
Opinion|Videos|October 21, 2024
The Evolving Role of Radium-223 in mCRPC and the Impact of Combination Therapies
Author(s)Pedro Barata, MD, MSc, FACP
Key Takeaways
- The PEACE III study explores combining radium-223 with androgen receptor-targeted therapies to improve PSA control in prostate cancer treatment.
- Radium-223's poor clinical uptake is due to its inability to control PSA alone, necessitating combination with androgen receptor inhibitors.
Panelists discuss how combining radium-223 with androgen receptor–targeted therapy like enzalutamide addresses historical challenges in treating metastatic castration-resistant prostate cancer, including poor radium-223 uptake, prostate-specific androgen–level control issues, and the need for multimodal treatment approaches.
Advertisement
Video Content above is prompted by the following:
- What are the challenges, historically, that the PEACE III study addresses?
- Discuss reasons for the relatively poor uptake of radium-223 (Xofigo) in the clinic.
- Radium alone doesn’t control prostate-specific androgen (PSA), nor does docetaxel. PSA control is addressed by androgen receptor inhibitor (ARI).
- Layered radium-223 and enzalutamide plus ARI will control PSA, so radium-223 can be administered without being questioned or second-guessed.
- Similar to the ARASENS trial, maintain relationship and management and share care with med oncology for docetaxel.
- Discuss the rationale for combining radium-223 with androgen receptor–targeted therapy (enzalutamide). (Sartor et al [2018]; Shore et al [2020])
- Allows for 2 distinct mechanisms of action.
Advertisement
Related to this article

Chad R. Ritch, MD, MBA, FACS, discusses how PSMA-PET informs staging, treatment planning, recurrence workup, and the interpretation of equivocal findings.

Jeffrey M. Spier, MD, discusses how fatigue may impact patient quality-of-life and when dose reduction may be an appropriate treatment strategy.

Jeffrey M. Spier, MD, reviews evidence on ARPI dose reduction in prostate cancer and discusses monitoring treatment response, tolerability, and dose reescalation.

Jeffrey M. Spier, MD, discusses managing ARPI-related fatigue through dose adjustments, patient monitoring, and strategies to maintain treatment adherence.

Moderators and participants reviewed ARANOTE, ARACOG, and ARASEC data and how they inform individualized treatment for mCSPC.

Jack R. Andrews, MD, discusses BED-PSMA-411 findings comparing PSMA-PET detection rates and urinary excretion in prostate cancer biochemical recurrence.

VIR-5500 is a PSMA-targeted PRO-XTEN dual-masked T-cell engager entering phase 3 development for prostate cancer.
Advertisement
Advertisement
Trending on Urology Times
1
How PSMA-PET shapes staging and recurrence workup in prostate cancer
2
European Commission approves perioperative pembrolizumab plus enfortumab vedotin for MIBC
3
Engy Habashy, MD, on the role of androgens in GSM management
4
FDA accepts new drug application for UGN-103 in recurrent LG-IR-NMIBC
5


