Prostate-specific acid phosphatase: re-evaluation of radioimmunoassay in diagnosing prostatic disease

The availability of a radioimmunoassay for prostate-specific acid phosphatase has allowed a correlative study between this technique and conventional colorimetric assays in the four clinical stages of prostatic adenocarcinoma. Results of such a study show an increased diagnostic sensitivity of the radioimmunoassay in all stages, but in 14% of Stage IV adenocarcinomas there was no increase in prostatic acid phosphatase above the ranges ordinarily expected for all methods. In cases of benign prostatic hyperplasia, there was an increase associated with in vivo tissue cytolysis, comparable to Stage II and III adenocarcinoma. The sensitivity of the test in Stage I is still low, but testing for combinations of tumor markers might increase the diagnostic yield. Conversely, a different clinical approach might be to establish baseline values in the "at-risk" patient, followed by regular determinations of prostate-specific acid phosphatase activity. Increases in activity within the normal expected range may be interpreted by the clinician as a herald of disease.