Dupont A, Cusan L, Gomez J L, Thibeault M M, Tremblay M, Labrie F
Clinical Research Unit in Endocrinology-Oncology, CHUL Research Center, Quebec, Canada.
J Urol. 1991 Oct;146(4):1064-7; discussion 1067-8. doi: 10.1016/s0022-5347(17)38001-1.
Serial serum prostatic acid phosphatase (PAP) and prostate specific antigen (PSA) measurements were performed in 871 patients treated with hormonal combination therapy for stage C (95 patients) or stage D2 (776) prostate cancer for an average followup of 26 months. The relative efficacy of serum PAP and PSA for predicting recurrence of the disease was evaluated by 2 statistical methods at the time of progression as well as 6 and 12 months before clinical relapse of disease using optimized cut-off values of 2.0 and 4.0 micrograms/l. for serum PAP and PSA, respectively. At the time of progression the sensitivity (plus or minus standard deviation) of the 2 tests was estimated at 61.1 +/- 3.2% and 86.7 +/- 3.1% for PAP and PSA, respectively, while the specificity (plus or minus standard deviation) was calculated at respective values of 79.6 +/- 1.3% and 92.4 +/- 4.1%. Receiver operating characteristic analysis disclosed a greater accuracy for PSA at 89.2 +/- 1.7% versus 78.7 +/- 1.6% (plus or minus standard deviation) for PAP. The somewhat lower positive predictive value of the PSA test (81.4% versus 89.6%) is more than compensated by its superior negative predictive value (92.4% versus 79.6%). The present data also show that serum PSA measurements are superior to those of serum PAP for predicting disease recurrence in stages C and D prostate cancer patients treated by combination endocrine therapy and they indicate that measurement of serum PAP does not add significantly to single measurement of serum PSA alone.
对871例接受激素联合治疗的C期（95例）或D2期（776例）前列腺癌患者进行了系列血清前列腺酸性磷酸酶（PAP）和前列腺特异性抗原（PSA）检测，平均随访26个月。采用两种统计方法，分别以血清PAP和PSA的优化临界值2.0和4.0微克/升，评估在疾病进展时以及疾病临床复发前6个月和12个月时血清PAP和PSA预测疾病复发的相对效能。在疾病进展时，PAP和PSA这两项检测的敏感性（±标准差）分别估计为61.1±3.2%和86.7±3.1%，而特异性（±标准差）分别计算为79.6±1.3%和92.4±4.1%。受试者工作特征分析显示，PSA的准确性更高，为89.2±1.7%，而PAP为78.7±1.6%（±标准差）。PSA检测的阳性预测值略低（81.4%对89.6%），但其优越的阴性预测值（92.4%对79.6%）足以弥补这一不足。目前的数据还表明，对于接受联合内分泌治疗的C期和D期前列腺癌患者，血清PSA检测在预测疾病复发方面优于血清PAP检测，且表明血清PAP检测单独对血清PSA单次检测并无显著补充作用。
