At our institution, a PAP (Prostatic Acid Phosphatase) blood test is also routinely performed, as this test has been demonstrated by myself as well as others in medical literature to be perhaps the single most adverse feature associated with prostate cancer. Before the advent of the PSA test, the PAP test was the only prostate tumor marker. In fact, doctors believed that the test was so accurate that if the patient had an elevated PAP, he should not undergo surgery because he would predictably have cancer beyond the prostate capsule, and therefore could not be cured by surgery.
“Prostatic Acid Phosphatase Adversely Affects Cause-Specific Survival in Patients with Intermediate to High-Risk Prostate Cancer Treated with Brachytherapy”
After the advent of the PSA test and with the general excitement over the PSA marker, the PAP became less and less used. However, we never stopped using it and have even found that this test can be an independent prognosticator for treatment failure. In other words, in patients undergoing radiation therapy, we found that the PAP was as important as the PSA, and possibly more important for patients with advanced cancer, so we routinely employ it. Similar to radiation data, the PAP also carries tremendous statistical power for predicting whether or not a patient will relapse after surgery. Recent studies are finding that in patients with an elevated PAP over 85% of those patients are going to fail after surgery. This should be no surprise in view of older pre-PSA surgical data In contrast, however, while PAP is still an adverse prognosticator, at our institution, patients, despite having elevated PAPs, are being routinely treated using advanced radiation methods.
1. Ploidy Analysis – “A pathological analysis to determine the number of sets of chromosomes in a cell.”
2. Neuron Specific Enolase (NSE)
3. Chromogranin (CGA)
4. Carcinoembroyonic Antigen (CEA)..
5. A number of other lab tests help to determine whether or not some form of hormonal therapy may be indicated either in short term or at a later date…
“Another test sometimes performed by the pathologist utilizes a high- tech examination called flow cytometry to analyze the nuclear DNA content, or DNA Ploidy, of cancer cells. Samples for analysis may be obtained from biopsy or operating tissue. The genetic information derived from this test allows cancer cells to be classified a ‘diploid’, ‘tetraploid’, or ‘aneuploid’.”
Aneuploid cancers generally have a less favorable prognosis than diploid cancers, and if left untreated are more likely to progress rapidly. Diploid cancers have a more favorable prognosis than either aneuploid or tetraploid. Why ploidies differ and why some indicate a more aggressive cancer than others remains the subject of continuing research.
While this method of analysis is very sensitive, the predictive value of flow cytometry is not definite, and the test in not reliable enough to be used by itself as a diagnostic tool. As far as determining the aggressiveness of the tumor, ploidy can be enhanced when combined with the patient’s PSA and Gleason score. It is a subject of debate whether the data on ploidy is solid enough to be used as a basis fro treatment decisions. Most physicians do not rely on this form of testing. When ploidy is used, it is most often called for when the patient’s Gleason score is greater than or equal to 7. Some studies have suggested that if the PSA is greater than or equal to 15, and if the ploidy is aneuploid, then the likelihood is that the cancer will already have metastasized to the lymph nodes or beyond.”
Aneuploid: Having an abnormal number of chromosomes, as revealed by ploidy analysis. Aneurploid prostate cancer cells tend not to respond well to androgen deprivation therapy (ADT).