5/6/2023 0 Comments Radium 223 treatment3- 6 However, the majority of the patients eventually develop castration-resistant prostate cancer (CRPC). Docetaxel and drugs interfering with androgen signaling by directly binding to androgen receptor (AR) or inhibiting CYP17A involved in androgen synthesis have increased survival in combination with ADT. 2 Androgen-deprivation therapy (ADT) is the cornerstone for the treatment of metastatic prostate cancer due to the high dependence of prostate cancer cells on androgen signaling. Bone and lymph node metastasis are typical in prostate cancer, but occasionally also visceral or other metastases may be present. 1 The 5-year survival rate for local or regional prostate cancer is over 90%, but metastatic disease remains incurable. Prostate cancer is the second most commonly diagnosed cancer in men and sixth leading cause of cancer-related death among men globally, but even more common cause of cancer-related mortality in Western countries. Our results support using radium-223 for mCRPC patients with symptomatic bone metastases even in the era of new-generation androgen receptor-targeted agents. The efficacy of radium-223 in mCRPC as estimated using OS was comparable to earlier randomized trial in this retrospective real-world study. Pain relief, ALP normalization, lower baseline PSA, and PSA decrease during radium-223 treatment were prognostic for better survival. Radium-223 was well tolerated in routine clinical practice, and most patients achieved pain relief. Only 12.5% of the patients had grade III–IV adverse events, most commonly anemia, neutropenia, leucopenia, and thrombocytopenia. Pain relief indicated better OS ( p = 0.002). Most patients (57%) experienced pain relief. High prostate-specific antigen (PSA) level (≥100 μg/L) before radium-223 treatment was associated with poor OS compared to low PSA level (<20 μg/L) ( p = 0.0001). Alkaline phosphatase (ALP) values within the normal range before and during the radium-223 treatment or the reduction of elevated ALP to normal range during treatment were associated with better OS when compared to elevated ALP values before and during treatment ( p < 0.0001). The median overall survival (OS) was 13.8 months (range 0.5–57 months), and the median real-world progression-free survival (rwPFS) was 4.9 months (range 0.5–29.8 months). We identified 160 patients who had received radium-223 in Finland in 2014–2019. We report results of a retrospective multicenter study including all patients with metastatic CRPC treated with radium-223 in all five university hospitals in Finland since the introduction of the treatment. However, real-world data are also needed with wider inclusion criteria. Results of a previously reported phase III randomized trial showed survival benefit for radium-223 compared to best supportive care in castration-resistant prostate cancer (CRPC) with bone metastases. Radium-233 dichloride is an alpha emitter that specifically targets bone metastases in prostate cancer.
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