Prostate International最新文献

{"title":"Efficacy and safety of pentosan polysulfate therapy in patients with interstitial cystitis for relief of lower urinary tract symptoms: 15-year single center experience","authors":"Sang Hun Song ,&nbsp;Byeongdo Song ,&nbsp;Gyoohwan Jung ,&nbsp;Hwanik Kim ,&nbsp;Jong Ho Park ,&nbsp;Seong Jin Jeong ,&nbsp;Sung Kyu Hong","doi":"10.1016/j.prnil.2025.05.001","DOIUrl":"10.1016/j.prnil.2025.05.001","url":null,"abstract":"<div><h3>Background</h3><div>Benefit of pentosan polysulfate sodium (PPS) for reducing chronic pain and lower urinary tract symptomin patients with interstitial cystitis/bladder pain syndrome (IC/BPS) remains inconclusive with modest effect. We aimed to evaluate the impact of PPS on improvement of lower urinary tract symptom based on the International Prostate Symptom Score (IPSS), quality of life (QoL), and uroflowmetry (UFM) in patients with IC/BPS.</div></div><div><h3>Materials and methods</h3><div>A total of 204 patients who were prescribed oral PPS for IC/BPS from October 2006 to May 2021 were retrospectively reviewed. Patients were divided by age for treatment effect comparison. Linear mixed models were utilized to evaluate improvements in IPSS, QoL, and UFM parameters after PPS treatment.</div></div><div><h3>Results</h3><div>There were significant gains in total IPSS (−0.335, <em>P</em> &lt; 0.001) and QoL (−0.061, <em>P</em> &lt; 0.001) over time, achieving stable phase within 3 months from the initiation of PPS treatment. For UFM parameters, postvoid residual decreased significantly over time (−1.052, <em>P</em> = 0.029), while maximum flow rate (0.093, <em>P</em> = 0.334) and voiding volume (0.751, <em>P</em> = 0.586) showed no significant differences. Compared to patients older than 65 years, those younger than 65 years showed significantly better improvements in the IPSS (−0.492 vs. −0.184, <em>P</em> = 0.018) but worse in voiding volume (−2.481 vs. 5.032, <em>P</em> = 0.006).</div></div><div><h3>Conclusions</h3><div>PPS provides clinical benefits in urinary symptoms voiding symptoms and QoL over time, arriving plateau within 3 months. Such benefits based on the IPSS tend to be more evident in younger patients, suggesting that PPS mostly benefits early treatment if suspected for IC/BPS.</div></div>","PeriodicalId":20845,"journal":{"name":"Prostate International","volume":"13 4","pages":"Pages 207-213"},"PeriodicalIF":2.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145712347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"18F-florastamin positron emission tomography/computed tomography in men with clinical suspicion of prostate cancer: A phase I prospective study","authors":"Sonya Y. Park ,&nbsp;Hyong Woo Moon ,&nbsp;Chansoo Park ,&nbsp;Dae Yoon Chi ,&nbsp;Ie Ryung Yoo ,&nbsp;Ji Yeol Lee","doi":"10.1016/j.prnil.2025.07.001","DOIUrl":"10.1016/j.prnil.2025.07.001","url":null,"abstract":"<div><div>Research on prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) and pending Food and Drug Administration (FDA) approval are predominantly aimed at biochemical recurrence rather than presurgical staging. Studies on the latter indication have almost exclusively investigated biopsy-proven cancers. We herein present the first-in-man clinical evaluation of a novel ¹⁸F-labeled PSMA ligand, florastamin, in screening for prostate cancer.</div></div><div><h3>Methods</h3><div>We recruited twenty men with prostate-specific antigen (PSA) levels between 3 (the threshold for biopsy) and 20 n/mL. A dose of 267-370 MBq (8-10 mCi) ¹⁸F-Florastamin was administered. Whole-body images were acquired at 90 minutes postinjection, followed by an additional pelvic PET/CT acquisition at 30 minutes. Conventional imaging (MRI) was performed within one week of, usually preceding, the PET/CT. PET/CT findings were compared to preoperative diagnostic magnetic resonance imaging (MRI) and correlated with final biopsy pathology. Diagnostic performance of the two modalities and both timepoints were compared on a per-patient, per-lobe, and per-segment basis. Inter-rater agreement was also measured for three readers.</div></div><div><h3>Results</h3><div>Twenty patients, who had a median PSA of 8.02 ng/mL (range 3.24-18.6), were enrolled in this study. Twelve patients were biopsy-proven with prostate cancer, of which four were low-risk and eight were intermediate risk. PET/CT visual analysis identified abnormal ¹⁸F-Florastamin uptake in at least one primary prostatic tumor focus in 10/12 patients at 90 minutes and 11/12 patients at 120 minutes. The per-segment sensitivity, specificity, and accuracy was 50%, 99.3%, and 93.1% for MRI with the best-performing threshold of ≥4, and 85%, 99.3% and 97.5% for ¹⁸F-Florastamin at 60 minutes, respectively. Delayed imaging showed comparable accuracy, with detection an additional true-positive lesion. The inter-rater agreement was substantial to almost perfect.</div></div><div><h3>Conclusion</h3><div>¹⁸F-Florastamin is a promising PET tracer that correctly identifies foci of cancer within the prostate with a higher accuracy than conventional imaging (MRI), and may be helpful in stratifying patients with low to intermediate PSA levels to better assess the need for an invasive biopsy. Our cohort study suggests triage with ¹⁸F-Florastamin PET/CT has the potential to reduce unnecessary biopsies in 9/20 (45%) patients.</div></div><div><h3>Clinical trial number</h3><div>(CRIS) KCT0004609.</div></div>","PeriodicalId":20845,"journal":{"name":"Prostate International","volume":"13 4","pages":"Pages 239-245"},"PeriodicalIF":2.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145712350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence–driven digital pathology in urological cancers: current trends and future directions","authors":"Inyoung Paik ,&nbsp;Geongyu Lee ,&nbsp;Joonho Lee ,&nbsp;Tae-Yeong Kwak ,&nbsp;Hong Koo Ha","doi":"10.1016/j.prnil.2025.02.002","DOIUrl":"10.1016/j.prnil.2025.02.002","url":null,"abstract":"<div><div>Artificial intelligence (AI) in digital pathology has gained attention owing to its potential in urological cancer diagnosis and management. This review highlights AI's applications and challenges in three major urological cancers. Prostate cancer studies have demonstrated reliable diagnostic performance and promising prognosis prediction. Renal cancer study shows potential but faces challenges in generalizability and prognosis. Bladder cancer studies are limited by the lack of large-scale datasets. Despite of these active studies, challenges remain regarding data availability, prognosis, and generalizability. Future efforts should emphasize multimodal approaches and multi-institutional collaboration with larger datasets to fully realize the potential of AI in urological cancers.</div></div>","PeriodicalId":20845,"journal":{"name":"Prostate International","volume":"13 4","pages":"Pages 181-190"},"PeriodicalIF":2.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145712406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The dose-volume histogram–based evaluation of predictors for gross hematuria after postprostatectomy radiotherapy","authors":"Byeongdo Song ,&nbsp;Younsoo Chung ,&nbsp;Sang Hun Song ,&nbsp;Hakmin Lee ,&nbsp;Sung Kyu Hong","doi":"10.1016/j.prnil.2025.08.003","DOIUrl":"10.1016/j.prnil.2025.08.003","url":null,"abstract":"<div><h3>Background</h3><div>Gross hematuria following postprostatectomy radiotherapy (PPRT) is common and usually self-limited but could require hospitalization with surgical intervention in severe cases. In the present study, we have evaluated the prevalence and predictors associated with gross hematuria after PPRT.</div></div><div><h3>Materials and methods</h3><div>From November 2003 to December 2017, 433 patients underwent radiotherapy after radical prostatectomy for prostate cancer. The Kaplan–Meier survival analysis was utilized to estimate the incidence of gross hematuria following PPRT, and the multivariable Cox regression analysis was performed to assess significant risk factors.</div></div><div><h3>Results</h3><div>In our cohort, a total of 124 patients (28.6%) experienced gross hematuria after PPRT within a median follow-up time of 104 months. Among them, 20 patients (16.1%) required transurethral fulguration. The estimated 10-year gross hematuria–free survival rate was 67.7%. The multivariable Cox regression analysis demonstrated that treatment history of anticoagulant/antiplatelet agent [hazard ratio (HR): 1.76, <em>P</em> = 0.019), an absolute bladder V40 Gy ≥median (HR: 1.63, <em>P</em> = 0.047), and a relative bladder V65 Gy ≥median (HR: 1.82, <em>P</em> = 0.019) were associated with gross hematuria following PPRT.</div></div><div><h3>Conclusion</h3><div>Our results suggest that gross hematuria after PPRT occurs frequently, especially among patients on anticoagulant/antiplatelet therapy and those with an absolute bladder V40 Gy ≥median and relative bladder V65 Gy ≥median during PPRT. Although most cases of gross hematuria were self-resolved, up to 16.1% required invasive surgical intervention. Limiting PPRT dose exposure to the bladder may also reduce the incidence of gross hematuria.</div></div>","PeriodicalId":20845,"journal":{"name":"Prostate International","volume":"13 4","pages":"Pages 264-270"},"PeriodicalIF":2.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145712434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time to castrate the cost? the rising expense of chemical castration for the management of prostate cancer","authors":"Alice Thomson ,&nbsp;Haidar Al Saffar ,&nbsp;Jake Tempo ,&nbsp;Nathan Lawrentschuk ,&nbsp;Declan G. Murphy ,&nbsp;Marlon Perera","doi":"10.1016/j.prnil.2025.01.003","DOIUrl":"10.1016/j.prnil.2025.01.003","url":null,"abstract":"<div><h3>Background</h3><div>Androgen deprivation therapy (ADT) remains the backbone of treatment of advanced prostate cancer. Conventionally, this is achieved by means of Gonadotropin Releasing Hormone (GnRH) analogs, though in recent years, four novel androgen receptor pathway inhibitors (nARPIs) have been approved for the treatment of advanced prostate cancer. We aim to analyze the increase in cost of chemical castration in advanced prostate cancer associated with the introduction of these medications.</div></div><div><h3>Methods and methods</h3><div>The publicly available Pharmaceutical Benefits Scheme database was accessed for conventional ADT and nARPI prescription data between January 2010 and January 2024. The number of prescriptions and cost of prescriptions were categorized by month and state. A descriptive analysis was performed outlining the therapy-prescribing patterns and discordances at a national and state-/territory-based level.</div></div><div><h3>Results</h3><div>From January 2010 to January 2024, over 1.7 million scripts were dispensed for conventional ADT compared to 412,925 for nAPRI therapy. The average cost for ADT rose from $9.9 million to 10.9 million. The average cost for nARPI therapy rose from $5.2 million to $17.3 million. There was significant difference between state-prescribing practices despite population-adjusted analysis.</div></div><div><h3>Conclusions</h3><div>While intensified treatment has proven to improve prostate cancer survival, this had led to an exponential increase in the cost of treatment. Clinicians must exercise caution when prescribing these medications to ensure patients will appropriately benefit from their advantage to cancer-specific survival in the context of their overall health to ensure appropriate distribution of resources.</div></div>","PeriodicalId":20845,"journal":{"name":"Prostate International","volume":"13 3","pages":"Pages 142-147"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145027858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anterior versus posterior first approach for robot assisted radical prostatectomy-perioperative, functional, and oncological outcomes","authors":"Faisal Masood Pirzada,&nbsp;Amlesh Seth,&nbsp;Rishi Nayyar,&nbsp;Brusabhanu Nayak,&nbsp;Rajeev Kumar","doi":"10.1016/j.prnil.2025.01.001","DOIUrl":"10.1016/j.prnil.2025.01.001","url":null,"abstract":"<div><h3>Background</h3><div>Robot-assisted radical prostatectomy (RARP) is commonly performed using either the anterior (AF) or posterior first (PF) approaches, depending upon where the dissection begins. While there is some data comparing outcomes of conventional RARP and Retzius sparing posterior RARP, there is limited data comparing outcomes between the AF and PF approaches to conventional RARP. We compared the two approaches in terms of perioperative, functional, and oncological outcomes.</div></div><div><h3>Materials and methods</h3><div>We retrospectively reviewed our data of RARP performed between 2014 and 2023 and identified 258 patients who had undergone the procedure using one of the two approaches. The choice of approach was dependent upon the surgeon with five surgeons with varying experience having performed all surgeries. We compared the two cohorts for perioperative, functional, and oncological outcomes.</div></div><div><h3>Results</h3><div>One hundred thirty-nine patients underwent RARP using the AF approach and 119 the PF approach. AF group were younger and had larger prostate volume at baseline. Operative time, blood loss was higher in the PF approach, whereas the positive surgical margins, biochemical recurrence, need for adjuvant therapy, potency, and continence parameters were similar between the two groups.</div></div><div><h3>Conclusions</h3><div>Our data suggests that the AF approach offers certain advantages in operative outcomes in RARP. However, this could be due to surgeon experience and needs better-controlled studies for validation.</div></div>","PeriodicalId":20845,"journal":{"name":"Prostate International","volume":"13 3","pages":"Pages 137-141"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145027855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concurrent antiandrogen therapy in the salvage radiotherapy setting for recurrent prostate cancer: a literature review","authors":"Dhiraj Mannar,&nbsp;Ryan Urban,&nbsp;Tina Zhang,&nbsp;Michael Peacock","doi":"10.1016/j.prnil.2024.11.001","DOIUrl":"10.1016/j.prnil.2024.11.001","url":null,"abstract":"<div><div>Radical prostatectomy is widely used to treat localized prostate cancer; however, 20%-50% of patients will experience disease progression despite surgical management. Management of these patients involves salvage radiotherapy (SRT), which has variable efficacy ranging from cure to disease progression in roughly 50% of cases with aggressive prognostic factors. Based on the success in combining antiandrogen therapy (AAT) with definitive radiotherapy for prostate cancer, it has been suggested that the addition of AAT may benefit patients receiving SRT. Here we review the literature surrounding the rationale for AAT in this setting and synthesize the results of several key trials assessing the benefits of AAT within the SRT setting.</div></div>","PeriodicalId":20845,"journal":{"name":"Prostate International","volume":"13 3","pages":"Pages 121-127"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145027856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the efficacy and safety of holmium laser enucleation of the prostate and prostate artery embolization: Short-term follow-up results","authors":"Ei Chan Lim ,&nbsp;Hui Mo Gu ,&nbsp;Seong Hyeon Yu ,&nbsp;Do Gyeong Lim ,&nbsp;Ho Seok Chung ,&nbsp;Seung Il Jung ,&nbsp;Dongdeuk Kwon ,&nbsp;Yang Jun Kang ,&nbsp;Nam Yeol Yim ,&nbsp;Eu Chang Hwang","doi":"10.1016/j.prnil.2025.03.001","DOIUrl":"10.1016/j.prnil.2025.03.001","url":null,"abstract":"<div><h3>Purpose</h3><div>The treatment options for benign prostatic hyperplasia vary. Holmium laser enucleation of the prostate (HoLEP) and prostate artery embolization (PAE) have emerged as novel surgical treatments for benign prostatic hyperplasia. However, limited comparative evidence exists between these two techniques. Thus, we investigated their efficacy and adverse events with a short-term follow-up.</div></div><div><h3>Materials and methods</h3><div>This prospective study reviewed the medical records of 329 patients who underwent HoLEP (<em>n</em> = 249) or PAE (<em>n</em> = 80). The International Prostate Symptom Score (IPSS), IPSS Quality of Life (QoL), maximal flow rate (MFR), and post-void residual urine (PVR) were measured to assess efficacy. For adverse events, the International Index of Erectile Function-5 (IIEF-5), the Male Sexual Health Questionnaire (MSHQ)-Short Form, and procedure-related complications were evaluated. All variables were compared within and between the two treatments at baseline and 1 and 3 months after the procedure.</div></div><div><h3>Results</h3><div>A total of 108 patients were matched for each group and baseline characteristics were balanced between the groups. The IPSS, IPSS QoL, MFR, and PVR improved following each procedure. However, compared with PAE, HoLEP achieved greater improvements in the IPSS, IPSS QoL, MFR, and PVR from baseline to 3 months (all <em>P</em> &lt; 0.05). In terms of sexual function, PAE better preserved both erectile (<em>P</em> = 0.001) and ejaculatory (<em>P</em> = 0.001) function compared with HoLEP over the same period. The overall incidence of adverse events was higher with HoLEP (28.1%) than with PAE (10%) (relative risk 3.19; 95% confidence interval 1.61–6.34, <em>P</em> = 0.009). One case of penile glans necrosis, a unique adverse event, was observed following PAE.</div></div><div><h3>Conclusions</h3><div>In the short term, HoLEP and PAE can significantly improve lower urinary tract symptoms. However, compared with PAE, HoLEP provides superior efficacy yet is associated with less preservation of sexual function and a higher rate of adverse events.</div></div>","PeriodicalId":20845,"journal":{"name":"Prostate International","volume":"13 3","pages":"Pages 155-160"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145027857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pelvic lymph node management in prostate cancer: a narrative review","authors":"Bryan Chong ,&nbsp;Vincent Khor ,&nbsp;Jing Xue Hoo ,&nbsp;Alvin Lee ,&nbsp;Yu Guang Tan ,&nbsp;Henry Ho ,&nbsp;Christopher Cheng ,&nbsp;Kae Jack Tay ,&nbsp;Jeffrey Tuan ,&nbsp;John Yuen ,&nbsp;Kenneth Chen","doi":"10.1016/j.prnil.2025.02.001","DOIUrl":"10.1016/j.prnil.2025.02.001","url":null,"abstract":"<div><div>Pelvic lymph node management plays an important role in the staging and treatment of early prostate cancer, especially for higher risk patients. This narrative review explores the current practices and emerging techniques, including advanced imaging, surgical techniques, and radiotherapeutic strategies. The introduction of prostate-specific membrane antigen (PSMA) positron emission tomography/ computed tomography (PET/CT) has revolutionized nodal staging, offering improved diagnostic accuracy compared to conventional imaging modalities. However, pelvic lymph node dissection (PLND) remains the gold standard, albeit with significant morbidity and uncertain survival benefits due to its invasive nature. Less invasive approaches, such as sentinel lymph node biopsy and radioguided surgery, are promising techniques which aim to reduce procedural morbidity, while maintaining a reasonable standard of staging accuracy. We also explored the role of extended lymph node dissection (ePLND), which suggests potential oncological benefits in selected patients. Additionally, advancements in radiation therapy, including whole-pelvic irradiation guided by predictive risk scores offer alternative modalities for managing node-positive disease. However, the current heterogeneity in clinical protocols and outcomes highlights the need for more standardization and robust comparative studies. This review highlights the evolving paradigm of pelvic lymph node management, advocating for personalized approaches that integrate molecular imaging and emerging technologies to optimize outcomes for prostate cancer patients.</div></div>","PeriodicalId":20845,"journal":{"name":"Prostate International","volume":"13 3","pages":"Pages 128-136"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145027854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment outcomes with radium-223 in patients with metastatic castration-resistant prostate cancer with bone metastasis in real-world practice: a multiinstitutional study","authors":"Hiroyuki Kitano ,&nbsp;Kunihiro Hashimoto ,&nbsp;Yasuhisa Hasegawa ,&nbsp;Akira Fujita ,&nbsp;Shunsuke Shinmei ,&nbsp;Fumiaki Kirishima ,&nbsp;Satoshi Shirane ,&nbsp;Akihiro Asami ,&nbsp;Miki Naito ,&nbsp;Yuki Kohada ,&nbsp;Kohei Kobatake ,&nbsp;Yohei Sekino ,&nbsp;Masao Kato ,&nbsp;Yuichi Kadonishi ,&nbsp;Hideki Mochizuki ,&nbsp;Mitsuru Kajiwara ,&nbsp;Nobuyuki Hinata","doi":"10.1016/j.prnil.2025.03.004","DOIUrl":"10.1016/j.prnil.2025.03.004","url":null,"abstract":"<div><h3>Background</h3><div>Radium-223 (Ra-223) treatment is used to extend the overall survival (OS) of patients with metastatic castration-resistant prostate cancer (mCRPC) with bone metastases. However, the optimal timing for its administration remains ambiguous. Hence, this study aimed to determine the optimal timing for Ra-223 administration.</div></div><div><h3>Materials and methods</h3><div>We retrospectively included Japanese men with mCRPC with bone metastases who were treated with Ra-223. The primary endpoint was OS from Ra-223 treatment. Secondary endpoints included the maximum reduction in alkaline phosphatase (ALP), lactate dehydrogenase (LDH), and prostate-specific antigen (PSA) levels and the incidence of adverse events following Ra-223 treatment. The exploratory endpoint was the association between clinical parameters and OS.</div></div><div><h3>Results</h3><div>Overall, 100 men with mCRPC with bone metastasis treated with Ra-223 wereenrolled. The median OS from the Ra-223 treatment was 38.6 months. Post Ra-223 treatment, ALP, LDH, and PSA levels decreased in 78.6%, 56.1%, and 44.9% of patients, respectively. Grade ≥3 anemia occurred in three (4.1%) patients. The median OS of patients with ≥10 months from diagnosis to developing mCRPC (52.4 months, <em>P</em> &lt; 0.014), a PSA doubling time ≥3 months (52.4 months, <em>P</em> = 0.035), prior docetaxel (DOC) treatment (108.2 months, <em>P</em> = 0.002), five or less numbers of bone metastasis (97.9 months, <em>P</em> = 0.006), five or more cycles of Ra-223 treatment (46.1 months, <em>P</em> = 0.045), hemoglobin measuring ≥13.1 g/dl (52.4 months, <em>P</em> = 0.003), ALP measuring ≤260 (54.8 months, <em>P</em> = 0.003), or LDH measuring ≤220 (46.1 months, <em>P</em> = 0.002) was significantly longer than that of those who had &lt;10 months from diagnosis to developing mCRPC, a PSA doubling time &lt;3 months, absence of prior DOC treatment, more than five bone metastasis, less than four cycles of Ra-223 treatment, hemoglobin measuring &lt;13.1 g/dl, ALP measuring &gt;260, or LDH measuring &gt;220. Multivariate analysis showed that prior DOC administration prolonged the OS.</div></div><div><h3>Conclusions</h3><div>Ra-223 treatment is safe and effective for mCRPC.</div></div>","PeriodicalId":20845,"journal":{"name":"Prostate International","volume":"13 3","pages":"Pages 167-173"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145027851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}