Prostate cancer: alkaline phosphatase predicts OS, risk for bone mets

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  • Rapid alkaline phosphatase velocity (APV) predicted shorter OS and bone metastasis-free survival (BMFS) in patients with castration-resistant prostate cancer (CRPC).

Why this matters

  • 12% of patients with organ-confined prostate cancer at initial presentation develop bone metastases (BM). 
  • <1% of these patients survive ≥5 y. 
  • Efficacy of PSA doubling time (PSADT) in predicting BM in patients with rising PSA is limited. 
  • Present findings confirm previous evidence of the benefit of APV+PSADT for risk stratification. 
  • Racial/ethnic composition of this study is more representative of the general US population than previous cohorts, making it more generalizable.
Study design
  • Retrospective cohort study evaluated 89 patients with CRPC who received androgen deprivation therapy between 1989 and 2010.
  • Funding: None disclosed.

Key results

  • Faster APV significantly predicted shorter BMFS and OS (P=.0451 and P=.0109).
  • In multivariate analysis, APV ≥5.42 U/L/y vs APV <5.42 U/L/y was strongly associated with BMFS (HR, 3.25; P=.027) and OS (HR, 4.47; P=.0052).
  • PSADT<10 vs PSADT ≥10 mo was significantly associated with shorter BMFS (HR, 33.32; P<.0001) and OS (HR, 12.25; P<.0001)


  • Small sample size.