鐳-223治療對去勢抗性前列腺癌（CRPC）患者的疼痛改善與PSA變化之關聯性

李懿文¹、蘇祐立²、王弘仁¹、陳彥達¹、莊燿吉¹、鄭元佐¹、康智雄¹、陳建旭¹、劉惠瑛¹、張殷綸¹、吳彥廷¹、羅浩倫^1*

¹高雄長庚紀念醫院泌尿科,²高雄長庚紀念醫院腫瘤科

The Correlation between Pain Improvement and PSA Change in Patients with Castration-Resistant Prostate Cancer (CRPC) Treated with Radium-223 dichloride

I-Wen Lee¹, Su Yu Li², Hung-Jen Wang¹, Yen-Ta Chen¹, Yao-Chi Chuang¹, Yuan-Tso Cheng¹, Chih-Hsiung Kang¹, Chien-Hsu Chen¹, Hui Ying Liu¹, Yin Lun Chang¹, Yen Tin Wu¹, Hao-Lun Luo^1*

Kaohsiung Chang Gung Memorial Hospital, ¹Department of Urology, ²Department of Oncology, Kaohsiung, Taiwan

Abstract

Aim: We aimed to evaluate the pain response and oncological impact of Radium-233 dichloride (Ra223) in patients with castration-resistant prostate cancer (CRPC) and bone metastases.

Materials and methods: Our study involved 282 CRPC patients with bone metastases treated with Radium-233 dichloride obtained from Chang Gung Research Database from April 2018 to August 2022. We analyzed pain response and clinical parameters, including initial changes in prostate-specific antigen (PSA) and alkaline phosphatase (ALP) within 2 months, visceral metastasis-free survival, and overall survival (OS). Pain responses were categorized as improvement, stability, or worsening.

Results: We observed that patients with castration-resistant prostate cancer (CRPC) and bone metastases treated with Radium-233 dichloride had significantly lower PSA elevation at 2 months among those with pain improvement or stability compared to those with exacerbation (P = 0.002). We determined the cutoff point for PSA elevation within 2 months to be 200% according to the ROC curve. Patients with a PSA change at 2 months < 200% exhibited better pain control (P=0.004), lower ALP change at 2 months (78.9% vs 89.6%; P<0.001), more first line CRPC treatment with Radium-223 (P=0.001), and higher completion rate of 5-6 treatment cycles (P=0.001). Moreover, patients with a <200% increase in PSA at 2 months demonstrated superior overall survival (P<0.001) and visceral metastasis-free survival (P=0.027) compared to those with a ≥200% increase, as observed in Kaplan Meier analysis.

Conclusion:

Although ALP is a common prognostic factor for Radium-223 therapy, dynamic PSA change could be also a useful predictor for pain response and oncological outcome. Initial PSA elevation less than 200% after Ra223 treatment showed better pain control and higher completion rates. Regarding to oncological outcomes, it is also associated with superior post-treatment visceral metastasis-free survival and overall survival.