Radium-223 (Ra-223) is a targeted alpha therapy that has been shown to prolong overall survival (OS) in patients with metastatic castration-resistant prostate cancer (mCRPC) with bone metastases. However, prognosis after Ra-223 administration varies among patients. The aim of the present study was to assess risk factors associated with the poor prognosis of patients treated with Ra-223.
We retrospectively reviewed patients’ records of treatment with Ra-223 between October 2016 and December 2019. All patients had mCRPC, bone metastasis, and no known visceral metastases, and received up to six cycles of Ra-223 (55 kBq/kg). Prognostic factors for OS were analyzed by Cox proportional hazards model and log-rank test.
We identified 42 patients who received at least one cycle of Ra-223 (median six cycles, range 1–6). Approximately two-thirds of patients had received at least two lines of therapy for mCRPC. The median age was 74 years, and the median follow-up duration was 13.6 months. The median OS time was 16.6 months. On multivariate analysis, PSA doubling time (PSADT) (0–3 months) at baseline, number of bone metastases (≥ 20), and treatment line of Ra-223 (4th–5th line) remained significantly correlated with the poor OS (HR 4.354, P = 0.003; HR 2.855, P = 0.020; and HR 4.871, P = 0.001, respectively).
Our study demonstrated that a shorter PSADT, a heavier volume of bone metastases, and a later treatment line before Ra-223 are poor prognostic factors for mCRPC patients. These newly discovered risk factors may help select patients who potentially have long-term OS after Ra-223 treatment.
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Metastatic castration-resistant prostate cancer
PSA doubling time
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The authors wish to thank the patients and their families for participating in this study, as well as the staff for supporting the study. We also thank H. Nikki March, PhD, from Edanz Group (https://www.edanzediting.com/ac) for editing a draft of this manuscript.
Conflict of interest
KN received speaker honoraria from Astellas, Novartis and Bayer; research funding from Bayer outside the submitted work. Remaining authors declare that they have no conflict of interest.
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Yamamoto, Y., Okuda, Y., Kanaki, T. et al. Clinical indicators for predicting prognosis after radium-223 administration in castration-resistant prostate cancer with bone metastases. Int J Clin Oncol 26, 192–198 (2021). https://doi.org/10.1007/s10147-020-01776-w
- Castration-resistant prostate cancer
- Number of bone metastases
- Overall survival
- PSA doubling time