Comparison of assays for prostatic and total acid phosphatase

Total and tartrate inhibited acid phosphatase was determined on the Technicon Chem 1 and evaluated against a Cobas-Bio centrifugal analysis procedure and an immunochemical method. Precision and reference range studies were performed for the Chem 1 acid phosphatase procedure and correlation was established with the other methods. The Chem 1 method for measuring total and prostatic acid phosphatase is a sensitive method with good correlation to the centrifugal analysis and the immunochemical method. The assay is fully automated and requires no manual off-line sample preparation.     

Incontinence related to management of benign prostatic hypertrophy

Background: The prevalence of incontinence ranges from 11% to 34% among community-dwelling men aged ≥65 years.Objective: The objective of this analysis was to determine the nature of incontinence diagnosed in men with benign prostatic hypertrophy (BPH), focusing on its incidence, prevalence, diagnostic workup, and management.Methods: A cohort of patients with BPH was identified in the Integrated Healthcare Information Services National Managed Care Benchmark Database (1997-2003). Age and duration in the database after the first diagnosis of BPH were used as matching strata. Therapeutic subgroups consisted of watchful waiting, g-blockers, 5-α-reductase inhibitors (5ARIs), and BPH-related surgery.Results: A total of 411,658 males with BPH were identified from 12,298,027 males (3.3%). Of the BPH cohort, 2.7% (n = 11,172) were identified as having incontinence; of these, 57.8% of patients were ≥65 years of age. Alter applying inclusion/exclusion criteria, the final matched case-control sample included 6346 men as case subjects and 229,154 men as control subjects. The overall incidence of incontinence in this BPH sample was 1835/100,000/year, and the prevalence was 2713/100,000 men. In 48.5% of the incontinent men, the type of incontinence was not specified. Diagnostic testing was performed in 2.9% of men with incontinence. Conditional logistic regression analyses found that BPH-related surgery and g-blocker use increased the adjusted odds ratio for the risk of incontinence 3.1-fold, and 1.1- to 1.7-fold, respectively. The odds ratio of the risk of incontinence was not significantly increased with long-term 5ARI use.Condusions: Use of g-blockers, 5ARIs for the short term (<1 year), and BPH-related surgery were independently, significantly associated with BPH-related incontinence; 5ARI use for >1 year and watchful waiting were not. BPH-related incontinence may be related to progression of BPH or as a postsurgical complication. Patients with BPH should be asked specifically about incontinence, especially after BPH-related surgery, and undergo a full diagnostic workup for the diagnosis of urinary incontinence.     

Counterimmunoelectrophoresis in determination of prostatic acid phosphatase in human serum

We evaluated counterimmunoelectrophoresis for use in measuring prostatic acid phosphatase in detection of prostatic cancer. After staining for acid phosphatase, we could detect as little as 0.3 ng of purified enzyme standard complexed with antibody by this technique. However, when serum samples were used as antigen, the method was less sensitive (1.5-2.0 ng) because some of the serum proteins migrate with the phosphatase and decrease the intensity of the stain for acid phosphatase. For this reason we could not detect the phosphatase in serum samples of normal persons; only patients with moderately (or greater) increased activity in their serum showed positive results. In contrast, by radioimmunoassay as little as 1.0 ng of the phosphatase can be detected in serum.     

Rapid, fully automated radioimmunoassay of prostatic acid phosphatase in serum

Prostatic acid phosphatase was purified from human semen and its purity established by biochemical and immunological criteria. Rabbits were injected with the purified isoenzyme to raise specific antisera. The prostatic acid phosphatase was radiolabeled with 125I by the Chloramine T method. We developed a fully automated double-antibody radiommunosassay for measuring prostatic acid phosphatase in serum from patients with carcinoma of the prostate and from several control groups. The lower detection limit of the radioimmunoassay was 2.0 microgram of prostatic acid phosphatase per litre of serum. Values for most members of the control group was <2.0 microgram/L; patients with metastatic carcinoma of the prostate had values ranging from <2.0 to 300 microgram/L of serum.     

Comparison of radioimmunoassay and immunoradiometric assay for serum prostatic acid phosphatase

We have compared the laboratory performance of immunoradiometric (IRMA) and radioimmunoassay (RIA) methods developed in this laboratory for measurement of serum prostatic acid phosphatase (PAP). The IRMA utilizes a radiolabelled mouse monoclonal anti-PAP and a solid phased rabbit polyclonal anti-PAP. The same rabbit antibody is used in the RIA. The IRMA shows excellent precision over a much wider working range (0.25-1000 micrograms/l) than the RIA (0.73-14.0 micrograms/l), and can be completed in 5 h, while the RIA requires 3 days. Levels in healthy males and in patients with benign prostatic hypertrophy are similar in both assays, upper limits of normal being 1.8 micrograms/l (IRMA) and 4.7 micrograms/l (RIA). The two assay methods correlate very well (r = 0.97) when PAP is measured in serum from prostatic cancer patients, although IRMA results are generally lower than those obtained by RIA. About 20% of patients with non-metastatic prostatic carcinoma had elevated serum PAP, whereas about 80% of those with metastatic disease had raised levels. The diagnostic efficiencies of the RIA and IRMA appeared similar. The value of the IRMA in follow-up and staging remains to be determined.     

Intracellular localisation of 5alpha-dihydrotestosterone in human benign prostatic hypertrophy.

When slices of benign hypertrophied human prostate and abdominal muscle were incubated with either [3H]testosterone or 5alpha-dihydro[3H]testosterone, the uptake of radioactivity by prostatic tissue was significantly higher than that of the muscle (P less than 0.01). The uptake of labelled androgen by prostatic tissue could be significantly reduced by adding the unlabelled steroid to the incubation medium. After the incubation of prostatic tissue with 5alpha-dihydro[3H]testosterone, the amount of the radioactivity taken up by the whole homogenate and the nuclear preparation of the prostatic tissue were measured. DNA content of the nuclei and the whole homogenate was also estimated. The mean+/-S.E.M. of 5alpha-dihydrotestosterone associated with the nuclei was 65+/-4.4%, ranging from (52.2-79.8%). The activity of acid phosphatase was measured in 30 samples of prostatic tissue. The mean +/- S.E.M. was 20.7+/-1.5 U/g tissue (9.8+/-0.9 U/mg DNA). The correlation between the activity of this enzyme and the uptake of androgen by prostatic tissue is evaluated.     

Lymphoma of the prostate presenting as benign prostatic hypertrophy.

A case of lymphocytic lymphoma involving the prostate is reported. Lymphomatous infiltration of the prostate had been mentioned infrequently in the literature, so that the incidence, prognosis, and treatment are not well known. Lymphomatous or leukemic infiltrate should be considered as a causative agent of prostatism, particularly in patients with hematologic abnormalities where chemotherapy may relieve the symptoms.     

Tamsulosin for the treatment of benign prostatic hypertrophy

OBJECTIVE: To review the information necessary to assess the efficacy and safety of tamsulosin compared with other adrenergic antagonists for treatment of symptomatic benign prostatic hyperplasia. DATA SOURCES: A search was conducted of Cumulated Index Medicus, January 1993-August 1999, which was restricted to human trials and English-language journals. STUDY SELECTION AND DATA EXTRACTION: Efficacy studies were included if the design was randomized and included a control group. Drug safety was assessed using data from any patient series or controlled study. DATA SYNTHESIS: Tamsulosin, a uroselective alpha1A-adrenergic receptor antagonist, relaxes smooth muscle in the prostate and bladder neck, thereby enhancing bladder emptying. In randomized, controlled clinical trials using standardized instruments, tamsulosin improves obstructive voiding symptoms by at least 25% in 65-80% of patients with symptomatic benign prostatic hyperplasia. Tamsulosin also improves peak urinary flow rate by 1.4-3.6 mL/sec in various studies and reduces post-void residual urine volume. The usual dosage of tamsulosin was 0.4 or 0.8 mg orally once a day in the studies performed in the US and Europe; daily doses of 0.1-0.4 mg were used in studies performed in Japan. The beneficial effects of tamsulosin on voiding symptoms, peak urinary flow rate, and bladder emptying appear to be dose-related, up to a ceiling dose of 0.4 mg. The most common adverse effects are headache, asthenia, dizziness, and rhinitis-like complaints. Retrograde or delayed ejaculation occurs in 4.5-14.0% of patients and has required discontinuation of treatment in a minority of these patients. At the usual dose of 0.4-0.8 mg/d, tamsulosin does not appear to significantly reduce blood pressure, increase heart rate, or cause first-dose syncope; therefore, dosage titration is not necessary when initiating treatment. Use of nifedipine, enalapril, atenolol, furosemide, or digoxin does not require dosage modification when tamsulosin is initiated concomitantly; hypotension has not been reported with combined use of tamsulosin and these commonly used agents. CONCLUSIONS: Tamsulosin is an improvement over other alpha-adrenergic antagonists for the management of symptoms of benign prostatic hyperplasia. It is a more convenient alternative that does not require initial dosage titration, has a fast onset of action, and has a low potential to cause hypotension when used alone or in combination with commonly used antihypertensive agents. It is more costly than some of the other second-generation alpha-adrenergic antagonists.     

Analytical and physiological characteristics of prostate-specific antigen and prostatic acid phosphatase in serum compared

We did a comparative analysis of the physiological and analytical properties of prostate-specific antigen (PSA), acid phosphatase (ACP; EC 3.1.32) activity, and acid phosphatase antigen (PAP) in serum. The PSA assay is sensitive to 0.2 microgram/L and demonstrates good linearity (y = 1.01x + 0.74). The CV was 3.9% at 40 micrograms/L, 8.0% at 3.1 micrograms/L. PSA and PAP are less stable at 4 degrees C than at -20 degrees C. Serum PAP and ACP concentrations showed large intra-individual fluctuations (average CVs of 22% and 24%, respectively), which were not observed with PSA measurements (average CV 6.2%). We saw significant correlation with the magnitude of physiological change when analytes were compared for serially collected split samples [y(PSA) = 0.14x(PAP) + 0.00, r = 0.767], which indicates that a common factor is influencing this variation. The excellent analytical performance, tissue specificity, and small degree of intra-individual variance are characteristics that favor the measurement of PSA in serum for monitoring patients with prostatic cancer.     

The application of photobleaching to sequential staining of antigen-antibody precipitates in gels for prostatic acid phosphatase and protein.

A modified procedure is described for the sequential staining of agar precipitates of seminal plasma and antiseminal plasma serum for acid phosphatase and total protein. The procedure employs Gomori's glycerophosphate-lead sulphide method for acid phosphatase, ultraviolet light for photobleaching and amidoschwartz for total protein staining. In a single agar diffusion plate, a minimum of 7 protein bands was observed, 3 of which contained acid phosphatase activity.