title: Radium-223 and metastatic castration-resistant prostate cancer: All that glitters is not gold.
abstract: After being approved by the National Drug Agency in several countries, Radium-223 (Ra-223) is gaining wide acceptance in the treatment of bone metastatic castration resistant prostate cancer. The exact mechanism of action remain unclear: The established model of direct alpha-particle irradiation from the remodelling bone surface, where Ra-223 accumulates, surrounding the tumor foci can explain a lethal effect only on metastatic microdeposits, but not on higher tumor burden. According to the "pre-metastatic niche model", it is likely that Ra-223 targets several non-tumoral cell types of the tumor microenvironment involved in the complex mechanism of cancer bone homing and colonization. A deeper insight into this hypothetical mechanism will lead to a more accurate dosimetric approach and to find optimal sequencing and/or combination with the other therapeutic options.
authors.affiliation: Carlo Aprile, Marco G Persico, Lorenzo Lodola, Federica E Buroni, Nuclear Medicine Unit, Department of Oncohaematology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Aprile
authors.affiliation: Carlo Aprile, Marco G Persico, Lorenzo Lodola, Federica E Buroni, Nuclear Medicine Unit, Department of Oncohaematology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy.
authors.forename: Marco G
authors.initials: MG
authors.lastname: Persico
authors.affiliation: Carlo Aprile, Marco G Persico, Lorenzo Lodola, Federica E Buroni, Nuclear Medicine Unit, Department of Oncohaematology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Lodola
authors.affiliation: Carlo Aprile, Marco G Persico, Lorenzo Lodola, Federica E Buroni, Nuclear Medicine Unit, Department of Oncohaematology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy.
authors.forename: Federica E
authors.initials: FE
authors.lastname: Buroni
keywords: Bone metastases; Castration resistant prostate cancer; Pre-metastatic niche model; Radium-223; Tumor microenvironment