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Author reply

2002; Wiley; Volume: 95; Issue: 5 Linguagem: Inglês

10.1002/cncr.10795

1097-0142

Guido Francini, Roberto Petrioli, Pierpaolo Correale, Daniele Pozzessere, Stefania Marsili, Stefano Gonnelli, A Montagnani, B. Lucani, Roberto Di Monaco, Stefania Rossi, Antonio Manganelli, Francesco Salvestrini, Anna Ida Fiaschi,

Cancer Diagnosis and Treatment

We thank Berruti et al. for their comments. In relation to their first comment, unlike some of our previous studies,1, 2 this study was not designed to investigate the role of parathyroid hormone (PTH)-related protein (PTHrP) in the genesis of bone metastases. Serum PTHrP levels, as stated in the text (page 1472, second column, lines 2–5), were higher in the group of patients with bone metastases compared with levels in the group of patients without bone metastases, but this difference was not statistically significant. This nonsignificant difference also has been reported by other authors.3, 4 With reference to the correlation between serum PTH levels and metastatic bone involvement that Berruti et al. state we should have found, we would like to point out that the higher serum PTH levels in our patients with bone metastases than in patients without bone metastases, again, was statistically nonsignificant. To the best of our knowledge, the possibility that serum PTH levels can discriminate between patients with prostate carcinoma with or without bone metastases remains to be defined.5-7 Berruti et al. previously reported8 a statistically significant correlation between serum PTH levels and metastatic bone involvement in a completely heterogeneous population in which patients with bone metastasis of various origin were compared (including patients with thyroid, gastroenteric tract, lung, breast, urinary pathway, head-and-neck, and other carcinomas), but this finding cannot be compared with those of any other study that is not based on a perfectly similar population. Finally, the objective of our study was to verify whether the urinary excretion of calcium (UCa/Cr) may be useful in evaluating the response of bone metastases to treatment. Among others, we measured two classical bone resorption markers: hydroxyproline and C-terminal telopeptide (ICTP). We do not know whether the N-telopeptide (NTX) can provide better results, because the scientific community is still awaiting definitive data. The only published results concerning NTX refer to the monitoring of patients with bone metastases from breast carcinoma, and, to the best of our knowledge, these have never been compared with the UCa/Cr ratio.9, 10 With regard to bone alkaline phosphatase, we could discuss forever the question of osteoblastic flares (which Berruti et al. define as a > 15% increase in the already very high levels of total alkaline phosphatase!). However, even assuming that it can be demonstrated unequivocally, an osteoblastic flare may be related to the beginning of hormone therapy, because it is widely known that it can be caused by lutenizing hormone-releasing hormone therapy.11, 12 However, these speculations have nothing to do with our patients, because they all developed recurrent disease during hormone therapy (see Materials and Methods, page 1469, lines 1–3). In conclusion, we do not share the perplexities of Berutti et al. concerning the validity of the UCa/Cr ratio as a marker of bone turnover in prostate cancer patients. It is very easy and inexpensive to measure, highly sensitive and undoubtedly useful in monitoring the evolution of bone metastases in prostate cancer patients. It also has the advantages that it involves little patient discomfort and reduces community health costs. We thank the Editorial Board of Cancer for giving us this opportunity to make our experience known to the international scientific community. Guido Francini M.D.*, Roberto Petrioli M.D.*, Pierpaolo Correale M.D.*, Daniele Pozzessere M.D.*, Stefania Marsili M.D.*, Stefano Gonnelli M.D. , Andrea Montagnani M.D. , Barbara Lucani Ph.D. , Roberto Monaco M.D. , Stefania Rossi Ph.D. , Antonio Manganelli M.D.§, Francesco Salvestrini M.D.¶, Anna I. Fiaschi Ph.D.**, * Medical Oncology Division, Institute of Internal Medicine, University of Siena, Siena, Italy, Institute of Internal Medicine, University of Siena, Siena, Italy, Department of Statistics, University of Siena, Siena, Italy, § Urology Department, University of Siena, Siena, Italy, ¶ Clinical Urology, University of Siena, Siena, Italy, ** Pharmacology Department, University of Siena, Siena, Italy.