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Advanced Prostate Cancer
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For those with bone metastasis: what are (were) your ALP numbers or bone-ALP?

Not sure if really sensitive, but after 2 PSMA PET CT, 1 biopsy and now a very detailed mri (waiting results, very long inside mri for about 1,5 hours), doctor still don't know if my husband has or not bone metastasis....

So I am trying to see if ALP numbers are related. His numbers are in the norm, and CRP 0.2. Calcium score also normal.

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Great C-Reactive Protein. Was the Alk Phos, number in the 60's or 70's, you did not say?

Nalakrats

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Thanks for CRP, I think our alternative medicine is helping a lot (and thanks for additional hints!!!).

Alk Phos last one was 82 U/l (being the normal range 38-126 in this lab), one year ago at DX about the same, just in july it was 64 (when also PSA declined a lot). Bone ALP is 32.3 microg/l (on the higher end of normal range).

The point is the idea to target the bones with radiation not knowing if there are mets is not so great... specially the one in the spine (near heart). But if oligo bone mets the aggressive treatment idea of radiation + ADT + mets radiation could give him some chances...

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And now I read that Paget's disease also causes higher ALP.... complicated

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With Mets, the Alk Phos, should be up over 150.

Nalakrats

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Thats what i am trying to figure out .My Naf,PET CT Bone scan in February showed increased uptake ,some new areas .I was on Zytiga and i am confused over ALK.Phosphatase .a year ago they were over a 100 each month .The last two months they are 54 ,second reading after stopping Zytiga for a month ?I guess Zytiga reduces the Alk Phosphatase ?

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Maybe Tall-Allen has an analysis--I do not have an answer here.

Nalakrats

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Did they shrink with hormone therapy?

Can any be biopsied?

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He had 1 biopsy to the biggest point on the ilium, but they did not find anything. It seems it is very difficult to hit and also there is always a 30% chance of false negative...

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Did they shrink with hormone therapy?

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he did not begin yet.

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if he begins with ADT and points don't shrink on PSMA it could mean they are not mets, that's your idea? So in this case radiation to this points would not be necessary. But is this a sure enough way to know if the points are mets or not?

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That's the way it's usually assessed. Since they are PSMA avid, and there is bone overgrowth on CT, they should respond to hormone therapy if they are prostate cancer. But PSMA false positives are very rare in bone.

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seems a logical approach. Let's see. But from literature and speaking to doctors there are more than just rare cases of false positives in bone, at least here in Switzerland where PSMA is already standard. They are not sure probably because of low signal and it did not advance over almost a year, PSA when detected was under 20 and biopsy was negative.

Would the response to hormone therapy in case of mets be quite fast, so that in let's say 2 months when radiation to mets would begin, we would know more?

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It is not true that false positives in bone are common with PSMA PET scans, They are VERY rare:

"Region-based analysis revealed a sensitivity and specificity of 98.8-99.0 % and 98.9-100 % for PET"

link.springer.com/article/1...

But you have to have a competent radiologist. Maybe get a second opinion from a more experienced radiologist in Germany.

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We will have a second opinion here in Switzerland , this time in the french part (the German doctors are already here, because they prefer to work here for lots of reasons... and in Zürich they were the first to have all these new machines). I did not say it's common, but there are cases.... you know, inflammation, or Paget's disease there are lots of possible causes for false positives. But I hope that after 2 PSMA PET CT and now RMI they will come to a conclusion.

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Does he have a diagnosis of Paget's disease? The Ga-68-PSMA-11 PET was developed in Germany. The people who developed it are still there.

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I will keep you updated. Thanks for your advice. Sure, Germany still has doctors working there :)), but here we have a real invasion of them (very appreciated, since I prefer to speak German to Swiss German, that is difficult to understand, and they are very qualified) If really needed we can go to Freiburg, but I don't think necessary. Where Germany has much more to offer is in alternative treatment clinics.

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I have scan proven bone mets ,and i am asymptomatic

My ALP was 15 then month later 16.My ALK Phosphatase was54 each month .

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very low numbers! or is it another basis? U/l?

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It is the same basis in New Zealand U/I.Numbers are low from what I read on this Forum and so far I am not getting answers from M.O I envy you the alternatives you have in Germany ?

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I am not sure if ALK numbers are enough sensitive, but they are somehow related. I don't know which scan you did, and what therapy you are taking, since with therapy ALP can go down.

The point is to be sure about the mets, since scans can also give false positives, because the mets influences a lot the choice of therapy.

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My alkaline phosphatase was at 782. It came down to 121 in last reading. I was told that is now in normal range

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it came down with therapy?

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Lupron and zytiga

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My alkaline phosphatase was approaching 1000 after diagnosis with many bone mets. Started dropping on Eligard, and dropped faster and further on docetaxel, now in the upper 40s. Still have pain in back and ribs and hoping those low numbers mean it's healing pain.

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it declined a lot! did you have also bone ALP checked?

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Nope, just general ALP. As I understand it, with numbers that large and known cancer, the assumption is that it's primarily coming from the bones.

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My ALP numbers got up to over 600 even after chemo and Zytiga.

Currently down in 400’s.

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It was over 500 at dx has been running in the low to mid 50’s for quite a while now.

Ed

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and did you measure bone ALP too?

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Ya for a while I was getting bone specific Alka Phos tested which was in normal range, my local oncologist said he is comfortable with testing just total Alka Phos because if bone Alka Phos was high then regular Alka Phos would be elevated too. Then he would do the more specific AP test. This made sense since my other numbers were good.

Ed

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My husband’s ALP was close to 400 at DX and went down to low normal in a few months on ADT. We have new bone scan and tests this coming week. His PSA is rising while off of Lupron so we will see what’s next.

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and did you measure bone ALP too?

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I don’t think they ever did a bone ALP.

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And his last labs 6 weeks ago showing PSA rising the ALP was in low normal range.

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I see. Don't really know the importance or sensitivity of ALP

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My ALP was 110 IU/L at its peak and when diagnosed with PCa and my PSA was 55 with a gleason-8 stage-4 with 5 bone mets that lite up under the full body bone scan. Today, my ALP is 91 IU/L with a PSA of <0.10 as of last week.

During that same time my CRP went down from .78 mg/L down to 0.52 mg/L.

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and did you measure bone ALP too?

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Not aware of a specific "bone" ALP other than the Alkaline phosphatase (ALP) enzyme blood test. Please explain!

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well, bone ALP is more specific to bones, Alkaline phosphatases are present in many human tissues, including bone, intestine, kidney, liver, placenta and white blood cells, so a high ALP can have other reasons than bone issues.

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My oncologist specifically said he could rule out placenta in my case :-)

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In other words the amounts of different types of ALP in the blood may be measured and used to determine whether a high level is from the liver or bones.

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Yes, I had same experience. Oddly, when my numbers were abnormal, no bone mets. The numbers can only go so far. I think commons sense and looking at your bigger picture is more important.

Good luck.

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