生化指標對鐳223治療之轉移性去勢抗性前列腺癌患者的預後價值

郭育任¹、吳冠諭¹、蔡育賢¹

成功大學附設醫院 泌尿部¹

The prognostic value of biochemical markers in Radium-223 treated metastatic castration-resistant prostate cancer patients

Yuh-Ren Kuo¹, Kuan-Yu Wu¹, and Yuh-Shyan Tsai¹

¹Department of Urology, National Cheng Kung University Hospital, National Cheng Kung University

Purpose: Metastatic castration-resistant prostate cancer (mCRPC) represents a pivotal phase where androgen deprivation therapy resistance signals accelerated disease progression and a graver prognosis. Radium-223(Ra-223) was believed to enhance overall survival rates in mCRPC patients with bone metastases. Nonetheless, not all patients benefit equally from Ra-223 treatment, with several potential prognostic indicators identified. While existing studies predominantly focus on pre-treatment status and background biomarkers, scant attention has been paid to favorable biomarker changes post Ra-223 administration. In this context, our study aims to explore whether early dynamic shifts in biomarkers post radium-223 injection can serve as surrogate markers for successful Ra-223 treatment completion.

Material and Methods: This retrospective cohort study focuses on 30 mCRPC patients receiving Ra-223 at NCKUH from 2020 to 2022. Inclusion criteria comprised histologically confirmed prostate cancer, mCRPC as per European Association of Urology guidelines, radiologically confirmed bone metastases via bone scan, and at least one administered Ra-223 injection. Evaluated background characteristics included complete blood count, prostate specific antigen (PSA) levels, alkaline phosphatase (ALP) levels and extent of bone disease. Changes in blood biomarker levels were compared between groups using Fisher's exact tests. Kaplan-Meier estimator and log-rank test evaluated survival fractions, while Cox regression analyzed overall survival risk factors.

Results: Sixty percent (18/30) of patients completed 6 cycles of Ra-223. Sixteen patients had elevated baseline PSA (≥50ng/ml). Eleven patients experienced early PSA flare (PSA rise >30% after the first cycle), and seventeen exhibited early ALP response post the first cycle. Elevated baseline PSA (p=0.021), anemia (p=0.025), and absence of early ALP response (p=0.014) emerged as negative predictors of overall survival. Moreover, 6-cycle completion correlated with early ALP response (p=0.001).

Conclusion: Our findings suggest that an early ALP response post the initial Ra-223 cycle may predict 6-cycle completion in mCRPC patients. Additionally, we underline the prognostic value of serum biochemical markers during treatment.