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Radium-223 Treatment Outcomes in Patients with Metastatic Castration-Resistant Prostate Cancer: A Taiwan-Japan

Hao Lun Luo1, Yi Yang Liu1, Hui Ying Liu1

  • 1Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.

Biomedical Journal
|April 12, 2026
PubMed
Summary
This summary is machine-generated.

Earlier Radium-223 (Ra-223) treatment in metastatic castration-resistant prostate cancer (mCRPC) patients improves biomarker responses and survival. Favorable prostate-specific antigen (PSA) and alkaline phosphatase (ALP) changes indicate better outcomes.

Keywords:
Alkaline phosphatase (ALP)BiomarkersMetastatic castration-resistant prostate cancer (mCRPC)OutcomesProstate cancerProstate-specific antigen (PSA)Radium-223 (Ra-223)Survival risk

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Area of Science:

  • Oncology
  • Nuclear Medicine
  • Prostate Cancer Research

Background:

  • Metastatic castration-resistant prostate cancer (mCRPC) with bone metastases presents significant treatment challenges.
  • Radium-223 (Ra-223) is a therapeutic option, but its optimal timing and prognostic markers require further investigation.
  • Evaluating oncologic outcomes and biomarker responses (PSA, ALP) during Ra-223 therapy is crucial for patient management.

Purpose of the Study:

  • To examine oncologic outcomes of Radium-223 (Ra-223) based on its administration timing in mCRPC patients.
  • To assess the prognostic value of biomarker dynamics, specifically prostate-specific antigen (PSA) and alkaline phosphatase (ALP), during Ra-223 therapy.
  • To correlate biomarker responses with survival outcomes in mCRPC patients treated with Ra-223.

Main Methods:

  • Retrospective analysis of 306 mCRPC patients treated with Ra-223 across multiple institutions (August 2016 - March 2023).
  • Primary endpoint: Changes in PSA and ALP biomarkers during Ra-223 treatment.
  • Secondary endpoints: Hematologic adverse events and survival outcomes, analyzed using multivariable Cox regression.

Main Results:

  • Earlier Ra-223 administration correlated with more favorable biomarker dynamics (smaller PSA increase, greater ALP reduction; p=0.003).
  • Lower post-treatment PSA velocity and longer survival were observed (p<0.001), especially with ALP decreases or <100% PSA increases.
  • Biomarker dynamics, not treatment line, were more strongly associated with survival from Ra-223 initiation.

Conclusions:

  • Early Ra-223 use in mCRPC patients is linked to improved biomarker responses and extended survival.
  • Decreased ALP and limited PSA increases (<100%) after Ra-223 treatment define distinct survival risk profiles.
  • Biomarker responses (ALP, PSA) serve as valuable prognostic indicators for mCRPC patients undergoing Ra-223 therapy.