However, its use can also lead to many problems, such as overdiagnosis and overtreatment, due to its lack of specificity and poor ability to reflect tumor aggressiveness. Moreover, researchers have demonstrated that serum ALP level is an independent predictor of bone metastasis of prostate cancer. Prostate-specific antigen (PSA) is a protein secreted primarily by prostatic epithelial cells it is one of the most effective serum biomarkers available and has been used in clinical practice for many years.

The first evidence of prostate cancer relapse is an increase in the level of prostate-specific antigen. Patients with localized prostate cancer can undergo radical prostatectomy, which leads to good clinical outcomes, but some patients experience clinical relapse and die from the malignancy. It is the cancer with the second highest mortality in males. Although most prostate cancer cases show indolent tumor behavior, it remains a significant public health problem. In 2018, it was estimated that approximately 164 690 men would be newly diagnosed with prostate cancer and that it would lead to 29 430 deaths in the United States. As the most common and non-cutaneous malignant disease in men in the United States, prostate cancer (PCa) is one of the leading causes of death in older men.

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