Slightly elevated bone fractionated alkaline phosphatase with decrease PSA and steady calcium levels.. bone metastases or from recent fall?

[Lynsi13]

Good morning! It's been a while since I've asked a question here because (thank the good Lord) things have been pretty steady and good on my dad's end! So, I've been enjoying the ride!

However, that ride has hit a couple of speed bumps and I'm wondering if someone could give me some insight?

So, my dad's latest bloodwork showed a small decrease in his PSA (it's been really steady around .22) but an increase in his alkaline phosphatase level. It came back at 133 with the upper limit being 113 with my dad's lab. My dad's oncologist re-ordered the basic panel to see if it was just an outlier and also a fractionated test in the event that it was in fact elevated. The follow-up test showed that it was indeed elevated but had decreased a bit to 127 and that his bone fraction was elevated to 57 (with 52 being the upper limit of the normal range). As a side note, my dad's calcium and other levels are within normal range.

It's worth noting that my dad suffered a fall about 3 weeks ago. He was burning wood in his backyard and didn't realize that he had dropped a stick behind him and tripped over it. He went to a chiropractor because he was certain that he hadn't broken anything and was just out of alignment. My dad is still pretty sore but has just been treating with Tylenol and Ibuprofen for pain and says he's improving.

Dad is on Lupron, Xtandi, Foxamax, blood pressure medication and an antidepressant. His PSA has been staying a steady for quite a while. He was diagnosed in 2015 with a PSA of 257 and a single met to a nearby lymph node. He had scans about a year ago and it showed no evidence of disease. At that time he had 2 rounds of Provenge and started on Xtandi shortly after.

My dad's oncologist is ordering a bone scan, to look closer. But, I was wondering if anyone here could give me some insight (or better yet, peace of mind!) about the activity in his alkaline phosphatase level! I'm nervous!

[LearnAll]

Lynsi13,Total Alk Phos is not going to tell the real situation. Bone specific Alk Phos is needed to assess bone status. But lets assume that his bone ALP is also slightly increased.

This only means that bones are being repaired at a faster rate than before. When do we need repair ...? When we have bone corrosion. Bone ALP only tell us that bone repair is happening...It can not tell if this little extra repair is needed because of prostate cancer mets or by injury to bone.

My guess is that increase in ALP is most likely due to injury caused to bone because his PSA is still going down. A little increase in ALP should not be major concern. But Bone ALP keeps rising, that will certainly be a concern.

[Lynsi13 in reply to LearnAll]

Thank you for your reply! Yes, we did a bone specific and it was in fact elevated (57, when the upper limit is 52.6). However, his overall alkaline phosphatase has decreased slightly from 133 to 127. His intestine and liver alkaline phosphatase levels were within the normal limits.

[Tall_Allen]

It's not very elevated. It could just be some bone remodeling from the fall. Bone scan is a better indicator.

[Lynsi13 in reply to Tall_Allen]

Thank you. I was hoping to hear that. He's scheduled to get a bone scan. Hopefully it will clear it up. I was encouraged to see that it dropped (if only a bit) on the re-test. I would assume if we were looking at bone metastasis we'd be seeing only an upward movement (that's my assumption anyhow, haha!) Thanks for your input!

[j-o-h-n in reply to Lynsi13]

Lynsi13,

Hello again. Your Dad who is now 76 years old should have his balance checked. BTW I just viewed your original post with the photo of your Dad and his girlfriend.... they are a nice looking couple.... Regards....

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 12/02/2020 6:01 PM EST

[Lynsi13 in reply to j-o-h-n]

Thanks John! I hadn't considered having his balance checked. I'm assuming his primary care physician would do that? I will have to look into that for him. He has a bone scan on Friday, so I'm hoping that we can get some insight into if the recent fall did any damage!

And thank you! That's actually my dad's wife of 40+ years and my sweet momma! She looks like she could be his daughter and my sister! Haha! I'm hoping that I inherited her amazing genetics!

Thanks, John!

[Lynsi13]

Hidden , thank you! That's good to hear. I'm not exactly sure what you are referring to with the pathology description? I'm sorry!! I took a screenshot of the fractionated test results and posted them in the original post.. is that what you're looking for?

[SuppWife]

So glad to hear your dad has been doing so well ❤️