Question on Alkaline phosphatase

[michael00]

On lupron and zytiga, after 19 months PSA went from 1230 to 0.08, Alkaline phosphatase went from 782 to 109 but then ALP increased to 169. My question is can that ALP increase be attributed to bone healing or only to cancer activity?

[LearnAll]

It can be both. You need to keep checking Alk Phos evry two weeks to see the pattern.

If it consistently goes up, this may be active cancer corroding bones....If it goues up and down and declines eventually, its due to bone remodeling and healing.

Other way is to compare ALP level with PSA, Hb, Albumin, and of course scans...If they are all pointing in wrong direction ..then chances of cancer being more active goes up.

[Dachshundlove]

To add to the confusion, I believe ALP is also produced by liver, so liver stress can increase that number.

I think this is why LearnAll suggests also watching Albumin?

May your treatment continue to be a success!

[LearnAll in reply to Dachshundlove]

Thanks. I should have mentioned that liver function tests (AST,ALT, LDH and Albumin) needs to be checked as 40 to 50 units of Alk phos is released by a HEALTHY liver. This liver part of Alk PHos can go way up if your liver is injured due to any reason.

(Note: In a healthy man, Total ALP is between 50 to 100 ...of which Liver produces 40 to 60 and bones produce 40 to 50 units) Take into consideration your height and lenghth of your long bones.

[michael00 in reply to LearnAll]

Thank you. My other liver function numbers are in normal ranges and last nuclear bone scan showed reduced uptake and some shrinkage existing mets. Not sure what you mean when you say take into account height and length of bones. I'm short 5"6"

[LearnAll in reply to michael00]

Normal Alk Phos level is affected by height and length of thehealthy person. Example" A 5 feet tall Vietnames man is likely to have normal ALP of 35 whereas a 6feet 7 inches tall African American man is likely to have normal ALP of 110.

I am 5'6" and my ALP came 59 last week.

[Kaliber in reply to LearnAll]

My alp was over 180 when DXed 14 months ago . PSA over 1400. Started Lupron Xtandi. I’m 6’1” .. ... alp quickly dropped to 33 in 3 months and hovers 33 to 36 ... which is slightly below Kaiser’s normal range of 37 to 117. Dunno why it would be so low. Seems like a good thing tho, considering? Current psa <0.1 for 8 months.

[LearnAll in reply to Kaliber]

of course, there are individual variations in ALP.

[Kaliber in reply to LearnAll]

When DXed I had a couple things way high , alp one of them. All the rest were dramatically low , half way or more between the low end of green zone and zero. A couple near two thirds to zero. My high PSA and these low results were part of the reason they discussed my entering hospice when DXed. I was in high pain and very sick. All blood panels now back to normal or close. All thanks to adt. 😁😁😁

[Hidden in reply to Kaliber]

ADT is a bitch, but then you live.

[Kaliber in reply to Hidden]

Yep .... it’s worked near miracles for prolonging my life for now. I’m happy about that. Some guys have an easy time of adt, Unfortunately I’m not one of those. Yayahahahaya I pay a steep price for the extra days alive. I’m good with it tho ... extra time with my wife , time to enjoy a few more things in life .... it’s worth it to me. I feel lucky and thankful to be here. 👍👍👍

Have a good one brother Gregg ✌️

[pete-ginger in reply to LearnAll]

Yes, aren’t these liver enzyme metrics? And, if so, aren’t they biomarkers for the impact of a number of things — like alcohol and other drugs that are metabolized via the liver?

[LearnAll in reply to pete-ginger]

pete-ginger...Total Alkaline phosphatase comes from 3 main sources. .about 40% of total comes from Bones and the remaining 60% comes from, Liver, Intestines etc.When we are trying to assess bone mets, we are looking into Bone Specific Alkaline phosphatase only. Bone portion of ALP is a good indicator of bone repair going on at that particular moment. Higher BALP means excessive bone repair and that in turm means that body is dealing with more bone corrosion..(due to mets_

If possible, one should track bone specific ALP for accuracy but it is about 3 times more expensive than total ALP test.

[Hidden]

You can also measure the Bone Specific ALP which eliminates other sources such as liver, intestines, pancreas and kidneys.

[michael00 in reply to Hidden]

They told me bone specific was a very expensive test and would not do it

[Hidden in reply to michael00]

I read that it is not expensive so I looked around online and found one provider that charges $99 (in the US). I'm sure there are other providers that could be found.

walkinlab.com/labcorp-alkal...

[michael00 in reply to Hidden]

Thank you

[timotur in reply to michael00]

Try ultalabs.com. Last I looked it’s about $60 before discounts.

[larry_dammit]

when I was diagnosed my alkaline phosphate was 900 with a PSA of 11. The high number was the trigger for the doctors to finally eat the cancer diagnosis correct. Since chemo and xtandi the alkaline has stayed at or near the 90 number with a PSA of <0.05. Thank goodness for a family doctor who ordered the blood panel. And yes they tell me that the alkaline number does say that the cancer can still be there or that it’s the bones healing. 40 months and counting. 😜😜😜🙏🙏🙏

[LearnAll in reply to larry_dammit]

Alk Phos only tells you about bone mets ..not other mets. Larry...alk phos at 90 is very good.

[larry_dammit in reply to LearnAll]

I know that , but I had been arguing with my urologist and family doctor for 3 months prior to diagnosis. I had a large lymph node in my groin that swelled up but they all thought it was a strain. Both doctors blew the cancer until I saw a old doctor who did my full blood panel and found the alkaline level at 900. Just saying 🙏🙏🙏🙏

[Max135]

This number - alkaline phosphate is one that has always (well the last three years - since I have been paying attention) been one that I do not completely understand. For me the number has always been around 25. By everything that I have been able to read it is super lower for some reason so it may not be a good number for me to use? Does anyone else have such low numbers... my height is 6ft and weight is 192. When first diagnosed my PSA was 729 but for some reason cannot find the original labs on alk phos...

Sorry Michael kind of got off track... would follow LearnAll since he is spot on! Good travels in 2020 .

Max

[LearnAll in reply to Max135]

Max...sometimes a simple thing such as LOW phosphate level in blood is enough to take AlkPhos lower than normal. But, still a lower number os Alk phos is always better overall as long as your liver is not damaged. A very damaged liver can not produce much Alk Phos. Check your liver enzymes and phosphate level.

[Max135 in reply to LearnAll]

thanks LearnAll...

my liver numbers all seem to be within the normal range. In the past three years the only time they were off a bit was when doing Chemo (six rounds). Alk Phos has always been low - maybe its just me! will ask the question one more time to my local medonc since my labs are scheduled again for this Monday. must say more concerned about another rise in PSA after on Enza for just 90 days. first 30 days on the drug was able to get a good drop but the second 30 had the bugger up again. will see whats next after Mondays labs.

thanks again!