title: Predictive implications of bone turnover markers after palliative treatment with (186)Re-HEDP in hormone-refractory prostate cancer patients with painful osseous metastases.
abstract: OBJECTIVE
  To prospectively evaluate the predictive value of various bone formation and resorption markers in patients with bone metastases from prostate cancer after palliative treatment with (186)Re-1,1-hydroxyethylidene diphosphonate ((186)Re-HEDP).
  
  
  METHODS
  Included in the study were 36 men with prostate cancer, suffering from painful osseous metastases and treated with (186)Re-HEDP. None had received any treatment that would have interfered with bone metabolism before (186)Re-HEDP treatment or throughout the follow-up period. For each patient, pretreatment and posttreatment serum levels of osteocalcin (OC), bone alkaline phosphatase (BALP), aminoterminal (PINP) and carboxyterminal (PICP) propeptides of type I collagen, amino-terminal (NTx) and carboxyterminal (CTx) telopeptides of type I collagen and their combinations were compared with the level and duration of pain response to radionuclide treatment.
  
  
  RESULTS
  Pain response was correlated only with pretreatment NuTaux/PINP, PICP/PINP and NTx/CTx ratios and posttreatment decrease in baseline NTx and PICP values (p = 0.0025-0.035). According to multivariate and ROC analyses, the best marker-derived predictors of better and longer duration of response to (186)Re-HEDP treatment were a posttreatment decrease in NTx of > or = 20% (RR = 3.44, p = 0.0005) and a pretreatment NTx/PINP ratio of > or = 1.2 (RR = 3.04, p = 0.036)
  
  
  CONCLUSIONS
  NTx, a potent collagenous marker of bone resorption, along with the novel NTx/PINP ratio provide useful cut-off values for identifying a group of patients suffering from painful osseous metastases from hormone-refractory prostatic carcinoma who do not respond to palliative treatment with (186)Re-HEDP. This information could help avoid an inefficient and expensive radionuclide treatment. Also, in the cohort of patients who will eventually undergo such treatment, the medium-term posttreatment changes in NTx offer valuable predictive information regarding long-term palliative response.
authors: Department of Nuclear Medicine, 401 Army Hospital of Athens, Mesogeion & Kanellopoulou 1, 11525, Athens, Greece, epiphany@in.gr.
authors: Athanasios
authors: A
authors: Zafeirakis
authors: Georgios
authors: G
authors: Papatheodorou
authors: Athanasios
authors: A
authors: Arhontakis
authors: Athanasios
authors: A
authors: Gouliamos
authors: Lambros
authors: L
authors: Vlahos
authors: Georgios S
authors: GS
authors: Limouris
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood; D001859:Bone Neoplasms / Q000097:blood / Q000175:diagnosis / Q000532:radiotherapy / Q000556:secondary*; D024042:Collagen Type I / Q000097:blood*; D012739:Gonadal Steroid Hormones / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000097:blood; D010146:Pain / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D010166:Palliative Care / Q000379:methods; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000532:radiotherapy*; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D024042:Collagen Type I; D012739:Gonadal Steroid Hormones; D009363:Neoplasm Proteins; D019275:Radiopharmaceuticals