Cause of steady increase in Alt (liver) score

[RunningViv]

Hello, looking for advice regarding cause of steady increase in Alt (liver) score please. My husband is on ADT 3 monthly (10.8mg) Zoladex and due to have 6th and final Doxetaxal infusion next Thursday but his Alt score is now 114. He also takes Prednisolone and Omeprazole and he’s on a clinical trial too so is taking Metformin. He’s not drinking alcohol or taking any supplements and he’s eating a well balanced diet.  I’d appreciate any thoughts/ideas - thank you!

[tango65]

Docetaxel could cause elevation of liver enzymes.

accessdata.fda.gov/drugsatf...

[Tall_Allen]

What does his oncologist say about it?

[RunningViv in reply to Tall_Allen]

We’ve spoken to 2 different oncologists and both said his meds shouldn’t affect Alt score but I wondered if anyone disagreed/thought meds might!

[Tall_Allen in reply to RunningViv]

I was wondering if he wants to delay his next chemo to allow his liver some time to heal

[RunningViv in reply to Tall_Allen]

Could progressing cause permanent damage or make the treatment less effective?

[Tall_Allen in reply to RunningViv]

It's an effect, not a cause.

[RunningViv in reply to Tall_Allen]

My husband’s oncologist has decided to cancel his final chemo infusion because his ALT score has risen again - now at 124. Oncologist doesn’t think the benefit of the 6th infusion is worth the potential damage it might cause to his liver. She’s sending him for liver ultrasound to check everything is ok. His primary cancer treatment has always been ADT, brachy and RT, the chemo was the “icing on the cake” as it were. Thought you might be interested. Thanks for responding.

[Tall_Allen in reply to RunningViv]

Good decision, IMO! Docetaxel only adds marginally to results in high risk localized patients.

prostatecancer.news/2016/08...

[SeosamhM in reply to RunningViv]

Believe me, I love oncologists, since they've kept me alive. But I've found that, unless I ask very specific questions, they (perhaps understandably) lump me in with the statistical norm of treatment reactions and easily dismiss my concerns. I've used the following academic paper a couple of times to form some questions to box my providers in a bit more - including my primary care provider (since we can't simply conclude that abnormal blood work is simply the outcome of cancer treatments). There is a lot of technical jargon, but it may be of help to you since you appear to be well-informed in the first instance! Good luck! - Joe M .

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

[kenner6398]

Metformin is hard on the liver from what I have discerned from some friends that are on it for Diabetes.

[OzzieJ]

On my third cycle of Docetaxel my ALT was 80 and AST 130 and they delayed the next one by a week. Probably doesn't apply here but I put it down to a particularly heavy gym work out the day before my bloods were taken and haven't had a problem since. I wouldn't worry if they have to delay the final treatment to allow ALT to come down.

[Ingress]

I didn’t have any problems with ALT, AST, of GGT during chemo. But now 13 months later my GGT has jumped but the other two are still fine.

[Cackalacky_cyclist]

I have had an elevated ALT since august, with all other liver numbers in the normal range. Last checked this past January it is still elevated slightly above normal. The only thing that had happened between May (last time ALT showed normal) and august that might have caused this was catching Covid at the end of July, since I didn’t start my 6 month ADT until October.

Another possible cause is my statin which I’ve been taking for decades. My primary is thinking of changing it just to see if it’s the cause.

I know we correlate much of our issues that happen in our bodies to PCa and its treatments, but that may not be the cause. The cause in your case may be similar to mine, which remains unknown for now

[LakeT]

An oncology nurse recommended Lypo-Spheric Glutathione to help ‘protect’ the liver. MO didn’t want me to use supplements during treatment so I waited until after chemo before using. ALT is down to 36 from a peak of 133 during chemo which finished 6 months ago.

[MikeMartin]

if inflammation of liver did you test for virus?

[RunningViv in reply to MikeMartin]

no they haven’t but we’re pretty certain it must be the Doxetaxal