Can high ALP indicate therapy before bone mets are confirmed?

[Purple-Bike]

Diagnosed two months ago with GS9, low PSA 1.7 intraductal cancer, I have already got invaluable advice from this forum.

I have suspected mets in my bones, to be confirmed or not at my next PSMA / NaF in April. . So I tested my ALP which came to 141 now, up from 85 when I started ADT and brachy boost therapy.six weeks ago., I understand this is an “ALP flare”, from interaction between ADT and bone mets.

Does anyone know if this can be considered a strong indication that I indeed have metastasis in bones? Mets in lymph nodes are already confirmed.

I am on Firmagon/degarelix + Bicalutamid now. Any thoughts on whether additional treatment is warranted now, to be proactive, even though the mets are not 100 % confirmed? I understand bone mets should be hit heavy and early, but is it wrong to do so before they are fully confirmed? My doc is not very approachable and I want to be as informed as possible before reaching out to him.

I have no side effects so far from ADT.

[Tall_Allen]

There are two sources of ALP- liver and bones. You can get a separate bone ALP blood test. You are already treating metastases everywhere with ADT.

[timotur]

Don't be concerned with ALP at this point, just wait until your PSMA scan to determine bone met status. It's more likely a change due to your treatment than metastasis. ALP is a better marker after bone mets are confirmed in later stages. My ALP was all over the place during/after HDR-Brachy and IMRT, falling to as low as 44 after radiation, from a baseline of 75 pre-tx, then as high as 119 over the course of the next 12 months on ADT. Now, three months after finishing 18 months ADT, it has fallen to 104.

[Purple-Bike in reply to timotur]

Thanks Timotur. I think I get it. Therapy like ADT somehow affects bone and ALP even in the absence of bone metastasis, so it's no use taking ALP tests until all therapy is finished, is that right? I suspect I will have to wait a long time for that, with a likely long-duration ADT or other hormone therapy.

[timotur in reply to Purple-Bike]

Yes, PB-- Just my lay opinion, but I think ADT stresses the system by causing osteopenia, so the body responds by increasing the normal deposition/apposition cycle, which is reflected in an increased ALP. My Uro kept telling me not to worry about increasing ALP near the end of my ADT, so much that he stopped testing it near the end of 18-mo ADT, and indeed he was right, as it has fallen 30 pts since stopping ADT three months ago. All three doctors, Uro , RO, and MO said with very low PSA and negative PSMA for bone mets, ALP changes within normal limits is not important while on ADT. You could check bone-specific ALP on your own by ordering the test through Ultalabs online, and drawing at a local lab like Quest, I believe would only be about $40-50. I didn't do this but would have if my ALP continued to increase.

[j-o-h-n]

me <----- purple cane, walker, ambulance.........

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 12/22/2020 7:24 PM EST