In patients with castration resistant prostate cancer(CRPC), the most frequent site of metastases is bone particularly with osteoblastic change, which accounts for 90% at the late stage of CRPC and is accompanied by symptomatic skeletal symptoms(SSEs)such as bone pain or pathological fractures. Radium-223(Ra-223)dichloride emits α particles and has been proven to improve overall survival(OS)and QOL by reducing SSEs in metastatic CRPC patients. Although hemotoxic adverse events(AEs)of Ra-223 treatment including anemia, neutropenia and thrombocytopenia, and non-hemotoxic AEs including nausea, diarrhea and bone pain have been reported, they were mild and well tolerated. The completion of 6 injections of Ra-223 is important for prolonging OS. The optimal time of Ra-223 administration is recommended the duration when PSA is increasing regardless of abiraterone or enzalutamide treatment prior to chemotherapy.
Clinical calcium. 2018 Jan [Epub]
Hiroji Uemura
Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Japan.