OSTEOBLASTIC FLARE ASSESSED BY SERUM ALKALINE-PHOSPHATASE ACTIVITY ISAN INDEX OF SHORT-DURATION OF RESPONSE IN PROSTATE-CANCER PATIENTS WITH BONE METASTASES SUBMITTED TO SYSTEMIC THERAPY

A transient rise in serum alkaline phosphatase (ALP) activity (ALP fla re) after androgen deprivation in prostate cancer patients with bone m etastases has been previously correlated with both response to therapy and poor prognosis. In the present study we analyzed data coming from an Italian multicenter phase III, trial aimed to compare the efficacy of treatment with goserelin alone with that of goserelin plus mitomyc in C. Sixty-seven bone metastatic patients were enrolled: 32 were trea ted with goserelin and 35 with and goserelin plus mitomycin. 58 cases had ALP measured every month; and were considered for flare assessment . Remarkably elevated ALP and PSA levels at baseline were significantl y correlated with poor prognosis. The addition of mitomycin to goserel in resulted in a greater percent reduction of PSA values with respect to goserelin alone but did not augment the time to progression and ove rall survival. The monthly profile of ALP serum levels was superimposa ble in patients assigned to hormone therapy or chemotherapy plus hormo ne therapy. Patients showing a flare in ALP activity (transient rise > 15% in ALP values with respect to baseline at the first month) were cl assified as responders to therapy or as having stable disease upon PSA evaluation and/or at bone pain assessment, but had a shorter time to progression (median 12 months) in comparison to those showing a differ ent ALP pattern (median 23 months). The measurement of flare in ALP ac tivity during androgen suppression with or without concomitant mitomyc in administration, may permit the early identification of patients who are likely to progress rapidly, and hence be candidate for more aggre ssive treatments.