Rapidly increasing ALP levels....has anyone experienced?

[DSEE]

I was diagnosed 8-2015 stage 4 Gleason 9 extensive Mets.

Have done Taxotere, Xgeva , Lupron , Zytiga for one year but off now for one month.

Long story but currently waiting to see about Xofigo treatment which was started while on Zytiga until this forum posted the warning from Bayer pharmaceuticals regarding Zytiga and Xofigo used together.

My ALP is climbing with every bloodwork done. Bone pain increasing also.

I am in limbo while they try to figure a strategy. This huge ALP number of 615 concerns me that there is rapid cancer growth in bones.

Any response is greatly appreciated.

[Hidden]

Did you stop Zytiga because it wasn't working any more or so that you could go on Xofigo? What was you ALP before you stopped Zytiga?

[DSEE]

Actually I was on both for one month until oncologist was shown the combo warning.

Then they stopped Xofigo

Then I had a bad fall

Then they stopped Zytiga and now I have no therapy.

Anything on rising ALP?

Have you had that?

[Tall_Allen]

I think you are better off doing Xofigo first, then Zytiga - here's why: Xofigo is 6 injections, 4 weeks apart. So in about 6 months, you're ready to move onto Zytiga. If you start with Zytiga, it can take 2 years until you're ready to move onto Xofigo. So you get the benefit of both sooner by starting with Xofigo. If you haven't had Provenge yet, I think starting it together with Xofigo will optimize results of both.

[sedgley in reply to Tall_Allen]

Hi TA.

I was not offered a choice between Radium 223 and AA, but 14 months ago started Abiraterone and it is now failing, with increased bone mets. The proposed switch, apart from a trial at the Royal Marsden, (to be discussed next week) is to Radium223.

I am interested in the '2 years delay' you mention - what is that about?

Additionally are there any other treatments which may be worth raising?

Thanks.

sedgley

[Tall_Allen in reply to sedgley]

There was a recent study that found a high fracture risk in combining Xofigo and Zytiga. Perhaps it can be ameliorated with bone-preserving agents. But it is moot for you because you are done with Zytiga anyway.

Royal Marsden is running many good clinical trials.

[sedgley in reply to Tall_Allen]

Thanks TA. Just hadn't heard of a 2 year 'cooling off period' post AA and before Radium 223.

[Tall_Allen in reply to sedgley]

Who said anything about a 2-year cooling off period? You may be able to even take them simultaneously if you take Zometa or Xgeva.

[DSEE]

I am losing faith in my oncologist.

I was on Zytiga for a year.

When scans showed increase in Mets he added Xofigo with Zytiga which is forbidden.

We showed him the warning from Bayer, the makers of Xofigo.

After 1 Xofigovinjection he stopped Xofigo after he learned of the warning !

Then, 10-12 I blacked out and had a bad fall.

On 10-15 oncologist also removed Zytiga.

So currently under no treatment.

And Alkaline Phosphate is through the roof which I am told means bone Mets are increasing.

They cannot figure how to start Xofigo again after only one dose.

We are trying to get into Emory in Atlanta or Mayo Clinic in Jacksonville.

My question was has anyone experienced a sharp rise in Alkaline Phosphate?

And what did oncology tell them?

[DSEE]

We are in Atlanta.

Our original oncologist was great but retired.

Any thoughts on recommendations?

[MelaniePaul]

I don't know. To me it all sounds like your oncologist isn't too sure what he is doing and I would go to a place that specialises in Prostate Cancer treatment. You don't want to mess around with treatments like he does, starting and stopping them all the time.

Good luck, keep us posted.

[curious-mind1]

DSEE, your ALP increase could be simply related to your bad fall (especially if there was bruising in your bones, etc.). My dad, who is on Zytiga, had two bad falls, one resulting in hairline fracture on the ribs. The ALP numbers went rapidly up, but not the cancer. So you should watch your PSA and imaging if needed to acertain that it is the cancer that is causing this, because bad falls (or fractured/broken bones) cause rapid ALP increases as well.

Arthur

[DSEE in reply to curious-mind1]

Thank you.

ALP was high but went higher after fall.

Makes sense

[curious-mind1]

Yes, this is very common after falls. So, please don't assume that the therapy is failing, but double-check that all other measurements and indicators are ok.

[podsart]

If you begin to do weight training can that affect alp levels?

[j-o-h-n]

to DSEE: Falls due to balance or klutzy like me? You've gotten good advice here. mine is, get new a new Oncologist that specializes in Pca...

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 11/10/2018 7:08 PM EST

[podsart]

Thanks!

[Grandude]

Dr. Luke @gucancer.com is awesome!

A 2 hour consult with him will change your outlook tremendously.

Prostate and Urology only with state of the art facility, huge staff and the best access to upcoming trials for prostate cancer.