AST / ALT ratio

[MyDad76]

Hi everyone,

may I ask what is your AST / ALT ratio?

I'm panicking right now - my dad has slightly elevated ALP - 2,03 µkat/L (normal range till 1,93 µkat/L).

2,03 µkat/L = 120 IU/L

His AST/ALT ratio, which used to be 1 is now exactly 2 (AST: 0,44 µkat/L and ALT: 0,22 µkat/L).

This makes me worried, as I read that "liver diseases in which AST is higher than ALT include alcohol-induced liver damage, cirrhosis, and liver tumors." My dad does not drink at all. emedicine.medscape.com/arti...

His MO did not comment on results, we have referral for FDG and PSMA scan, but waiting times in our country are long (do not have the date for scan yet).

[Mw921000000]

hi! Im so sorry you’re dealing with this and I know you are probably putting yourself through a spiral at the moment which I do way too often and I come on here to hopefully find the answers I want to hear. Nothing will give you a definite answer about this situation other than an in-depth scan (such as PET), but I will give you my dad’s numbers if you want to use them for comparative reasons!

His current ALT/AST ratio is 0.8. He has an acute fatty liver which was detected on an abdominal ultrasound several months ago. These numbers increased about a year ago while he was on Zytiga because of inflammation, since he’s come off these values have remained stable.

As far as PSA goes, any time it increases I look at his ALK (alkaline phosphatase) and LD (lactate dehydrogenase). He has bone Mets. Recently a few new bone mets were found on a scan, and I noticed both of these numbers increased slightly. I know you said in a previous post he had an elevated ALK but no known Mets, but what about his LD value? The LD can be helpful to detect increasing or decreasing tumor burden/inflammation/tissue damage.

[cesanon in reply to Mw921000000]

ALK is associated with bone metastasis.

There are two types of all assays that the labs always mix up.

The "bone specific" is the one you are interested in. But it is the least common and I think they share the same IDC Number or something or other.

[MyDad76 in reply to Mw921000000]

Thank you for sharing. Yes, I’m in a spiral at the moment, trying to calm down.

[Mw921000000 in reply to MyDad76]

How long do you have to wait for a scan?

[Gym-rat]

My AST and ALT levels were both highly elevated recently. I am on Lupron & Zytiga. A known possible side effect of Zytiga is liver damage/fatty liver. My MO took me off the drug for a few months until the AST & ALT levels went down, then started me back on a lower dose. If it goes back up again my MO will switch the Zytiga with another drug

I read that it is not known if Xtandi causes liver damage/fatty liver, but you could certainly ask your MO about that.

Alcohol disease (fatty liver) has the same elevations in AST & ALT.

FYI, I do not consume alcohol and have not for many decades.

[Mw921000000 in reply to Gym-rat]

My dad had the same exact issue with Zytiga. We switched right away to xtandi but it didn’t work for long. His oncologist is putting him back on Zytiga at a lower dose or with a different steroid. Praying it doesn’t affect his liver again 🙏🏻 I’m hoping the same for you. Please keep us updated!!!

[Justfor_]

My statistics for the past 5 years, N=15 tests altogether. Only 2 less than unity, the remainder above unity. Average value 1.28. CT has detected that my liver has a small part at the outskirts cirotic (right term?), doc said nothing to worry about. Not an alcohol drinker. There is a 3 years old outlier result of 3.27 (AST=36, ALT=11), probably a lab error. Most recent value 1.06 (19/18). Hope it helps you.

[NecessarilySo]

I guess a spiral is like a tizzy. Anyway, to try to get you off a spiral, I suggest that you wait for another test before worrying too much. One test can be slightly high, and it can be normal in the next. 0 to .40 is normal range, so he is slightly elevated AST, at .44. Mine, by comparison, is .17.

My AST/ALT ratio is 1.1

[MyDad76]

I wanted to update this post. Today we got results of FDG PET CT. Besides already known wide spread lymph node mets, my dad now also has a couple of bone mets (that SPET/CT for bones in May failed to show). There is no mentioning of anything wrong with livers, for which I'm really grateful!