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Updated: Jun 2, 2026
A Bioluminescent and Fluorescent Orthotopic Syngeneic Murine Model of Androgen-dependent and Castration-resistant Prostate Cancer
Published on: March 6, 2018
Early Prostate-Specific Antigen Dynamics as Predictors of Treatment Response and Survival Outcomes in Patients with
Hui-Ying Liu1, Chun-Yi Jen1, Yin-Lun Chang1
1Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Purpose:
Radium-223 (Ra-223) is a bone-targeting radiopharmaceutical used to treat symptomatic bone metastases in men with castration-resistant prostate cancer (CRPC), but there are no reliable biomarkers to guide timely therapeutic adjustments. This study explored the prognostic significance of early prostate-specific antigen (PSA) dynamics during Ra-223 therapy in patients with CRPC and bone metastases.
Materials And Methods:
This multi-institutional, retrospective cohort study analyzed 243 patients with CRPC and bone metastases treated with Ra-223 between January 2018 and December 2023 at Chang Gung Memorial Hospital, Taiwan. PSA and alkaline phosphatase (ALP) levels were recorded before and after two cycles of Ra-223 treatment (PSA 2M, ALP 2M). Additionally, the association between PSA, ALP, and clinical outcomes, including response, visceral metastasis-free survival (VMFS), and overall survival (OS), was assessed. Kaplan-Meier analysis, multivariate Cox regression, and receiver operating characteristic curve analysis were used to evaluate the prognostic value of PSA 2M.
Results:
Patients whose PSA 2M increase≤40% demonstrated significantly better pain control (p=0.003), improved VMFS (p=0.005), and longer OS (p=0.012) compared to those whose PSA 2M increase>40%. Kaplan-Meier analyses confirmed shortened VMFS (p=0.005) and OS (p=0.012) in patients with a PSA 2M increase of >40%. In multivariate Cox regression analyses, baseline opioid use and completion of Ra-223 injections were independent predictors of VMFS, while baseline ALP>94, PSA 2M increase>40%, and completion of Ra-223 injections were independently associated with OS.
Conclusions:
Early PSA dynamics during Ra-223 therapy can predict clinical outcomes in patients with CRPC and bone metastases. Patients with a PSA 2M increase of >40% had worse pain control, shorter VMFS and OS, and may benefit from early therapeutic modifications, including combination therapies. These findings underscore the importance of early biomarker-driven interventions to optimize treatment outcomes.
