The Study Of Serum Prostate Specific Antigen--论文代写范文精选

测量酸性磷酸酶(ACP)作为一个常规筛查检测患者，血清ACP异常高。这是因为同工酶研究不仅表明前列腺癌的存在与否,还是否有骨转移。下面的essay代写范文进行详述。

Abstract
Serum activities of Acid Phosphatase (ACP) and Prostatic Acid Phosphatase (PAP) are still employed in most hospitals in Nigeria for the diagnosis of prostate cancer, because of lack of resources for prostate specific antigen (PSA) assay. Serum PSA and activities of phosphatase isoenzymes ACP and PAP, Alkaline Phosphatase (ALP) and Heat stable Alkaline Phosphatase (HSAP) were studied in 71 apparently healthy male controls and 47 proven prostate cancer patients. There were statistically significant increases in the mean serum levels of PSA, PAP, ACP, ALP and HSAP in the prostate cancer patients compared to the controls. PSA level was increased above the cut-off level in 85.1% of patients, PAP in 66.0%, ACP in 57.5%, ALP in 34.0% and HSAP in 21.3% of cases. Serum levels of PSA, ACP and PAP were lower and of ALP and HSAP higher in patients with longer duration of the disease.

Introduction 
Prostate cancer is the most common malignant tumour in men over the age of 65 years. It has been declared a public health epidemic in black American men because of its high incidence. 1 Africa was reported in the past to have a low incidence of this disease, 2 however recent studies indicate a high and rising incidence in Nigerians. 3,4 The measurement of acid phosphatase(ACP) isoenzymes is recommended as a routine screening test for patients whose serum ACP is abnormally high. This is because the isoenzyme study not only indicates the presence or absence of prostate cancer but also whether or not there is bony metastasis. 5 However, with the advent of prostate specific antigen (PSA) measurement, assay of ACP and prostatic acid phosphatase (PAP) in the diagnosis, staging and monitoring of prostate cancer has taken a back-stage. 6 

ACP and PAP estimations are still employed in most hospitals in Nigeria because of lack of resources for PSA. 7 On the other hand, heat stable alkaline phosphatase (HSAP), a placenta – type ALP that is expressed in gonadal and urologic cancers 8 , including prostate carcinoma and metastatic diseases with bony lesions, 9 may play a role in the diagnosis of prostate cancer in the absence of facilities for PSA. Thus, the need for the evaluation and reappraisal of the combined serum activities of ALP, HSAP, ACP and PAP in the presence or absence of PSA assay in the diagnosis and monitoring of prostate cancer in Nigeria. This may provide a simpler, more common and affordable combined method for the diagnosis of this disease and/or encourage hospital management to improve on the resources necessary for this diagnosis.

Materials and methods 
Subjects Forty-seven (47) prostate cancer patients within the ages of 50-90 years were selected from University of Benin Teaching Hospital, Benin City (UBTH), and Nnamdi Azikiwe University Teaching Hospital, Awka (NAUTH), Nigeria between July 2002 and July 2003. Prostate cancer patients were grouped as 2 years after diagnosis. The control population was made up of 71 male volunteers, who were apparently healthy and prostate cancer asymptomatic. They were selected to match the patients in age and socio-economic status. Informed consent was obtained from all subjects. Collection of Samples Five millilitres (5ml) of venous blood was obtained from each of the subjects, dispensed into plain container without anticoagulant, allowed to clot and retract. The serum was separated from the whole blood after centrifugation and stored frozen until the assay. However, sera for ACP and PAP estimations were stabilised using 5mg sodium hydrogen sulphate monohydrate per ml of serum before freezing.

Discussion 
Results of this study indicate significant elevations in serum PSA concentrations as well as ACP, PAP, ALP and HSAP activities in prostate cancer patients compared to controls. It shows that PSA remains a potent marker for diagnosis of prostate cancer. However, ALP and HSAP, and of course ACP and PAP may be effective markers for prostate carcinoma with reliability in the range of PSA (85.1%) > PAP (66.0%) > ACP (57.5%) > ALP (34.0%) > HSAP (21.3%). The higher reliability shown by PSA, PAP, and ACP may be due to the fact that they are prostate specific proteins. 16,17 The continued use of ACP and PAP assays due to the absence of PSA assay facility may account for the reported low incidence of prostate carcinoma in Nigeria. 18 

Higher levels of ALP and HSAP activities in patients with longer duration of prostatic cancer corroborates the finding that increases in serum levels of ALP occur with concomitant advancement of prostate cancer. 19 This may be due to, not only elevation in serum HSAP, but also increase in the concentration of bone and liver ALP isoenzymes in advanced prostate carcinoma with bone and liver metastasis respectively. 20 Increase in ALP and HSAP with advanced prostate cancer may make ALP and HSAP as markers of relapse during treatment. Elevated levels of HSAP appear to occur in prostate cancer patients with metastatic disease that are clinically progressive as well as those apparently responding to chemotherapy. 8,21 The lower mean values of PSA, PAP and ACP in the prostate cancer subjects with longer duration after diagnosis may indicate that these may be better indices of the organ’s response to treatment of the tumour. Therefore PSA is a useful marker in the management of patients with prostate carcinoma and it surpasses PAP in this regard. 22

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