126 PROGNOSTIC VALUE OF FLARE IN ALKALINE PHOSPHATASE AFTER ORCHIECTOMY increased cancellous bone turnover after orchiectomy in ma- ture rats. J. Bone Miner. hs., 8 5268, 1993. 24. Willie, D. A,, Eisenberger, M. A,, Carducci, M. A., Hseih, W.-S., Kim, W. Y. and Simons, J. W.: Interleukin-6: a candidate mediator of human prostate cancer morbidity. Urology, 45 542, 1995. 25. Tarle, M., Kovacic, K. and Strelkov-Alfirevic, A,: Correlation between bone scans and serum levels of osteocalcin, prostate- specific antigen, and prostatic acid phosphatase in monitoring patients with disseminated cancer of the prostate. Prostate, 15: 211, 1989. EDITORIAL COMMENT The flare phenomenon observed after endocrine treatment for metastatic prostate cancer has been the subject of several previous reports (references 4 and 18 in article). The authors reviewed retro- spectively the prognostic value of the flare in alkaline phosphatase in 112 patients with metastatic prostate cancer and demonstrated that a flare following orchiectomy correlated prognostically with progression-free survival in a negative manner, that is patients with the highest flare would most likely have progression sooner. Total serum alkaline phosphatase, as traditionally measured, re- flects a combination of liver, bone and placental alkaline phosphatases.1 In patients with extensive bone metastasis most of the activity comes from bone alkaline phosphatate. Killian et al previously re- ported on the increased prognostic value of bone alkaline phosphatase in patients with metastatic prostate cancer (reference 17 in article). Therefore, I believe that the observation made by the authors is a reflection of the extent of bone involvement at the initiation of therapy. Indeed, review of the data of the National Prostatic Cancer Project in 1985 revealed that important variables associated with progression included pain, and acid and alkaline phosphatases, reflecting perhaps the extent of the disease and of bone involvement in those patients.* When developing protocols for patients with metastatic prostate cancer, a difficult task is assuring uniformity of criteria for extent of disease at initiation of therapy. Although PSA is a good indicator of the status of the disease, there is a risk that as the tumor becomes less differentiated proportionally less PSA is pro- duced, making this marker less useful. The authors are to be con- gratulated in emphasizing again the value of a simple assay that can be used to select patients at an increased risk for progression. J. Edson Pontes Department of Urology Wayne State University School of Medicine Detroit, Michigan 1. Pontes, J. E.: Biological markers in prostate cancer. J. Urol., 130: 1037, 1983. 2. Emrich, L. J., Priore, R. L., Murphy, G. P. and Brady, M. F.: Prognostic factors in patients with advanced stage prostate cancer. Cancer Res., 45: 5173, 1995.

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126 PROGNOSTIC VALUE OF FLARE IN ALKALINE PHOSPHATASE AFTER ORCHIECTOMY

increased cancellous bone turnover after orchiectomy in ma- ture rats. J. Bone Miner. h s . , 8 5268, 1993.

24. Willie, D. A,, Eisenberger, M. A,, Carducci, M. A., Hseih, W.-S., Kim, W. Y. and Simons, J. W.: Interleukin-6: a candidate mediator of human prostate cancer morbidity. Urology, 4 5 542, 1995.

25. Tarle, M., Kovacic, K. and Strelkov-Alfirevic, A,: Correlation between bone scans and serum levels of osteocalcin, prostate- specific antigen, and prostatic acid phosphatase in monitoring patients with disseminated cancer of the prostate. Prostate, 15: 211, 1989.

EDITORIAL COMMENT

The flare phenomenon observed after endocrine treatment for metastatic prostate cancer has been the subject of several previous reports (references 4 and 18 in article). The authors reviewed retro- spectively the prognostic value of the flare in alkaline phosphatase in 112 patients with metastatic prostate cancer and demonstrated that a flare following orchiectomy correlated prognostically with progression-free survival in a negative manner, that is patients with the highest flare would most likely have progression sooner.

Total serum alkaline phosphatase, as traditionally measured, re- flects a combination of liver, bone and placental alkaline phosphatases.1 In patients with extensive bone metastasis most of the activity comes from bone alkaline phosphatate. Killian et al previously re- ported on the increased prognostic value of bone alkaline phosphatase in patients with metastatic prostate cancer (reference 17 in

article). Therefore, I believe that the observation made by the authors is a reflection of the extent of bone involvement a t the initiation of therapy. Indeed, review of the data of the National Prostatic Cancer Project in 1985 revealed that important variables associated with progression included pain, and acid and alkaline phosphatases, reflecting perhaps the extent of the disease and of bone involvement in those patients.* When developing protocols for patients with metastatic prostate cancer, a difficult task is assuring uniformity of criteria for extent of disease a t initiation of therapy. Although PSA is a good indicator of the status of the disease, there is a risk that as the tumor becomes less differentiated proportionally less PSA is pro- duced, making this marker less useful. The authors are to be con- gratulated in emphasizing again the value of a simple assay that can be used to select patients at an increased risk for progression.

J. Edson Pontes Department of Urology Wayne State University School of Medicine Detroit, Michigan

1. Pontes, J. E.: Biological markers in prostate cancer. J. Urol., 130: 1037, 1983.

2. Emrich, L. J., Priore, R. L., Murphy, G. P. and Brady, M. F.: Prognostic factors in patients with advanced stage prostate cancer. Cancer Res., 45: 5173, 1995.

$Comment Letter A13 A13-6 - cpuc.ca.gov · A13-6\rcont. Comment Letter A13. Comment Letter A13. Comment Letter A13. Comment Letter A13. Comment Letter A13. Comment Letter A13. Comment$