Bone-Protective Agents Beneficial in Patients Receiving Radium-223 for Metastatic Prostate Cancer

Researchers emphasized the importance of bone-protective agents in patients treated for metastatic castration-resistant prostate cancer.

Researchers assessed real-world outcomes of patients with bone-predominant metastatic castration-resistant prostate cancer (mCRPC) treated with radium-223, focusing on the impact of concurrent bone-protective agents (BPAs) on pathologic fracture risk. Conducted in Manitoba, Canada, the retrospective cohort study included 92 patients treated with radium-223 from 2014 to 2021. The median follow-up was 8.1 months. Hanbo Zhang, MD, FRCPC, and colleagues found that 26% of patients who did not receive concurrent BPAs developed pathologic fractures, compared to 3% of those who did. Researchers adjusted for number of bone metastases and corticosteroid use and found that BPAs were associated with a significant delay in time to pathologic fracture (median not reached vs 15.9 months; HR=0.20, 95% CI: 0.05-0.76, P<0.05). Findings indicated that 39% of patients had documented pain relief. There were 46 patients with elevated alkaline phosphatase levels at baseline; 57% of these patients saw a reduction of at least 30%. PSA levels decreased in 29% of patients. Median overall survival was 9.4 months (95% CI 5.8-15.9). Findings suggest that concurrent BPA administration significantly reduces the risk of pathologic fractures in patients with mCRPC who receive radium-223. Dr. Zhang and colleagues emphasized the importance of considering BPA therapy in this patient population.