Predictive implications of bone turnover markers after palliative treatment with (186)Re-HEDP in hormone-refractory prostate cancer patients with painful osseous metastases.

Abstract

PURPOSE:

To prospectively evaluate the predictive value of various bone formation and resorption markers in patients with bone metastases from prostate cancer after palliative treatment with (186)Re-1,1-hydroxyethylidene diphosphonate ((186)Re-HEDP).

METHODS:

Included in the study were 36 men with prostate cancer, suffering from painful osseous metastases and treated with (186)Re-HEDP. None had received any treatment that would have interfered with bone metabolism before (186)Re-HEDP treatment or throughout the follow-up period. For each patient, pretreatment and posttreatment serum levels of osteocalcin (OC), bone alkaline phosphatase (BALP), aminoterminal (PINP) and carboxyterminal (PICP) propeptides of type I collagen, amino-terminal (NTx) and carboxyterminal (CTx) telopeptides of type I collagen and their combinations were compared with the level and duration of pain response to radionuclide treatment.

RESULTS:

Pain response was correlated only with pretreatment NuTaux/PINP, PICP/PINP and NTx/CTx ratios and posttreatment decrease in baseline NTx and PICP values (p = 0.0025-0.035). According to multivariate and ROC analyses, the best marker-derived predictors of better and longer duration of response to (186)Re-HEDP treatment were a posttreatment decrease in NTx of > or = 20% (RR = 3.44, p = 0.0005) and a pretreatment NTx/PINP ratio of > or = 1.2 (RR = 3.04, p = 0.036)

CONCLUSION:

NTx, a potent collagenous marker of bone resorption, along with the novel NTx/PINP ratio provide useful cut-off values for identifying a group of patients suffering from painful osseous metastases from hormone-refractory prostatic carcinoma who do not respond to palliative treatment with (186)Re-HEDP. This information could help avoid an inefficient and expensive radionuclide treatment. Also, in the cohort of patients who will eventually undergo such treatment, the medium-term posttreatment changes in NTx offer valuable predictive information regarding long-term palliative response.

• Authors: Athanasios Zafeirakis, Georgios Papatheodorou, Athanasios Arhontakis, Athanasios Gouliamos, Lambros Vlahos, Georgios S Limouris
• Journal: European journal of nuclear medicine and molecular imaging (Eur J Nucl Med Mol Imaging) Vol. 37 Issue 1 Pg. 103-13 (Jan 2010) ISSN: 1619-7089 [Electronic] Germany
• PMID: 19662405 (Publication Type: Clinical Trial, Journal Article)

Chemical References

• Biomarkers, Tumor
• Collagen Type I
• Gonadal Steroid Hormones
• Neoplasm Proteins
• Radiopharmaceuticals

Topics

• Adult
• Aged
• Aged, 80 and over
• Biomarkers, Tumor (blood)
• Bone Neoplasms (blood, diagnosis, radiotherapy, secondary)
• Collagen Type I (blood)
• Gonadal Steroid Hormones (therapeutic use)
• Humans
• Male
• Middle Aged
• Neoplasm Proteins (blood)
• Pain (blood, diagnosis, etiology, prevention & control)
• Palliative Care (methods)
• Prognosis
• Prostatic Neoplasms (blood, diagnosis, radiotherapy)
• Radiopharmaceuticals (therapeutic use)
• Reproducibility of Results
• Sensitivity and Specificity
• Treatment Failure
• Treatment Outcome