title: Radium-223 in Heavily Pretreated Metastatic Castrate-Resistant Prostate Cancer.
abstract: Radium-223 is a bone-targeting radiopharmaceutical that extends survival in mCRPC. Postapproval data are limited, and the value of biochemical and radiologic monitoring during radium therapy is unknown.
  
  
  
  We conducted a retrospective study of 29 patients with mCRPC who received radium-223 at 1 of 3 participating institutions between August 2013 and December 2014. Trend of PSA, radiographic changes, and association of biochemical and clinical variables with PSA trend were measured.
  
  
  
  The median age of patients was 70 years, 79% of patients (N = 23) were European Americans, and 17% of patients (N = 5) were African Americans. Twenty patients (69%) had received at least 3 lines of prior therapies. Some 38% of patients (N = 11) received all 6 cycles of radium-223. Twenty patients (69%) had an increase in PSA during radium therapy, and 4 patients (14%) had a decline in PSA levels. Five patients had visceral metastases on computed tomography imaging performed during the course of radium-223.
  
  
  
  Radium therapy in mCRPC was associated with an increase in PSA in the majority of these heavily pretreated patients. The development of visceral disease was not uncommon, suggesting a need for follow-up computed tomography monitoring during radium-223 therapy. The significance of early increases in PSA and pain with radium-223 is still uncertain. Although pain and PSA flare have been reported in patients who subsequently have a dramatic response to therapy, we observed that a PSA increase or pain flare correlates to an improvement in bone scans only in a minority of patients.
authors.affiliation: Department of Internal Medicine, University Health Center, Wayne State University/Detroit Medical Center, Detroit, MI.
authors.forename: Dipenkumar
authors.initials: D
authors.lastname: Modi
authors.affiliation: Department of Hematology-Oncology, Henry Ford Health System, Detroit, MI.
authors.forename: Clara
authors.initials: C
authors.lastname: Hwang
authors.affiliation: Department of Hematology-Oncology, Indiana University, Indianapolis, IN.
authors.forename: Hirva
authors.initials: H
authors.lastname: Mamdani
authors.affiliation: Biostatistics Core, Department of Oncology, Karmanos Cancer Institute, School of Medicine, Wayne State University, Detroit, MI.
authors.forename: Seongho
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, McLaren Cancer Institute, Flint, MI.
authors.forename: Hesham
authors.initials: H
authors.lastname: Gayar
authors.affiliation: Department of Hematology-Oncology, Karmanos Cancer Institute/Wayne State University, Detroit, MI.
authors.forename: Ulka
authors.initials: U
authors.lastname: Vaishampayan
authors.affiliation: Department of Nuclear Medicine, Wayne State University, Detroit, MI.
authors.forename: Richard
authors.initials: R
authors.lastname: Joyrich
authors.affiliation: Department of Hematology-Oncology, Karmanos Cancer Institute/Wayne State University, Detroit, MI. Electronic address: heathe@karmanos.org.
authors.forename: Elisabeth I
authors.initials: EI
authors.lastname: Heath
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D017430:Prostate-Specific Antigen / Q000378:metabolism*; D064129:Prostatic Neoplasms, Castration-Resistant / Q000188:drug therapy* / Q000208:ethnology / Q000378:metabolism; D011868:Radioisotopes / Q000008:administration & dosage / Q000627:therapeutic use; D011883:Radium / Q000008:administration & dosage* / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States / Q000208:ethnology; D044465:White People / Q000706:statistics & numerical data
chemical_list: D000970:Antineoplastic Agents; D011868:Radioisotopes; D017430:Prostate-Specific Antigen; C581106:radium Ra 223 dichloride; D011883:Radium
keywords: Alpha-emitter; Bone scan; Bone-targeting radiopharmaceutical; Pain flare-up; Prostate-specific antigen