Final outcome of223Ra-therapy and the role of18F-fluoride-PET in response evaluation in metastatic castration-resistant prostate cancer–a single institution experience

Kalevi Kairemo, Denái R. Milton, Elba Etchebehere, Eric M. Rohren, Homer A. Macapinlac

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Background:223Ra was the first therapeutic alpha-emitting radionuclide registered for clinical practice. This radionuclide is targeting actively bone-forming cells, and it is approved for treating metastatic skeletal disease in prostate cancer.18F-PET is used to detect skeletal metastatic disease based on osteoblastic activity. The aim of this study was to analyze, if18F-PET can be used assessing the results of223Ra therapy, and to report final median overall survival in a total of 773 therapy cycles. Methods: A 161 men with castration-resistant prostate cancer were included in a single institution study (Protocol#: PA14-0848) and they received a total of 773223Ra therapy cycles. Results: The median overall survival (95% CI) was 12.4 (9.1, 16.1) months in patient population. Interim Na18F-PET imaging was applied in 14 patients at baseline, after 3 cycles and after 6 cycles. TLF10 (skeletal disease burden at SUV-values >10 on Na18F-PET) were calculated in all these PET studies, and there was no significant association between change in TLF10 after 3 cycles and TLF10 after 6 cycles (p=0.20). Conclusion: From these results, we conclude that interim imaging does not help in assessing the final outcome of223Ra therapy. The survival benefit of223Ra therapy alone is more than a year in a high-risk group of advanced prostate cancer.

Original languageEnglish (US)
Pages (from-to)147-152
Number of pages6
JournalCurrent Radiopharmaceuticals
Issue number2
StatePublished - 2018


  • Alpha emitter
  • Castration resistant
  • Prostate cancer
  • Radionuclide therapy
  • Radium-223
  • Response evaluation
  • Skeletal metastases
  • Sodium fluoride-18

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Pharmacology


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