Treatment outcome of radium-223 treatment for castration-resistant prostate cancer and bone metastases at a single university hospital

Background: we investigated therapeutic outcomes of radium-223 (ra-223) treatment in patients with metastatic castration-resistant prostate cancer (mcrpc) and bone metastases. materials and methods: outcomes were retrospectively examined in 20 patients starting ra-223 treatment at a single university hospital from january 2017 to january 2020. results: median patient age was 70 years. median values included prostate specific antigen (psa) 10.73 ng/ml, psa doubling time (psadt) 3.7 months, alkaline phosphatase (alp) 315 iu/l, lactate dehydrogenase (ldh) 186 iu/l, neutrophil-to-lymphocyte ratio (nlr) 2.22, and gleason score 9. extent of disease (eod) was 3 or more in 55%, and eastern cooperative oncology group performance status was 0 in 80%. 16 patients (80%) completed ra-223 treatment. ra-223 was administered in 11 (55%) with ≤ 3 lines of treatment and 9 (45%) with ≥ 4. concomitant drug was enzalutamide and abiraterone in 6 and 7 patients, respectively. bone modifier agents (bma) were used in 11 patients. symptomatic skeletal events (sse) occurred in 5 patients and were associated with abiraterone combination. bma during ra-223 treatment did not affect sse. median overall survival from initiation of ra-223 treatment was 32.7 months. prognosis was significantly better with psadt ≤ 3 months, eod ≤ 2, no sse, no opioid use, and completion of ra-223 treatment. psa, ldh, nlr, psadt, and ra-223 treatment line after mcrpc were associated with ra-223 completion. anemia of grade 3 occurred in 1 patient. conclusion: ra-223 treatment is safe, with good prognosis if completed. combination treatment with abiraterone during ra-223 treatment may cause sse.