The world journal of men's health · 2026
Early Prostate-Specific Antigen Dynamics as Predictors of Treatment Response and Survival Outcomes in Patients with Castration-Resistant Prostate Cancer and Bone Metastases Undergoing Radium-223 Therapy.
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Moon Jun Sung, Suh Sunghwan, Kim Sang Soo, Jin Heung Yong, Kim Jeong Mi, Jang Min Hee, Lee Kyung Ae, Lee Ju Hyung, Chung Seung Min, Lyu Young Sang, Kim Jin Hwa, Kim Sang Yong, Jang Jung Eun, Kim Tae Nyun, Kim Sung Woo, Jeon Eonju, Cho Nan Hee, Kim Mi-Kyung, Kim Hye Soon, Nam-Goong Il Seong, Kim Eun Sook, Chung Jin Ook, Cho Dong-Hyeok, Lee Chang Won, Kim Young Il, Chung Dong Jin, Won Kyu Chang, Kim In Joo, Park Tae Sun, Kim Duk Kyu, Shon Hosang
Аннотация
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.
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.