Introduction and question re spike in ALT test following radiation

[dgcmcm]

Hello,

Firstly, I'd like to express my gratitude to the mods and everyone here who has contributed to making this space such a supportive and valuable resource.

My question: Has anyone experienced a spike in their ALT levels as a side effect of ADT and/or radiation?

(ALT stands for alanine transaminase. It is an enzyme found mostly in the liver. An ALT test measures the amount of ALT in the blood. When liver cells are damaged, they release ALT into the bloodstream. High levels of ALT in your blood may be a sign of a liver injury or disease)

Along with my recent PSA test (now .015), I had a liver panel done and whilst all other indicators are in the normal range my ALT has gone from a normal 40 to 240. Not sure about the significance of this but am wondering if this is a 'side effect' of recent prostate radiation treatment.

Bit of history: I was diagnosed with PC in February this year and tests (biopsy and PSMA) revealed I had Gleason 8, cribiform ,and seminal vesicles and lymph node involvement and one single met in my pubic ramus.

Initial treatment was to be ADT (Firmagon + Nubeqa) and chemo. I started ADT immediately and was gearing up (pragmatically and mentally) for chemo as strongly advised by my MO. This this treatment plan was presented to and endorsed by the multidisciplinary team at my hospital here in Canberra (Australia) - (I'm still trying to get my hands on the minutes of this meeting in order to understand why/how this decision was changed)

On the day of my chemo info/briefing session, my MO suddenly advised against chemo on the grounds that it was an "overtreatment" ! - and referred me to several research papers. I struggle with connecting/communicating with my MO who has a significant case load but also patronises me and can't seem to understand that I have undertaken extensive reading on PC. (I recently requested a transfer to another MO but as I was to learn, being a public patient, this is not possible and I 'd have to be referred to an MO in another state).

A meeting with my RO followed where I was strongly advised to undergo the "standard" 20 sessions to my prostate (only). We discussed radiating a broader pelvic area/lymph nodes but was advised against this due to the range of side effects he had witnessed as the head of RO over many years.

Would be interested in your thoughts.🤔

David

[LearnAll]

I might be able to clarify your ALP rise question as in 2019, I had a surge in ALP from 191 to 498 after starting lupron and Abiraterone. After 12 weeks, ALP started falling until it reached to 68. Fast forward, 5 and 1/2 years, meds changed to Orgovyx and Enzalutamide (plus 3 spot radiations), my ALP going up ,up and up and now it is 375 ( up from 105).... THIS IS CALLED ALP BOUNCE. It means your body is busy and trying to repair bone on war footing. If ALP starts falling after 12 weeks, its a very good news..it indicates that bone has repaired. If ALP keeps rising even after 12 weeks, that is bad news ...meaning that there is ongoing bone damage and body is not able to repair it. Now, you also need to see is PSA is rising or falling. If PSA is falling and ALP is also falling... Means your current treatment is working..just wait and watch. If PSA is rising and ALP is also rising after 12 weeks on new meds...You might have to intensify treatment. 12 week point is crucial BTW, This info applies to men with Bone met Only disease.

[LearnAll in reply to LearnAll]

ALT has nothing to do with bones....It is an enzyme which indicates liver injury if it rises too high. Most commonly due to medication side effect. Above answer was for ALP (alkaline phosphatase ) and not ALT.

[DrummerfightC in reply to LearnAll]

sorry you are wrong. ALT is to do with the bone metastasis as well as the liver function.

[j-o-h-n]

From Mr. Google:

ALT stands for alanine aminotransferase, an enzyme found in the liver that helps convert food into energy. An ALT blood test measures the amount of ALT in your blood, and can help diagnose or monitor liver disease.

ALP stands for alkaline phosphatase, an enzyme found in many parts of the body, including the liver, bones, intestines, and kidneys. ALP levels in the blood can be measured with an ALP test, which can help diagnose or screen for liver or bone diseases.

Good Luck, Good Health and Good Humor.

j-o-h-n