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Clinical indicators for predicting prognosis after radium-223 administration in castration-resistant prostate cancer with bone metastases

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Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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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Abbreviations

AE:

Adverse event

ALP:

Alkaline phosphatase

HR:

Hazard ratio

mCRPC:

Metastatic castration-resistant prostate cancer

LDH:

Lactate dehydrogenase

OS:

Overall survival

OR:

Odds ratio

PS:

Performance status

PSADT:

PSA doubling time

Ra-223:

Radium-223

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Acknowledgements

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.

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Authors and Affiliations

  1. Department of Urology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan

    Yoshiyuki Yamamoto, Yohei Okuda, Tomohiro Kanaki, Ryo Tanaka, Akira Nagahara, Yasutomo Nakai, Masashi Nakayama, Ken-ichi Kakimoto & Kazuo Nishimura

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  1. Yoshiyuki Yamamoto
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  2. Yohei Okuda
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  3. Tomohiro Kanaki
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  4. Ryo Tanaka
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  5. Akira Nagahara
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  6. Yasutomo Nakai
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  7. Masashi Nakayama
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  8. Ken-ichi Kakimoto
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  9. Kazuo Nishimura
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Corresponding author

Correspondence to Kazuo Nishimura.

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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

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  • DOI: https://doi.org/10.1007/s10147-020-01776-w

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