Longitudinal change in castration-resistant prostate cancer biomarker AST/ALT ratio reflects tumor progression

We investigated whether aspartate transaminase (AST)-to-alanine aminotransferase (ALT) ratio and its change during the course of treatment in castration-resistant prostate cancer (CRPC) patients is associated with tumor condition and lethality. Clinical data from 130 CRPC patients were retrospectively evaluated. AST/ALT ratios at the time of prostate cancer (PC) diagnosis, androgen deprivation therapy (ADT), CRPC diagnosis, and the final follow-up examination after CRPC treatment were calculated for each. The prognostic capabilities of the AST/ALT ratio for overall survival (OS) were analyzed by the Kaplan-Meier method and Cox hazard models. The median AST/ALT ratio at the PC diagnosis was 1.517 and the optimal value predicting lethality defined by the receiver operating curve was 1.467. The AST/ALT ratio decreased once during ADT and then elevated in a stepwise manner with cancer progression. The median AST/ALT ratio at the PC diagnosis in surviving patients was 1.423, which did not change longitudinally, whereas that of in deceased patient was significantly higher (1.620) and further elevated after CRPC diagnosis. Kaplan-Meier curves indicated significantly worse OS in patients with the AST/ALT ratio ≥ 1.467, which was confirmed by multivariate analysis. We identified the AST/ALT ratio as a prognostic biomarker for CRPC that changed longitudinally reflecting tumor progression.