don't know if this will help at all, but I did find and opinion about
post prostatectomy PAP. Perhaps a repeat test would help. Apparently the specimen cannot set for more than 3 hours at room temp. Sometimes uros send this stuff out, so specimen handling could also be in question.
Neha Vapiwala MD, Senior Editor for Oncolink, responds:
Thank you for your interest and question.
Acid phosphatases are a group of enzymes, which are proteins found in living organisms that are critical for various chemical reactions. In the 1930's, it was discovered that these acid phosphatases were found in high concentrations within the prostate gland. Furthermore, there were found to be responsive to androgen (male hormone) regulation. Although present in the highest concentrations in the prostate, acid phosphatases can also be found in various other tissues in the body as well as in various isoenzymatic forms. Different assays that can accurately measure acid phosphatase levels have been attempted in order to be more prostate cancer-specific. Thus, the measurement of prostatic acid phosphatase (PAP) was developed. Unfortunately, although the ability to detect very low levels of PAP exists, i.e. high sensitivity), the specificity of this test as a reliable marker of prostate cancer is still quite limited.
Other inherent problems with prostatic acid phosphatase measurements are:
PAP levels fluctuate greatly over the course of just 24 hours, whereas serum varies little over weeks to months (and sometimes years)
PAP is less stable than PSA, causing increased variability in the lab reading
False elevations of PAP after prostate manipulation are notable
Sensitivity of PAP is much less than PSA, causing more false negatives.
Based on the many documented inconsistencies with PAP, it has no significant role at present in the monitoring of patients after initial therapy. PSA is much better in that regard. Initial PAP readings maybe helpful in estimating risk of extracapsular extension: the higher the PAP, the higher the risk for having cancer outside the prostate at the time of presentation. However, this should not be the only screening test obtained since PSA has a much higher prognostic value when used in combination with digital rectal examination.
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic 4/14/09 Nerves spared
0/23 lymph nodes involved pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks due to anatomical issues with location of ureters with respect to bladder neck. Try 3 tubes where no tubes are supposed to be for 2 weeks !
Neg Margins, bladder neck negative
Living the Good Life, cancer free 6 week PSA <.03
3 month PSA <.01 (different lab)