Significance of Bone Alkaline Phosphatase, CA 15-3 and CEA in the Detection of Bone Metastases During the Follow-Up of Patients Suffering from Breast Carcinoma

Abstract

Summary: After the introduction (1, 2) and methodical evaluation (3, 4) of a new method for the quantitative measurement of the bone isoenzyme of alkaline phosphatase (test-combination bone alkaline phosphatase, Boehringer Mannheim), we started a retrospective clinical study for the follow-up investigations of breast cancer patients. Our aim was to establish the significance of the routinely used tumour markers, CEA and CA 15-3, in combination with bone alkaline phosphatase for the early detection of metastatic spread to the bone. We investigated 492 sera from 92 patients suffering from breast carcinoma, and we compared each date of investigation with the results of the clinical examination and with the results of medical imaging, if that had been performed. From a previous study involving skeleton scintigraphy (5) we knew that single examinations do not allow a differential diagnosis between benign and malignant disorders of the bone, so we based our calculations on differences between sequential investigations. We found that in follow-up investigations of patients with breast carcinoma the combined determination of CEA, CA 15-3 and bone alkaline phosphatase may be indicative for the localisation of metastatic disease. The determination of the bone alkaline phosphatase is easy to handle with a short assay time and good reproducibility; it can therefore be recommended. Introduction,. ,. ~ ^ ,. -earlier diagnosis of recurrent disease, they are not Breast cancer is still the most frequent malignant able to discriminate between the localization of the disease in women, with growing incidence and mor-metastatic spread. Knowing the low specificity and tality rates in Western countries. In the follow-up of sensitivity of skeleton scintigraphy for the early dethese tumour patients the early detection of relapse tection of bone metastases and the high risk of the or metastases is of great importance for successfull development of bone involvement in patients suffering treatment and therefore influences prognosis. The de-from breast carcinoma, it would be of great interest termination of tumour markers in serum, like CEA to determine whether the joint assay of bone alkaline and CA 15-3, is useless for screening or primary di-phosphatase

Simultaneous Assessment of Bone Collagen Synthesis and Degradation in Patients with Different Malignant Tumours Comparison with the Results of 99mTc-Methylene Bisphosphonate Bone Scintigraphy

“…Our results show a high discriminating power of bone alkaline phosphatase values for differentiating between patients with and those without bone metastases, in contrast to the results of van Hoff et al (10) as well as Stieber et al (11) who found no such statistically significant difference. This difference may be due to the different localization of the primary tumours as well as due to the different character of the bone lesions (osteoblastic, osteolytic and mixed, respectively).…”

“…In patients with prostate cancer it has already been shown that serial measurements of the urinary excretion of pyridinium cross-links are suitable for monitoring of clinical progression (29); the same applies to the determination of bone alkaline phosphatase activity in patients with breast cancer (11). Moreover, in patients with tumour-induced osteolysis the urinary excretion of pyridinium cross-links may be a useful quantity for monitoring therapy with agents inhibiting osteoclast activity (e.g., bisphosphonates) (19).…”

Biochemical Evaluation of Glycoprotein Components, Lysosomal Enzymes and Marker Enzymes upon Kalpaamruthaa Administration in Experimental Mammary Carcinoma Rats

“…56) ALP, an orthophosphoric monoester phosphorylase, is found to be the most sensitive marker in metastasis. 57) Stieber et al, 58) have shown that determination of ALP is a rapid method to detect progressive disease in breast cancer and serves to gauge the localization of metastatic diseases. The elevated ALP activity in mammary carcinoma is attributed to the secondary malignancies of mammary carcinoma that metastasizes to bone and liver.…”

Serum CEA and CA 15-3 as prognostic factors in primary breast cancer

“…It is generally agreed that tumour markers in breast cancer patients are not a tool for primary diagnosis, because of their low sensitivity and specificity (Tondini et al, 1989;Fateh-Moghadam and Stieber, 1993;Lamerz et al, 1993). Their use for early detection of metastases seems to be promising (Lamerz et al, 1991;Stieber et al, 1992;Vizcarra et al, 1994;O'Hanlon et al, 1995) and their use for measuring therapeutic response in metastatic disease is widely accepted (Tondini et al, 1988;Dnistrian et al, 1991;Robertson et al, 1991;Safi et al, 1991). Many studies tried to assess the prognostic role of these tumour markers (some analysed in serum, some in tissue), but most of them had low patient numbers or short follow-up periods, and used only univariate analyses (Myers Tormey and Waalkes, 1978;Bezwoda et al, 1981;Mansour et al, 1983;Kallioniemi et al, 1988;Hammer et al, 1992;O'Hanlon et al, 1995).…”