title: Pain, PSA flare, and bone scan response in a patient with metastatic castration-resistant prostate cancer treated with radium-223, a case report.
abstract: BACKGROUND
  Radium-223 has been shown to improve overall survival in men with metastatic castration-resistant prostate cancer with symptomatic bone metastases. The bone scan response to radium-223 has only been described in one single center trial of 14 patients, none of whom achieved the outstanding bone scan response presented in the current case.
  
  
  METHODS
  In this case report, we describe a 75 year-old white man with extensively pre-treated metastatic castration-resistant prostate cancer and symptomatic bone metastases who experienced a flare in pain and prostate-specific antigen, followed by dramatic clinical (pain), biochemical (prostate-specific antigen), and imaging (bone scan) response.
  
  
  CONCLUSIONS
  The flare phenomena and bone scan response we observed have not previously been described with radium-223. This case suggests that the degree and duration of bone scan response may be predictive of overall survival benefit.
authors.affiliation: Division of Medical Oncology, Duke University Medical Center, Durham, NC, USA. Megan.diehl@duke.edu.|Duke University Medical Center, 1 Trent Drive, Morris Building Rm #25169, Box 3841, Durham, NC, 27710, USA. Megan.diehl@duke.edu.
authors.forename: Megan A
authors.initials: MA
authors.lastname: McNamara
authors.affiliation: Division of Medical Oncology, Duke University Medical Center, Durham, NC, USA. Daniel.george@dm.duke.edu.|Duke University Medical Center, 10 Bryan Searle Drive, 471 Seeley Mudd Bldg, Box 102002, Durham, NC, 27710, USA. Daniel.george@dm.duke.edu.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: George
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology / Q000556:secondary*; D006801:Humans; D007610:Kallikreins / Q000378:metabolism; D008297:Male; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D017430:Prostate-Specific Antigen / Q000378:metabolism; D064129:Prostatic Neoplasms, Castration-Resistant / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D011868:Radioisotopes / Q000627:therapeutic use; D011883:Radium / Q000627:therapeutic use*; D014055:Tomography, Emission-Computed; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D011868:Radioisotopes; C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen; C581106:radium Ra 223 dichloride; D011883:Radium