Download - Biomarker Form

BIOMARKERS & HORMONE LEVELS

This form is a magnified portion of the flow sheet; it concentrates on the biologic markers (biomarkers) and hormone levels associated with PC. Durable responses as a result of treatment are more likely if all biologic expressions of cancer growth are minimized (Steineck G, Kelly WK, Mazumdar M, et al: Urology 47:719-26, 1996). PC cells make innumerable products of which we only measure a few. It makes a great deal of sense that if we are to induce complete remissions in PC, we must identify the biomarkers of disease activity and determine if our treatments suppress all of these products.

Typical garden variety PC produces mostly PSA. However, as the tumor undergoes mutation and as more primitive cell populations are expressed within the cancer cell population, other markers such as PAP, CGA, NSE and CEA are produced. This form directs our attention to such markers and calls for their baseline measurement. In essence, we are assessing the tumor cell population for products indicating more aggressive variants of PC. If we find elevations of any of these biomarkers, it would be appropriate to not only follow their level over the course of therapy, but to also identify sites of disease activity associated with such biomarker expression.

PAP not uncommonly is elevated in PC that has spread to the bone. This may be related to the fact that PAP is an enzyme (a phosphatase) that digests (hydrolyzes) phosphates within the bone marrow. This enzyme is most active at an acid pH and therefore it is called prostatic acid phosphatase or PAP. The growth and spread of PC may be facilitated by PAP expression.

CGA and NSE elevations, especially in concert, are associated with a small cell variant of PC. In such patients, looking for disease activity in liver and lung is reasonable. Patients with small cell PC (SCPCP) often have bone metastases that are not readily seen on bone scan but are seen as lytic or destructive lesions on plain x-rays or on CT scans. Such patients may have relatively little PSA expression.

The middle section of this form relates to the endocrine aspects of PC. PC is an endocrine disease for the most part. When we use ADT or androgen deprivation therapy, we deprive the tumor of needed androgens. We cannot intelligently treat this type of a disease unless we monitor the endocrine production from the PC cell population. It is imperative that men on ADT have their testosterone (T) levels checked to see if therapy has brought them to castrate levels (<20 ng/dl). Once this has been confirmed, there is no need to continue repeating this measurement. If T is not suppressed to this level, PC tumor regression may not be complete. If LH suppression by the LHRH agonists like Lupron or Zoladex is inadequate to totally suppress T, then measuring LH will confirm this suspicion. Measuring DHEA-S and Androstenedione may indicate high production of these adrenal androgen precursors. Such hormones are metabolized within the PC cell to T and from there to DHT. Both T and DHT contribute to PC cell growth. Measuring these agents gives us clues as to ways we can manipulate the tumor cell population. This is also true if we find the prolactin level elevated. This form therefore focuses on the biology and endocrinology of PC. Other measurements are indicated as well for evaluating bone integrity, cholesterol, thyroid status and iron stores.

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Download Biomarker Form.rtf - Right click the link and choose "Save Target As" or "Save Link As". File type is for Microsoft Word 2000/7.0/97 and other word processors.

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Download Biomarker Form.pdf - Contains the file in Adobe Acrobat "PDF" format for universal viewing and printing.

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