1877 EVALUATION OF ALKALINE PHOSPHATASE AS A MARKER FOR BONE METASTASIS IN PATIENTS WITH MUSCLE-INVASIVE BLADDER CANCER

Abstract

You have accessJournal of UrologyBladder Cancer: Metastatic Disease + Staging1 Apr 20131877 EVALUATION OF ALKALINE PHOSPHATASE AS A MARKER FOR BONE METASTASIS IN PATIENTS WITH MUSCLE-INVASIVE BLADDER CANCER Phillip Abbosh, Adam Kibel, Janine Oliver, and Robert Grubb Phillip AbboshPhillip Abbosh St Louis, MO More articles by this author , Adam KibelAdam Kibel Boston, MA More articles by this author , Janine OliverJanine Oliver St Louis, MO More articles by this author , and Robert GrubbRobert Grubb St Louis, MO More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2296AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Skeletal metastases are common in patients with muscle invasive bladder cancer. Proper staging is critical in treatment planning. The NCCN recommends screening history, physical, and serum alkaline phosphatase (AP) followed by bone scintigraphy if these screens are positive. We sought to determine the performance of AP as a marker for bone metastasis in patients with muscle-invasive or clinically metastatic bladder cancer. METHODS Patient clinical, radiological, surgical, pathological, and laboratory data was entered into a database of patients with muscle-invasive or clinically metastatic disease and a bone scan or 18F-fluorodeoxyglucose postiron emission tomography/computed tomography (PET/CT) and no other malignancy. Patient data was collected from 1 Jan 2004 to 31 Jan 2011. Patients were considered to have bone metastasis if the bone scan or PET/CT showed bone metastasis or if they had pathologically proven bone metastasis. Confirmatory biopsy was not routinely performed. AP values were collected within 2 months before or after skeletal evaluation and were considered positive if elevated above normal thresholds. If AP values before and after skeletal evaluation were measured, then only the value prior to skeletal evaluation was used. We calculated the sensitivity, specificity, negative and positive predictive value of AP in evaluating for bone metastasis. RESULTS 176 patients were identified with muscle-invasive or clinically metastatic bladder cancer and had valid AP data. 38 (22%) patients had bone metastasis. AP was elevated in 38 patients, 18 of whom had bone metastasis. AP was normal in 138 patients, 20 of whom had bone metastasis. The sensitivity, specificity, positive and negative predictive values for elevated AP as a marker for bone metastasis are 47%, 86%, 47%, and 86%, respectively. CONCLUSIONS AP as a marker for bone metastasis exhibits reasonable specificity and negative predictive value. However, following current NCCN guidelines and only obtaining bone scan if AP is elevated could miss half of patients with bone metastasis. The high risks associated with missing bony metastatic disease may prompt consideration of skeletal imaging in all patients with muscle-invasive bladder cancer, regardless of their AP levels. + Skeletal disease - Skeletal disease Abnormal AP 18 20 Normal AP 20 118 © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e770 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Phillip Abbosh St Louis, MO More articles by this author Adam Kibel Boston, MA More articles by this author Janine Oliver St Louis, MO More articles by this author Robert Grubb St Louis, MO More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...