1Department of urology, the first affiliated hospital of the medical college, shihezi university Shihezi , Xinjiang, P.R.China. 832008 - 2Department of urology, The 3rd hospital of Chengdu, Chengdu Sichuan, P.R.China. 610031 - 3Department of blood transfusion , No.1 Hospital of Jilin University, two, Changchun, Jilin, P.R.China,130000


Objective: To investigate the correlations of ALP, PSA and associated indicators (fPSA, fPSA/tPSA and PSAD) and osseous metastasis in prostate cancer, and the predictive value of these indicators for diagnosis of osseous metastasis of prostate cancer.

Methods: A retrospective study was conducted for 167 prostate cancer patients who were confirmed by needle biopsy of prostate gland or postoperative pathologic examination between September 2014 and August 2017. Osseous metastasis was diag- nosed through ECT, X-ray, CT/MRI or bone biopsy, and we analyzed the correlations of ALP, PSA, fPSA, fPSA/tPSA and PSAD with the osseous metastasis of prostate cancer and their diagnostic value for osseous metastasis.

Results: In 183 patients, there were 114 with osseous metastasis (62.3%) and 69 with non-osseous metastasis (37.7%). In the osseous metastasis group, the levels of ALP, PSA and PSAD were significantly higher than those in the non-osseous metastasis group (p<0.01), while the difference in comparison of fPSA/tPSA between two groups showed no statistical significance (p>0.05). In patients with PSA>50 ng/m, the incidence rate of osseous metastasis was significantly higher than that in those with PSA in concentrations between 20 and 50 ng/mL, 10 and 20 ng/mL and not higher than 10 ng/mL (p<0.05); for patients with ALP larger than 90 U/L, incidence of osseous metastasis was significantly elevated in comparison with that in patients with ALP in concen- tration not higher than 90 U/L (p<0.05); the rate of osseous metastasis in patients with PSAD>0.4 ng/ml/cm3 was significantly higher than that in those with PSAD≤0.4 ng/ml/cm3. With ALP>90 U/L, PSA>50 ng/mL and PSAD>0.4 ng/ml/cm3 as critical val- ues, we analyzed the predictive values of ALP, PSA, PSAD, PSA+ALP, PSA+PSAD and PSA+PSAD+ALP in diagnosis of osseous metastasis in prostate cancer, and the results revealed that combined application of these indicators is more effective for positive and negative predictions in comparison with the single indicator, and combination of PSA+PSAD+ALP showed optimal outcomes in sensitivity (100%), specificity (79.17%), positive predictive value (91.38%) and negative predictive value (100%).

Conclusion: ALP, PSA and PSAD are the reliable indicators for evaluating the osseous metastasis in prostate cancer patients, while the combination of PSA, PSAD and ALP is conducive to prediction of prostate cancer. PSA<50 ng/mL, PSAD<0.4 ng/ml/cm3 and ALP<90 U/L can help physicians to rule out the osseous metastasis.


Prostate cancer, osseous metastasis, prostate specific antigen, prostate-specific antigen density