Investigation into the Optimal Strategy of Radium-223 Therapy for Metastatic Castration-Resistant Prostate Cancer

The optimal sequence and combination of radium-223 therapy (Ra-223) for castration-resistant prostate cancer with bone metastasis (mCRPC) remain unclear. This study aimed to explore the prognostic factors after Ra-223 administration determine treatment strategy. We enrolled 64 patients mCRPC who underwent from June 2016 July 2022 at a single institution in Japan. Overall survival (OS) pain progression-free (p-PFS), which was proposed as measure quality life (QOL), were analyzed using Cox proportional hazards models log-rank tests, between-factor analysis performed Mann–Whitney U (MWU) test. Univariable multivariable analyses revealed factors; specifically, early (≤third line), completion six cycles, low scan index (BSI) (<0.61), alkaline phosphatase (ALP) (<140 U/L), prostate-specific antigen (PSA; <22.9 ng/mL), lactate dehydrogenase (LDH; <240 high hemoglobin (Hb) (≥11.4 g/dL), prior denosumab use significantly prolonged OS. Low BSI, ALP, also p-PFS tests. MWU test showed that BSI (≥0.61) associated PSA ALP tendency Hb decrease. Late (≥fourth line) PSA. Early improved OS, administering before novel hormonal or anticancer agents may be meaningful.