Radium-223 for the treatment of metastatic castration-resistant prostate cancer: A window of opportunity

The elimination of bone metastases, restoration and/or preservation of bone morphology and prevention and/or delay of skeletal events are a fundamental objective in the management of metastatic castration-resistant prostate cancer (mCRPC). Radium-223 is the first targeted alpha therapy with effects on bone that has been shown to increase survival in these patients, besides providing other bone-related benefits.

To analyze the impact of bone metastasis on mCRPC, and the benefits and the window of opportunity provided by radium-223 in the treatment of patients with mCRPC in the current treatment era.

A bibliographic search of PubMed and Spanish and international congresses on radium-223 and other first-line treatments for mCRPC was performed. Recent guidelines and recommendations by experts were also consulted.

Evidence for the mechanism of action of radium-223 widen its effects to the tumor bone environment. Survival of patients treated with radium-223 is higher in those with mild symptoms as opposed to those with moderate-severe symptoms. The presence of visceral metastases even in the early stages of mCRPC supports starting radium-223 therapy before the symptoms become clinically relevant. A 3-year study has confirmed its good safety profile. Changes in tALP and LDH may be useful markers for monitoring the treatment with radium-223, but they are not predictors of overall survival.

Radium-223 is a valuable therapeutic alternative in the treatment of patients with mCRPC in early stages of the disease, with a good safety profile. Its benefits extend to the bone environment.

Actas urologicas espanolas. 2018 Jul 02 [Epub ahead of print]

F Gómez-Veiga, J L Álvarez-Ossorio, J Carballido-Rodríguez, A Juárez-Soto, A Rodríguez-Antolín, J M Cozar-Olmo

Hospital Clínico Universitario de Salamanca, Salamanca, España. Electronic address: ., Hospital Puerta del Mar, Cádiz, España., Hospital Puerta de Hierro, Majadahonda, Madrid, España., Hospital de Jerez, Jerez de la Frontera, Cádiz, España., Hospital 12 de Octubre, Madrid, España., Hospital Virgen de las Nieves, Granada, España.