Bone metastasis with normal ALP levels?

[JSHT]

Has anyone had bone metastasis and normal ALP levels? Asking for my dad. He isn’t really wanting to get the bone scan which I know is the best and probably only way to determine this. Just curious as his ALP levels are always really good - around 50 in a normal range of 40-120 U/L. Thanks for any help!

[fireandice123]

I have a normal ALP level with bone mets. Not huge mets but they’re there. They were initially detected with bone and CT scans after I was diagnosed.

[JSHT in reply to fireandice123]

Thank you for the response. Hope you’re doing ok now. Did it show at all on the CT Scan ? He’s had those but is hesitant to do the bone scan .

[fireandice123 in reply to JSHT]

They showed slightly on the CT scan but I’m sure they would have been caught without the accompanying bone scan to guide them. The bone mets light up on the bone scan. It’s my understanding that the CT scan is more for lymph nodes and visceral mets which is why they usually do both scans.

[JSHT in reply to fireandice123]

Right. Makes sense. Thanks.

[fireandice123 in reply to JSHT]

Why is he reluctant to get a bone scan? It’s pretty painless. Just have the injection of the tracer and lay perfectly still for about 30 min during the scan.

[JSHT in reply to fireandice123]

I think it’s partly he’s concerned about radiation levels. Although someone just mentioned to me that the bone scan has a lot lower radiation than the PMSA-PET scan which I thought was the same thing. So maybe he’d do it to start.

I think it’s also partly that it’s easier for him not knowing. He’s been nervous of a lot of the conventional treatments so I’m not sure if he would be open to trying anything different even if he did know for sure.

He’s in his early 80s now so he has done well. I can’t help but wonder if some of his physical symptoms are caused by metastasis if something like a bit of localized radiation could help improve QOL without too many side effects. It’s ultimately up to him though and I just try to learn what I can and support his decisions.

[Woodstock82]

I had many bone mets when diagnosed. My ALP was well within the normal range. Now almost six years later, I have still have mets, but they are fewer, and my ALP is lower but still within the normal range.

What is his concern about the bone scan?

[JSHT in reply to Woodstock82]

Thanks for sharing your experience. Do you know if your liver function tests were/are normal? I’ve read that both liver and bones determine ALP so if liver function is lower to begin with that could be one reason why someone might not see an increase in ALP with bone mets?

Honestly I think it’s he’s partly worried about the radiation (but he does do ct scans) and partly being unsure whether he wants to know or if knowing would change his approach. He’s in his early 80s now. I do worry though it’s progressing.

[Woodstock82 in reply to JSHT]

My history and treatment details are in my profile, but the short version is I started with ADT and chemo. I am still on quarterly Lupron and daily abiraterone. I am very fortunate to have had better than expected response to treatment. My immune system has held up well, and my liver function has held up well.

I enrolled in the CHAARTED2 clinical trial back in November 2020, and as a consequence I get CT scans and bone scans every three months. I am not at all worried about the radiation exposure.

The scans show I still have some lesions, but they are not growing or spreading, so the medications are doing what I need them to do.

CT scans, bone scans, MRI scans, and PET scans all give slightly different perspectives. Being able to compare and contrast the results from different scans gives extra dimension (pun intended) to the analysis of the state of the disease.

I like to think that "more information is better." However, I am mindful of Segal's Law: "A man with one watch knows what time it is. A man with two is never sure."

[JSHT in reply to Woodstock82]

Okay thank you for the info. I would agree. For me personally I think I’d rather know than not know and wonder. I’ll check out your profile for more details. Happy to hear you’re doing so well with treatments!

[ctflatlander]

I have normal ALP and bone Mets. Get a scan

[JSHT in reply to ctflatlander]

Thanks for your response. Hope you’re doing ok.

[DaveKY]

I have high ALP and PSA with many mets and have had 4 bone scans. He needs the bone scan. The amount of radiation is very low compared to PSMA PET or radiopharms. A bone scan is more like a camera than other radiography devices. It uses Technetium-99m (Tc99m) at 4-6 millisieverts (mSv) which is pretty light dose. You pee it out in no time with lots of fluids.

If the lesions are few and sizable, EBRT can knock them right out.

[JSHT in reply to DaveKY]

Thanks for this info. I’ll share that with him. I didn’t realize a bone scan was different than the PSMA-PET.

[j-o-h-n]

To JSHT,

QUOTE: " He isn’t really wanting to get the bone scan". Tell your Dad to get off the stick and stop the JSHT. Please update his bio, all info is voluntary but it will help him/you and help us too. Thank you and Regards. (Keep posting).

Good Luck, Good Health and Good Humor.

j-o-h-n