Alkaline Phosphatase Kinetics Predict Metastasis among Prostate Cancer Patients Who Experience Relapse following...

Area of Science:

• Urology
• Oncology
• Biochemistry

Background:

• Metastasis in prostate cancer (CaP) is a critical challenge for prognostication.
• Improved methods are needed to predict disease progression after treatment.

Purpose of the Study:

• To evaluate alkaline phosphatase velocity (APV) as a predictor of distant metastasis-free survival (DMFS) in prostate cancer patients.
• To assess the association between APV and other prognostic factors.

Main Methods:

• Retrospective cohort study of 1783 prostate cancer patients with post-radical prostatectomy (RP) biochemical recurrence (BCR).
• APV calculated as the slope of alkaline phosphatase (AP) values post-BCR and prior to metastasis.
• Kaplan-Meier curves and multivariable Cox analysis used to determine DMFS predictors.

Main Results:

• Of 1783 patients, 701 had sufficient AP data for APV calculation.
• Rapid APV (uppermost quartile) was associated with significantly poorer DMFS (Log-rank p=0.003).
• Rapid APV independently predicted a twofold increased probability of DMFS (HR=2.2; p=0.008) after controlling for covariates.

Conclusions:

• Rapid APV is a strong predictor of DMFS in a broad group of prostate cancer patients with post-RP BCR.
• APV can be considered a valuable complementary clinical factor for predicting distant metastasis.
• This study supports APV's utility in longitudinal cohorts with long-term follow-up and equitable healthcare access.