Bone Mineral Density and ALP

Before PCA, ALP was mid 60s. It rose to mid 70s after starting ADT in July 2019.

Then in Jan 2021. ALP increased to 95.

Now, 3 months being off ADT (last 3mo Eligard injection was July 2021) ALP increased to 103. I KNOW THESE NUMBERS ARE STILL CONSIDERED NORMAL. However, could this slightly and continuos increase in ALP be associated with BMD? DEXA scan in August 2020 showed normal BMD.

PSA since Jan 2020 is < 0.1. Lastest. Jan 21, 2022 was <0.04 so I'm not thinking bone METS.

Curious what others think or have experience similar results.

[Shooter1]

My ALP started to rise in Oct 2020 followed by PSA rising Jan-June 2021. Scans clear. PSADT up to 12 days. Na-f18 scan picked up 2 new bone mets in June 2021. Zapped them in July and PSA and ALP started to drop... Provenge in Aug 2021. PSA continued to drop and leveled out in Dec 2021 at 0.24. ALP back down to 70. Your #s look lots better. My ALP just a pre-problem indicator. Life Is Good, especially with #s like yours.

[Hidden in reply to Shooter1]

Your profile states your bone scan showed no new mets but that was after your surgery. Did you have a bone scan before your surgery? Did that show any mets?

[Shooter1 in reply to Hidden]

Bone scans before surgery were read as clean. However, when MO looked at them with me on a slice by slice, side by side comparison, there was one small dot met/ It progressed to a large comma shape quarter sized met in 2 1/2 months when we started chemo. Scans before surgery showed only prostate, extracapsular extension and 2 lymph nodes enlarged. Surgeon said he could get it all. Boy was he wrong. Pathology came back a disaster..

[tango65]

The ALP usually measured in the Metabolic Panel is not specific for he bone. There could be changes in the ALP coming from other organs, mainly the liver. You could request a bone ALP test which measure the ALP related to bone metabolism..

mayocliniclabs.com/test-cat...

[Hidden]

Assuming the bALP was elevated...could that be associated with BMD..as in losing BMD?

[tango65]

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

[Tall_Allen]

You can get a separate bone ALP. It's not linked to BMD but can indicate bone metastases.

[j-o-h-n]

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[Dett]

I would have replied earlier, but I just saw your post. My husband’s experience - diagnosed 8/19 GL 9 PSA mid 70s, 4 bone Mets, 68 YO. Eligard followed by radiation, then Zytiga. Current PSA is .008. ALP went from around 70 to around 133 during treatment, which greatly concerned me, although the numbers aren’t all that high. But he has hyperparathyroidism (benign tumor on parathyroid gland), which is known to elevate ALP, so I tried to relax.

Husband was recently diagnosed with osteoporosis and began taking Prolia. Three months later his ALP dropped back down to about 70. The MO believes that it was the bone strengthening effects of the Prolia that caused the big decrease. So yes, anecdotally, it would seem that there can be a correlation between increasing ALP and decreased BMD, and vice versa. Hope that helps.

[Hidden in reply to Dett]

Thanks for your reply. I did a little research and I came away that BMD loss can raise ALP. There are studies confirming this. I'm due for a dexa scan in August so I'll know for sure if the ADT is the culprit.

[timotur]

My ALP followed a very similar trajectory on ADT after radiation. Beginning ALP was about 75, then steadily, like clockwork, rose about 7 points per month all the way up to about 120 as I reached 18 months on Lupron. Then it fell back to around 75 a few months after stopping ADT. PSA was <0.02 during that time.