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We examined the effect of neoadjuvant hormonal therapy (NHT) on biochemical failure. We retrospectively analyzed 146 high-risk prostate cancer patients (clinically (c), T1c-3N0M0) who underwent radical prostatectomy between June 2002 and March 2008. Thirty-eight patients were treated with NHT for ≥2 months (NHT group), and 108, with surgery alone (SA group). The study population comprised 89 cT1c-2N0M0 patients and 57 cT3N0M0 patients, and pathologically (p), 66 pT0-2N0M0 patients and 76 pT3N0M0 patients. Downstaging was noted in 36.4 and 0% of cT1c-2N0M0 patients and in 74.1 and 20.0% of cT3N0M0 patients in the NHT and SA groups, respectively. For both cT1c-2N0M0 and cT3N0M0 patients, the downstaging rate was significantly higher in the NHT group than in the SA group (p＜0.01). Positive resection margin rates were significantly lower in the NHT group (34.2%) than in the SA group (65.7%) (p＜0.01). The overall prostate-specific antigen (PSA) progression-free rate did not differ significantly between the 2 groups in both pT0-2N0M0 and pT3N0M0 patients. However, in pT0-2N0M0 patients with negative resection margins, the 5-year PSA progression-free rate was significantly lower in the NHT group than in the SA group (p＜0.01), whereas this rate did not differ significantly between the groups in both pT0-2N0M0 and pT3N0M0 patients with positive resection margins. Although NHT seemed to have some effect on downstaging, its pathological effects could be underestimated. Thus, NHT was considered to have no significant effect on biochemical failure.

シュウ酸分解菌を保有する健康成人男性12例に乳果オリゴ糖を1日10g、14日間、就寝前に服用させた。服用開始日・終了日に24時間尿中ショウ酸排泄量測定、糞便培養を行い、更に糞便中の総嫌気性菌数、総シュウ酸分解菌数を測定した。糞便培養検査では、12例中1例でシュウ酸加PYG寒天培地でのシュウ酸分解菌発育はみられたが、PYG寒天培地での菌発育はみられず、総嫌気性菌数は測定不可であった。糞便中の総嫌気性菌数はオリゴ糖投与後増加し、総シュウ酸分解菌数も投与後増加した。24時間尿中シュウ酸排泄量は投与前後で有意差はなかった。ショウ酸分離菌として分離同定された細菌は、細菌生化学的検査にてBifidobacterium adolescentisと判明した。そこで、Bifidobacterium adolescentisのtype strainの1つであるYIT 4011を用いてシュウ酸分解能の有無を調べた結果、YIT 4011にはシュウ酸分解能を認めず、全てのBifidobacterium adolescentisがシュウ酸分解能を有しているわけではないことが明らかとなった。, A variety of oxalate-degrading bacteria including Oxalobacter formigenes and some species of Bifidobacterium are known to colonize the human intestinal tract. Oral lactosucrose supplementation promotes the growth of Bifidobacterium in the human intestine. Therefore, we investigated the effect of oral lactosucrose supplementation on enteric oxalate-degrading bacteria in twelve healthy men (age ranging from 25 to 39 years). Lactosucrose was orally administered 10 g daily for 2 weeks without restriction of dietary intake. The total number of oxalate-degrading bacteria in feces and the 24-hour urinary excretion of oxalate were examined before and after lactosucrose supplementation. The total number of oxalate degrading-bacteria was significantly increased by lactosucrose supplementation (9.20 +/- 0.44 versus 9.77 +/- 0.46, p

20～70代の健康人92名(男性55名, 女性37名)を対象に糞便のOxalobacter formigenes(OxB)の有無を調査した.PCR法によるOxBの検出率は男性が80%, 女性62%, 培養法では男性62%, 女性50%であった.同時に検出された蓚酸分解菌(Bifidobacterium breve)の遺伝子解析を行った結果, OxB株に存在する三つの遺伝子(frc, oxc, OxlT)を全て保有していることが示唆された, The first objective of the present study was to examine the presence of Oxalobacter formigenes (an oxalate-degrading bacterium in the human intestine) according to sex in a large number of Japanese. The second objective was to study the presence of three related genes in Bifidobacterium breve, which is considered to be a new oxalate-degrading bacterim. Fecal samples were collected from 55 male and 37 female healthy volunteers. O. formigenes was detected by a polymerase chain reaction (PCR) and a culture-based method. DNA was amplified by the PCR method including the site of important base sequences of each gene in order to detect oxc, frc, and OxlT. O. formigenes was present in 80% of 54 male and 62% of 34 female subjects in the PCR-based assay, while it was present in 62% of 40 male and 50% of 24 female subjects in the culture-based assay. The partial base sequences of the three related genes in B. breve were determined. The RNA polymerase-binding site in promoters and the rho-independent termination sequence were preserved in oxc and frc. In conclusion, the rate of the presence of O. formigenes was the same as in previous reports. Female subjects showed a 15% lower rate than males. B. breve is considered to be an oxalate-degrading bacterium since it was found to have oxalic acid-degrading ability and three genes involved in oxalate degradation.

1996年3月から30ヵ月間に前立腺全摘術を施行したT1c前立腺癌40例を対象に検討した.1)術前の生検でGleason scoreが7以上の症例は, PSA, PSAD, free PSA, % free PSAの全てにおいてGleason scoreが6以下の症例と有意な分布差を認め, 全例腫瘍体積が0.5cm3以上であった.2)Gleason scoreが6以下の症例では, 腫瘍体積0.5cm3の区分に, PSA, PSAD, free PSA, % free PSAのうち% free PSAが最も有用で, % free PSAが15ないし20より低い症例は, 腫瘍体積が0.5cm3以上の可能性が高いことが示唆された, The number of cases of stage T1c prostate cancer has dramatically been increasing since the introduction of PSA as a screening test. The patients with T1c prostate cancer are usually treated by radical prostatectomy. In this group, however, some cancers are of small tumor volume and with a Gleason score of less than 7. These cancers are considered to be good candidates for watchful waiting management. We have investigated 40 patients with T1c prostate cancer treated by radical prostatectomy between 1996 and 1998. All 9 patients harboring tumors of Gleason score 7 or greater had tumors larger than 0.5 cm3. We have investigated PSA-related parameters including total PSA (PSA), PSA density (PSAD), free PSA, and % free PSA in 31 patients with T1c cancers of Gleason score 6 or less in order to clarify good preoperative predictors of tumor volume. We compared the distribution of PSA, PSAD, free PSA, and % PSA between the larger and smaller tumor groups. There was no significant difference in PSA, PSAD, or free PSA value. The small tumor group had a greater mean % free PSA than the larger tumor group (23.27 versus 11.88, p = 0.007). Areas under receiver operating characteristic curves were 0.715, 0.794, 0.636, and 0.842 for PSA, PSAD, free PSA and % free PSA. In stage T1c prostate cancer of Gleason score 6 or less, % free PSA may be the most useful preoperative predictor for tumor volume of 0.5 cm3 or greater.

70歳男。患者は左陰嚢腫大を主訴とした。初診時, 超音波断層法で陰嚢水腫を伴う陰嚢内腫瘤が複数認められ, 腫瘤は最大25mmで, 精巣からは離れた部位から内腔に突出していた。また, 陰嚢部CTでは陰嚢内に均一に造影される充実性腫瘍が認められた。左精巣鞘膜から発生した陰嚢内腫瘍と診断され, 左高位精巣摘除術を施行したところ, 陰嚢内溶液は黄色透明で100 mlであった。更に精巣には異常は認められなかったものの, 精巣鞘膜面から生じていると考えられる黄色の不整な隆起病変が複数確認された。一方, 病理組織学的所見では白膜に腫瘍細胞の浸潤がみられ, 異形成を伴う中皮細胞が腺腔形成や乳頭状に増生していた。以上より, 本症例は免疫組織学的所見を含め, 精巣鞘膜に発生した悪性中皮腫と診断された。目下, 術後3ヵ月経過で明らかな再発や転移は認められてていない。尚, 画像上で他臓器の病変はなく, 追加治療は行なわれなかった。, A 70-year-old man was referred to our hospital with a painless swelling of the light scrotal contents. Ultrasonography and computed tomographic scan revealed a hydrocele testis and irregular masses in the scrotum. The patient underwent left orchidectomy under the diagnosis of left intrascrotal tumor. Pathological diagnosis was malignant mesothelioma. The patient has not received additional therapy because there has been no evidence of metastasis. He has been free of disease 3 months postoperatively.

235例を対象として, 予後因子を検討した. 1)単変量解析ではperformancestatus, ヘモグロビン値, 血清アルカリフォスファターゼ値, 血清LDH, 組織学的分化度, 骨転移の拡がり(EOD), 内分泌療法の反応性が重要な因子であった. 2)以上の7項目を全て施行した196例を対象として, Coxの比例ハザードモデルを用いて行った多変量解析では血清LDH, 内分泌療法の反応性, 組織学的分化度, 骨転移の拡がり(EOD)が重要な因子であった.以上より, 治療前LDHの高値のものと治療後のマーカーの正常化しないものは, 内分泌療法の高危険群であった, To evaluate prognostic factors in stage D2 prostate cancer, 235 patients who had been treated with endocrine therapy were investigated. With univariate analysis, performance status, hemoglobin concentration, serum alkaline phosphatase, LDH, histological grade, extent of disease (EOD), and response of tumor markers at 3 months were shown to be significant prognostic factors. To compare these 7 factors, multivariate analyses was performed in 196 cases. Cox proportional hazard model demonstrated that LDH, followed by response of tumor markers at 3 months, histological grade, and EOD were significant for predicting prognosis. We concluded that the patients whose serum LDH was above the normal range and/or whose tumor markers were not or had not been normalized 3 months after the onset of endocrine therapy were in the high risk group, and should be given more aggressive treatment.

1)測定検出感度は, 0.2ng/mlであった。2) 46歳以上の男子成人の平均値+2SDは1.41ng/mlであったので, 男子成人の正常上限値は1.5ng/mlとした。3)前立腺癌および前立腺肥大症より, 診断効率, ROC曲線をえて, 両者の鑑別が最も良好な2.5ng/mlを本キットのcut offとした。この結果, 男子成人, 前立腺癌, 前立腺肥大症および前立腺癌以外の泌尿器科癌での異常値出現率は, それぞれ0.7%, 65%, 20%および10%であった。4)前立腺癌の病期別の検出率は, 病期A2, B2, C, D1+D2それぞれ0%, 0%, 64%および83%であった。5)マーキットMPAキット(R)によるPSAと本PAPにて, 前立腺癌および前立腺肥大症を測定した。Delfia PAPキット(R)およびマーキットMPAキット(R)の診断効率は前者が52%, 後者が71%と, 後者が約20%高かった。正診率でも, 前者が69%, 後者が84%と, 後者が優れていた, Fundamental and clinical studies of serum prostatic acid phosphatase (PAP) detected by a Delfia PAP kit were performed. The system is a time-resolved fluoroimmunoassay using europium as a tracer. The lower limit of detection was 0.2 ng/ml. Sera from 54 patients with prostate cancer, 20 with benign prostatic hypertrophy, 20 with urological malignancies other than prostate cancer and 140 adult males over 46 years old were determined. From the mean + 2 S.D. of serum PAP values obtained on the adult males, 1.5 ng/ml was considered as the upper normal level of adult males. By calculating the efficiency and ROC curve using the PAP values of prostate cancer and benign prostatic cancer, 2.5 ng/ml was decided as a cut-off value of this kit. The positive rates of adult males, prostate cancer, benign prostatic cancer and urological malignancies other than prostate cancer were 0.7%, 65%, 20% and 10%, respectively. The sensitivity of stage A2, B2, C and D1 + D2 was, 0%, 0%, 64% and 83%, respectively. The efficiency of the Delfia PAP kit was 52% and that of the Markit M PA kit was 71%. The correlation between the values assayed with the Delfia PAP kit and the Dinabot PAP kit was very high; the value obtained with the Delfia PAP kit was about 80% of that obtained with the Dinabot PAP kit.

To clarify the effects and limitation of medical treatment for benign prostatic hyperplasia (BPH), 2, 476 patients with BPH were analyzed in terms of symptoms, objective findings, treatment modality and whether surgery was required during the course of medical treatment. As initial therapy, 1, 320 cases (53.3%) were treated with medicine and 783 cases (31.6%) underwent surgery. In the group of patients initially treated with medicine, 264 cases (20.0%) required surgery and most operations were performed within six months from the start of medical treatment. Those who required surgery had a larger prostate and more residual urine than those who continued medical treatment. This tendency was also observed in the patients treated with antiandrogen. Therefore, medical therapy might be inappropriate to treat the patients with more than 50 ml of residual urine or significantly large prostate such as goose egg sized or larger. In conclusion, medical treatment possessed potential usefulness for the management of BPH, however, there seemed to be limitation of the effects of medical treatment.

内分泌療法反応後燃した群とP群に対する化学療法の効果を比較検討した.近接効果は再燃群(24例)により多く, 予後は良好であった.Pは14例で, 両群間にPerformance status (PS)・貧血に差をみたので, PSを2と3とし両者を比較したところ, 近接効果・予後に差をみなかった, Effects of chemotherapy to endocrine therapy (castration with estrogen/antiandrogen)-relapsed (24 cases) or endocrine therapy-resistant (14 cases) prostate cancer were compared. Pretreatment clinical stages in these groups were stage D1 (3 cases) and D2 (35 cases). Regimens of chemotherapy in this study were as follows: cis-platinum (CDDP) (1 case), phosphamide (3 cases), combination of vincristine, phosphamide and peplomycin (5 cases), combination of cyclophosphamide, adriamycin (ADM) and CDDP (8 cases) and combination of phosphamide, ADM, and CDDP (21 cases). Response to chemotherapy and subsequent survival in these two groups were examined. When evaluated at 3 months after the start of the chemotherapy, partial response and stable cases were 50% and 36% in endocrine therapy-relapsed and -resistant groups, respectively. Because the worse performance status contained more cases in the endocrine therapy-resistant group, the response was compared at the same base of performance status, and the response was almost equal in the two groups. Survival in the endocrine therapy-relapsed group was better than that in the therapy-resistant group. When compared at the same base of performance status, the difference in survival time between the two groups was not evident. In conclusion, the response of chemotherapy was similar between endocrine therapy-relapsed and -resistant patients, and performance status was a main factor influencing the prognosis of endocrine therapy-refractory prostate cancer.

初回治療として内分泌療法を施行した病期D2前立腺癌120例について, PAP, γ-SmおよびPSA値と予後およびマーカー併用の有用性を検討した.1)治療前マーカー値の高低と予後とは, PAP, γ-SmおよびPSA共関連が認められなかった.2) PAPおよびγ-Smにおいては, 内分泌療法後3ヵ月および6ヵ月の時点で, マーカーが異常値にとどまるものの予後は正常化したものより不良であった.ただし, 1ヵ月後ではこの関連がみられなかった.3)内分泌療法後3ヵ月の時点で, PAPが正常化したもののうち癌死例があるが, これらの大多数はγ-Smは異常値にとどまっていた.したがって, 両マーカーの併用により, よりよく予後を推測できる.4)低分化腺癌で, 内分泌療法後3ヵ月でマーカー正常化の有無は予後に差があり, 正常化したものは中分化腺癌で異常値のままのものと同じ予後であった.このことにより, 組織学的分化度は経過を腫瘍マ, ーカーにて観察することでより有用となることを確認した, Prostatic acid phosphatase (PAP), gamma-seminoprotein (gamma-Sm) and prostate specific antigen (PSA) were examined on 120 cases of stage D2 prostate cancer between 1979 and 1989. All patients received endocrine therapy as the first treatment; castration and immediate administration of estrogen or antiandrogen (101), LH-RH analogs (13), estrogen (3) and antiandrogen (3). The actuarial survival rates were calculated by the cause-specific survival method. Pretreatment levels of PAP, gamma-Sm and PSA did not influence prognosis. After start of treatment, the relationship between the changes of the markers and prognosis were examined. At 1 month after the start of the treatment, normalization of PAP or gamma-Sm was not reflected in the following course. On the contrary, at 3 and 6 months, groups with normalization of PAP or gamma-Sm showed better prognosis than those with elevated levels. The same tendency of PSA was obtained at 6 months after start of treatment. In patients with normalized PAP at 3 months, abnormal gamma-Sm showed worse prognosis than normalized gamma-Sm. Therefore, the significance of determination on the two markers was manifested. As histological grade influenced the following course, poorly differentiated adenocarcinoma with normalized PAP at 3 months showed better prognosis than those with elevated levels. In conclusion, it is worthwhile to measure multiple markers for predicting the prognosis of stage D2 prostate cancer treated with endocrine therapy.

A slow-release formulation of the luteinizing hormone releasing hormone (LH-RH)analog(TAP-144-SR) was administered in 6 cases of prostatic cancer. Five were untreated cases, 3 of moderately-differentiated and 2 of poorly-differentiated cancers (four D2 and one C, NX), the other (D2) was under control by another LH-RH analog. The plasma level of luteinizing hormone and follicle stimulating hormone fell below normal, and the plasma testosterone was less than 1 ng/ml by four weeks after start of treatment. According to the National Prostatic Cancer Project Criteria, 2 of the untreated cases showed a partial response and 3 of the untreated ones showed a stable response, one of which underwent transurethral resection later. The pretreated case still continued controlled more than 4 months. No side effect was noticed.

1985年8月以降2年5ヵ月間受診した未治療33例, 既治療63例の前立腺癌および15例の前立腺肥大症を対象として, DPC, 大日本製薬よび栄研キットのPA 3キット間の比較検討を行った.1)未治療前立腺癌の診断効率は, 大日本製薬>DPC=栄研キットの順に良好であった.2) PA 3キット間の相関性は良好であったが, 個々の値は大きく相違し, 大日本製薬キットにおける測定値が最も低かった.3)標準値の設定が3キットとも大きく相違しており, 大日本製薬キットによる診断効率が高い理由は同キットにおける標準値が3キット中最も低値に設定されていることによる, The serum prostate specific antigen (PA) of the patients with prostatic cancer were determined with 3 assay kits, the Diagnostic Products Cooperation (DPC) kit, the Eiken kit and the Dainippon Pharmaceutical Co. (MARKIT F) kit. The first 2 assay kits involve radioimmunoassay and the latter EIA. For comparison, prostatic acid phosphatase (PAP) and gamma-seminoprotein (gamma-Sm) were determined using an Eiken kit and Chugai kit. Efficiency of the DPC kit, Eiken kit and the MARKIT F kit for untreated prostatic cancer was 26, 25 and 36%, respectively. The PA level measured using the Eiken kit and the MARKIT F kit both well correlated to the PAP level, but with the DPC kit correlation was slightly low. The PA level measured using the 3 different kits correlated poorly with the gamma-Sm level. The PA values obtained with 3 different assays from patients with prostatic cancer were highly correlated, but showed great differences in the values measured. When the standards used in the DPC kit were analyzed by the Eiken kit, the DPC standards as measured by the Eiken kit had only about half of their assigned values. The same standards were analyzed by the MARKIT F kit, the standards yielded measured values about one third of their assigned values. When the standards used in the MARKIT F kit were analyzed by the Eiken kit, the MARKIT F standards yielded measured values about 2.5 fold of their assigned values. The differences between the values obtained with the 3 assay kits presented a serious problem in clinical use of PA. Standardization of these assay kits will be awaited.

9施設565例の初診時年齢は70歳代をピークとする分布を示した.来院時症状は排尿困難が72.2%と最も多く, 癌性疼痛を訴える例が13.6%あった.検査法では, アルカリ性ホスファターゼ, 前立腺生検, IVP, 骨シンチグラフィー, 尿道膀胱造影, 前立腺酸性ホスファターゼ, 酸性ホスファターゼなどが広く施行されていた.臨床病期では, A1 6.2%, A2 3.7%, B 14.9%, C 20.7%, D1 7.4%, D2 43.7%であり, 進行病期のものが多かった.組織学的分化度は, 高, 中, 低分化癌が, それぞれ20.4%, 33.3%, 32.7%であった.初診時年齢が低いほど, 分化度の低い癌がやや多くなる傾向がみられた.また進行病期のものほど, 低分化癌の占める割合が増加していた.治療として内分泌療法が多く行われ, 方法としてほぼ全例にホルモン剤が投与され, その約半数に除睾術が併用された.臨床病期や組織学的分化度を考慮し, 手術療法, 放射線療法, 化学療法や複数の治療を組み合わせた治療法もある程度は試みられていたが, 年齢による制約がみられた.臨床病期別実測5年生存率は, 病期A1 89.2%, A2 66.1%, B 72.7%, G 51.0%, D1 47.5%, D2 28.0%であった.D2において低分化癌の実測5年生存率は16.0%であり, 高中分化癌より悪かった, Five hundred and sixty-five patients with prostatic cancer, who first visited 9 institutions in Japan between 1981 and 1985, were analyzed. The peak of age distribution was in the seventies. As clinical symptoms, disturbance on micturition was the most frequent and pain caused by metastasis was a complaint in approximately one tenth of the cases. Alkaline phosphatase measurement, prostatic biopsy, intravenous pyelography, bone scintigraphy, cystourethrography, and measurements of serum prostatic acid phosphatase and serum acid phosphatase were performed on more than 80% of the patients. The clinical stage was stage A1 in 6.2%, A2 in 3.7%, B in 14.9%, C in 20.7%, D1 in 7.4%, and D2 in 43.7%. According to the histological grade, well, moderately and poorly differentiated adenocarcinoma were observed in 20.4, 33.3 and 32.7%, respectively. Increased ratio of high grade to low grade was noticed in the lower age group as well as in the advanced stage. In this series, endocrine therapy was still accepted in most of the patients. Almost all were treated with hormonal medication and half of them had undergone bilateral orchiectomy. Surgery, radiation, chemotherapy or multidisciplinary therapy were attempted judging from the clinical stage and histological grade. However, old age restricted the therapeutic modality. Actuarial survival rate at 5 years for stage A1, A2, B, C, D1 and D2 was 89.2, 66.1, 72.7, 51.0, 47.5 and 28.0%, respectively. In the patients with stage D2, the 5-year actuarial rate of poorly differentiated adenocarcinoma was lower than that of well or moderately differentiated adenocarcinoma, even though more intensive therapy was given to the former.

1)未治療前立腺癌31例で前立腺特異抗原(PA)が異常値を示すものの割合は, stage A1 50%, C(pN0, NX) 50%, D1 80%, D2 100%であった.2)病理組織分化度とPA値との間に関係はなかった.3)組織学的に診断された前立腺肥大症, 前立腺炎, 尿路結石でそれぞれ52%, 18%, 0%に異常値をみた.4)Stage D2に対する内分泌療法後, 低分化型のものは, 正常化しにくい傾向にあった.5)再燃例は, 制癌例に比し, PA異常値を示すものの割合が高く, 再燃の診断の一助となると考えた.PA異常値で臨床的に制癌とした例に数ヵ月後, 再燃したものがあった, Prostatic specific antigen (PA) level was determined with a Wako test kit (Japan) for prostatic cancer and others. The incidence of abnormal values of PA in untreated prostatic cancer, was 50, 50, 80, and 100% for stage A1, C (pN0, NX), D1 and D2 cancers, respectively. Grade was not related to the level of PA. Prostatic hypertrophy, prostatitis and urinary stone showed a false positive rate of 52, 18 and 0%, respectively. The level of PA was not correlated to those of prostatic acid phosphatase (RIA). In 31% of the cases, the elevated PA decreased 4 weeks after start of endocrine treatment. Elevated PA in low grade cancer was not normalized as much as that in high and moderate grade cancers. The positive rate of PA in the serum of reactivated patients was significantly higher than that of the patients with cancer under good control by endocrine treatment.

A 35-year-old man visited our clinic with the chief complaint of headache and an upper abdominal mass. Renal vein renin activity, drip infusion pyelogram, GT scan and selective renal angiogram demonstrated a retroperitoneal tumor and right renovascular hypertension. Thus tumor extirpation and right nephrectomy were performed. After nephrectomy, blood pressure was corrected within the normal range. Histologically the tumor was diagnosed to be chondrosarcoma and there was no lesion in the wall of the right renal artery. This case had secondary chondrosarcoma arising from the first and second lumbar vertebrae and produced renovascular hypertension due to compression of the tumor.

1979年から1987年までに, 治療前にPAP, γ-Sm, PAのいずれかを測定した前立腺癌200例および前立腺肥大症179例を対象として, PAP, γ-Sm, PAの有用性を比較検討した.1)前立腺癌の検出率は, PA, γ-Sm, PAPの順に高かった.2)前立腺肥大症の特異性はPAP, γ-Sm, PAの順に高いため, 前立腺癌の診断効率はPAPが最も優れ, ついでγ-Sm, PAが最も低値であった.3) PAPとγ-Smとを併用することによる検出率の上昇は若干名のみあり, またPAP, γ-Sm, PAを併用することによる検出率の上昇は認められず, cut off値を10 ng/mlと高く設定しても少数例のみ認められた.併用することにより, 特異性が低下するために, 診断効率はPAP単独よりも低値となったので, 診断面での併用測定の有用性は大きなものではなかった.4)未治療前立腺癌において, PAPとγ-Smとの間には相関がなく, γ-SmとPAとの間は低かったが, PAPとPAとの間は高い相関を示した.5)再燃例の検討において, PAPは再燃時約9割が異常値を示した.PAP正常例の大多数はγ-Sm, PA共異常値を示したので, 複数マーカー測定の意義を認めた, The levels of prostatic acid phosphatase (PAP), gamma-seminoprotein (gamma-Sm) and prostate specific antigen (PA) were determined in the serum of 200 untreated patients 28 patients with reactivated prostatic cancer and 179 patients with benign prostatic hypertrophy (BPH) from 1979 to 1987. PAP and gamma-Sm were determined using an Eiken and Chugai kit, respectively and PA was assayed using an Eiken or Travenol kit. The sensitivity of PAP, gamma-Sm and PA respectively in the untreated prostatic cancer cases was 0, 0% and 67%, for Stage A1, 25, 17 and 100% for Stage A2, 23, 50 and 60% for Stage B, 62, 81 and 94% in Stage C, 58, 67 and 90% for Stage D1, 86, 88 and 100% for Stage D2. The specificity of PAP, gamma-Sm and PA is 89, 69 and 43%, respectively. The efficiency of PAP was the highest at all stages as a whole, but when compared at each stage, gamma-Sm was the highest at Stages B and C. The sensitivity of simultaneous assays of PAP and gamma-Sm was slightly increased, but sensitivity was not increased by simultaneous use of three markers. The efficiency of a simultaneous assay was lower than that of a single assay with PAP. However, combined determination of gamma-Sm or PA with PAP was found to be useful for monitoring the clinical course of the reactivated patients. Correlation between PAP and PA levels was high, but that between gamma-Sm and PA levels was low. There was no correlation between PAP and gamma-Sm levels. In conclusion, PAP is the most valuable marker for prostatic cancer, and gamma-Sm is of value for use in combination with PAP. However, an additional PA assay was not found to be of advantage.

DPCキットを用いて, PAの前立腺癌における有用性を検討した.1)未治療前立腺癌33例で, PAおよびPAPの陽性率はそれぞれA1 67%, 0%, A2 100%, 100%, B 100%, 0%, C 100%, 100%, D1 100%, 67%, D2 100%, 80%であり, PAの方がlow stageより陽性率が高かった.2)前立腺肥大症のPAは73%, PAPは33%に異常値を示した.3) PAの他キットとの関係は, 対栄研キットはr=0.82, 対トラベノールキットはr=0.90と高い相関関係を認めた.4) PAとγ-SmおよびPAPとの間ではr=0.62およびr=0.61といずれも相関性は良くなかった.5)再燃例においても, PAPよりPAが早くから上昇し, PAの経過観察における有用性がみられた, The serum prostate specific antigen (PA) was determined with the Diagnostic Products Cooperation (DPC) PSA double antibody radioimmunoassay kit. The upper limit of the normal range was set at 4 ng/ml which was the mean + 3S.D. for males over 50 years old in a mass examination. For comparison, prostatic acid phosphatase (PAP), and gamma-seminoprotein (gamma-Sm) were determined using an Eiken kit and Chugai kit, and PA was also assayed using another kit (Eiken, Travenol). Positive rate of PA and PAP in the untreated prostatic cancer was 75 and 33% in Stage A, 100 and 0% in Stage B, 100 and 100% in Stage C, 100 and 67% in Stage D1, 100 and 80% in Stage D2 and 73 and 33% in benign prostatic hypertrophy (BPH), respectively. The level of PA determined during the follow-up of prostatic cancer showed the usefulness of simultaneous PA and PAP assays for monitoring the clinical course. The PA level using a DPC kit was highly correlated to that of PA using other kit, but the correlation with gamma-Sm and PAP was low. These results show that the DPC kit is useful for determining PA, and determination of PA and PAP is of great value both in diagnosis and in the follow-up of prostatic cancer, but the high positive rate in BPH remains a problem.