Research Papers:

Radium-223 for primary bone metastases in patients with hormone-sensitive prostate cancer after radical prostatectomy

Vera Wenter, Annika Herlemann, Wolfgang P. Fendler, Harun Ilhan, Natalia Tirichter, Peter Bartenstein, Christian G. Stief, Christian la Fougère, Nathalie L. Albert, Axel Rominger and Christian Gratzke _

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Oncotarget. 2017; 8:44131-44140. https://doi.org/10.18632/oncotarget.17311

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Vera Wenter1,*, Annika Herlemann2,*, Wolfgang P. Fendler1, Harun Ilhan1, Natalia Tirichter1, Peter Bartenstein1,3, Christian G. Stief2,3, Christian la Fougère4,5, Nathalie L. Albert1, Axel Rominger1 and Christian Gratzke2,3

1Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany

2Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany

3Comprehensive Cancer Center, Ludwig-Maximilians-University of Munich, Munich, Germany

4Department of Nuclear Medicine and Clinical Molecular Imaging, Eberhard Karls University, Tuebingen, Germany

5German Cancer Consortium, German Cancer Research Center Partner Site Tuebingen, Tuebingen, Germany

*These authors have contributed equally to this work

Correspondence to:

Christian Gratzke, email: [email protected]

Keywords: hormone-sensitive prostate cancer, radium-223, radical prostatectomy, bone metastases, off-label use

Received: January 23, 2017     Accepted: April 03, 2017     Published: April 21, 2017


Radium-223 dichloride (Ra-223) is the first bone-targeting agent showing improvement in overall survival in patients with castration-resistant prostate cancer (CRPC) and bone metastases. We aimed to assess feasibility of Ra-223 treatment in patients with metastatic hormone-sensitive prostate cancer (mHSPC). Ten patients with primary bone metastases received Ra-223 following radical prostatectomy (RP). Changes in alkaline phosphatase (ALP) and prostate-specific antigen (PSA) were recorded, while pain intensity was evaluated using the self-reporting Brief Pain Inventory (BPI) questionnaire. Bone scintigraphy (BS) was performed to assess treatment response. Seven patients completed six cycles of Ra-223. Discontinuation was due to leuko- and lymphopenia, progressive lymph node metastasis or newly diagnosed liver metastasis. Treatment-related adverse events occurred in three patients and included leuko- and lymphopenia, fatigue, abdominal discomfort and nausea. Overall, a median decrease of 28% in ALP and a median decrease of 83% in PSA were noted at follow-up. However, PSA progressed in five patients at follow-up. Improvement of pain was observed in all patients (median decrease of 36% after 3 cycles and of 40% at the end of therapy). On BS, three patients showed remission, four had stable disease, and one showed progressive disease at follow-up. Our results suggest that Ra-223 for primary bone metastases in patients with mHSPC after RP is feasible and alleviates pain. ALP, rather than PSA, may be a good marker for assessing treatment response. Ra-223 could therefore be taken into consideration as part of a multimodal approach for carefully selected patients with advanced prostate cancer.

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