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Published on: March 6, 2018
Sarcopenia in Men With Bone-Predominant Metastatic Castration-Resistant Prostate Cancer Undergoing Ra-223 Therapy
Maira Khan1, Shruti Parshad1, Mahdi F Naimi1
1Sunnybrook Research Institute and Odette Cancer Centre, Toronto, Ontario, Canada.
Introduction:
Osteosarcopenia is the progressive loss of musculoskeletal structure and functionality, contributing to disability and mortality. Despite complex interactions between bone and muscle, osteosarcopenia prevention and treatment in men with metastatic castration-resistant prostate cancer (mCRPC) focuses predominantly on bone health. It is unknown whether Radium-223 (Ra-223) therapy affects sarcopenia.
Methods:
We identified 52 patients with mCRPC who had received Ra-223 and had a baseline plus ≥1 follow-up abdominopelvic CT scan. The total contour area (TCA) and averaged Hounsfield units (HU) of the left and right psoas muscles were obtained at the inferior L3 endplate, and the psoas muscle index (PMI) was calculated therefrom. Intrapatient musculoskeletal changes were analyzed across various time points.
Results:
TCA and PMI gradually declined over the study period (P = .002, P = .003, respectively), but Ra-223 therapy did not accelerate sarcopenia, nor the decline of HU compared to the pre-Ra-223 period. The median overall survival of patients with baseline sarcopenia was numerically worse (14.93 vs. 23.23 months, HR 0.612, P = .198).
Conclusions:
Ra-223 does not accelerate sarcopenia. Thus, worsening muscle parameters in men with mCRPC undergoing Ra-223 therapy are attributable to other factors. Further research is needed to determine whether baseline sarcopenia predicts poor overall survival in such patients.
Insights
Radium-223 (Ra-223) therapy does not accelerate sarcopenia in men with metastatic castration-resistant prostate cancer. Muscle loss during treatment is likely due to other factors, warranting further investigation into baseline sarcopenia
Area of Science:
- Oncology
- Radiology
- Geriatrics
Background:
- Osteosarcopenia, a dual decline in bone and muscle, significantly impacts morbidity and mortality.
- Current osteosarcopenia management in metastatic castration-resistant prostate cancer (mCRPC) primarily targets bone health, neglecting muscle mass.
- The effect of Radium-223 (Ra-223) therapy on sarcopenia in mCRPC patients remains uninvestigated.
Purpose of the Study:
- To investigate the impact of Ra-223 therapy on sarcopenia progression in patients with mCRPC.
- To assess changes in muscle mass and density during Ra-223 treatment.
- To explore the relationship between baseline sarcopenia and overall survival in mCRPC patients undergoing Ra-223 therapy.
Main Methods:
- Retrospective analysis of 52 mCRPC patients treated with Ra-223.
- Abdominopelvic CT scans were used to measure psoas muscle total contour area (TCA) and Hounsfield units (HU).
- Psoas muscle index (PMI) was calculated to assess muscle mass, with intrapatient changes analyzed over time.
Main Results:
- A gradual decline in TCA and PMI was observed during the study period (P=.002, P=.003).
- Ra-223 therapy did not accelerate sarcopenia or the decline in muscle HU compared to the pre-treatment period.
- Patients with baseline sarcopenia showed numerically worse median overall survival (14.93 months) compared to those without (23.23 months).
Conclusions:
- Radium-223 therapy does not exacerbate sarcopenia in mCRPC patients.
- Observed muscle parameter decline is likely attributable to factors other than Ra-223 treatment.
- Further research is warranted to determine if baseline sarcopenia is a predictor of poor survival in this patient cohort.
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