The flare in alkaline phosphatase activity post-orchidectomy predicts which patient may benefit from early chemotherapy in metastatic prostate cancer.
BACKGROUND
A flare in serum alkaline phosphatase (ALP) activity post-orchidectomy has been shown to be of negative prognostic value for progression-free survival (PFS) in patients with prostate cancer. The aim of this study was to investigate whether a flare in ALP may help identify patients in whom prognosis could be positively influenced by early chemotherapy.


METHODS
A retrospective analysis of the database of a Dutch multicenter study was conducted to evaluate the prognostic value of the flare in ALP post-orchidectomy for survival and PFS in 112 patients treated with orchidectomy (previously reported) compared to 121 age- and stage-matched patients additionally treated with estramustine-phosphate (EMP) as first line therapy.


RESULTS
There was no overall difference in PFS and survival between the two treatment regimen. Subgroup analysis of patients demonstrating a greater than 50% increase in ALP post-orchidectomy showed, however, a significant increase in PFS in patients additionally treated with EMP.


CONCLUSIONS
Our data suggest that the simple measurement of ALP activity within 4 weeks of castration represents a useful adjunct in assessing which patients with prostate cancer undergoing androgen ablation may benefit from additional early chemotherapy.
Pelger
Rob C M
RC
Departments of Urology, Leiden University Medical Center, The Netherlands.
Lycklama A Nijeholt
Guus A B
GA
Zwinderman
Aielko H
AH
Hamdy
Neveen A T
NA
D000368:Aged; D000369:Aged, 80 and over; D000469:Alkaline Phosphatase / Q000097:blood / Q000378:metabolism*; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D004961:Estramustine / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009919:Orchiectomy; D011237:Predictive Value of Tests; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
D018931:Antineoplastic Agents, Hormonal; D004961:Estramustine; D000469:Alkaline Phosphatase