Good Morning,
My dad’s first day of treatment is today. He has been taken prednisone and bicalutimide for about two weeks now since being diagnosed. His alkaline phosphatase levels were 800 on July 21st, but now 1,300 when checking in. Does anyone know what this could mean? Anyone have experience with this?
I’m sorry for all the questions. Just new to test and a worried daughter.
Generally speaking it can be an indicator of bone activity
Does that mean just anything? I have seen where some say it could mean things are working like they should. But I obviously know it could mean bad too.
I lack the expertise to say conclusively. I’m sure others here who are more knowledgeable will be more definitive. From what I’ve learned it could mean tumor growth in the bones.
He is staring Docetaxel and a hormone therapy shot today.
Did you mean abiraterone rather than bicalutamide? Abiraterone is given with prednisone but bicalutamide isn't. His ALP level may reflect liver toxicity and or bone metastases or both. There is a bone-specific test he can take. One expects ALP to go up at first because therapy kills the cancer cells which release their PSA and ALP into the serum. It should go down over time.
He’s been taking prednisone then the doctor gave him bicalutimide for two weeks before giving him the eligard shot. He’s not on bicalutimide now since he started shot. She told him the bicalutimide was so he wasn’t in extreme pain with eligard. He’s also on Docetaxel every three weeks until December.
Now it makes sense. The prednisone is given with docetaxel. The docetaxel is probably increasing his liver and bone ALP - it shows it's working.
Thank you so much! It’s hard not to worry when you see so something increasing, but sounds like it may be a good thing! All his other test were in range 🙏🏻🙏🏻
Murphy....fast rising ALP after starting ADT med is a GOOD sign....I know you will not believe it...Its a well known phenomenon called "ALP flare"
It indicates that your Dad is likely to respond well to PCa treatments. I had ALP 191 on day of diagnosis and then after 3 weeks of being on Bicalutamide ,ALP shot up to 490..BUt then it kept falling relentlessly ending at 49 after 10 months. So nothing to worry ! You better believe me..I know exactly what I am talking. I have studied this in depth because I had this surge of ALP.
We just got his PSA level back and after being on bicalutimide for two weeks his PSA has dropped in half!! Alkaline Phosphatase shot up so I’m thinking you are right!
Wonderful...He is going to be super responder like me. My PSA dropped from 830 to 0.2 in 11 months. My ALP went from 191 to 490 in 3 weeks and then ended up at 49 after 10 months. Bone mets are gone. Your Dad is likely to live many many years more. My PSA dropped 79% after being on Bicalutamide for 3 weeks.
Mine was 900 when they decided to test me for cancer, it indicated bone cancer in my case. 90 is normal for me. Good luck
Hi there! Your Dad's case sounds similar to my Dad's. My Dad was diagnosed May 2020, PSA 680 and Alk Phos creeping up towards 800. His PC Metastasized to bone, he started Bicalmutide right away, Lupron shot, and is approaching 3rd Docetaxel cycle. PSA is at 4.3 right now and Alkaline down to 190 so througb treatment it will start to go down as bone activity slows down. If you have any questions feel free to message me, we have been keeping chemo side effects to a minimum so far, he is 75 years old.
My husband’s experience was different. His ALP started increasing after Taxotere. His PSA was 49 when initially diagnosed in March 2018 and his ALP was within normal level (low 100). He only had metastasis in the lymph nodes (pelvis and abdominal areas). After Zytiga and Xtandi did not longer work (PSA decreases to 12 and then increased to 93 at the end of his first year of treatment), then had six rounds of Taxotere, which reduced his PSA to 3 by July 2019. His ALP was 540 during Taxotere but dropped later and doctors said it could be the due to death of cancer cells or tumor growth. He also had radiation. Bone scans always indicated NO bone metastasis. After he finished Taxotere, his ALP started raising until it was 1100 and his PSA increased to 13 by December 2019. He continued with immunotherapy and ALP initially increased to 1300 and PSA was 18. Then ALP dropped to 900 and PSA to 9. Doctors did another biopsy of tumor, which indicated that it was becoming Neuroendocrine Prostate cancer, and gave him Citaplin chemo. After the second dose, he went to ER in February 2020, had a scan and doctors said the tumors in the lymph nodes have grown and were taking over. They recommended hospice and my husband died at home in April 2020. My advice is to monitor the PSA and ALP, get regular scans and an annual biopsy of the tumor to detect any changes or mutations. My husband’s oncologist always told us that the most important indicator to know is a treatment is working is the scan, because the tumor should be shrinking if the treatment is working.
Just offering my 2 cents in this.
I'm glad the gang have made you feel better Murphy. 
I was just thinking since we're talking about "Alkaline." If you're thinking of getting some Alkaline water, don't bother, it's a lie. Your body naturally alkalizes itself. I would just encourage your pop to drink more water. Keep it simple.
That's Funny..Boss..Alkaline phosphatase is an enzyme released by bones which are trying to repair themselves......it has nothing to do with Alkaline Water...or any other water.
Low Alkaline Phosphatase means low bone corrosion and thus, needing less repair.
I learned something new this morning haha.
Just sharing my experience, when I was diagnosed my Alka Phos was 800 and PSA was 33, after a bone scan I was found to have extensive metastasis. That was over 6 years ago. My current Alka Phos runs around 52-55 and I get it tested monthly, it’s one of the indicators I watch carefully along with PSA for signs of cancer activity in my bones. Currently my PSA is undetectable and has been for quite a while now after some of the same treatments your dad is undergoing. You can click on my profile to see what I’ve done thus far. There’s lots of treatments out there hang tough.
Ed
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