Does ALP indicate bone mets?

[Purple-Bike]

Does anybody have an idea whether my 141 total ALP on December 18, six weeks after starting monthly injections of Firmagon, indicates bone mets (an "ALP flare")? All other ALP:s are in the high side of the reference range, between 85 and 109, as can be seen in the table below. If say 40 % of this is from the bones, it would been mean a bone-ALP of around 35 - 40.

A PSMA on November 3 showed spread of prostate cancer to lymph nodes. In addition, there were four suspected PC spots in my bones, with a "50 % risk" of being cancer. I will get this confirmed or not at the end of April with a new PSMA, but obviously I would like to get an idea now if somebody can contribute.

I managed to get a doc to order a bone-specific ALP, but when my blood sample was taken on February 25, the lab doc frustratingly decided not to test it with the remark "Fully normal total S-ALP so isoenzymes are not carried out since it is very improbable to find a clinically significant deviation in the isoenzym pattern". The given reference range was 42 - 115 so I assume that it was indeed total and not bone-specific ALP that was measured, although the "S" in "S-ALP" confused me.

[LearnAll]

Not necessarily. Because it is Serum ALP (S-ALP) and that is why it is Total ALP. Total ALP includes ALP coming out of Bones, Liver and Intestine. With this number, it is not possible to say that whether there are bone mets or not. You will have to get Bone ALP to figure out the portion which is coming out of bones. The approximate 40% guesswork formula is not accurate because bone portion can vary from 15% to 40% in different individuals.

[Purple-Bike in reply to LearnAll]

If I manage to get a Bone ALP and it is significantly higher than 30 - 40 % of total ALP, this should indicate probability of bone mets, am I correct? I am slim, BMI 20, height 5´11´´ so I would guess my percentage, if there are no bone mets, should be in the lower part of the 15- 40 % range. I have no liver issues.

[LearnAll in reply to Purple-Bike]

There is no exact cut off point for BALP. Lower the number below 40% , more likely it is..that there are no bone mets. Also, once there are bone mets..does not mean they will remain alive. Bone mets are basically a bunch of cancer cells which corrode the bone and body tries to repair these damaged areas....In this process..an enzyme called..ALP (alkaline phosphatase) is released...which is roughly a measure of how much repairing of bones is going on. So it is an indirect measure of bone mets.With treatment,,cancer cells get killed and they can no more damage the bone and that means no more need for repair. This causes drop in level of BALP.

If treatment is working, bone mets will disappear.. sometimes very fast as Dead Cancer cells CAN NOT cause damage and that leads to fall in BALP.

[noahware]

I guess another way to phrase the question would be, what else is a possible cause of the apparent ALP flare? ALP can rise due to liver, kidney, bile duct or other inflammatory issues or even reactions to meds, supplements, etc.

The fact, though, that it rose about a month after beginning treatment, and then fell, is consistent with the observed flare phenomenon in some metastatic patients. It doesn't mean you have mets, but would be consistent with having them.

I would have to agree with the doc that at this point, after the flare has subsided, both your ALP and your BSAP numbers are not going to tell you much about suspected mets, because either 1) you don't have mets, or 2) the ADT is now doing its job and suppressing metastatic osteo-activity.

It's probably too late now to know for sure if your S-ALP dropped because BSAP dropped, but the good news is... the ALP has dropped!

[lewicki]

What is ALP?

[maley2711 in reply to lewicki]

people want to know!!!

[Purple-Bike in reply to maley2711]

My apologies to you too for having missed answering. Please see my response to maley2711

[Hotrod65 in reply to lewicki]

Alkaline Phosphatase.

[lewicki in reply to Hotrod65]

Thanks

[Purple-Bike in reply to lewicki]

Hi Lewicki,

My apologies for somehow having missed answering you. As Hotrod65 already wrote, ALP is Alkaline Phosphatase. As LearnAll wrote, (Total) ALP is released when bone repair is going on and a high value is an indication of something going on which might be repair made in response to bone breakdown from bone metastasis. However, ALP is also released because of liver and intestine repairs so it is a rough measure and you have to estimate the percentage that might accrue to the bones which can vary widely between individuals. But significant increases in total ALP are interesting; as noahware wrote, the increase to 141 may be an indication of metastasis.

A better measure than total ALP is bone-specific ALP which only measures repairs made to bones. From Tall Allen I received the following articles showing the merits of bone specific ALP for detecting metastasis.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...

[lewicki in reply to Purple-Bike]

Thanks for your response. I did a bone scan results were a -4. With the years of ADT plus failed trial ESK 981, chemo and LU-177 and AC-225 this is where I am. Now five months no ADT I wonder if my bones will get stronger as I fear fractures.

[Purple-Bike in reply to lewicki]

How can your bone scan show a minus 4 - what is your unit of measurement?

[Tall_Allen]

There is bone-specific ALP and liver ALP. Total ALP combines them.

[Purple-Bike]

How can your bone scan show a minus 4 - what is the unit of measurement?

[lewicki in reply to Purple-Bike]

I think the scan was for bone density and not for mets. Sorry if I confused this. After years of ADT I guess the ADT drains out you bones calcium. This is what the test was for.