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The importance of 1CTP in the diagnosis and monitoring of bone disease in patients with prostate cancer
8th European Multidisciplinary Meeting on Urological Cancers, 24-27 November 2016, Milan, Italy
P097
The importance of 1CTP in the diagnosis and monitoring of bone disease in patients with prostate cancer Eur Urol Suppl 2016; 15(13);e1681
Matoušková M.1, Hanuš M.1, Dudková V.2, Králová V.1 1
Urocentrum, Dept. of Uro-oncology, Prague, Czech Republic, 2Hospital Na Homolce, Dept. of Nuclear Medicine and PET Centrum, Prague, Czech Republic INTRODUCTION & OBJECTIVES: Bone disease accompanies advanced Prostate Cancer (CaP) with high prevalence. For metastatic prostate cancer, bone generalization is proven in up to 90% of patients with varying degrees of pain response syndrome and the potential risk of bone complications. Bone disease is characterised by increased resorption with impaired bone remodelling and impaired calcium metabolism. Clinical symptomatology is preceded and accompanied by abnormalities detectable by laboratory tests or by changes on imaging. MATERIAL & METHODS: We evaluate continuous monitoring of bone resorption markers (pyridinoline cross-linked carboxyterminal telopeptide of type I collagen – 1CTP) in patients with CaP. Since 2002 we have added 1CTP monitoring into the standard algorithm for monitoring patients with malignant prostate tumours. Currently we have the results of 16,155 examinations in 992 CaP patients in different stages of the disease. RESULTS: The average age of patients at the time of CaP diagnosis is 67.5 years. We monitor the correlation between PSA or sPSA levels, the clinical stage of the disease, ALP and 1CTP. When establishing the diagnosis of CaP, we evaluate the disease staging in all patients (skeletal scintigraphy and possibly other imaging methods: X-ray, CT or MRI) and the levels of the above listed laboratory markers. In patients with long-term hormonal suppression we complement the examination with densitometry (DEXA). In patients with clinical symptomatology or isolated 1CTP increase, we examine the skeleton using scintigraphy. Average 1CTP values differ for the different stages of the disease. In patients without bone disease, the average value of 1CTP is 5.31 ug/l (median 4.55), in M1b patients it is 11.6 ug/l (median 6.58). Any long immobilization of the patient, bone trauma (including benign causes of fractures) or orthopaedic surgery, are accompanied by an śignificant increase in 1CTP. Therefore it is necessary to ask the patient targeted questions about the recent history, before a more deatiled examination of the possible causes of 1CTP elevation is initiated. CONCLUSIONS: The 1CTP level is sensitive to treatment with BMA (bisphosphonates or denosumab). The ALP level reacts much later and only in the case of a more generalised process. The inclusion of bone markers examination into the algorithm of CaP patient dispensarization allows us to abandon regular scintigraphy in these patients and enables a much earlier detection of bone disease in patients with low PSA levels.
Eur Urol Suppl 2016; 15(13);e1681 Powered by TCPDF (www.tcpdf.org)
P097
The importance of 1CTP in the diagnosis and monitoring of bone disease in patients with prostate cancer Eur Urol Suppl 2016; 15(13);e1681
Matoušková M.1, Hanuš M.1, Dudková V.2, Králová V.1 1
Urocentrum, Dept. of Uro-oncology, Prague, Czech Republic, 2Hospital Na Homolce, Dept. of Nuclear Medicine and PET Centrum, Prague, Czech Republic INTRODUCTION & OBJECTIVES: Bone disease accompanies advanced Prostate Cancer (CaP) with high prevalence. For metastatic prostate cancer, bone generalization is proven in up to 90% of patients with varying degrees of pain response syndrome and the potential risk of bone complications. Bone disease is characterised by increased resorption with impaired bone remodelling and impaired calcium metabolism. Clinical symptomatology is preceded and accompanied by abnormalities detectable by laboratory tests or by changes on imaging. MATERIAL & METHODS: We evaluate continuous monitoring of bone resorption markers (pyridinoline cross-linked carboxyterminal telopeptide of type I collagen – 1CTP) in patients with CaP. Since 2002 we have added 1CTP monitoring into the standard algorithm for monitoring patients with malignant prostate tumours. Currently we have the results of 16,155 examinations in 992 CaP patients in different stages of the disease. RESULTS: The average age of patients at the time of CaP diagnosis is 67.5 years. We monitor the correlation between PSA or sPSA levels, the clinical stage of the disease, ALP and 1CTP. When establishing the diagnosis of CaP, we evaluate the disease staging in all patients (skeletal scintigraphy and possibly other imaging methods: X-ray, CT or MRI) and the levels of the above listed laboratory markers. In patients with long-term hormonal suppression we complement the examination with densitometry (DEXA). In patients with clinical symptomatology or isolated 1CTP increase, we examine the skeleton using scintigraphy. Average 1CTP values differ for the different stages of the disease. In patients without bone disease, the average value of 1CTP is 5.31 ug/l (median 4.55), in M1b patients it is 11.6 ug/l (median 6.58). Any long immobilization of the patient, bone trauma (including benign causes of fractures) or orthopaedic surgery, are accompanied by an śignificant increase in 1CTP. Therefore it is necessary to ask the patient targeted questions about the recent history, before a more deatiled examination of the possible causes of 1CTP elevation is initiated. CONCLUSIONS: The 1CTP level is sensitive to treatment with BMA (bisphosphonates or denosumab). The ALP level reacts much later and only in the case of a more generalised process. The inclusion of bone markers examination into the algorithm of CaP patient dispensarization allows us to abandon regular scintigraphy in these patients and enables a much earlier detection of bone disease in patients with low PSA levels.
Eur Urol Suppl 2016; 15(13);e1681 Powered by TCPDF (www.tcpdf.org)