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Sandy Srinivas, MD


Does Adding Radium-223 to Third-Line Therapy Offer Survival Benefit in Metastatic Prostate Cancer?

By: Julia Fiederlein Cipriano, MS
Posted: Tuesday, December 12, 2023

Based on the results of a single-institution retrospective analysis, which were presented during the 2023 Society of Urologic Oncology (SUO) Annual Meeting (Poster 24), patients with bone-dominant metastatic castration-resistant prostate cancer did not derive a survival benefit from the addition of second-generation hormone therapy to third-line treatment with the radionuclide radium-223. However, according to Kelly Lehner, MD, of the Mayo Clinic, Rochester, Minnesota, and colleagues, further prospective studies are warranted.

“Radium-223 has been recommended for patients with bone-dominant metastatic prostate cancer,” the investigators commented. “[Prior to this study,] the addition of second-generation hormone therapy to radium-223 [in patients with] metastatic castration-resistant prostate cancer had been attempted, but its benefit had not yet been elucidated.”

The investigators focused on patients who received radium-223 alone (n = 32) or concomitantly with a second-generation hormonal agent (enzalutamide: n = 17; abiraterone: n = 8). In this study population, the mean patient age was 70.1 years. The median levels of alkaline phosphatase and prostate-specific antigen before radionuclide therapy were 91.0 U/L and 21.1 ng/mL, respectively. The median primary Gleason score was 9, and the median number of radium-223 cycles was six. 

The 3-year rates of overall survival in patients who underwent monotherapy and combination therapy with either abiraterone or enzalutamide were 10%, 25%, and 10%, respectively. According to the investigators, the 3-year overall survival outcomes did not significantly differ with vs without second-generation hormone therapy.

Disclosure: No information regarding conflicts of interest was provided.

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