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Alkaline phosphatase in metastatic castration-resistant prostate cancer: reassessment of an older biomarker

    Daniel Heinrich

    *Author for correspondence: Tel.: +47 913 95554;

    E-mail Address: daniel.heinrich@ahus.no

    Department of Oncology, Akershus University Hospital, Sykehusveien 25, 1478 Lørenskog, Norway

    ,
    Øyvind Bruland

    Department of Oncology, Oslo University Hospital–Norwegian Radium Hospital, Ullernchausseen 70, 0379 Oslo, Norway

    ,
    Theresa A Guise

    Department of Medicine, Indiana University School of Medicine, 980 W. Walnut St, Walther Hall, R3, Room C130 Indianapolis, IN 46202, USA

    ,
    Hiroyoshi Suzuki

    Department of Urology, Toho University Sakura Medical Center, 564-1 Shimazu, Sakura-shi, Chiba 285-8741, Japan

    &
    Oliver Sartor

    Departments of Medicine & Urology, Tulane Cancer Center, 1430 Tulane Ave., SL-42, New Orleans, LA 70112, USA

    Published Online:https://doi.org/10.2217/fon-2018-0087

    Since most patients with metastatic castration-resistant prostate cancer (mCRPC) have bone metastases, it is important to understand the potential impact of therapies on prognostic biomarkers, such as ALP. Clinical studies involving mCRPC life-prolonging agents (i.e., sipuleucel-T, abiraterone, enzalutamide, docetaxel, cabazitaxel, and radium-223) have shown that baseline ALP level is prognostic for overall survival, and may be a better prognostic marker for overall survival than prostate-specific antigen in patients with bone-dominant mCRPC. Mechanism of action differences between therapies may partly explain ALP dynamics during treatment. ALP changes can be interpreted within the context of other parameters while monitoring disease activity to better understand the underlying pathology. This review evaluates the current role of ALP in mCRPC.

    Papers of special note have been highlighted as: • of interest; •• of considerable interest

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