Abstract
BackgroundRadium-223 has been shown to improve overall survival in men with metastatic castration-resistant prostate cancer with symptomatic bone metastases. The bone scan response to radium-223 has only been described in one single center trial of 14 patients, none of whom achieved the outstanding bone scan response presented in the current case.Case presentationIn this case report, we describe a 75 year-old white man with extensively pre-treated metastatic castration-resistant prostate cancer and symptomatic bone metastases who experienced a flare in pain and prostate-specific antigen, followed by dramatic clinical (pain), biochemical (prostate-specific antigen), and imaging (bone scan) response.ConclusionThe flare phenomena and bone scan response we observed have not previously been described with radium-223. This case suggests that the degree and duration of bone scan response may be predictive of overall survival benefit.
Highlights
Radium-223 has been shown to improve overall survival in men with metastatic castration-resistant prostate cancer with symptomatic bone metastases
The pain flare phenomenon that our patient experienced has only been reported in a Phase I trial of radium-223, in which seven of twenty-five patients had a “flare” in pain during the first week of radium-223 treatment [11]
Other forms of radiotherapy have been associated with a transient increase in prostate-specific antigen (PSA)
Summary
Radium-223 has been shown to improve overall survival in men with metastatic castration-resistant prostate cancer with symptomatic bone metastases. He eventually developed mCRPC with symptomatic, widespread osseous metastases and was treated with radium-223, with an initial flare in pain and PSA, followed by dramatic and durable improvement in pain, alkaline phosphatase, and bone scan. He had transient improvement in his mCRPC in response to many of these therapies, but overall his course was characterized by disease progression, with rising PSA, increasing alkaline phosphatase, and growing osseous metastases.
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