Curie Element: Experience of Radium-223 Use in Patients With Bone Metastases in Castration-Resistant Prostate Cancer

Introduction . Radionuclide therapy of bone metastases with radium-223 dichloride has been approved for patients with castration-resistant prostate cancer. Targeted therapy, which is being actively introduced into clinical practice, can improve overall survival rates, reduce pain with the possibility of discontinuing potent analgesic drugs, and reduce or delay the risk of potentially serious complications, such as pathological fractures and spinal cord compression. Objective. To evaluate the effectiveness of radium-223 dichloride in patients with castration-resistant prostate cancer. Materials and methods . Since 2023, at the Clinic of the Bashkir State Medical University, 43 patients with metastatic castrationresistant prostate cancer have received radionuclide therapy. Prior to each administration of radium-223 dichloride, blood parameters and prostate-specific antigen were monitored; functional status and pain syndrome were assessed. Patients were divided into groups depending on the use of radium-223 dichloride as a second-, third-, or fourth-line therapy. The drug effectiveness was assessed using control bone scintigraphy. Results and discussion . 62.7% of the patients who completed the course of radionuclide therapy showed stabilization of the process, which is consistent with the data of key publications of the largest world databases. Overall survival was higher in the group receiving the drug as a second-line therapy compared to that in the groups of later lines. During treatment, pain syndrome decreased in 58% of patients. In the general group, the alkaline phosphatase level decreased by 16.4%, which is consistent with the data of the ALSYMPCA phase 3 randomized study. Conclusion . Our study has confirmed the clinical effectiveness of radium-223 dichloride, thereby contributing to the evidence base for the optimization of its application in routine oncological practice. Since radium-223 dichloride is contraindicated in visceral metastases and is recommended as a second-line therapy, continuity in the work of specialists and timely routing of patients for early appointment are of high importance.