Clarification on ALP and LDH markers

[fmoser]

I was wondering if anyone can fill me in on Alkaline Phosphatase (ALP) and lactate dehydrogenase (LDH) changes with second time docetaxel treatment. What do these values help indicate and is it normal to have them higher after one dose of chemo? I figure it takes a while for the chemo to have time to work and to see the effect on these blood values?

My father had Docetaxel 6 rounds 5 years ago was stable for about a year. Has been on enzalutamide after reoccurance until Dec 20, 2022 when he came off of it to start chemo again (docetaxel 10 rounds + prednisone is the plan). In early Oct, bone scan was clear and CT scan revealed prostate tumour and some lymph involvement. Initial diagnosis had extensive bone metastasis so I'm assuming from Oct to Dec the cancer likely went to his bones again. His ALP went from about 500 Dec 20 before chemo to 900 Jan 9, after his first chemo dose, and there was an increase in LDH as well, can't recall the numbers. His PSA pre chemo was 189 his PSA value from today has not come through yet. How many cycles of chemo do they tend to do before determining if it's working?

Symptoms are right lateral glut pain and insomnia (due to slight discomfort, urgency to pee, worry, and taking second pill of prednisone late in the day). He is adjusting the prednisone to earlier in the day to see if that is the major factor of poor sleep quality.

Any suggestions are welcome!

Thank you!

[KocoPr]

Hi, sorry to hear about your father's struggles.

I am on darolutamide and have been researching drug resistance to the lutamides and one of the resistance's are neuro-endicrine cancer which rise in LDH is a good marker.

here are some links on this subject

Advances in neuroendocrine prostate cancer research: From model construction to molecular network analyses

nature.com/articles/s41374-...

"In addition, before the diagnosis of t-NEPC, changes may be observed in the pathological and molecular characteristics of the patients. For example, in certain cases, the disease progresses rapidly when PSA levels are low, liver metastasis is detected shortly after the detection of elevated lactate dehydrogenase (LDH) levels, and “non-AR-driven” characteristics appear immediately after the loss of TP53 or RB140. These results indicate that the expression of these “predictive” factors should be tested earlier for the early diagnosis of NEPC."

Second generation androgen receptor antagonists and challenges in prostate cancer treatment

ncbi.nlm.nih.gov/pmc/articl...

" The utility of these agents has expanded with the emergence of second-generation AR antagonists, which began with the approval of enzalutamide in 2012 by the United States Food and Drug Administration (FDA). Together with apalutamide and darolutamide, which were approved in 2018 and 2019, respectively, these agents have improved the survival of patients with prostate cancer, with applications for both androgen-dependent and castration-resistant disease. While patients receiving these drugs receive a benefit in the form of prolonged survival, they are not cured and ultimately progress to lethal neuroendocrine prostate cancer (NEPC). Here we summarize the current state of AR antagonist development and highlight the emerging challenges of their clinical application and the potential resistance mechanisms, which might be addressed by combination therapies or the development of novel AR-targeted therapies."

Apalutamide, Darolutamide and Enzalutamide for Nonmetastatic Castration-Resistant Prostate Cancer (nmCRPC): A Critical Review

ncbi.nlm.nih.gov/pmc/articl...

A study confirmed that use of abiraterone acetate and enzalutamide increases the percentage of t-NEPC, which are found in 17% of metastatic biopsies obtained from patients with mCRPC [76].