The following descriptions of markers and other tests, sometimes used by doctors in the staging of Prostate Cancer.  If the title is in "blue" it means you can click on it for additional information.

CEA (CarcinoEmbryonic Antigen) Is a cell surface a-fetoprotein expressed by many different tumor types, including poorly differentiated PC. Prior to the advent of PSA elevated CEA was found in 30% of newly diagnosed prostate cancers. Moderately elevated CEA concentrations have been found only in patients with either "pure"or "predominantly" hormone insensitive disease (without soft tissue lesions) and particularly after suppression of hormone sensitive cell subpopulations.

CgA (Chromagranin A) There is a B, C, etc,. These "markers" are products of the tumor cell population and sometimes are clues as to the tumor taking on an identity that is associated more with certain clinical behavior, such as small cell prostate cancer. Such small cell tumors grow faster, involve liver,lung and lymph nodes in unusual sites, frequently don't express much PSA and have lytic bone lesions instead of dense blastic lesions, etc. CGA is an excellent marker for neuroendocrine tumors, particularly nonfunctioning tumors, and the measurement of CGA is also useful to detect prostatic carcinoma in patients whose PSA is not elevated."

DNA-Ploidy DNA (DeoxyriboNucleic Acid) is the basic biologically active chemical which defines the physical development and growth of nearly all living organisms. PLOIDY is a term used to describe the number of sets of chromosomes in a cell. Tests performed on biopsy samples are reported as: DIPLOID; having one complete set of normally paired chromosomes, which is a normal amount of DNA. Diploid cancer cells tend to grow slowly and respond well to hormone therapy, ANEUPLOID: having an abnormal number of sets of chromosomes and Ttetraploid which means having two paired sets of chromosomes, which is twice as many as normal. Aneuploid cancer cells tend not to respond well to hormone therapy.

DHEA (DeHydroEpiAndrosterone) is an adrenal androgen. DHEA levels decline with age, yet prostate gland enlargement and cancers increase with age. It is possible that DHEA, being a weak androgen, can actually attach to and block testosterone or DHT receptors on prostate tissue, thus preventing the influence by more powerful androgens

DHT (DiHydroTestosterone) 5 alpha-dihydrotestosterone is the male hormone which is most active in the prostate. It is made when an enzyme (5 alpha reductase) in the prostate stimulates the transformation of testosterone to DHT. There are reports that DHT is as much as 4X more active in prostate cancer than Testosterone. Proscar (finasteride) is considered a potent 5 alpha reductase inhibitor and often prescribed as part of a complete androgen blocade (CAB).

Free PSA Free Prostate-Specific Antigenreports the percentage of free-PSA to total-PSA (total-PSA = free-PSA + bound-PSA)and is helpful for screening purposes when PSA values are above the normal threshold for an age group and less than 10; one study showed that men with PSA II > 25% had no PCa; those with < 10% were likely to have PCa.

NSE (Neuron-Specific Enolase) is a specific marker for neuroendocrine tumors which express proteins or enzymes that are reflective of a de-differentiated tumor cell population such as small cell prostate cancer. When both CGA and NSE are elevated the prognosis is considered poor.

PAP (Prostatic Acid Phosphatase) is an enzyme measured in the blood whose levels may be elevated in a patients with prostate cancer that has invaded or metastasized elsewhere. PAP is not elevated unless the tumor has spread outside the anatomic prostatic capsule. A persistently elevated serum PAP is considered evidence of mets, but only 75% of patients with mets have an elevated PAP

Serum PAP noted at the time of diagnosis of prostate cancer is usually associated with extra-prostatic spread. In a study at the Johns Hopkins University School of Medicine, 21 of 460 men or 4.6% had elevations of PAP. Of those men fully evaluated evidence of extra-prostatic disease was documented in all. Positive bone scans, extraprostatic extension of disease, PSA > 100, positive lymph nodes and positive seminal vesicles were found. Most of the above patients with increased PAP's (17 of 21) had abnormal DRE's consistent with disease outside of the prostate or PSA's > 100. Therefore in these patients the PAP was not that helpful. In the remaining 4 patients, the PAP was helpful in directing treatment towards systemic therapy as opposed to local therapy. A PAP determination as part of the initial staging evaluation is still reasonable. In addition, in some patients PSA may be normal or zero while the PAP is elevated proving the PAP to be the only remaining biologic marker that can be followed.

PSA (Prostate Specific Antigen) is a protein secreted by the epithelial cells of the prostate gland including cancer cells. An elevated level in the blood indicates an abnormal condition of the prostate gland, either benign or malignant. PSA is used to detect potential problems in the prostate gland and to follow the progress of treatment. PSA is currently used as a specific diagnostic marker for the early detection of prostate cancer and to separate patients with tumors from those without tumors; multiple criteria are often used.

PSADT (PSA Doubling Time) has been evaluated in patients with a rising PSA after local treatment with either RP or RT. In these settings PSADT has been shown to be significantly shorter in those patients who developed metastases than in those who did not develop metastatic disease. If the PSADT is < 10 months there is a high probability of metastatic disease. Patients post-RP with this finding would not be good candidates for local RT; however patients with a long PSADT would be such candidates. Patients post-RT with a short PSADT have a high likelihood of metastatic disease whereas those with a long PSADT might be candidates for salvage cryosurgery.

PSA RT-PCR: PSA (Reverse Transcriptase-Polymerase Chain Reaction)is a blood test that detects micrometastatic cells circulating in the blood stream; may be useful as a screening tool to help avoid unnecessary invasive treatments (RP, RT, etc.) on patients with metastasized Pca, although not FDA approved it is available at locations where FDA approved clinical trials of the test are being done.

PROLACTIN (PRL) is a trophic hormone produced by the pituitary which increases androgen receptors and increases sensitivity to androgens. Prolactin modulates prostatic androgen uptake, affects its intracellular metabolism and utilization, and thereby promotes differentiation, growth and secretory function of the prostate. Many but not all men treated with hormone manipulations develop elevated prolactin levels and men who develop hyperprolactinemia during estrogen, diethylstilbestrol, cyproterone or estramustine treatment have been reported to have a much higher rate of disease progression and death from prostate cancer. It has been theorized that prolonged prolactin stimulation from long-term hormone therapy could play role in the onset of androgen resistant tumors.

Prostascint Monoclonal Antibody Scan (111 In-CYT-356) The Prostascint scan may prove useful in the staging of prostate cancer prior to any local therapy. It involves the use of an Indium-111 labeled monoclonal antibody which reacts with prostate cancer, benign prostatic hypertrophy and to a lesser extent, normal prostate tissue. An abnormal scan may detect metastatic prostate cancer to lymph nodes or other sites and identify patients who are not candidates for local therapy. It may also prove valuable in assessing patients who have a PSA elevation after RRP. If an abnormal Prostascint scan is found confined to the prostatic bed it may support the rationale for local radiation therapy.

Pyrilinks-D is a laboratory test that mesures deoxypridinoline (Dpd), a specific marker of bone resorption(loss), which is excreted unmetabolized in urine. It can be used to support the decision to initiate antiresorptive therapy and track changes in bone resorption rates in response to therapy. If Dpd levels are higher than 5.4 in men, then the patient is experiencing accelerated bone resorption and may be at increased risk of bone loss. The test is usually run to establish a base line and then at 3 to 6 month intervals to monitor therapy.

TESTOSTERONE (T) is the male hormone or androgen which comprises most of the androgens in a man's body; chiefly produced by the testicles; may be produced in tissues from precursors such as androstenedione; T is essential to complete male sexual function and fertility.

Page Reviewed and/or Updated:

September 21, 2008