Blood work before radiation and elevated liver enzymes

[Footballlover]

Hi there, my husband (42) was diagnosed with prostate cancer in Feb. Gleason score 9, RP done in March. He was started on Eligard prior to surgery and is still on it (suggested for 2 years). He will starting radiation on Aug 1 for 6.5 weeks (he had one positive lymph node and multiple positive margins). His tumor was a 3ta.

PMSA PET scan in July was negative for metastasis

He had lab work done yesterday and his GGT, AST, ALT were all elevated quite a bit. His PSA is still <0.1

He does take medication for High Blood Pressure, but that is it.

I was reading the liver enzymes could be related to bone mets, but his PSA is still undetectable and PMSA PET scan was negative.

What could be the cause and should we be worried?

[Hidden]

I she taking more than just Eligard?? Any other ADT like Zytiga (Abiraterone)?

[Footballlover in reply to Hidden]

Just Eligard, was taking Abiraterone for the first 30 days and now just Eligard.

[Hidden in reply to Footballlover]

If he was still taking Abi, then that might have been the case. But you'll need to consult your MO

[tn12]

Did they check his blood ALP?

[Footballlover in reply to tn12]

Yes, slightly elevated, but not elevated as much as the other enzymes

[maley2711]

Any reason you haven't asked his Docs?

[Footballlover in reply to maley2711]

Of course we have a call into his doctor. It’s usually a 1-2 day wait. Like everything else, just seeing if anyone else has had similar experiences.

[pakb]

I believe it's the ALP that may be an indicator of bone mets. How long was he off of abiraterone before labs? That can cause elevated AST and ALT. Is there a reason he stopped taking that? Did he have scans or elevated liver numbers prior to his prostate removal surgery? My husband does take milk Thistle to support his liver in processing the meds- but check with your husband's MO to be sure it won't interfere with his meds. We run everything by my husband's team of doctors before taking. Sorry you're dealing with this!

[Footballlover in reply to pakb]

Thank you for your response. He had normal liver enzymes back in November (prior to his diagnosis). abiraterone Was only given for the first 30’days, as prescribed by his urologist. Hoping this is all just nothing.

[pakb in reply to Footballlover]

Is there a reason the abiraterone was stopped? Assuming he's seeing an oncologist now. I'm not sure if it is different in Canada (I'm in the US) but it's suggested to have an MO who specializes in PCa (medical oncologist- not just radiation or surgical oncologist) to manage total care. My husband is also Gleason 9- but had mets to bones from the start. Gleason 9 is usually treated with multiple treatments. But each case is so individual. Hope you find answers💙

[Momtonani]

Hi. From our understanding after dealing with this beast for 6 years. A PSMA scan is not a tool for initial staging. If his cancer does not express PSMA then the cancer will show up. Maybe suggest a different bone scan? Not all prostate cancer has PSA either…..

[Footballlover in reply to Momtonani]

Thank you. He had a bone scan done earlier in the spring (March) and it didn’t show any metastasis.

[Momtonani]

So, two scans no metastasis? That is great news! Did they stop Zytiga because of the liver enzymes? Seems with a gleason score of 9 and a positive node he should continue Zytiga if he can?

[Momtonani]

I know my significant other has had the same concerns from time to time with the liver enzymes. Hopefully just a blip!

[j-o-h-n]

Get your dear husband a good Medical Oncologist.....to oversee his Pca.................

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 07/28/2023 2:26 PM DST

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

Thanks. His oncologist called and they are investigating. Liver ultrasound and more labs to be done.

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

That's good to see....tell him to keep on kicking,,,,,

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 07/28/2023 5:32 PM DST

[Bret5]

The only possible clue in my blood work (other than PSA) that the PC could be moving to bones was a doubling of ALP (alkaline phosphatase) at annual physical about 3 weeks before my planned RP at end of January this year 2023. It was missed as a clue because although it went from 60 stable range over several years to 120, it was still within the “normal” range (under 130). An MRI only a few weeks prior to that showed “no evidence of cancer outside the prostate”. All liver functions for me have been and continue to be normal even during triple therapy.

3 months after RP PSA had gone to 156 and ALP was 700! Scans showed numerous bone Mets. As of yesterday at #3 Docetaxel chemo infusion, PSA down to 1.2 and ALP down to 180. Note that elevated ALP can be caused by bone OR liver issues, based on my understanding.

[Nfler]

Hopefully it’s just the remnants of the Abi. The ALP is the one you want to keep a close eye on relating to bone Mets and glad to see it’s the least elevated n hopefully keep kicking. Football 🏈 might b over but he can still enjoy watching it…😁