Perplexed

[wolverine11]

Just received PSA results yesterday 0.59 that's great. 21days earlier was PSA 1.23. However, all is not so great.. I'm baffled, 21days ago ALP was 171. why did it INCREASE ALP 205. An increase of 34 points??? while PSA went down....Anybody have any ideas why this happened? Thanks

[noahware]

I wouldn't worry too much until a definitive trend has been established. (And even then, I wouldn't worry TOO much.) You may be experiencing an "ALP bounce."

I recently started Zytiga and had a dramatic PSA decline, but was alarmed to see my very high ALP go even higher. I little research revealed that it is normal for ALP to rise early on, and in fact it is a GOOD sign when you get a little spike in ALP before it comes back down, when first starting Zytiga.

Now the fact that you are already well into your Zytiga treatment makes it a little strange. Did you change anything (like switch from pred to dex)? Could it be stopping the meds for that brief time, then restarting, is giving you a "starting over" effect that nicely dropped PSA while bouncing ALP? Not sure, but I think your doc will also say just keep an eye on the next few results. But bottom line is, a one-time rise in ALP is not always bad news that indicates progression or treatment failure... sometimes can mean the opposite!

[wolverine11 in reply to noahware]

Thank you for your response, I feel more at ease now. Yes alot has gone on. Started zytiga about 4 months ago with 5 mg prednisone & monthly Lupron. Latter part of Sept. all of a sudden I had bradycardia. resting heartbeat dropped to 38 quickly. Day before it was 67 monitor my BP often. Googled, could be meds. So I stopped zytiga etc. for 5 days. Had no stamina and almost passed out several times. Went to ER pacemaker was inplanted. Doc said okay to start meds. Was taking 1 zytiga pill with food. Bloodwork showed for the 1st time PSA went up. AHHH. Saw here person taking 1000 mg with water before bedtime. I adapted this. My PSA went from 1.23 to 0.59 in 21 days. and ALP went up to 205. Thanks again noahware your info. puts me more at ease

[LearnAll in reply to noahware]

ALP bounce is a real phenomenon. When ADT was started, My ALP skyrocketed from 199 to 430 ..only to fall in next few months to 46. Thru out all these months, PSA kept falling to finally reach 0.19 at 12 months.

[wolverine11 in reply to LearnAll]

WOW, You just might have saved me from a heart attack. Meaning these blooodworks are so stressful real cliff hangers. Your info. about ALP with such large swings puts things in perspective for me. Learnall are you considered high volume metastatic stage 4, I am. Thank you all for your help

[LearnAll in reply to wolverine11]

yes...only bone mets..many in the beginning. Now, just one 2mm in size on pubic bone (seen with Ga68 PSMA-PET)Let me tell you the mechanism of "ALP Bounce".....Bone ALP is an enzyme needed to repair damaged bones..So when repair is going fast and full speed, a lot of bone ALP

is required..it indicates that healing of bone damage is happening at high pace.

Once most of the bone healing has occurred, ALP starts falling and reaches normal range....because now, with healed bones, not much ALP (bone) is needed.

ALP bounce does not happen in all men but it is a good sign if it happens. It indicates longer survival.

If your AST, ALT and bilirubin are in normal range...then, your liver is good and extra ALP is not coming from Liver....It is coming from bone healing.

[wolverine11 in reply to LearnAll]

That's the best clear and concise understanding for a lay person like me...got it. Then I appear to be on a good path....10 months in PSA 0.59..Thank you

[LearnAll in reply to wolverine11]

Your PSA might go further down and reach 0.2..that will be a very good news.. Generally...Length of survival depend on two readings...How low PSA falls( Nadir PSA) and how long it takes to reach the lowest point ( Time to Nadir or TTN)

If some one's PSA falls to 0.2 or lower and takes 11 to 12 months to fall...most likely survival can be expected from 6 to 10 years (in some cases even longer)

I can explain why this happens but then the post will become too long...so later.

[wolverine11 in reply to LearnAll]

Actually, I saw an article on PUB Med some time ago that echoes what you have stated, which seems counter intuitive, Meaning faster the better to reach nadir. Apparently, not so. There is some conflicting info. Dr. Mark Scholz of Marina del rey ca. Claims reaching nadir of PSA 0.05 within 6 months is a good sign for long OS Can be a bit confusing.....Thanks LearnAll.

[LearnAll in reply to wolverine11]

Dr Sholtz was talking about men whose prostate was surgically removed. Not the ones who have prostate intact.

[wolverine11 in reply to LearnAll]

Thanks

[Tall_Allen]

ALP has two sources - bone and liver. Liver reaction to drugs can increase liver ALP. If you want to track bone ALP, there is a bone-specific test for it.

[wolverine11 in reply to Tall_Allen]

Thanks Tall Allen ...scheduled to see my oncologist Dec. 3rd will ask about this specific test.

[tango65]

i would ask to repeat the studies along with bone specific ALP and liver enzymes since Zytiga may affect the liver.

accessdata.fda.gov/drugsatf...

[wolverine11 in reply to tango65]

Thanks tango65 will request from oncologist

[tango65 in reply to wolverine11]

Best of luck!!

[wolverine11 in reply to tango65]

Thank you....Like most of you, this has been life changing. So much yet to learn. This site has been great.

[Hidden]

My ALP increased by 30 some points after starting ADT + Zytiga....from (66-68) to (96-97). Its still well within the normal range but I was perplexed. Seems to be a result of ADT treatments?

[wolverine11 in reply to Hidden]

Thank you TomTom1111 for sharing along with others who have experienced this ALP bounce.

[wolverine11]

thanks for the info Nalakrats. Fortunately, so far I have no symptoms of heart disease, diagnosed with between stage 1 and 2. Not taking any BP meds weight training and fast walking are my go to Thanks

[wolverine11]

Thank you for the advice... I do tend to get a little worked up always looking at worst case scenario which has its advantages but also disadvantages.

[j-o-h-n]

Hello wolverineleven

Please tell us your bio. Age? Location? When diagnosed? Treatment(s)? Treatment center(s)? Scores Psa/Gleason? Medications? Doctor's name(s)?

All info is voluntary, but it helps us help you and helps us too. When you respond, copy and paste it in your home page for your use and for other members’ reference.

THANK YOU AND KEEP POSTING!!!

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 11/13/2021 1:04 PM EST

[wolverine11 in reply to j-o-h-n]

I have tried twice to enter info. I do not know if it works. But here I will be 78 this Nov. Diagnosed at Little co of Mary in Torrance ca. Dec 2020 PSA was 860 CT scan showed nodule invasion of Bladder. Bone Scan, to many mets to count. Only symptoms I had was frequent voiding at night, when edema showed up in my feet & legs Catheter was inserted at hospital. Started on casodex added lupron days later. Switched to zytiga at 6 month mark. I'm a Gleason 8. Seeing med. Oncologist & urologist. As of Now, n o longer wearing Catheter voiding good on Proscar 5mg & flomax 0.4 Latest No. PSA 0.59 ALP 205.

[wolverine11 in reply to j-o-h-n]

John I just looked at your profile. What is your medical history? I ask, because there is nothing in your profile????

[monte1111 in reply to wolverine11]

LOL

[Hidden in reply to monte1111]

That is funny!...

[wolverine11 in reply to Hidden]

I'm the new kid on the block, did I just get played? Anyway, do not mind sharing my medical info.

[Hidden in reply to wolverine11]

Yes you did get played.

[Hidden in reply to wolverine11]

Not played...it's j-o-h-n's MO.Monte1111 and I know j-o-h-n well so we just laughed when you asked about his history.

[monte1111 in reply to Hidden]

I believe j-o-h-n's history includes The New York College of Clowns.

[j-o-h-n in reply to wolverine11]

Refer to my private post.........

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 11/13/2021 7:47 PM EST

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

He'll never be the same....

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

me too..........

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 11/13/2021 8:09 PM EST

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

He'll end up like Monte...living with cats..

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

HAHAHAHAHAHAHAHA......

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 11/13/2021 8:23 PM EST