Elevated Alkaline in the Liver - What does this mean?

After suffering for 2 years with what was deemed a recurring urinary tract infection, my father was diagnosed with stage IV bladder cancer and had a radical cystoprostatectomy (his prostate and bladder removed) 3 years ago.  They believed they were able to remove all of the cancerous cells.  Recently, in one of his regular blood tests, there was an indication of alkaline elevation in his liver.  He has also been experiencing burning in his penis and the need to urinate, even though he no longer has a bladder or urethra.  This pain mirrors exactly what he felt before his cancer was diagnosed 3 years ago.  As a result of this bloodwork, his GP has scheduled a bone scan for him.  We have been unsuccessful in getting any good answers on what all this means and what correlation there might be between the burning pain and the elevation of alkaline in the liver. For instance, why would he be feeling these pains where there is no longer any organ present?  What does the alkaline increase in his liver mean?  Are these indications that his cancer has returned in his liver or elsewhere, or could there be other explanations for these symptoms?  Why does his doctor now want to do a bone scan?  Should he be referred at this point to an oncologist or some other kind of specialist?

[Kevin Pho, MD]

Alkaline phosphatase is an enzyme found in high concentrations in the cells that make bone and in the liver. In the liver, it is found on the edges of cells that join to form bile ducts.

In addition to a variety of liver and gall bladder disorders, bone disorders can also cause an elevation of alkaline phosphatase.  

The first test to do is to determine whether the elevation in alkaline phosphatase is coming from the bone or liver.  This can be done by measuring a GGT, or fractionating the alkaline phosphatase.  

With the bone scan, your GP is assuming that the cause is coming from the bone (perhaps the GGT was normal).  

Regarding further referrals, I would hold off until the results of the bone scan.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.