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Clinical Research

Imaging response during therapy with radium-223 for castration-resistant prostate cancer with bone metastases—analysis of an international multicenter database

Prostate Cancer and Prostatic Diseases volume 20, pages 289–293 (2017)Cite this article

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Abstract

Background:

The imaging response to radium-223 therapy is at present poorly described. We aimed to describe the imaging response to radium-223 treatment.

Methods:

We retrospectively evaluated the computed tomography (CT) and bone scintigraphy response of metastatic castration-resistant prostate cancer (CRPC) patients treated with radium-223, in eight centers in three countries.

Results:

A total of 130 patients were included, the majority (n=84, 65%) received radium-223 post docetaxel. Thirty-four of 99 patients with available data (34%) received concomitant abiraterone or enzalutamide. A total of 54% (n=70) patients completed the planned six injections of radium-223. In patients with available data, a transient increase in bone metastases-related pain was observed in 27% (n=33/124) and an improvement of bone metastases-related pain on treatment with radium-223 was noted in 49% of patients (n=61/124). At 3 and 6 months of treatment with radium-223, bone imaging showed stable disease in 74% (n=84/113) and 94% of patients (n=93/99) with available data, respectively. An increase in the number of bone lesions was documented at 3 months compared with baseline in 26% (n=29/113) and at 6 months compared with 3 months in 6% of patients (n=6/99), respectively. Radiological extraskeletal disease progression occurred in 46% of patients (n=57/124) with available CT data at 3 and/or 6 months.

Conclusions:

Progression of bone metastases during radium-223 therapy is uncommon. A bone flare (pain and/or radiological) may be noted during the first 3 months, and should not be confused with progression. Imaging by CT scan should be considered after three and six doses of radium-223 to rule out extraskeletal disease progression.

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Author information

Author notes

  1. D Keizman and M O Fosboel: These two authors contributed equally to this work.

  2. G Daugaard and A Omlin: These two authors contributed equally to this work.

Authors and Affiliations

  1. Genitourinary Oncology Service, Institute of Oncology, Meir Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    D Keizman, M Gottfried & H Dresler

  2. Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark

    M O Fosboel & J Mortensen

  3. Department of Oncology and Haematology, Kantonsspital St Gallen, St Gallen, Switzerland

    H Reichegger, M-C Desax, J Mueller, S Gillessen & A Omlin

  4. Department of Radiology and Nuclear Medicine, Kantonsspital St Gallen, St Gallen, Switzerland

    H Reichegger, M-C Desax, J Mueller, S Gillessen & A Omlin

  5. Department of Oncology, Rambam Medical Center, Haifa, Israel

    A Peer

  6. Department of Oncology, Rabin Medical Center, Petah Tikva, Israel

    E Rosenbaum & V Neiman

  7. Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark

    P M Petersen & G Daugaard

  8. Department of Oncology, Kantonsspital Chur, Chur, Switzerland

    R Cathomas

  9. Department of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    D Sarid

  10. Department of Oncology, Soroka Medical Center, Beer-Sheva, Israel

    W Mermershtain & K Rouvinov

Authors
  1. D Keizman
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  2. M O Fosboel
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  10. R Cathomas
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  11. M Gottfried
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  16. J Mortensen
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  17. S Gillessen
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  18. G Daugaard
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  19. A Omlin
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Corresponding author

Correspondence to D Keizman.

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Competing interests

DK is a member of the advisory boards and speaker for Astellas, Bayer, BMS, Janssen, MSD, Novartis, Pfizer, Sanofi, Teva. AO is a member of the advisory boards (compensated, institutional) for Bayer, Astellas, Janssen, Sanofi, Pfizer. Travel support was provided by Bayer, Astellas, Janssen, Sanofi. Research support was provided by Janssen, Teva. J Mortensen is a member of the advisory board (without honorarium) in Bayer. SG is an advisor for Active Biotech, Astellas, Bayer, Bristol-Myers Squibb, Curevac, Dendreon, Ferring, Janssen Cilag, Janssen Diagnostics MaxiVAX, Millennium, Novartis, Orion Pharma, Pfizer, Sanofi Aventis, ProteoMediX, ESSA Pharmaceuticals Corp, Nectar. Speakers Bureau comprises Amgen, Astellas, Bayer, Janssen Cilag, Novartis, Sanofi Aventis. Patent application for a method for biomarker WO 2009138392 A1 is pending. RC is a member of the advisory board for Astellas, Bayer, Janssen, Sanofi. GD has an advisory board role in Bayer, Janssen Cilag, Pfizer, Sanofi Aventis. PMP has an advisory board role in Bayer. The remaining authors declare no conflict of interest.

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Keizman, D., Fosboel, M., Reichegger, H. et al. Imaging response during therapy with radium-223 for castration-resistant prostate cancer with bone metastases—analysis of an international multicenter database. Prostate Cancer Prostatic Dis 20, 289–293 (2017). https://doi.org/10.1038/pcan.2017.6

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  • DOI: https://doi.org/10.1038/pcan.2017.6

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