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Keywords:

  • bone metastasis;
  • bone turnover marker;
  • prostate cancer;
  • zoledronic acid;
  • skeletal-related events

Study Type – Prognosis (case series)

Level of Evidence 4

What’s known on the subject? and What does the study add?

  • Bone turnover markers such as BAP and 1CTP in patients with SRE or metastatic bone progression were significantly higher at a later phase after starting treatment with zoledronic acid compared with those without SRE or progression. However, there are no evident biomarkers predicting SRE or survival at an early phase after starting zoledronic acid treatment.

  • The increase in serum 1CTP and BAP levels at an early phase after starting zoledronic acid treatment predicts short SRE-free survival and overall survival. The measurement of bone turnover markers may be useful for physicians to inform patients of their prognosis and to determine the subsequent treatment plan.

OBJECTIVE

• To examine whether bone turnover markers could be predictive markers of the probability of newly arising skeletal-related events (SRE) after the start of zoledronic acid treatment in patients with prostate cancer with bone metastasis.

PATIENTS AND METHODS

• In all, 30 patients with prostate cancer with bone metastasis were treated with zoledronic acid infusion every 4 weeks.

• Serum C-terminal crosslinking telopeptide of type 1 collagen (1CTP), bone alkaline phosphatase (BAP), and prostate-specific antigen (PSA) levels were measured at the start of zoledronic acid treatment to establish baseline values, and every 4 weeks thereafter.

• To judge in the early phase whether zoledronic acid is effective in these patients, we retrospectively compared 1CTP, BAP, and PSA levels at 1, 3, and 6 months after starting zoledronic acid treatment with those at baseline.

RESULTS

• SRE-free survival of patients with increases of 1CTP levels at 1 and 3 months and BAP levels at 3 months were significantly poorer than those of patients with decreases in 1CTP or BAP levels (P = 0.001, P = 0.042, and P = 0.004, respectively).

• Overall survival of patients with increases of 1CTP levels at 1 and 3 months and of BAP levels at 6 months were significantly poorer than those of patients with decreases of 1CTP or BAP levels (P = 0.013, P = 0.027, and P = 0.035, respectively).

CONCLUSION

• The measurement of 1CTP and BAP levels at an early phase after starting zoledronic acid treatment may be useful for physicians to inform patients of their prognosis and to determine the subsequent treatment plan.