Two years in to my de novo high volume metastatic prostate cancer diagnosis, I am pleased to report excellent results so far with triplet therapy (Docetaxel chemo completed, Abiraterone ARPI, Firmagon/Degarelix GnRH antagonist as ADT).
However I would be grateful for any advice today. My ALT has fallen from about 35 steadily down to about 22 now. I've been struggling to exercise. All my other markers are pretty good in my PSA is sort of undetectable.
But I see that a low ALT maybe evidence of declining muscle mass and pointing in the direction of sarcopenia. Of course sarcopenia is predictive of progression and reduced LE.
If I push myself to exercise again, and maybe even build a little more muscle mass, is it possible that the ALT marker will rise?
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JohnInTheMiddle
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John all I feel even remotely qualified to comment on is your actual exercise modality. Its effect on your blood is truly beyond my knowledge. I will leave that to a real expert.
In regards to exercise there are three things that you need to consider - Form, Intensity and Duration. These are really best addressed by getting instruction and guidance from someone trained in the field.
After your initial training and plan development then perhaps a 3 month follow up is appropriate to make sure you are on track in regards to those three above.
For what its worth my ALT is 12. So not sure what to read into that. My white and red cell counts are also on the low border of normal or just outside.
Everyone says to exercise but whenever I try to get into a fitness regime I end up completely fatigued and it is difficult to get through the normal week of work and family stuff which takes priority.
Ive been on ADT and Apalutamide for the last 20 mths.
Fantastic comment Ozzie; it really resonates. I do take methylphenidate pills a couple of times a day (Ritalin). And I have a pretty good exercise plan (per Mgtd above, good advice). This is important because it's hard to figure out how to exercise!
For example, the importance of Zone 2 (just walking briskly); whether one should have high intensity intervals; how to do resistance exercise otherwise known as weights when three of my vertebrae could fracture at any moment; the question of weekly exercise volume (there is evidence that volume counts and I was targeting 10 hours a week). The balance between aerobic, resistance and even isometric exercise. Apparently any exercise is good exercise.
And as we know the myokines which are generated especially by resistance exercise are also anti-cancer adjuncts. But then again I'm tired. I find that the support for the importance of exercise for people with metastatic prostate cancer is not really there in the depth that is needed.
My RBC's are little low and I'm slightly anemic. From what I read apparently my slight anemia is probably not because I'm not getting enough iron - and thus supplements are of no help and could even be dangerous of course. My anemia is probably driven by a prostate cancer specific process.
About every 6 weeks or so I get a blood panel with 20 different things. And there isn't a lot of interpretation as to the implications.
Our goal of course is to avoid progression, resistance, and sarcopenia! And in terms of things that we can do, exercise number one!
My next plan is I'm going to try to make an effort of the will to exercise!
My palliative care doc prescribed it. It's a long story, I wasn't expected to be thriving. But GP's can probably prescribe. If you look there's quite a bit of literature (see methylphenidate too). Watch your BP.
In my personal experience I worked out doing HIIT and lifting heavy. I actually lost muscle until I got my nutrition right and started taking body building supplements. In the following 2 years I added lots of muscle lifting heavy 4 days a week and cardio two days a week. It can be done. Good luck in your journey
MO approved of all supplements taken, my trainer has gone to appts with me to ask about them too. I take creatine, BCCA's and a non FDA approved substance called Ostarine which is a SARM. MO knew exactly what it was and how it worked as it was an early PC drug. Introduction of the Ostarine really turned things around for muscle growth
There are of course a number of possible reasons for your low ALT, but if you’re concerned about sarcopenia have you had a dexa scan lately? The detail of body composition it provides what you need to know about that. Then you can exercise towards the predictable goal of increasing your lean muscle mass while lowering body fat-but armed with the numbers to mark your progress. Good times!
As one of my favorite guys Dr Mark Moyad says, ‘if you don’t measure it, it doesn’t exist!’
Despite your vulnerable vertebrae, you should still be able to lift weights with parts of your body safely. Get specific guidance if necessary. Nothing is more important.
Thanks London - this is good advice. I saw a reference once in a paper on the topic of prostate cancer and metastasis to bones - and to the fact that biomechanical engineering analysis, which while it is an actual thing, is basically not available. This is a missing and important service that can make a big difference. Why? Because then you have specific details on how to exercise safely. And in fact bone breakage is an important event in the decline of many men metastatic prostate cancer.
Super thanks for sharing this comprehensive article London! I actually have participated in a study that encouraged exercise. And as the article mentions the field is growing rapidly. My sense is though that the value of exercise and guidelines on how to do it is still mostly missing in action. Exercise for men with metastatic prostate cancer is enormously important! Both for quality of life and strength and avoidance of injury - and also even directly working against progression. I'm still fatigued.
You’re a smart man, moreover your comments on here are always supportive and detailed. Put the weights up front! All the exercise is good, but for ADT fatigue lifting is superior. Just go. 90% of it truly is just showing up.
Good question Sim - in my case it seems that I'm now on the borderline of concern in terms of the graph that the hospital gives me - but the big concern is the direction it's a steady decline over the last year. From what I read this points to muscle mass loss.
John, although I hadn’t done much swimming since my teen years, I’ve now made it the cornerstone of my exercise and I’m having a very good remission. By definition, swimming laps is the definition of HIIT, as you can stop between sprinting each lap, for a rest phase, or in my case , rapidly bouncing/bounding, which simulates being on a trampoline, while building bone , leg and arm muscle. I’m 69 , and have built up to swimming 28 fast laps. Also, my homegrown “freestyle “ involves holding my breath the entire 40 yards, so I’m doing great things for my heart rate. No risk of falling or bone breaks. You might try it.
Your swimming program Cape is fantastic! Although I don't understand the bounding part. I have read specifically that swimming is fantastic for aerobics, especially in the volume you do, and I really like the holding your breath part, but I've seen actual research that it doesn't help build bones because it's so low impact. But then you mentioned bounding and bouncing! 😃
and here’s an interesting fact, Perplexity AI says that people who play tennis into old age live ten years longer than those who don’t! I played a lot of tennis in years gone by, but it’s too much now. However, if you think about it, the bounding/bouncing involves a lot of arms flaying and twisting and turning that comes very close to whatever might be good about tennis. Imo, it’s about moving lymph, which basically just sits there, unlike blood. Just walking or even light weights does not accomplish what is needed.
Apparently bones are not fixed but astonishingly are living in constantly adapting and building and rebuilding themselves all the time. It's amazing! So that's why exercise is so helpful because it can help the bones in their job. The bones respond to stresses and strains and especially impacts. Little impact such as brisk walking or pounding on the clay of a tennis court sends the right signals to the bones.By the way the lives longer by 10 years if you play tennis all your life sounds like a really sketchy study. It's the best possible example of correlation not being causation. Because tennis is well known as a sport of the upper middle and upper class. And of course such cohorts live longer. 😂
Your ALT seems to be still within reference range: <50 (lifelabs), 5-48 (labcorp (US)).
I've only had 2 recorded ALT measurements before starting ADT, one was ALT of 24 and the other was 19. The ALT 19 one was the day after a 18 mile run (possible factor) but a PSA of 24.1 was measured at the same time. After about 15 months ADT, ALT has moved around a bit: on April 11, 2024 it was 23 but up to 28 on May 2, 2024, other times in 30s.
Strenuous exercise can raise ALT, but usually this is transient.
I'm also slightly anemic, confirmed by MO that it is caused by ADT treatment (my ferritin levels are normal, so no iron intake issues).
Interesting. In fact my ferritin levels are high. As for ALT I liked what your comment about exercise driving it up, even if it is a little transient. This is my "something that I can do that's not crazy" plan right now. Build muscle mass by more consistently exercising.
Thank you for sharing your situation. Let’s break this down and consider how to approach it:
ALT and Muscle Mass
Alanine aminotransferase (ALT) is an enzyme primarily found in the liver, but it's also expressed in smaller amounts in skeletal muscle. While elevated ALT levels are often associated with liver injury, low ALT levels can sometimes indicate reduced muscle mass. However, ALT is not a direct measure of muscle mass, and many other factors can influence ALT levels, including overall health, diet, liver function, and exercise habits.
Sarcopenia and ALT
Sarcopenia, or the loss of skeletal muscle mass and function, can indeed be associated with reduced ALT due to less muscle turnover contributing to enzyme levels. This connection is indirect, but research suggests a link between sarcopenia and various biochemical markers, including ALT.
Exercise and ALT
Engaging in regular physical activity, particularly resistance training, can:
Increase muscle mass: Building muscle may indirectly affect ALT levels by improving muscle turnover.
Improve overall metabolic health: Exercise reduces inflammation, improves liver function, and helps regulate many biochemical markers.
Raise ALT transiently: Strenuous exercise can sometimes cause a temporary increase in ALT due to muscle microdamage, which is not harmful and reflects muscle remodeling.
Your Plan Moving Forward
1. Restart Exercise Gradually:
Focus on resistance training (e.g., weightlifting, bodyweight exercises) to target muscle mass.
Include some aerobic exercise for cardiovascular health and overall fitness.
Start slowly to avoid injury or overexertion.
2. Dietary Considerations:
Ensure you're consuming adequate protein to support muscle repair and growth (1.2–2.0 g/kg body weight per day, depending on your activity level).
Include nutrient-dense foods that support liver and muscle health, like omega-3-rich fish, leafy greens, and whole grains.
3. Monitor Progress:
Regularly track your ALT and other biomarkers.
Consider other tests or metrics to assess muscle mass, such as DEXA scans, grip strength, or simple functional tests like chair stands.
4. Consult Your Healthcare Team:
Discuss your concerns about sarcopenia and ALT trends with your doctor. They might recommend additional tests to evaluate muscle mass or function directly.
If sarcopenia is a concern, they may refer you to a dietitian or physical therapist specializing in muscle preservation.
Expected ALT Changes
If your ALT is indeed reflecting reduced muscle turnover, building more muscle through resistance training and proper nutrition could lead to a modest increase in ALT over time. However, it’s important not to focus solely on ALT as a marker of health but to consider the broader picture of fitness, strength, and well-being.
Would you like help creating a tailored exercise or nutrition plan?
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