Open AccessArticle
Investigation into the Optimal Strategy of Radium-223 Therapy for Metastatic Castration-Resistant Prostate Cancer
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Yasuo Oguma, Makoto Hosono, Kaoru Okajima, Eri Inoue, Kiyoshi Nakamatsu, Hiroshi Doi, Tomohiro Matsuura, Masahiro Inada, Takuya Uehara, Yutaro Wada, Aritoshi Ri, Yutaka Yamamoto, Kazuhiro Yoshimura, Hirotsugu Uemura and Yasumasa Nishimura
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Abstract
The optimal sequence and combination of radium-223 therapy (Ra-223) for castration-resistant prostate cancer with bone metastasis (mCRPC) remain unclear. This study aimed to explore the prognostic factors after Ra-223 administration and to determine the optimal treatment strategy. We enrolled 64 patients with mCRPC
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The optimal sequence and combination of radium-223 therapy (Ra-223) for castration-resistant prostate cancer with bone metastasis (mCRPC) remain unclear. This study aimed to explore the prognostic factors after Ra-223 administration and to determine the optimal treatment strategy. We enrolled 64 patients with mCRPC who underwent Ra-223 therapy from June 2016 to July 2022 at a single institution in Japan. Overall survival (OS) and pain progression-free survival (p-PFS), which was proposed as a measure of quality of life (QOL), were analyzed using Cox proportional hazards models and log-rank tests, and between-factor analysis was performed with the Mann–Whitney U (MWU) test. Univariable and multivariable analyses revealed prognostic factors; specifically, early treatment (≤third line), completion of six treatment cycles, low bone scan index (BSI) (<0.61), alkaline phosphatase (ALP) (<140 U/L), prostate-specific antigen (PSA; <22.9 ng/mL), lactate dehydrogenase (LDH; <240 U/L), high hemoglobin (Hb) (≥11.4 g/dL), and prior denosumab use significantly prolonged OS. Low BSI, low ALP, and early Ra-223 treatment also prolonged p-PFS in the log-rank tests. The MWU test showed that high BSI (≥0.61) was associated with high PSA and high ALP and a tendency for Hb to decrease. Late Ra-223 treatment (≥fourth line) was significantly associated with low Hb and high PSA. Early Ra-223 treatment was significantly associated with improved OS, and administering Ra-223 before novel hormonal or anticancer agents may be meaningful.
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