Bone metastases
ICD-10 C79.5 · ICD-11 2E03

Treatment of Bone Metastases in Castration-Resistant Prostate Cancer with Symptomatic Metastases

This protocol addresses the management of bone metastases arising in the context of castration-resistant prostate cancer (CRPC) — specifically patients who have symptomatic bone involvement without concurrent visceral metastatic disease.

Clinical Scenario
  • Castration-resistant prostate cancer (CRPC)
  • Symptomatic bone metastases
  • Absence of visceral metastatic disease
Treatment Approach

Management in this setting involves a targeted alpha-emitting radiopharmaceutical — Radium-223 — administered intravenously on a multi-cycle schedule. Adequate bone-marrow function is required before treatment can begin. The complete regimen, eligibility criteria, and dosing schedule are in the full protocol.

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References

  1. The randomized, double blind, ALSYMPCA trial included 921 patients with bone metastases from CRPC, without visceral disease, after progression to docetaxel or unfit for this agent.
  2. As a result, radium-223 was approved for patients with CRPC with symptomatic metastases and without visceral disease by FDA in May 2013.
  3. Radium dichloride 223 emits alpha particles, with high energy but low penetration (<100 μm or a range of 2–10 cells of diameter), and acts in the microenvironment of bone metastases.
  4. Due to the potential haematological toxicity of radium 223, adequate bone-marrow function parameters — haemoglobin ≥10 g/dL, absolute neutrophil count ≥1.5 × 10⁵/L, and platelets >100 × 10⁵/L — are required.

DOI: 10.1007/s12094-016-1590-1

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