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Updated: Jul 31, 2025

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Radium-223 Utilization Patterns and Outcomes in Clinical Practice.

Lior Taich1, Hanson Zhao1, Shannon R Stock2,3

  • 1Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, California.

Urology Practice
|May 5, 2023
PubMed
Summary

Radium-223 treatment patterns in prostate cancer patients showed varied survival outcomes. Many patients did not complete the full radium-223 course, suggesting later disease stage use in real-world settings.

Keywords:
prostatic neoplasmsprostatic neoplasms, castration-resistantradium-223

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Area of Science:

  • Oncology
  • Radiopharmaceutical Therapy

Background:

  • Radium-223 is approved for metastatic castration-resistant prostate cancer (mCRPC) based on the ALSYMPCA trial.
  • Real-world treatment patterns and outcomes require characterization in diverse patient populations.

Purpose of the Study:

  • To characterize radium-223 treatment patterns in a large, equal-access health system.
  • To assess the association between treatment patterns and overall survival (OS) in mCRPC patients.

Main Methods:

  • Retrospective analysis of 318 mCRPC patients receiving radium-223 in the Veterans Affairs (VA) Healthcare System (2013-2017).
  • Abstracted prior treatments; followed patients for survival outcomes.
  • Analyzed treatment patterns and their association with OS using Cox models.

Main Results:

  • The median OS was 11 months.
  • Five predominant treatment patterns were identified, with "androgen receptor-targeted agent (ARTA)-docetaxel-radium" associated with the worst survival.
  • Only 42% of patients completed the full 6 radium-223 injections; 25% received 1-2 injections.

Conclusions:

  • Real-world radium-223 use in mCRPC patients within the VA system differs from clinical trial settings.
  • Lower OS and incomplete treatment courses suggest later-stage disease or population heterogeneity compared to the ALSYMPCA trial.