A Case of Success: Complete Response to Radium-223 in Metastatic Castration-Resistant Prostate Cancer

TL;DR

A 67-year-old man with advanced prostate cancer showed a complete response to Radium-223 treatment, despite initial misleading imaging results.

Contribution

This case highlights the scintigraphy flare phenomenon and demonstrates a successful long-term response to Ra223 in mCRPC.

Findings

The patient experienced a flare phenomenon after Ra223 treatment, initially suggesting disease progression.

A complete resolution of lesions was observed three months post-treatment, with sustained response for seven months.

The case underscores the importance of monitoring beyond initial imaging for accurate treatment assessment.

Abstract

Radium-223 dichloride (Ra223) is the first targeted alpha agent approved for treating metastatic castration-resistant prostate cancer (mCRPC) with bone-exclusive disease. A benefit in overall survival and time to the first symptomatic skeletal-related event was shown in the Alpharadin in Symptomatic Prostate Cancer Patients (ALSYMPCA) trial. However, this trial did not describe a bone scan response to Ra223, and there is no universal consensus about how it should be monitored. Furthermore, a scintigraphy flare phenomenon may lead to false-positive tracer uptake in responsive cases, thereby misleading the interpretation of imaging results.

We present the case of a 67-year-old male with mCRPC and exclusive bone disease treated with Ra223. The bone scintigraphy after the end of the treatment showed an apparent aggravation of the lesions, corresponding to a flare phenomenon, with an almost complete resolution after three months. The patient maintained a scintigraphic response for seven months.

Figures