Inflammation. [2] Albumin & C-Reactive Protein [CRP]

This follows on from my recent post:

"Inflammation. [1] Neutrophil-to-Lymphocyte Ratio [NLR]"

Albumin & CRP could justify separate posts, but the Glasgow Prognostic Score formula combines them.

[1] Albumin.

Albumin is a protein that transports all sorts of things in the blood. For instance, about half of our circulating testosterone is weakly bound to albumin (& is thus considered to be bioavailable).

"Normal range of human serum albumin in adults ... is 3.5 to 5 g/dL." [1a]

My feeling is that we should not be below 4.0 g/dL, & that one should perhaps aim for 4.5 g/dL as a comfortable place to be.

Albumin is an acute-phase protein that decreases with inflammation.

About 10 years ago, a man who headed up a west coast PCa group told me that the best indication of long-term survival in PCa was albumin. Nothing else was really predictive to the same extent. Mine was 3.9 at diagnosis, but increased to 4.5 as I increased polyphenol intake. (& maybe tumor debulking helped.)

[1b] (2017 - China)

"A simple prognostic model involving prostate-specific antigen, alkaline phosphatase and albumin for predicting the time required to progress to castration-resistant prostate cancer in patients who received androgen deprivation therapy."

"One hundred and sixty-eight patients were evaluated. The median age was 72 years, and the mean time required to progress to CRPC was 15 months. Multivariable analysis indicated that ... albumin {was an} independent predictor of ADT failure."

[1c] (2013 - Japan)

"Low pre-operative levels of serum albumin predict lymph node metastases and ultimately correlate with a biochemical recurrence of prostate cancer in radical prostatectomy patients."

"A low pre-operative serum albumin level (<4.0 g/dl) was significantly correlated with {biochemical recurrence} univariately."

[1d] (2000)

"A retrospective review was performed on 354 patients who underwent a radical prostatectomy ... from 15 April, 1990 until 3 December, 1996 who had a pretreatment serum albumin within 6 months prior to surgery."

"Albumin level ... was an independent prognostic factor in predicting risk of nonorgan-confined disease (T3 or T4)"

"Albumin appears to be of clinical utility to augment assessment of pretreatment pathological stage."

[2] C-Reactive Protein [CRP].

CRP is "an acute-phase protein synthesized in response to systemic inflammation" [2b]. As such, it is logical that I would find more studies than for albumin (which falls with inflammation). But albumin is generally included in a basic panel, whereas CRP is usually an add-on test.

With CRP, the ideal number is zero. The "normal" range is too broad, & lower is always better. The CRP range is 0-10mg/dL.

[2a] "A more sensitive CRP test, called a high-sensitivity C-reactive protein (hs-CRP) assay, is available to determine a person's risk for heart disease."

"According to the American Heart Association, results of the hs-CRP in determining the risk for heart disease can be interpreted as follows:

- You are at low risk of developing cardiovascular disease if your hs-CRP level is lower than 1.0 mg/L.

- You are at average risk of developing cardiovascular disease if your levels are between 1.0 mg/L and 3.0 mg/L.

- You are at high risk for cardiovascular disease if your hs-CRP level is higher than 3.0 mg/L."

[2b] (2016 - China)

"The aim of this study was to investigate the association between CRP and progression-free survival (PFS), overall survival (OS) and radiological response in CRPC patients treated with docetaxel."

"In multivariable analysis, patients with a CRP > 8 mg/l were at significantly higher risk of tumor progress (hazard ratio (HR) 2.184 ...) and death (HR 2.003 ...) than patients with a CRP ≤ 8 mg/l."

[2c] (2015 - Austria)

"A total of 261 prostate cancer patients treated with 3D-conformal radiotherapy were evaluated retrospectively. Cancer specific survival (CSS), overall survival (OS) and clinical disease-free survival (DFS) were assessed ..."

"... the optimal cut-off level for the plasma CRP was 8.6mg/L. An elevated CRP level was associated with decreased CSS in univariate (hazard ratio (HR) 3.36 ...) and multivariate analysis (HR 4.31 ...). Furthermore, a significant association with OS was detected in univariate (HR 2.69 ...) and multivariate analyses (HR 3.24 ...). Multivariate analysis also showed a significant association between plasma CRP and clinical DFS (HR 2.07 ...)"

[2d] (2014 - China)

"... serum CRP level is useful to predict the prognosis of metastatic prostate cancer patients, and high serum CRP level is a significantly independent predictor of worse overall survival."

[2e] (2013 - U.S.)

"The association between C-reactive protein (CRP) level and biochemical failure-free survival in patients after radiation therapy for nonmetastatic adenocarcinoma of the prostate."

"A higher CRP level was associated with shorter biochemical failure-free survival on univariate and multivariable analyses ..."

[2f] (2011 - Japan)

"CRP is an independent prognostic factor for overall survival of patients with CRPC treated with docetaxel."

[2g] (2010 - U.S.)

"We previously reported that higher serum concentrations of C-reactive protein (CRP) are associated with shorter survival in men with castration-resistant prostate cancer (CRPC). To confirm this finding in an independent data set, we used 119 CRPC patients enrolled in 6 phase II clinical trials and examined the relationship of CRP, alkaline phosphatase, hemoglobin, age, ECOG PS, and prostate specific antigen (PSA) with survival."

"... log2 (CRP) was a significant predictor of shorter overall survival."

[2h] (2008 - U.S.)

"C-reactive protein (CRP) was found to be significantly predictive of a shorter overall survival (hazards ratio [HR] of 1.41 for each natural logarithm [ln] [CRP] increase"

"When categorized as normal (<or=8 mg/L) or abnormal (>8 mg/L), elevated CRP was found to be a significant predictor of shorter overall survival (HR of 2.96 ..."

[3] Modified Glasgow Prognostic Score [mGPS] (for cancer).

An absurdly simple formula that turns out to be useful.

- If CRP <= 10 mg/L, mGPS = 0

- If CRP > 10 mg/L & Albumin >= 3.5 g/dL, mGPS = 1

- If CRP > 10 mg/L & Albumin < 3.5 g/dL, mGPS = 2

{The background to the Glasgow Prognostic Score involves patients entering hospital for all manner of procedures. For a particular procedure, some patients inexplicably develop complications, & possibly die. Is it possible to identify a problem patient at admittance? It turns out that variables related to the condition that brought the patient to the hospital, are often less important than inflammation status.}

[3a] (2013 - Australia)

"Glasgow prognostic score as a prognostic factor in metastatic castration-resistant prostate cancer treated with docetaxel-based chemotherapy."

"... median survival, 23.5 months at mGPS 0 vs. 9.8 months at mGPS 2)."

[3b] (2013 - Scotland)

"The modified Glasgow prognostic score in prostate cancer: results from a retrospective clinical series of 744 patients."

"Patients with mGPS of 2 had poorest 5-year and 10-year relative survival, of 32.6% and 18.8%, respectively."

"The results of the present study indicate that a raised level of mGPS is associated with poorer short and long term survival in men with prostate cancer. This relationship was independent of age at diagnosis, socio-economic circumstances, Gleason score, PSA level and previous in-patient bed days. These findings are consistent with earlier observations from the Glasgow Inflammation Outcome Study, where the mGPS was compared with Neutrophil Lymphocyte Ratio and demonstrated significant prognostic value [11]. The prognostic value of mGPS remained consistent even after excluding deaths in the first 12 months after diagnosis, which suggest that disease stage is unlikely to explain the survival differences between mGPS categories.

"We observed 40% and 22% lower 5-year and 10-year relative survival respectively, among those with raised modified Glasgow Prognostic Score (mGPS = 2) compared to the normal (mGPS = 0) following diagnosis of prostate cancer."

...

[4] Conclusion.

Some might think that with a CRP < 10 mg/L & Albumin > 3.5 g/dL, they are home free, but some degree of morbidity exists while inflammation is present. & there really is no reason to accept the presence of subclinical inflammation.

To follow: "Inflammation. How to Change the Numbers"

-Patrick

[1a] en.wikipedia.org/wiki/Album...

[1b] ncbi.nlm.nih.gov/pubmed/278...

[1c] ncbi.nlm.nih.gov/pubmed/245...

[1d] ncbi.nlm.nih.gov/pubmed/124...

[2a] medlineplus.gov/ency/articl...

[2b] ncbi.nlm.nih.gov/pubmed/271...

[2c] ncbi.nlm.nih.gov/pubmed/256...

[2d] ncbi.nlm.nih.gov/pubmed/252...

[2e] ncbi.nlm.nih.gov/pubmed/238...

[2f] ncbi.nlm.nih.gov/pubmed/220...

[2g] ncbi.nlm.nih.gov/pubmed/202...

[2h] ncbi.nlm.nih.gov/pubmed/184...

[3a] ncbi.nlm.nih.gov/pubmed/238...

[3b] ncbi.nlm.nih.gov/pmc/articl...

8 Replies

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  • Great stuff, Patrick! I can hardly wait for the sequel!

    Neal

  • I'm ready to learn how to change the numbers.

  • Looking forward to post on how to change the numbers. I've never had a physician comment on my Albumin. My most recent is 3.9 gm/dL. When I asked about CRP, I was told that the test isn't used as much anymore and that I didn't need it. Thanks for taking the time to research and post this info.

  • Patrick: I mostly lurk but greatly enjoy your reporting. As a 4+3 and T3b I'm always looking for things I can do to stay in remission. My albumin & CRP are ok but could be better so will be interested in your next installment. Keep up your good work...Don

  • Patrick,

    I eat egg whites to increase my albumin; however, they also contain omega-6.

    Rich

  • To keep a proper balance, take omega-3 supplements.

  • Neal,

    There was some concern recently about high levels of omega-3 in your body and PCa progression.

    Rich

  • Rich,

    Do you have a reference for this? I'd really like to know how high is high. Here I am taking 1000 mg of omega-3 fish oil twice a day as part of my prostate cancer battle.

    Neal

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