Analysis of the Role of Alkaline Phosphatase and Gleason Score in Predicting Prognosis and Risk of Bone Metastasis in Prostate Cancer

Background: Prostate cancer ranks as one of the most common malignancies in men and is the second leading cause of cancer-related death. Bone metastasis is a frequent and severe complication, significantly worsening patient prognosis and quality of life. Early identification of bone metastasis risk is critical for guiding clinical decisions. Alkaline phosphatase (ALP) and Gleason score have been studied extensively as predictive markers, though their effectiveness remains debated. Objective: This study aimed to evaluate the predictive value of ALP levels and Gleason scores in assessing bone metastasis risk and prognosis in prostate cancer patients. Methods: A cross-sectional analytical observational study was conducted at Ulin Regional General Hospital, Banjarmasin, from January to June 2025. Forty-eight prostate cancer patients meeting the inclusion criteria were selected. Data including ALP, PSA levels, Gleason score, and radiologic findings were analyzed using logistic and ordinal regression. Predictive accuracy was assessed through ROC curve analysis. Results: Bone metastases were present in 58.3% of patients. ALP was a significant independent predictor of bone metastasis (OR: 1.56; p = 0.008) and showed a positive correlation with Gleason score (β = 0.07; p = 0.001). In contrast, the Gleason score alone was not significantly associated with metastasis (p > 0.05). The ROC curve for ALP demonstrated high diagnostic accuracy with an AUC of 0.923 and an optimal cut-off of 122.35 U/L (sensitivity 78.6%, specificity 95%). Conclusion: ALP outperforms Gleason score as a predictor of bone metastasis and may serve as a valuable prognostic marker in prostate cancer management.