PSA going down, but ALP increasing

[rsgdmd]

I'm 3 weeks into a clinical trial for ARV-766, an AR degrader. At 2 weeks, my PSA had dropped from 133 to 66! Bone pain is much less. All my liver numbers are fine, but alkaline phosphatase has gone from 199 when I started to 429 at two weeks and 519 at three weeks. Doc thinks may just be a surge, but this is a pretty big surge. Any thoughts?

[swwags]

ALP is associated with bone disorders and liver damage. Seems possible that the trial is giving you fits and not something organic. 199 is high too though. what kind of tests did you have done to drill down on 199 before you entered the trial? Normal ALP is 36-125. Do you have a link to the trial?

[God_Loves_Me]

Rising ALP and declining PSA - Liver stressed.

[God_Loves_Me]

In my opinion, Call immediately to medical triage line of clinical trial center and let them know about your concerns. It is good medicine and they will figure out for liver stress.

[rsgdmd]

So, all my other liver numbers are largely unchanged. Bilirubin and albumin are normal. ALT and AST are both a little low, but have been for a few months. Here's link to the trial: clinicaltrials.gov/study/NC...

[Justfor_]

It can be debris from bone metastases. You can check this (optimistic) hypothesis by having a bone ALP count to compare against total ALP.

[rsgdmd in reply to Justfor_]

Good idea. Having that done tomorrow.

[jeetu_g27]

ncbi.nlm.nih.gov/pmc/articl... link to a case study where a patient ALP gone to 3000 while PSA being decline . Though all cases are different, hope it may help a bit

[Grandpa4]

thinking liver toxicity. Seems awfully fast for bone Mets. Especially when your pain is better.

[rsgdmd]

So, My ALP is still very high, but Dr did additional tests, which all showed no issues with the liver. Had Gamma Glutamyl Transpeptidase, which was normal. Had ALKALINE PHOSPHATASE ISOENZYMES, which showed ALP of 542, but bone isoenzyme a little high, liver isoenzyme is normal. Increase in ALP is known side effect of ARV-766; so is elevated ALT, AST - mine are normal.

[Justfor_ in reply to rsgdmd]

Milk thistle lowered my ALT and AST to a nadir of the latest 20-30 years that I keep records on. Noticing this it became my #1 supplement.