Radium-223-Dichloride in Castration Resistant Metastatic Prostate Cancer-Preliminary Results of the Response Evaluation Using F-18-Fluoride PET/CT: Beyond the Abstract

This article [1] is a comprehensive analysis of 10 prostate cancer patients who received Ra-223-treatments. These patients were imaged with multiple quantitative PET methods according to our own algorithm [2], including fluoro-18-choline-PET and sodium fluoride-18 PET. These patients were additionally treated with multidisciplinary methods, including other radiation therapies. We recently reported an overall survival of 8.4 years in 46 patients of high-risk T3-4NXM1 primarily metastatic prostate cancer [2].

It turned out, that the response to Ra-223-treatment could be best assessed with sodium fluoride-18 PET. The local reactions in the metastatic bone were seen in the PET studies.

However, it was not possible to predict the outcome of the therapy after the first Ra-223-therapy cycle, but after the 6th cycle. All 10 patients demonstrated at least minor skeletal response in sodium fluoride-18 PET. Also flare phenomenon was sometimes associated with early interim imaging after the first cycle.

Now, these findings have been characterized by other investigators, by introducing quantitative PET interpretation criteria [3].  Our modified PERCIST criteria for response assessment in Ra-223-treatment are useful and simple, and can be used in the clinical routine. According to our experience Ra-223 is an essential part of treatment of metastatic castration resistant prostate cancer, if the disease is mainly in the skeleton.

Written by: Kalevi Kairemo, Docrates Cancer Center, Helsinki, Finland & MD Anderson Cancer Center, Houston, TX, USA

References:
1. Kairemo K, Joensuu T. Radium-223-Dichloride in Castration Resistant Metastatic Prostate Cancer-Preliminary Results of the Response Evaluation Using F-18-Fluoride PET/CT. Diagnostics (Basel). 2015; 5: 413-427. 

2. Joensuu T, Joensuu G, Kairemo K, Kiljunen T, Riener M, Aaltonen A, et al. Multimodal Primary Treatment of Metastatic Prostate Cancer with Androgen Deprivation and Radiation. Anticancer Res. 2016; 36: 6439-6447.

3. Rohren E, Etchebehere EC, Araujo JC, Hobbs BP, Swanston NM, Everding M, et al. Determination of Skeletal Tumor Burden of 18F-Fluoride PET/CT. J Nucl Med Mol 2015; 56: 1506-1512. 

Read the abstract




E-Newsletters

Newsletter subscription

Free Daily and Weekly newsletters offered by content of interest

The fields of GU Oncology and Urology are rapidly advancing. Sign up today for articles, videos, conference highlights and abstracts from peer-review publications by disease and condition delivered to your inbox and read on the go.

Subscribe