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PSA increasing - ALP levels going down


I have prostate cancer that evolved into metastatic bone cancer about 6 months ago. I am doing several treatments, some with success, some not. So far, doctors have not yet started chemotherapy.

At my last test (last week), the doctors were surprised that the PSA increased yet again from 35 to 70, but the LPA decreased from VERY high levels to levels well within normal LPA levels. What could be the cause of these seemingly contradictory results? I read that LPA levels could go down if one reacts positively to the treatment, but the PSA keeps increasing? Could it mean that the treatment is working to stop the bone degeneration, but that the cancer has spread outside the bones into the organs (therefore resulting in a continued PSA increase) ....

Is a PSA level of 70 very high?

Thanks for your input
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replied May 24th, 2010
I am uncertain about your use of the term "LPA." Do you mean "ALP" (an abbreviation for alkaline phosphatase)?

A PSA that rises from 35 to 70 certainly suggests progression of metastatic prostate cancer. The discordance between your rising PSA and your decreasing ALP could also suggest a decrease in the activity of the tumors in your bones but an increase in tumor activity in other areas, such as the pelvic lymph nodes. A CT scan or CT-PET scan should be considered to further evaluate your rising PSA level. (A bone scan can also be performed to reassess the extent of skeletal tumor activity.)

Sincerely/ Robert A. Wascher, MD, FACS

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