Study on bone ALP as a marker for bone metastasis in PC?

[Purple-Bike]

Can anybody point to a study showing Bone alakaline phosphatase to be a marker of bone metastasis in prostate cancer? It would be helpful to have it to get my primary care doc to write me a prescription for such a test since that is needed here. I find studies indicating ALP (not bone-specific) being somewhat of a marker, and I found one study on Bone ALP as a marker in the case of gastric cancer, but it would be stronger to have a study relating Bone ALP to prostate cancer.

BMC Cancer. 2016; 16: 385.

Published online 2016 Jul 4. doi: 10.1186/s12885-016-2415-x

PMCID: PMC4932725

PMID: 27377907

Bone alkaline phosphatase as a surrogate marker of bone metastasis in gastric cancer patients

Sun Min Lim, Youn Nam Kim, Ki Hyun Park, Beodeul Kang, Hong Jae Chon, Chan Kim, Joo Hoon Kim, and Sun Young Rhacorresponding author

[Tall_Allen]

Why your primary care doctor? Why isn't your medical oncologist monitoring this? This has been standard practice for about 30 years. Here's a few:

onlinelibrary.wiley.com/doi...

pubmed.ncbi.nlm.nih.gov/863...

ncbi.nlm.nih.gov/pmc/articl...

journals.lww.com/nuclearmed...

link.springer.com/article/1...

[Purple-Bike in reply to Tall_Allen]

Thank you, Tall Allen. With those links I got a prescription for a Bone-ALP test. Will shortly pose a question about the results.

[LearnAll]

futuremedicine.com/doi/pdf/...

There are many other articles which indicate the assessment value and prognostic value of bALP.

BALP is the accurate measure of Osteoblastic activity at any given point of time.

The real reason insurance companies do not easily allow this test is that bALP costs 3 times as much as total ALP.

Explain to your PCP that the bone ALP portion is that part of Total ALP which reflects only bone issue whereas Total ALP includes bone, liver and intestine fractions...and therefore..is not accurate.

[Garbonzeaux in reply to LearnAll]

But since bALP is a subset of ALP, shouldn't it be sufficient to have total ALP sufficiently low?

[LearnAll in reply to Garbonzeaux]

Yes, Approximately....IF your liver is perfectly normal. In healthy person with normal liver and intestine, the bone portion is about 30 to 40 % of total ALP.So Total ALP being a cheaper test, Insurances are fine with this....and doctors will GUESS based on 40% value of total ALP.

For example, based on my past bALP readings, I know that my bone fraction is about 20% . So sometimes I do total ALP and calculate 20% and consider it bALP. Last week, my total ALP was 44 so 20% (in my case) comes 8.8... And that becomes my approximate bALP.

Taller men with bigger and heavier bones, bALP tends to be higher than men like me who are 5'6" tall and have less overall skeletal area. So make that provision too when assessing.

[45yrsDenmark in reply to LearnAll]

What range is a "normal" bALP? Is lower or higher worse? And what is it that actually happen when you have bone mets since it affects (bone) ALP?

[LearnAll in reply to 45yrsDenmark]

Bone ALP: Up to 20 mcgm/L is usually considered normal. When you have growing bone mets, your bones are churning out more and more Alkaline phosphatase....this indicates that bone is getting corroded and it is trying to repair itself.When normal degree of repair is happening, Bone ALP remains below 20 mcgm/L.

If bALP is very high ,say 84 mcgm/L , it means there are growing bone mets releasing a lot of bALP.

[45yrsDenmark in reply to LearnAll]

Thanks

[Purple-Bike in reply to LearnAll]

Finally I managed to get a bone-ALP. It came to 19 micrograms per liter, just below the 20 mark. My total ALP came to 102 IU/L. I cannot find any conversion table to figure out the percentage of bone ALP. Do you have any idea?

[LearnAll in reply to Purple-Bike]

Bone ALP of 19 mcg/L indicates that the bone corrosion and consequent repair is going on at normal speed. Meaning bone repair is going on just like the person who does not have osteoblastic (sclerotic) lesions due to prostate cancer.Its a good news .Bone mets are dead at least for now. Needs monitoring of ALP /BALP to keep track if any thing changes in future.

[StayingOptimistic in reply to LearnAll]

Hi ,My ALP today is : 76

Last 3 readings 3 months apart are:

74,67,76(today).

Should I be concerned about this and ask MO to look into it more please?

[StayingOptimistic]

Hi Nal,Mine came today as ALP(76), should I be concerned and ask MO to look more into this please!

[StayingOptimistic]

Thank you, sir.