Serum, acid phosphatase

Measurement of serum acid phosphatase activities as an aid in the diagnosis and treatment of advanced prostatic carcinoma is based on the observation by Gutman and Gutman that the activity is elevated by skeletal metastases ( ). Many workers have... 

Nodular hyperplasia of the prostate is usually associated with a normal serum acid phosphatase activity. Complications such as acute urinary obstruction or prostatic infarction will elevate this serum activity for several days as will cystoscopy and catheterization (98). Digital palpation of the prostate may result in an elevation which subsides within a few hours. 

The substrate phenyl phosphate, which is hydrolyzed by the serum acid phosphatases originating from many tissues, has been used in most of the published studies. Total serum acid phenylphos-phatase is elevated in diseases of the liver, disease of bone such as Paget s disease, and several blood dyscrasias, especially those involving platelets (99>100). 

Hill, J. H. Prostatic serum acid phosphatase in patients with localized prostatic cancer. Am. J. Clin. Path. (1956), 26, 120-130. 

The pH of serum, after it is separated from the clot, tends to go up as carbon dioxide is evolved and will eventually reach pH 8.5. This is an important consideration in the determination of acid phosphatase, which is rapidly destroyed at alkaline pH (W16a). Eighty-nine percent of serum acid phosphatase activity remains after 4 hours at pH 7.8 or 1 hour at pH 7.98 (B2). At pH 7.98 only 58% remains after 4 hours (B2). If serum is maintained over the clot, no rise in pH or inactivation of acid phosphatase occurs for as long as 5 hours at room temperature or 24 hours in the refrigerator (B17b). 

A circadian variation in serum acid phosphatase has been reported in patients with prostatic carcinoma and phosphatase activity determined with phenyl phosphatase as substrate (DIO). The nocturnal values decreased 25-50% of the highest day time activity. The highest values were observed from 9 am to 3 pm and the lowest between 9 pm and 3 am. In one patient observations were made at hourly intervals. The peak of 14.2 King-Armstrong units was observed at 11 am and the lowest activity, 6.4 units, at midnight. Orchiectomy did not eliminate the variation. 

Elevations of serum acid phosphatase have been reported in specimens obtained from patients after rectal examination (D4). However, Rou-brick and Winsten, in a study of 38 men, found that rectal examination performed on patients without known prostatic disease did not significantly elevate the serum acid phosphatase level (Rl). In patients with... 

B6. Bases, R., Elevations of serum acid phosphatase in certain myeloproliferative diseases. New Engl. J. Med. 266, 538-540 (1962). 

D4. Daniel, 0., and Van Zyl, J. J., Rise of serum acid phosphatase level after palpation of the prostate. Lancet 1, 998-999 (1952). 

Rl. Roubrick, M., and Winsten, S., Effect of routine rectal examination on the level of serum acid phosphatase. J. Urol. 88, 288-291 (1962). 

What is the cause of elevation in serum acid phosphatase (ACP) activity in Gaucher disease ... 

Serum Acid Phosphatases, Determinations (Fishman and Davidson). 4... 

In 1950 Seligman and his co-workers (S13) suggested the use of sodium j8-naphthyl phosphate as a substrate for the determination of acid or alkaline phosphatase activity. For the former, 1 ml of 1 20 diluted serum was added to 5 ml of 0.4 mM sodium 8-naphthyl phosphate in 0.1 M acetate buffer of pH 4.8, and the reaction was allowed to proceed for 2 hours at 37.5°C. The addition of 4 drops of IM sodium carbonate solution served to retard the reaction as well as to raise the pH to the optimal level for coupling with 1 ml of a solution of tetrazotized ortho-dianisidine. After 3 minutes, the protein was precipitated with trichloroacetic acid, the dye extracted with ethyl acetate, and the color density determined in the region of 540 nm. The unit of phosphatase activity was defined as that amount of enzyme which liberates the color equivalent of 10 ml of j8-naphthol per hour at 37.5° in 1 hour. The serum acid phosphatase in a group of normal adults ranged from 0.7 to 1.6 units and averaged 1.0 unit per 100 ml of serum. 

Current Methods for Determination of Serum Acid Phosphatase Activity... 

The question may arise as to which is the preferred method. In the author s experience, and this will be documented more completely later, the use of the substrate, sodium (S-glycerophosphate, as in the Bodansky procedure (B18, 32), is more specific for elevations of serum acid phosphatase activity due to prostatic carcinoma. However, the use of other substrates, such as sodium phenyl phosphate in the Gutman method (GIO, G14), may elicit alterations of activity in the serum that reflect diseases in other tissues. 

The slight but definite elevations of serum acid phosphatase activity in conditions such as thrombocytopenia (02, Zl), Gaucher s disease (T6, T8), or various myeloproliferative diseases (B6) indicate the possibility that platelets, the marrow, and the reticuloendothelial system may also be sources of acid phosphatase. These aspects will be discussed more fully later in the review. 

Values for Serum Acid Phosphatase in Normal Adult Males by the Method op Gutman and Gutman (GIO, G14) or Slight Modifications of It... 

The next most common method for determination of serum acid phosphatase activity was based on the use of sodium )3-glycerophosphate as substrate. This method and its modifications have been described in Section 2.3. Values obtained by these methods in normal males are shown in Table 7 a liberal summary of these values indicates a mean value of about 0.4 0.2 Bodansky units. 

Carcinoma of the prostate is today one of the three most frequent causes of death from neoplastic disease in men in the United States (G4). The early studies of Gutman and his associates (Gil, G12, R6, S30) established that serum acid phosphatase activity was elevated very frequently in patients with metastatic carcinoma of the prostate. It is of interest to consider briefly the uncertainties inherent in the development of this relationship. Skeletal metastases, if sufficiently large, are of course detectable by roentgenographic examination, but smaller ones may not be, and metastases to soft tissues may likewise be undetectable. For example, in 15 cases of metastazing carcinoma reported by Gutman... 

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