Influence of bleeding on haemorheology and haemostasis in surgery.

Changes in haemorheology and haemostasis may contribute to bleeding or thrombosis, which is of concern particularly in surgery. Blood loss itself has a major influence on both parameters being closely involved in the clinical outcome. In order to analyze the underlying interrelations, a prospective study with 122 patients (64 females, 58 males) aged between 18 and 83 years (mean: 51.8 years) was conducted. All patients were electively submitted to orthopaedic surgery. Haemorheological parameters included measurements of plasma viscosity, red body cell (RBC) and platelet aggregation index preoperatively, as well as by day 1 and day 7 after surgery. Additionally hematological and haemostaseological parameters including leukocyte and platelet counts, haematocrit and fibrinogen were investigated. Bleeding was defined as high (>500 ml) or low blood loss (≤500 ml) according to the drainage volume. High but not low blood loss was associated with an increase of RBC aggregation by day 1 and 7 after surgery. Plasma viscosity decreased significantly by day 1, returning to normal 7 days after surgery. Platelet count decreased significantly, concurrent with the haematocrit, by day 1 postoperatively, whereas by day 7 a significant increase was observed, being more distinct in high blood loss. Platelet aggregation index did not change under the influence of blood loss. Plasma fibrinogen, clearly corresponding to the extend of blood loss, showed a continuous postoperative increase, which was significantly higher at day 7. Leukocytes increased moderately but significantly in particular in high blood loss. In conclusion, the postoperative decrease of plasma viscosity and of platelet counts, concurrent with the haematocrit, provides evidence of being clearly dependent on blood loss which is regarded as a dilution effect corresponding with the haemorrhagic risk. The increase of RBC aggregation at the early postoperative stage is solely observed in high blood loss and is esteemed as a result of volume therapy. The marked increase of platelet counts and plasma fibrinogen at the late postoperative stage, being more pronounced in high blood loss, might contribute to an elevated prothrombotic risk and is ascribed to an inflammatory response to surgery. In summary, it is concluded, that bleeding tendency corresponding with haemorheologic parameters is enhanced in the early, whereas the prothrombotic risk, well correlating with haemostaseologic parameters, is elevated in the later stage after surgery.

[Perineal approach to repair rectal and cutaneous fistulas involving the urethra and bladder]. / Perinealer Zugang zur Korrektur von rektalen und kutanen Fisteln zu Urethra und Blase.

The perineal approach was used in ten patients for the repair of fistulas involving the bladder or prostatic urethra. In the case of radiotherapy-induced (n=2) or recurrent fistulas (n=4) fecal diversion and interposition of the gracilis muscle was performed. In addition in three patients prostatectomy was performed. All fistulas were repaired successfully with minimal morbidity.

Differential diagnosis and evaluation of the clinical course of transurethrally resected T1G3 urothelial carcinoma of the bladder by DNA image cytometry.

The value of DNA image cytometry in the differential diagnosis of 106 T1G3 urothelial carcinomas of the bladder and the long-term prognosis (recurrence-free interval, survival) of the patients was tested in comparison with Ta/T1G1 (n=30) and Ta/T1G2 carcinoma (n=54). Monolayer smears were prepared from three 50-microm-thick sections by a cell separation technique and were stained according to Feulgen. The DNA content of 250 epithelial cells, chosen at random, was determined using a TV-image analysis system CM-1 (Hund, Wetzlar, Germany). The DNA content of 30 lymphocytes served as an internal standard for the normal diploid value in every individual case. Different DNA cytometric parameters and the mean nuclear area were calculated. In comparison with G1- and G2-cases, the mean values of all DNA cytometric variables were markedly increased in the group of T1G3 cases, most obviously for the 5cEE, the mean ploidy and the ploidy imbalance (0.0006 > or = p > or = 0.0001). However, a remarkable overlay of the data distribution had to be considered. An aneuploid DNA stemline ploidy was highly characteristic for T1G3 urothelial carcinoma (sensitivity: 92%), but not sufficiently specific (57%). However, if increased values for the mean ploidy, the 2cDI, the 5cEE or the 9cEE (specificity: 86%-89%) were present additionally, the diagnosis of a T1G3 urothelial carcinoma could be made cytometrically. Follow-up data for survival (recurrence) analysis was available for 90 (82) patients of the T1G3 group. Using the median value as threshold, significant differences in survival were found for the mean ploidy only (p=0.0353). The length of the recurrence-free interval was significantly different for the entropy (p=0.0205), the 2cDI (p=0.0309) and the mean ploidy (p=0.0442). In conclusion, DNA single cell cytometry represents a highly relevant tool in the objective identification of T1G3 urothelial carcinoma of the bladder, with a sufficient sensitivity and specificity. Further, this method enables prediction of tumor recurrence if suitable variables are chosen. The long-term survival of patients with T1G3 urothelial carcinoma can be estimated by DNA cytometry only in a limited manner, possibly due to the fact that the causes of death in the mostly elderly patients will be independent from the limited tumor disease.

[Lymphadenectomy for penile cancer. Diagnostic and prognostic significance as well as therapeutic benefit]. / Lymphadenektomie beim Peniskarzinom. Diagnostische und prognostische Bedeutung sowie therapeutischer Nutzen.

Lymphadenectomy is an essential part of diagnosis and treatment of the squamous cell carcinoma of the penis. Lymphadenectomy is performed depending on various characteristics of penile cancer such as depth of invasion, tumor grade, invasion into the corpora cavernosa, invasion into vascular and lymphatic vessels. In case the inguinal lymphnodes are not palpable a modified lymphadenectomy is indicated. The limits of lymphadenectomy are extended to the radical type of dissection when the frozen section indicates cancer. Inguinal lymphadenectomy is always performed on both sides. Are more than 2 nodes positive the lymphnodes in the true pelvis have to be resected as well. The dynamic sentinel lymphnode dissection may replace the modified approach in case randomized prospective studies will confirm the initial positive results and morbidity can be reduced as well. The immediate lymphadenectomy is superior to the delayed lymphadenectomy (palpable nodes during followup) in terms of local recurrence and survival. According to the risk profile patients with palpable inguinal lymphnodes can be initially managed conservatively. In case the lymphnodes remain palpable, lymphadenectomy is indicated. In this situation it is reasonable to perform imaging studies of the pelvis and abdomen for adequate planning of the surgical approach. Neoadjuvant chemotherapy is reasonable for patients with bulky nodes fixed to the skin or fascia because this improves respectability, freedom from local recurrence and increases survival. Adjuvant chemo- and/or radio-therapy are reserved for extended disease or palliative situations.

[Potency-sparing radical perineal prostatectomy]. / Potenzerhaltende radikale perineale Prostatektomie.

We evaluated the results of a unilateral nerve-sparing radical perineal prostatectomy in a prospective study. Thirty patients with histologically confirmed unilateral prostate cancer and adequate erectile function preoperatively underwent a nerve-sparing procedure. The criteria were a PSA of <10 ng/ml, prostate volume of <60 ml, and a Gleason score <7. In 29 patients the procedure was technically feasible. In one patient significant damage to the neurovascular bundle was seen at the end of the procedure. Bilateral tumors were present in 18 patients on final pathology. Positive surgical margins were observed in five patients (pT2: 2/20; pT3: 3/10). After a follow-up of 3-12 months, 15 of 29 patients (51%) reported some erectile function without additional medication. Of 14 patients, 2 had enough rigidity for penetration within 3 months.The short-term results after unilateral nerve-sparing perineal prostatectomy are encouraging. Since the neurovascular bundle can be exposed very well, interposition of sural nerve should be considered.

Radical prostatectomy in patients with previous groin hernia repair using synthetic nonabsorbable mesh.

OBJECTIVE: Identification of patients in whom the perineal route is the optimal approach to perform radical prostatectomy. MATERIAL AND METHODS: During 1992-1999, 376 patients with prostate cancer underwent radical perineal prostatectomy. Four patients were identified in whom the perineal approach was indicated because of previous bilateral groin hernia repair using synthetic meshes. In addition, 1 patient underwent perineal prostatectomy elsewhere for similar reasons. RESULTS: The perineal approach offered an uneventful surgical solution for an adequate and straightforward radical perineal prostatectomy without complications and without biochemical recurrence during the follow-up. CONCLUSION: Radical perineal prostatectomy is suggested to be the optimal approach in patients with previous bilateral groin hernia repair using synthetic, nonabsorbable meshes.

Perioperative morbidity of the extended radical perineal prostatectomy.

PURPOSE: Perioperative morbidity is an essential indicator for the quality of an operative technique. This fact is especially important in radical prostatectomy since different treatment modalities may provide similar outcome in terms of local tumor control. MATERIALS AND METHODS: The conventional type of radical perineal prostatectomy is associated with a significant percentage of positive surgical margins and was therefore substituted by a modified extended radical perineal prostatectomy at our institution. This procedure which includes partial resection of the dorsal vein complex and extrafascial resection of the seminal vesicals was performed in 200 patients with clinical T1 to T3 prostate cancer. The medical records were retrospectively reviewed for perioperative morbidity. RESULTS: There was no perioperative mortality and only 7% of the patients experienced postoperative complications. Blood substitution was indicated in 14% of the patients and could be reduced to 4% in the last 50 patients. The reintervention rate was 2.5% including 3 patients in whom a rectocutaneous fistula had to be repaired. The suction drainage was removed in 92% patients within 5 days. The indwelling catheter stayed in place for less than 14 days in 89% of all patients and was removed as early as after 2-7 days in 92% of the last 50 patients. Anastomotic strictures were observed in 8 (5%) of 160 patients followed for more than 6 months. 87.4% of patients were considered continent after at least 6 months follow-up. However, pad use was reported in 33.6%. CONCLUSION: The extended type of radical perineal prostatectomy provides excellent results in terms of perioperative morbidity, although a significant learning curve can be noted, which is indicated by blood substitution and duration of necessary catheter drainage. Since the rate of positive surgical margins in pT3 tumors is low (21%) and iatrogenic positive margins in pT2 tumors are avoided, this type of prostatectomy should be performed in case a potency sparing procedure is not indicated.

Multi-slice CT urography after diuretic injection: initial results.

PURPOSE: To investigate the feasibility of CT urography (CTU) using a multi-slice (MS) scanner and to find out whether a low-dose diuretic injection is advantageous for the opacification of the urinary tract. METHODS: MS-CTU was performed in 21 patients with urologic diseases. In 5/21 patients, 250 ml of physiologic saline Solution were injected. In 16/21 patients, 10 mg of furosemide were injected 3-5 min before contrast material administration. A 4 x 2.5 mm collimation with a pitch of 1.25 and a tube current of 100-150 mA were used. Scan time was 12-16 sec. 3 mm thin axial images with an overlap of 67% were reconstructed. Multiplanar maximum intensity projection (MIP) images were postprocessed to obtain urographic views. Bone structures were eliminated using the volume-of-interest method. RESULTS: Furosemide-enhanced MS-CTU achieved either near complete or complete opacification in 30/32 (94%) ureters and in 32/32 (100%) pelvicaliceal systems up to a serum creatinine of 150 mumol/l. In our series, only one CTU scan per patient was needed to obtain a diagnostic urogram after 10 min of contrast material injection. Ureteral compression was not necessary. When physiologic saline solution was used instead of furosemide, the radiopacity inside the enhanced pelvicalices was 4-5 times higher and more inhomogeneous. Diuretic-enhanced MS-CTU was more accurate in the depiction of pelvicaliceal details. In combination with furosemide, calculi were well identified inside the opacified urine and were safely differentiated from phleboliths. Postprocessing times of up to 20 minutes were problematic as were contrast-enhanced superimposing bowel loops on MIP images. CONCLUSION: Preliminary results demonstrate a good feasibility of furosemide-enhanced MS-CTU for obtaining detailed visualization of the entire upper urinary tract.

[Expanded, radical perineal prostatectomy]. / Die erweiterte, radikale perineale Prostatektomie.

One hundred and twenty-five consecutive patients with prostate cancer underwent an extended, radical perineal prostatectomy according to the technique described by VE Weldon. This technique was modified by an initial complete mobilization of the posterior aspect of the prostate and seminal vesicles from the rectum and pelvic wall, incision of the endopelvic fascia, and partial resection of the dorsal vein complex after suture ligature. The perioperative morbidity was low. An operative revision was necessary in four (3.2%) patients because of arterial bleeding from a drainage channel (n = 1), wound infection (n = 2), and rectocutaneous fistula (n = 1). The in-dwelling catheter was removed on day 4-8 in 104 (83%) patients. Positive surgical margins were diagnosed in 22 (17.6%) patients only. These patients had pT3 (n = 17) and pT4 (n = 5) tumors with a Gleason score > or = 7 (n = 17) mostly; extensive, multifocal capsular penetration (n = 18); seminal vesicle invasion (n = 11); and lymph node metastases (n = 4). The unifocal positive margins were localized at the apex (n = 3), dorsolateral (n = 6) aspect, and bladder neck (n = 4). In nine patients, multifocal positive surgical margins were noted. The risk for a positive surgical margin depends on the serum PSA level, Gleason score, and tumor volume. In case potency preservation is not considered, the extended, radical perineal prostatectomy with the above mentioned modifications should be considered to guarantee a low rate of surgical margins.

Altered prostate specific antigen reference range after transurethral resection of the prostate.

OBJECTIVES: We investigated how transurethral resection of the prostate (TURP) affected the serum concentration of prostate specific antigen (PSA) and whether the reference range for PSA has to be altered in these patients following TURP. METHODS: 55 patients were retrospectively analysed. All had undergone TURP for bladder outlet obstruction due to benign prostatic hyperplasia which was confirmed by histopathological amination. PSA was determined pre-operatively and postoperatively every 6 months for 48 months. These patients were compared to 12 patients who had undergone radical perineal prostatectomy (RPP) for prostate cancer (CaP). In the latter group, in all patients a TURP had been performed up to 7 years before CaP was diagnosed. RESULTS: The median PSA concentration was 4.9 ng/ml before TURP and was subsequently reduced to 0.6 ng/ml after 48 months. There was a steady decrease of the PSA concentration during the observation period. In contrast in patients who subsequently developed a CaP, the median PSA concentration before TURP was 6.8 ng/ml and was reduced to only 2.2 ng/ml after 48 months. PSA levels started to rise before CaP was diagnosed. CONCLUSION: After a TURP with a benign histopathologic specimer) PSA levels decrease steadily to values below 2 ng/ml. In case these patients demonstrate a rising PSA in the follow-up after partial prostatectomy, a CaP should be ruled out.

Are age-specific reference ranges for prostate specific antigen population specific?

INTRODUCTION: At present PSA is Considered to be the leading screening test for prostate cancer. We determined whether in men 60 to 79 year old with a serum prostate specific antigen (PSA) within age specific PSA reference ranges prostate biopsy could be safely eliminated. METHODS: We retrospectively analysed all 60-79 year old men who had undergone radical perineal prostatectomy (RPP) for prostate cancer (CaP) at our institution. All patients had undergone prostate biopsy following an abnormal rectal examination and/or PSA greater than 4.0 ng/ml. We compared our results using the standard reference range of 0 to 4.0 ng/ml with those we had obtained using the age specific PSA reference ranges of Oesterling et al. RESULTS: 204 men between 60-69 years and 67 men between 70-76 years had undergone RPP for CaP. Applying age specific PSA reference ranges 56 CaP would have been overlooked. Of those 46% had a favourable histology. Taken together 54% of the cancers overlooked had an unfavourable histology. CONCLUSION: In contrast to previous reports of unfavourable histological characteristics in only 5-24% of missed cancers, applying age specific PSA reference ranges, 54% of missed cancers in our patients exhibited an unfavourable histology. We therefore conclude that age specific PSA reference ranges did not safely eliminate the need for prostate biopsy in our study population.

Tissue polypeptide specific antigen serum concentrations in patients with newly diagnosed prostatic diseases.

UNLABELLED: Recently, tissue polypeptide specific antigen (TPS), a cytokeratin 18 marker, was described to be discriminative between cancer of the prostate (CaP) and benign prostatic hyperplasia (BPH). In our study we investigated the ability of the TPS serum concentration as a staging marker in patients with newly diagnosed CaP. METHODS: Serum levels of TPS and PSA were determined in patients with newly diagnosed, untreated CaP (pT1-3pNoMo: n = 71; T1-4NxM+: n = 39) and BPH (n = 30). The TPS serum concentration was correlated to the PSA serum concentration. RESULTS: Median TPS concentration was 33.6 U/L in the pT1-3pNoMo-group; 113.5 U/L in the Tl-4NxM(+)-group and 59.7 U/L in the BPH-group. Although the TPS concentration failed to discriminate between patients with localized CaP and BPH, it discriminated very well between patients with (M+) and without (Mo) bone metastases (p < 0.001). Furthermore no correlation with PSA levels could be established. CONCLUSION: The TPS serum concentration seems to provide additional information in the initial staging of patients with newly diagnosed untreated CaP.

Serum levels of prostate specific antigen in men on hemodialysis.

UNLABELLED: The measurement of prostate specific antigen (PSA) is widely used for the early detection of prostate cancer. However the influence of renal failure on the serum levels of the PSA molecular forms is still a matter of investigation. We therefore examined the serum concentration of total and free PSA in patients undergoing hemodialysis and discuss the influence of renal failure on both types. MATERIALS AND METHODS: Serum concentrations of total PSA, free PSA and the free-to-total PSA ratio were measured in 48 men undergoing hemodialysis. Total and free PSA levels were measured employing a chemiluminescent enzyme immunoassay. RESULTS: Serum levels of total PSA, free PSA as well as the free-to-total PSA ratio did not change significantly in uremic patients after hemodialysis. Median total PSA concentration was 1.1 ng/mL before and 1.15 ng/mL after hemodialysis (p = 0.24); median free PSA concentration was 0.29 ng/mL before and 0.32 ng/mL after hemodialysis (p = 0.14). Median free-to-total PSA ratio was 0.29 ng/mL before and 0.31 ng/mL after hemodialysis (p = 0.66). CONCLUSION: Serum free PSA as well as total PSA is not eliminated by hemodialysis and the slightly elevated levels of free PSA and the free-to-total PSA ratio in uremic patients after hemodialysis may be caused by the concomitant decrease in binding proteins. We therefore conclude that the reference ranges for total PSA, free PSA and the f-/t-PSA ratio are applicable undergoing chronic hemodialysis.

[Reverse transcriptase polymerase chain reaction and immunocytochemistry of bone marrow aspiration specimen and peripheral blood for detection of microdisseminated prostatic carcinoma. A comparative analysis]. / Reverse Transkriptase-Polymerase-Kettenreaktion und Immunozytochemie an Knochenmarkaspiraten und peripherem Blut zum Nachweis mikrodisseminierter Prostatakarzinome. Eine vergleichende Analyse.

Reverse transcriptase-polymerase chain reaction (RT-PCR) assay for prostate-specific antigen and immunocytochemistry for cytokeratin-18 (CK-18) are tests for the detection of microdisseminated carcinoma of the prostate. Bone marrow aspirates and peripheral venous blood from 50 patients with clinically organ-confined prostate cancer were examined. The rate of positive results was independent of the pT stage, serum PSA, and previous antiandrogen treatment. RT-PCR and immunocytochemistry have to be tested under standardized conditions in prospective trials, and the results have to be compared to the serum PSA follow-up.

Does positron emission tomography using 18-fluoro-2-deoxyglucose improve clinical staging of testicular cancer?--Results of a study in 50 patients.

OBJECTIVES: To compare positron emission tomography (PET) using 18-fluoro-2-deoxyglucose (FDG) with conventional clinical staging in unselected patients with germ cell cancer. METHODS: Fifty patients underwent PET scans of the abdomen (n = 50) and chest (n = 41 ) after the initial diagnosis. PET images were evaluated qualitatively and quantitatively using standardized uptake values (SUVs). The results were compared with computed tomography (CT) results and tumor markers (human chorionic gonadotropin, alpha-fetoprotein, and lactate dehydrogenase). Retroperitoneal lymphadenectomy in 12 patients and clinical staging, including follow-up data in all patients, were taken as a reference standard. RESULTS: PET detected metastases in 13 (87%) of 15 patients and excluded metastases in 33 (94%) of 35 patients. A sensitivity of 73% and a specificity of 94% were obtained using CT. The respective values for tumor marker determination were 67% and 100%. Retroperitoneal metastases were detected in 2 patients by PET only and in 1 patient by CT only. In the latter patient, surgery of a residual mass after chemotherapy revealed a well-differentiated teratoma. False-negative findings with PET and CT occurred in 2 patients with retroperitoneal metastases approximately 10 mm in size. False-positive findings were due to sarcoidosis or to muscular activity of the neck. Quantitative FDG uptake was very heterogeneous, with an SUV ranging from 1.8 to 17.3. CONCLUSIONS: FDG PET has the potential to improve clinical staging of testicular cancer. However, PET, as well as CT, is limited in the detection of small retroperitoneal lymph node metastases.

Detection of prostate-specific antigen immunoreactivity in amniotic fluid.

OBJECTIVE: To examine whether prostate-specific antigen (PSA) is present in amniotic fluid, whether the amniotic fluid PSA concentration changes with gestational age, and whether there is an association between amniotic fluid PSA and fetal sex. METHODS: The PSA concentration was measured in the amniotic fluid of 48 pregnant women. Thirty-four samples were obtained during routine amniotic fluid analyses performed during gestational weeks 16-18, whereas 14 samples were obtained during cesarean section performed after gestational week 36. RESULTS: PSA was detected in all amniotic fluid samples. The median amniotic fluid PSA was 0.193 ng/ml during gestational weeks 16-18 and 0.39 ng/ml after gestational week 36 (p = 0.1). Furthermore, no significant association was seen between amniotic fluid PSA and fetal sex. The median amniotic fluid PSA level was 0.233 ng/ml for the 21 boys and 0.222 ng/ml for the 27 girls investigated (p = 0.72). CONCLUSIONS: These results confirm recent literature reports that PSA may serve as a growth regulator during normal fetal development. However, further studies are necessary to elucidate the exact role of PSA during fetal development.

Critical aspects related to the interpretation of the free-to-total PSA-ratio.

INTRODUCTION: The number of assays available for the measurement of total and free PSA is increasing. As different methods can determine different PSA concentrations as well as different free-to-total PSA ratios in identical serum samples, the cut-offvalue for the ratio still needs to be determined. METHODS: 114 sera from patients with histologically confirmed benign prostatic hyperplasia (BPH; n = 58) and cancer of the prostate (CaP; n = 56) were analyzed with two different assays. Free PSA (free), total PSA (total) and the free-to-total- PSA ratio (ratio) were determined employing Enzym-Test PSA und freies PSA (Boehringer Mannheim, Germany) and Immulite PSA und freies PSA (DPC Biermann, Bad Nauheim, Germany) RESULTS: The statistical results are tabulated below: [table: see text] CONCLUSION: Direct comparison of the two assays revealed a high statistical correlation (r = 0.94-0.99) for free and total PSA. In contrast, the ratio of the two assays was not as reproducible (r = 0.81-0.83). This result indicates that the reference range for the ratio is dependent on the assay employed and an that uncritical use of an applied reference range can be counter-productive.

Age related changes of free and total prostate specific antigen in serum.

UNLABELLED: PSA in serum exists in several molecular forms. The amount of free and total PSA and ratio are discussed to be useful to increase the ability of PSA to distinguish prostate cancer from benign prostatic hyperplasia. Therefore, we tried to characterize the age related changes of free and total PSA in a German rural population. METHODS: Serum samples were obtained from 697 men. All study participants were between 20 and 79 years old and had no clinical evidence of prostate cancer by serum PSA, digital rectal examination and transrectal ultrasonography. The sera were kept frozen at -20 degrees C until analysis and were assayed within 3 months after sampling. Free and total PSA values were determined employing a chemiluminescent enzyme immunoassay (Immulite PSA and Freies PSA, DPC Biermann). RESULTS: Free PSA, total PSA and the free-to-total PSA ratio (f-/t-ratio) demonstrated a correlation with patient age (r = 0.855, p = 0.0141; r = 0.857, p = 0.0137; r = -0.788, p = 0.0352). Employing the median and the 95% percentile the age-specific reference ranges for free and total PSA were calculated. For the f-/t-ratio the median and the interquartile range (i.e. 25th-75th percentile) were calculated. CONCLUSION: In confirmation of a recent report, we found a direct correlation of free PSA, total PSA and the f-/t-ratio with age, whereas free and total PSA increases, the f-/t-ratio decreased with advancing age.

Metastatic workup of patients with prostate cancer employing alkaline phosphatase and skeletal alkaline phosphatase.

PURPOSE: To compare the efficacy of two tests, alkaline phosphatase (AP) and skeletal alkaline phosphatase (SAP) as staging markers to discriminate patients with cancer of the prostate (CaP) with bone metastases (M+) from those without bone metastases (Mo). MATERIALS AND METHODS: Patients with previously untreated CaP were entered in the retrospective analysis. Serum concentrations of AP (n = 215) and SAP (n = 73) were available. After staging the patients could be divided into 2 groups: Group I: patients with CaP and bone metastases (cT2-4 NxMoss AP: n = 40; SAP: n = 21) Group II: patients with CaP without bone metastases (cT3-4 Nx Mo; pT1-3 No Mo; AP: n = 175; SAP: n = 52). RESULTS: None of the Mo patients but 71% of the M+ patients exhibited a SAP value above the reference range (< 19 ng/ml). This difference is statistically significant (p < 0.001) and resulted in a sensitivity and specificity of 71% and 100%, respectively. The Youden-index is 0.7. In contrast 7% of the Mo patients and only 13% of the M+ patients exhibited a AP value above the reference range (< 170 U/l). This difference is statistically not significant (p = 0.71) and resulted in a sensitivity and specificity of 13% and 93%, respectively. The Youden-index is 0.06. CONCLUSION: SAP could become a useful marker in the evaluation of patients with newly diagnosed CaP as it provides more information than AP concerning the skeletal status of these patients.