經尿道前列腺切除術對於血清中列前列腺特異性抗原（PSA）及前列腺酸性磷酸酶（PAP）之影響

OBJECTIVE: PSA and PAP are now the best available tumor marker in the treatment of the prostate cancer. The purpose of this study is verify the effect of transurethral prostatectomy (TURP) of the prostate on serum prostate specific antigen (PSA) and prostate acid phosphatase (PAP). MATERIALS AND METHODS: and METHODS: From June 1990 to June 1997, 100 with benign prostate hyperplasia (BPH) treated by TURP were studied. Blood sample for PSA and PAP determination were obtained prior to, immediate after and seven days after TURP by evacuated tubes. The Abbott IMX PSA and PAP enzyme immunoassay was used as assay. Results of the PSA and PAP levels were analyzed statistically with the paried T-test. RESULTS: Of the 100 patients with BPH in this study, 26 (26%) patients showed initial PAP levels and 36 (36%) patients showed initial PSA levels ＞4ng/ml. A dramatic and statistically significant PSA and PAP rise immediately following operation; the mean pre-operative level rose from 3.0±1.29ng/ml of PSA and 3.76±1.98ng/ml of PAP to an immediate post-operative mean of 27.6±1.6ng/ml and 28.0±2.1ng/ml, respectively (p＜0.001). After 7 days, the mean PSA level returned to 2.13±1.27ng/ml, and the mean PAP level returned to 1.11±0.42ng/ml, the different form the initial level was not statistically significant (p＞0.05). The difference between the PSA and PAP levels immediately after operation and 7 days later was again significant (p＜0.05). PSA and PAP levels reflected either the time and prostate weight. The mean PSA of operation time less than one hour and prostate weight＜20gm. Were 17.02±1.3ng/ml and 39.93±2.4ng/ml. respectively, and the mean PSA of operation time more than one hour and prostate weigh＞20gm. Were 39.64±1.3ng/ml and 57.12±1.8ng/ml respectively (p＜0.05). The mean PAP of operation time less than one hour and prostate weight＜20gm. Were 20.50±2.5ng/ml and 17.41±1.6ng/ml, respectively; and the mean PAP of operation time ＞ one hour and prostate weight＞20gm. Were 41.78±2.1ng/ml and 62.67±1.8ng/ml, respectively (p＜0.05). Of the 74 PAP initial level normal patients, 6 (8.1%) cant’t return to normal 7 days after operation, and of the 64 initial PSA level normal patients, 6 (9.3%) can’t return to normal 7 days after operation, it showed no significant statistically (p＞0.05). CONCLUSIONS: This study shows that 36% and 26% of the patients with BPH had a Serum PSA and PAP greater than 4 ng/ml respectively. Because of the levels of PSA and PAP undergoes increase 10 fold after operation, we suggested that when applying the diagnostic triad of PSA and PAP should preferably be taken 7 days after operation. About 8.1% of the initial PAP and 9.3% of the initial PSA normal level patients can’t return to their initial levels one week after operation, the percentage were in relation to the patient’s clinical situation such as the duration of bladder catheterization, residual prostate gland tissue and occuld prostate cancer.