Management of metastatic castration-resistant prostate cancer: A focus on radium-223: Opinions and suggestions from an expert multidisciplinary panel

Radium-223, a calcium mimetic bone-seeking radionuclide that selectively targets bone metastases with alpha particles, is approved for the treatment of men with metastatic castration-resistant prostate cancer (mCRPC) and symptomatic bone metastases. In patients with mCRPC, treatment with radium-223 has been associated with survival benefit, regardless of prior docetaxel use, and also has a positive impact on symptomatic skeletal events and quality of life. Radium-223 is best suited for patients with symptomatic mCRPC and bone-predominant disease and no visceral metastases, and may lead to better outcomes when given early in the course of the disease. An expert multidisciplinary panel convened in Milan, Italy to review the current best-evidence literature on radium-223 and to convey their personal expertise with the use of radium-223 and identify possible strategies for best practice. This article summarizes the best available evidence for the use of radium-223, discusses the essential role of the multidisciplinary team in delivering effective treatment for mCRPC, clarifies pre- and post-treatment evaluation and monitoring, and outlines future scenarios for radium-223 in the treatment of men with MCRPC.

Critical reviews in oncology/hematology. 2017 Mar 06 [Epub]

Sergio Baldari, Giuseppe Boni, Roberto Bortolus, Orazio Caffo, Giario Conti, Giuseppe De Vincentis, Fabio Monari, Giuseppe Procopio, Daniele Santini, Ettore Seregni, Riccardo Valdagni

Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University of Messina, Italy. Electronic address: ., Department of Radiology and Nuclear Medicine, University of Pisa, Pisa, Italy., Radiotherapy Oncology, National Cancer Institute CRO, Aviano PN, Italy., Medical Oncology Department, Santa Chiara Hospital Trento, Italy., Department of Urology, S. Anna Hospital, Como, Italy., Department of Radiological, Oncological and Anatomo-Pathological Sciences, Nuclear Medicine Unit, Sapienza University, Rome, Italy., Radiotherapy, Department of Hematology and Oncology, Policlinico S. Orsola, Bologna, Italy., Genitourinary Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy., Medical Oncology, Campus Bio-Medico University, Rome, Italy., Nuclear Medicine Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy., Department of Oncology and Hemato-oncology, Università degli Studi di Milano, Milan; Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.

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