy.
abstract: OBJECTIVE
  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 Cox 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.
authors.affiliation: Department of Radiation Oncology, University of Washington Medical Center, Seattle, Washington 98195, USA. LMCFang@u.washington.edu
authors.forename: L Christine
authors.initials: LC
authors.lastname: Fang
authors.forename: Michael
authors.initials: M
authors.lastname: Dattoli
authors.forename: Al
authors.initials: A
authors.lastname: Taira
authors.forename: Lawrence
authors.initials: L
authors.lastname: True
authors.forename: Richard
authors.initials: R
authors.lastname: Sorace
authors.forename: Kent
authors.initials: K
authors.lastname: Wallner
mesh_terms: D000135:Acid Phosphatase; D000230:Adenocarcinoma / Q000401:mortality* / Q000532:radiotherapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010165:Palladium / Q000627:therapeutic use; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000532:radiotherapy*; D017027:Protein Tyrosine Phosphatases / Q000097:blood*; D011868:Radioisotopes / Q000627:therapeutic use; D011879:Radiotherapy Dosage; D012189:Retrospective Studies
chemical_list: D011868:Radioisotopes; D010165:Palladium; D000135:Acid Phosphatase; C428439:prostatic acid phosphatase; D017027:Protein Tyrosine Phosphatases