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ORIGINAL ARTICLE
Year : 2000  |  Volume : 17  |  Issue : 1  |  Page : 6-12

The significance of early changes in serum alkaline-phosphatase levels following endocrine treatment in patients with advanced prostate cancer


Pontefract General Infirmary, Pontefract WF8 IPL, England, U.K

Correspondence Address:
Aditya Pareek
Department of Urology, Suite 136, MRC 1st Floor, Bombay Hospital Institute of Medical Sciences, New Marine Lines, Mumbai - 400 020, India

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Source of Support: None, Conflict of Interest: None


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Objectives: The prognostic significance and the fre­quency of occurrence of serum alkaline-phosphatase fare in patients with advanced prostate cancer commenced on hormonal treatment is controversial. Present study was carried out to clarify its prognostic value and the frequency of occurrence in relation to progression and survival in these patients. Methods: Case notes of 168 (101 metastatic and 67 lo­cally advanced) patients with advanced carcinoma of the prostate diagnosed between July 1984 through December 1995 were analysed retrospectively. All cases were fol­lowed until death or until March 1997 when the cases were censored. Serum alkaline-phosphatase values ob­tained immediately prior to and within 6 weeks of initia­ting the hormonal therapy were analysed in relation to progression free and overall survival. Results: Of the total of 168 evaluable cases, 101(60.1 %) had metastatic and 67 (39.9%) locally advanced tumours. Mean pre-treatment serum alkaline-phosphatase levels were higher (350IU/1) in the group which exhibited fare phenomenon post-treatment than the other which didn't (180 IU/1). Overall, flare activity in SAP levels was ob­served in 59 (35.1 %) of the total cases. Also, a greater proportion of the cases with metastatic disease had SAP flare than the other who had locally advanced disease (52.4% verses 8.9%). Flare in SAP levels were associated with decreased progression free and overall survival (p=0.001; p=0.002); greater the rise in SAP levels post­treatment, worse the prognosis. Conclusions: A significant proportion of patients with advanced carcinoma of the prostate have flare in SAP le­vels soon after initiating the treatment. We confirm that the flare activity in SAP levels is a negative prognostic indicator and it is possible to identify early treatment fail­ures by frequent measurements of SAP levels during first 6 weeks of commencing the therapy. The significance of SAP fare and androgen resistance is discussed.


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