Radium-223’s Potential Quality of Life Benefits for mCRPC Patients

In 2020, there were roughly 3.1 million estimated cases of prostate cancer in the United States. Of those 3.1 million cases, about 43,000 men were affected by metastatic castration-resistant prostate cancer (mCRPC), an aggressive and more advanced form of the disease. mCRPC most commonly affects men over 70 years old, and it is rare in men under the age of 40.

Advanced prostate cancer can present various symptoms, including:

• Difficulty urinating
• Blood in urine
• Erectile dysfunction
• Weight loss
• Fatigue
• Bone pain

At this time, there is no cure for prostate cancer, but mCRPC is treatable through chemotherapy. A recent study shows that before beginning chemotherapy, it may be optimal to utilize radium-223 to boost quality of life.

How Radium-223 Impacts Quality of Life for mCRPC Patients

Radium-223 is an injectable drug used to help treat metastasized prostate cancer. According to a study known as the RAPSON trial, published in the Journal of Clinical Oncology, radium-223 could be a game-changing tool in maximizing  quality of life for patients undergoing mCRPC chemotherapy.

In the study, patients underwent two forms of treatment for mCRPC: radium-223 injections and docetaxel chemotherapy. Focused on patients with multiple bone metastases who had no history of chemotherapy treatment, the study split its participants into two groups; one group had monthly radium-223 injections prior to beginning chemotherapy, while the other group underwent chemotherapy, paired with two daily doses of prednisone, prior to being treated with radium-223.

After 12 weeks, patients undergoing chemotherapy prior to radium-223 treatment reported a considerable decline in quality of life due to the treatment’s side effects. Treatment reduction was observed in 19% of patients undergoing this plan, largely due to hematological toxicity. However, patients treated with radium-223 did not report these same issues. Both treatments recorded a similar probability of survival.

Side Effects of Docetaxel and Radium-223

Though many patients with mCRPC turn to docetaxel chemotherapy, this form of treatment presents a host of side effects, including:

• Fatigue
• Nausea
• Diarrhea
• Hair loss
• Irregular heartbeat

Radium-223 can also cause fatigue and diarrhea. Additionally, neutropenia, a severe form of hematologic toxicity, is considered a rare side effect of radium-223.

The Importance of Prostate Cancer Screenings

There is no clear way to prevent prostate cancer, so it is critical for men to undergo regular screenings.

Men at average risk of are recommended to get screened around the age of 55, though high-risk individuals are encouraged to undergo screenings much earlier.

There are several factors to consider while determining when a patient should be screened. These include:

• Age
• Family history
• Ethnicity
  • Black men are more commonly affected by prostate cancer than any other ethnicity
• PSA levels

Each patient is unique and requires individualized care. It is imperative to communicate openly with patients who may be at risk for prostate cancer and provide guidelines accordingly.

References:

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Scher, H. I., Solo, K., Valant, J., Todd, M. B., & Mehra, M. (2015, October 13). Prevalence of prostate cancer clinical states and mortality in the United States: Estimates using a dynamic progression model. PloS one. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4603789/

Caffo, O., Maines, F., Rizzo, M., Kinspergher, S., & Veccia, A. (2016, December 22). Metastatic castration-resistant prostate cancer in very elderly patients: Challenges and solutions. Clinical interventions in aging. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5192056/#:~:text=In%20the%20case%20of%20metastatic,patients%20aged%20%E2%89%A580%20years.

Ferretti, S., Mercinelli, C., Marandino, L., Litterio, G., Marchioni, M., & Schips, L. (2023, June 26). Metastatic castration-resistant prostate cancer: Insights on current therapy and promising experimental drugs. Research and reports in urology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10312338/

Henríquez, I., Roach, M., Morgan, T. M., Bossi, A., Gómez, J. A., Abuchaibe, O., & Couñago, F. (2021, September 17). Current and emerging therapies for metastatic castration-resistant prostate cancer (mcrpc). Biomedicines. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8468423/

Huynh-Le, M.-P., Shults, R. C., Connor, M. J., & Hattangadi-Gluth, J. A. (2020, June). Adverse events associated with radium-223 in metastatic prostate cancer: Disproportionality analysis of FDA data reflecting worldwide utilization. Clinical genitourinary cancer. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7272257/

Lillard, J. W., Moses, K. A., Mahal, B. A., & George, D. J. (2022, November 1). Racial disparities in black men with prostate cancer: A literature review. Cancer. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9826514/