If PSA decreases in MHsPC but ALP increases , is one still castrate sensitive ?

[Tinkudi]

I know that PSA decreasing or remaining steady while on hormone therapy means one is hormone sensitive but if PSA decreases but ALP increases , does that still mean one is hormone sensitive ?

[Justfor_]

ALP increase, in general, signals progression, that can happen independently of hormone sensitivity or not. There is the bone specific ALP measurement that can shed more light into the origination of the increase. In normal cases it is about half of the total ALP. More, tells us that bone lesions are disintegrating. Yet, for the optimists, this can be seen as the result of killing cancerous bone cells and body disposing off the debris. If it continues to increase this is an indication of progression. On the flip side, if bone specific ALP is within normal, i.e.50% of normal range and total is well over the max, the most probable cause is that the liver has got too much drugs to process that can't cope with them.

[Tinkudi in reply to Justfor_]

Thanks. I am just trying to learn. So if sgot sgpt and bilirubin are normal but alp high - does that too then point more to a bone etiology ?

[Justfor_ in reply to Tinkudi]

I have no knowledge of how the liver functions. What you deduct sounds reasonable, but no one (in our case nothing) is declared guilty until proven so. Have the bone specific ALP and follow the numbers. Stop the guesswork, or I will start the bolds.

[Tinkudi in reply to Justfor_]

The last report I had done for dad said that - if other liver parameters are fine increased alp only most likely is bone

Ok I will stop as I am scared of. BOLDS 😄

[Justfor_ in reply to Tinkudi]

"The bone-specific alkaline phosphatase (ALP) is one of the isoforms of total ALP, which originates from different tissues, primarily the liver and bones. In healthy individuals, the proportion of bone-specific ALP typically makes up about 40-60% of the total ALP levels. However, this can vary depending on factors such as age, growth, and bone activity.

In adults, the liver is the main source of total ALP, with bone ALP contributing less than 50%.

In children or adolescents, due to active bone growth, the percentage of bone-specific ALP can be significantly higher, even surpassing 60%.

Factors like bone diseases or liver conditions can alter these proportions.

Chat GPT explains

[maley2711 in reply to Justfor_]

SO, is it meaningful to know only the overall ALP #, and not both ALP #s?

When I askedmy urologist to order ALP, I didn't specify bone ALP, and the lab didn't mention bone ALP in the result. Studies I had read indicated "ALP" below 100 or so was a good sign re probably absence of bone metastasis. Or was my understanding wrong ? Latest results before recent RT +ADT for Gleason 4+5 were ALP 60, PSA 13(up from 8 two years ago) and negative PSMA PET. PET and MRI both indicated some lesion enlargement in the prostate PIRADS 5 area...no SVI,ECE, etc.

BTW, just my exxperience...switching from Kaiser to outside clinic care has been a nightmare. Major provider clinics here all want referrals from Kaiser, and both my Kaiser GP and urologist refuse to do so, for unknown reason. Finally found a smaller private oncology clinic who would schedule me, but another challenge in having them give me a Medicare-approved amount for initial Doc visit and a 3 month Eligard dose. Who designed this system??

[Justfor_ in reply to maley2711]

As I wrote earlier responding to Tinkudi, the total_ALP normal ranges aren't solidly standardized at least here. I don't know what happens in the US, but here, 3 labs/hospitals use 3 different normal ranges ( 25-129, 40-130, 40-150). If your ALP is within 2/3 of the max normal value bone specific ALT is redundant. If it is way above that, it must be additionally measured for further pin pointing the source (bones or liver)

[maley2711 in reply to Justfor_]

Thanks...no I didn't read your response to him. SO, as long as ALP remains low, reason to be hopeful , and likely PSMA PET or other type scan won't find any bone lesions? Evidently MDs believe PSA is a better determinant , so ALP measure not SOC? I believe that I read once that ALP was used more in bygone days? Seems useful primarily if a rising ALP is found while PSA relatively stable? I assume that situation could arise?

[Maxone73]

Hi! I remember you shared your dag's genetic panel. If I remember correctly he had high TMB. I don't know if this would fit with his situation and location, but there is this interesting trial: healthunlocked.com/advanced...

[Tinkudi in reply to Maxone73]

Yes. He has high TMB. Thanks. Seems a little scary as it says 2 deaths

[Maxone73 in reply to Tinkudi]

yes but the key point is that your father could be sensitive to immune therapies, discuss it with his MO

[Tall_Allen]

Yes. Most ALP comes from the liver. Some bone-specific ALP comes from bone metastases. There are biochemical tests for bone-specific ALP, but as long as PSA is declining,any increases in ALP is assumed to be coming from the liver.

[maley2711 in reply to Tall_Allen]

Think ALP should be a standard lab for PCa treated patients? Should I expect the new MO I am seeing next week to know all about this subject?

I have felt comforted over th past years by an overall ALP in the 50-60 range....but current ADT may affect liver, and thus ALP? Kaiser Docs didn't seem to care about ALP? I asked for it.

[Seasid]

What is your ALP now? My is 50 now.

[Tinkudi in reply to Seasid]

Dad’s ALP had risen to 325 at the start of ADT. After 2 months it’s down to 57

[Seasid in reply to Tinkudi]

That is great news

[Seasid]

My ALP is also increasing.

Biochemistry