I have a question for the biochemists on this forum. Since I was first diagnosed in Jan of 2018, my alkaline phosphate numbers have always been a little elevated. Also, my neutrophils have always been elevated and my lymphocytes low. I had a bone scan in April of 2018 and a axumin PET scan in Feb of 2019, both of which turned up nothing. My PSA is currently undetectable after RT and ADT, but I only just stopped the ADT last August and the RT last June.
In my last blood test last Nov, my ALP was 101, my neutrophil was 77.1% and my lymphocyte was 10%. These numbers have all been in a fairly narrow range since my DX two years ago.
My question is, are these numbers an indication of something lurking systemically or nothing to worry about?
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Murph256
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There is individual variation in ALP numbers for each person (range 45 to 117) Your ALP seems closer to upper end of normal. In this situation, you need to get ALP from last few years and see what has been your average ALP. In my case , years ago before diagnosis, my lowest ALP was 55, so that is what I consider my baseline. You need to find your baseline and compare with current number. Also, healthy liver generates about 40 to 50 points of the ALP. If scans and clinical symptoms are pointing towards remission, that is a very good news.
Remember, dead cancer cells do not produce PSA..they are just dead or in coma.
Next marker is Neutrophil to Lymphocyte Ratio which can give you some idea about how well things are going. N to L ratio should be as low as possible ,preferably below 1.5
N to L ratio higher than 3 is not desirable. Take absolute number of Neutrophils and divide by absolute numbers of Lymphocytes and that's how you get your N to L ratio.
So my impression is that your baseline ALP should be 90. Plus minus 10 points are not really significant. It can fluctuate from one lab test to another test by 10 points .
I think you should be fine with 110 BUT make sure it is not rising steadily...Monitoring is still needed.
Same thing with N to L ratio...up to 3 .0 is Ok so its somewhat higher. May be you have some hidden infection somewhere...try to look for that.
Hmm... I just received the results of my monthly blood draw. here are some of them:
Alkaline Phosphatase83 U/L
9 - 122 U/L
Alanine
Aminotransferase (ALT)17 U/L
6 - 34 U/L
Aspartate Aminotransferase (AST)22 U/L
11 - 33 U/L
Neutrophils81.3 %
45.0 - 90.0 %
Lymphocytes7.0 %
10.0 - 50.0 %
My dx was 16 months ago: G9,S3,high PSA 28 and no mets.
In April I had HDR Brachey and finished 25 days of IMRT in July.
I take Zytiga, prednisone and Lupron and will continue for another year and a half (my MSK MO says that I'm "slightly anemic and treatment is the culprit".
Should I be concerned about my N to L ratio (11/1)?
Dr Richard Frank, formerly of MSK and now heads up the Whittingham Cancer Center @ Norwalk (CT) Hospital. On SUNDAY 8/18 I sent him an email re: anemia and he replied within 4 hours! He is great!
A part of high neutrophil count is due to prednisone which causes benign increase in neutrophils. So, if you are taking prednisone the value of N to L ratio as a predictor marker goes down. Your liver appears in good shape based on AST and ALT numbers.
If you are with long bones (you are tall and bone heavy) then, ALP 83 seems pretty acceptable.
Race and size also needs to betaken into consideration when analyzing these numbers.
If you are Asian and 5'2" tall, you have smaller prostate and smaller bones so lower end of normal numbers are more accurate for you.
If you are African/Slavic/German with height of 6;5" , you have larger prostate and longer bones. .in that case upper end of normal range is more accurate in your case
Ethnic medicine is a new but fast growing field...because there are significant differences in dosing of medicines across race and ethnicity. If you give 5 mg of Valium to a 5" feet tall, Chinese woman...she will sleep for 20 hours.. But you give the same dose to a Caucasian or African woman..she will have effect for only a few hours.
"....The value of 2.494 for NLR was found to be a cut-off value which can be used in order
to distinguish recurrence according to Youden index. According to this, patients with a higher NLR value than 2.494 had higher rates of PSA recurrence with 89.7% sensitivity and 92.6% specificity..."
"... Patients were divided into a high-NLR group (NLR 2.36) and a low-NLR group (NLR<2.36) according to the pretreatment NLR...
...Our findings suggest that the pretreatment NLR may be associated with pathological stage and lymph node involvement in PCa patients receiving RP, and that PCa patients with a high NLR may have a higher rate of biochemical recurrence following RP than those with a low NLR..."
"....In summary, our meta-analysis demonstrates that an elevated NLR is a strong indicator of poorer prognosis of patients with mCRPC, whereas the NLR is not significantly associated with prognosis of patients with localized PCa...."
There is a whole family of markers apart from the Lymphocytes to Neutrofils Ratio, such as Platelets to Lymphocytes Ratio (PLR), Lymphocytes to Monocytes Ratio (LMR) and the Systemic Inflammation Index (SII) which combines 3 of them.
Also, an increase in Eosinophils signals a mounting defensive by the body.
Thanks, I'm a start your engines advanced PCa guy now pegged Metastic and Stage4.
Zytiga(Abiraterone) and Prednisone to be started this Wed. I've got my Blood Labs from Sept 10th at 1st Lupron inj and last week Dec 10th 2nd Lupron inj. Is it time to start baselining those results??
So what is the cutoff for platelets/lymphocytes and lymphocytes/monocytes, if I may ask?
Also, are these studies accurate for second recurrences after RT, as well as initial recurrences after RPs? I would assume that they are, if they are predicting lymph node involvement.
My personal retrospective data shows that during my "inocent" years it was 125+/- 25. During the "suspecious" years it surged up to 260 and now after the RP is falling but very slowly (latest one at 198) .
Regarding LMR one study sets the cutoff point to 3.05, but attention here. Higher is good, lower is bad, reciprocaly to the other ratios where less is better.
Equally, from an "inocent" 5.x I have gone down to 2.0 and now very slowly climbing up-hill (latest one 2.3).
My personal view is that, like PSADT, it is the derivative (rate of rise or fall) that signals the trend.
THxs again justfor, I've got some homework to compile starting with when it snows tomorrow, or after my PFT personal fitness training session#3. Anxiety exercising relief is doing me great lately. Really for the last 4 years. Exercising trying to keep my muscles, bones, legs, and especially my Cardio health as good as I can. Do not want a repeat of SCA arrest like May 2011, 12 days in CICU +5 cardiac rehab days.
Let's see I've had 7 older now not-my Urologists, 3 IU Health Urologist now 2, 2 Radiation Onc, 1 past Med Onc, and 1 newest present MO. That's a lot of laboratory testing reports.
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