Implications of serum bone turnover markers in prostate cancer patients with bone metastasis.
OBJECTIVE
To assess the diagnostic accuracy of serum bone turnover markers for detection of bone metastasis in patients with prostate cancer (PCa) and to assess the usefulness of these markers as predictors of mortality from PCa.


METHODS
Serum total alkaline phosphatase, bone-specific alkaline phosphatase, carboxy-terminal pyridinoline cross-linked telopeptide parts of type-I collagen (1CTP), tartrate-resistant acid phosphatase type 5 b, and prostate-specific antigen (PSA) levels were measured in 222 patients (58 with bone metastasis, 57 with T2M0 PCa, 55 with T3M0 PCa, and 52 without PCa). Multivariate stepwise logistic regression analysis was used to identify independent predictors of bone metastasis. Correlation of serum marker levels with bone metastasis was assessed using receiver operating characteristics analysis. Multivariate Cox proportional hazards analysis was used to predict cause-specific survival in PCa patients with bone metastasis.


RESULTS
Serum total alkaline phosphatase, bone-specific alkaline phosphatase, 1CTP, tartrate-resistant acid phosphatase type 5 b, and PSA levels were significantly elevated in patients with bone metastasis, and correlated significantly with the extent of disease on bone scintigraphy. Multivariate stepwise logistic regression analysis demonstrated that serum PSA and 1CTP were significant predictors of bone metastasis. Receiver operating characteristics analyses showed that serum 1CTP level was the most reliable predictor of bone metastasis (area under the curve = 0.85). Multivariate Cox proportional hazards analysis revealed that only serum 1CTP was an independent prognostic factor for PCa-related death.


CONCLUSIONS
Serum 1CTP level was a more reliable marker than the others to detect bone metastatic spread and to predict survival probability in PCa patients with bone metastasis.
Kamiya
Naoto
N
Department of Urology, Graduate School of Medicine, Chiba University, Chiba, Japan.
Suzuki
Hiroyoshi
H
Yano
Masashi
M
Endo
Takumi
T
Takano
Makoto
M
Komaru
Atsuhi
A
Kawamura
Koji
K
Sekita
Nobuyuki
N
Imamoto
Takashi
T
Ichikawa
Tomohiko
T
D000135:Acid Phosphatase / Q000097:blood; D000230:Adenocarcinoma / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000556:secondary*; D000368:Aged; D000369:Aged, 80 and over; D000469:Alkaline Phosphatase / Q000097:blood; D000704:Analysis of Variance; D014408:Biomarkers, Tumor / Q000097:blood*; D001859:Bone Neoplasms / Q000097:blood / Q000401:mortality / Q000556:secondary*; D015331:Cohort Studies; D024042:Collagen Type I / Q000097:blood; D006801:Humans; D007150:Immunohistochemistry; D007527:Isoenzymes / Q000097:blood; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011336:Probability; D011379:Prognosis; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology*; D016019:Survival Analysis; D000071681:Tartrate-Resistant Acid Phosphatase
D014408:Biomarkers, Tumor; D024042:Collagen Type I; D007527:Isoenzymes; D000469:Alkaline Phosphatase; D000135:Acid Phosphatase; D000071681:Tartrate-Resistant Acid Phosphatase; D017430:Prostate-Specific Antigen