Faruk Recep ÖZALP, Ahmet Melih ARSLAN, Özge YETGİNOĞLU, Hüseyin Salih SEMİZ
Journal of Basic and Clinical Health Sciences - 2026;10(2):222-228
Purpose: Metastatic hormone-sensitive prostate cancer requires accessible biomarkers for better prognostication. This study investigated the prognostic value of the alkaline phosphatase-to-albumin ratio (APAR) in metastatic hormone-sensitive prostate cancer survival risk stratification. Methods: We retrospectively analyzed 128 metastatic hormone-sensitive prostate cancer patients treated at a single institution between January 2015 and January 2025. A cut-off of 2.92 for the alkaline phosphatase-to-albumin ratio was determined via receiver operating characteristic analysis. Overall survival was assessed using Kaplan-Meier methods and multivariable Cox regression adjusting for standard prognostic factors, including tumor volume and Gleason score. Results: Patients with an alkaline phosphatase-to-albumin ratio of 2.92 or higher had significantly shorter overall survival compared to those with a ratio lower than 2.92 (log-rank p<0.001). In multivariable analysis, an alkaline phosphatase-to-albumin ratio of 2.92 or higher remained an independent predictor of poor overall survival (Hazard Ratio 3.26, 95% Confidence Interval 1.76-5.97; p<0.001), alongside Eastern Cooperative Oncology Group performance status (ECOG PS). Conclusion: The alkaline phosphatase-to-albumin ratio is an inexpensive, accessible marker that independently predicts survival in metastatic hormone-sensitive prostate cancer. APAR should be interpreted as a supportive, complementary marker alongside established clinical parameters such as ECOG PS, Gleason grade, and metastatic burden rather than as a standalone determinant. It holds promise for early risk stratification, though prospective validation is warranted
