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The Latest Research on CRPC with Bone Metastases

Curated by clinicians: educational forums with videos, abstracts and conference information
Rana R. McKay, MD

Rana R. McKay, MD is an Associate Professor of Medicine and Urology at the University of California San Diego and Co-Leader of the Genitourinary Oncology Disease Team at the Moores Cancer Center. She is a board-certified medical oncologist who specializes in treating people with urogenital cancers, including bladder, kidney, prostate, and testicular cancer. Her research interests include the design and implementation of clinical trials to advance the treatment of patients with urologic cancers. She serves as the Principal Investigator of several early phase trials in kidney and prostate cancer. As a clinical investigator, she is committed to advancements that will improve the lives of individuals with cancer. Furthermore, she is interested in understanding mechanisms of response and resistance to specific cancer therapies. Her work has appeared in peer-reviewed publications such as the Nature, Lancet, Journal of Clinical Oncology, Clinical Cancer Research, Cancer, among others. Dr. McKay earned her medical degree at the University of Florida College of Medicine before completing her residency in Internal Medicine at Johns Hopkins Hospital. She completed a fellowship in Oncology/Hematology at the Dana-Farber Cancer Institute, Harvard Medical School. She went on to serve as an Assistant Professor at Harvard Medical School and a medical oncologist at Dana-Farber/Brigham and Women's Cancer Center in Boston before joining UC San Diego Health.

Videos
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Clinical Conversations by Experts
Optimizing Multi-Disciplinary Care Teams for Radiopharmaceutical Administration - Neal Shore
The Correlation Between Alkaline Phosphatase Decline and Overall Survival in Men with Metastatic Castration-Resistant Prostate Cancer in the REASSURE Study - Nicholas James
Multidisciplinary Care Teams to Optimize Care of Patients with Bone Metastatic CRPC - Tanya Dorff
Optimizing the Use of Radium-223 Through Multidisciplinary Collaboration - Phillip Koo
Treatment Sequencing with Radium-223 in Symptomatic Disease - Fred Saad
A Real-World Analysis of Pain Efficacy of Radium-223 Treatment Among Patients With Metastatic Castration-Resistant Prostate Cancer and Symptomatic Bone Metastases – the REASSURE Trial – Celestia Higano
Real-World Data in Second-Line Treatment Progressing mCRPC – Oliver Sartor
Real-World Safety and Effectiveness of Radium-223 in Japanese Patients with Castration-Resistant Prostate Cancer (CRPC) and Bone Metastasis - Beyond the Abstract
The NCCN Guidelines on the Use of Radium-223 in Prostate Cancer - Tanya Dorff
Optimal Patient Selection for Treatment with Radium-223 in mCRPC Towards Improved Overall Survival and Improved Quality of Life - Brenda Martone
The Effect of Mandated Bone Protective Agents on Fracture Risk With Longer Follow-Up (EORTC 1333 / PEACE III Trial) – Fred Saad
Real World Evidence in the Treatment of mCRPC - Celestia Higano
Radium-223 plus Enzalutamide vs Enzalutamide Alone in Metastatic Castration-Resistant Prostate Cancer - Benjamin Maughan
The Combination of Pembrolizumab and Radium-223 in Metastatic Castration-Resistant Prostate Cancer (mCRPC) - Atish Choudhury
Real-World Treatment Patterns and Health Outcomes in Patients with Metastatic Castration-resistant Prostate Cancer (mCRPC) - Christopher Wallis and Zachary Klaassen
Sequential Radium-223 Treatment of mCRPC That Progressed After First-Line Novel Antihormonal Therapy, A Real-World Clinical Outcomes Study - Oliver Sartor
Changing the Mechanism of Action in The Treatment of Metastatic Castration Resistant Prostate Cancer (mCRPC) - Phillip Koo
PROSPER Trial Journal Club: Enzalutamide and Survival in Nonmetastatic, Castration-Resistant Prostate Cancer - Zachary Klaassen and Christopher J.D. Wallis
Optimal Treatment Sequencing in Metastatic Castration-Resistant Prostate Cancer (mCRPC) - Evan Yu
Bone Health and Osteoclast Targeted Therapies in Advanced Prostate Cancer - Matthew Smith
Bone Targeted Theranostics with 18F-NaF/ 223Ra Cl2 in Prostate Cancer - Hossein Jadvar
Real-World Clinical Outcomes with Radium-223 in Metastatic Castration-resistant Prostate Cancer - Neal Shore
Assessing the Aging Population and Treatment Considerations for Prostate Cancer - Joe O'Sullivan
Radium 223 Dichloride Use in Patients with Castrate Resistant Prostate Cancer - Hossein Jadvar
The Risk of Dose De-intensifying Treatment, Bone Health in Prostate Cancer - Fred Saad
Radium-223 and Bone Health Agents: Lessons Learned Presentation - Oliver Sartor
Antiresorptive Therapy to Reduce SRE Risk For The Majority of Men with CRPC and Bone Metastases Presentation - Bertrand Tombal
Supporting Improved Patient Care Through Advanced Prostate Cancer Clinics - Gordon Brown
Radium-223 in Clinical Practice - Phillip J. Koo
Decreased Fracture Rate When Adding Bone Protecting Agents to Radium-223: PEACE III- Bertrand F. Tombal
Real World Treatment Experience with Radium-223 - Dan George
Contemporary Treatment of Castration-Resistant Prostate Cancer (CRPC) - Fred Saad
Bone Health in Prostate Cancer - A Conversation with Neal Shore and Oliver Sartor
IRONMAN Registry: A Global Landmark Trial in Advanced Prostate Cancer
Prostate Cancer Osteomimicry in Circulating Tumor Cells in Men with Metastatic Castration Resistant Prostate Cancer (mCRPC) - Andrew Armstrong
Updates on Health-Related Quality-of-Life (HRQoL) analyses in GU Oncology - Cora Sternberg
The State of Nuclear Medicine in the Treatment of Prostate Cancer - Interview with Oliver Sartor
Clinical Implications of the Abi Race Study: Interview with Dan George
Imaging Modality and Recommendations Included in RADAR 3: Interview with Phillip Koo
Physician-Scientist Review Articles
State of the Evidence Review Articles
Written by Zachary Klaassen, MD, MSc
February 27, 2020

Patients with advanced prostate cancer are at significant risk of skeletal-related events (SREs) due to a complex interplay between bone health and prostate cancer due to cancer biology and the predilection of prostate cancer to spread to bone, the toxicity of prostate cancer treatments, and shared epidemiology of the two conditions.

 

Written by Christopher J.D. Wallis, MD, PhD and Zachary Klaassen, MD, MSc
December 3, 2019
Radiopharmaceuticals are pharmaceutical agents containing radioisotopes and emitting radiation that may be used for diagnostic or treatment purposes. The ALSYMPCA trial was the first to demonstrate that radiopharmaceuticals could improve overall survival, in addition to skeletal-related events, in patients with metastatic castrate-resistant prostate cancer. On the basis of this observation, there is an ongoing effort to identify molecular targets for linkage to radiopharmaceuticals.
Written by Zachary Klaassen, MD, MSc
April 16, 2019
Prostate cancer exhibits a wide spectrum of disease behaviour. Despite the majority of cases presenting with relatively indolent biologic behaviour, prostate cancer remains the second leading cause of cancer-related death in the United States, behind only lung cancer.
Conference Coverage
Conference Highlights Written by Physician-Scientist
Presented by Meryam Losee, BS
At the SNMMI 2024 Annual Meeting, Dr. Meryam Losee presented the results of a study evaluating the effect of bone marrow disease on hematologic toxicity and PSA response to 177Lu-PSMA-617 therapy. 
Presented by Ashwin Sachdeva, MBBS, PhD, FRCS
The 2024 American Society of Clinical Oncology (ASCO) Annual Meeting held in Chicago, IL between May 31st and June 4th, 2024 was host to a session addressing techniques to minimize the effects of androgen deprivation therapy (ADT) while explore alternatives in prostate cancer management. Dr. Ashwin Sachdeva discussed the appropriate use and timing of bone resorptive agents in patients with advanced prostate cancer.
Presented by Amit D. Raval, PhD
The 2024 GU ASCO annual meeting featured a prostate cancer session and a presentation by Dr. Amit Raval discussing real-world utilization patterns of radium-223 in metastatic prostate cancer in the United States. Radium-223 is approved for use in men with symptomatic castration-resistant prostate cancer (CRPC) with bone metastases, demonstrating benefits in terms of overall survival and quality of life with a reliable safety profile.1
Presented by Hanbo Zhang, MD, FRCPC
The 2024 GU ASCO annual meeting featured a prostate cancer session and a presentation by Dr. Hanbo Zhang discussing a real-world analysis of survival and fracture risk with radium-223 therapy in metastatic castrate-resistant prostate cancer (mCRPC). Radium-223 is a life-prolonging radionuclide therapy for men with bone-predominant mCRPC based on the phase 3 ALSYMPCA trial.
Presented by Joe O'Sullivan, MD FRCPI, FFRRSCI, FRCR
The 2022 ESMO annual meeting featured a prostate cancer session, including a presentation by Dr. Joe O'Sullivan discussing alkaline phosphatase decline and pain response as markers for overall survival in patients with mCRPC treated with radium-223 in the REASSURE study.
Presented by Elena Castro, MD
In the on-demand poster session of the ESMO Annual Congress, Dr. Elena Castro presented results from the PRORADIUM cohort (NCT02925702) examining the effect of germline mutations on outcomes for patients treated with radium-223.
Presented by Celestia S. Higano, MD, FACP
In the on-demand poster session of the ESMO Annual Congress, Dr. Higano presented a real-world analysis of pain efficacy of radium-223 treatment among patients with metastatic castration-resistant prostate cancer (mCRPC) and symptomatic bone metastases.
Presented by Stephen A. Boorjian, MD
The AUA annual meeting’s evolving landscape of advanced prostate cancer treatment session included a talk by Dr. Stephen Boorjian discussing bone health and radionuclide therapy. Dr. Boorjian notes that there are several clinically relevant aspects of bone health in CRPC including (i) the issue of bone loss, given that the median age of patients with CRPC is similar to the age of at-risk patients for physiologic/age-related decrease in bone mineral density
Presented by Silke Gillessen, MD
Beginning with the introduction of docetaxel for metastatic castration resistant prostate cancer (mCRPC) in 2004, there has been a dramatic and rapid proliferation of systemic therapy options in advanced prostate cancer including a number of novel hormonal therapies (including abiraterone acetate and enzalutamide),
Presented by Lawrence Mbuagbaw, MD, MPH, Ph.D.
At the 2021 ASCO GU, Dr. Lawrence Mbuagbaw and colleagues presented results of their real-world study evaluating clinical outcomes of patients when Radium-223 was used early (second-line) or late (third or later lines) among men with mCRPC.
Presented by Catherine H. Marshall, MD, MPH
 Immune modulation may be enhanced by radiation therapy through a variety of mechanisms, including via enhanced display of tumor-associated antigens. Furthermore, radiopharmaceutical agents have been shown to upregulate tumor antigens in prostate cancer models,1
Presented by Silke Gillessen, MD
San Francisco, CA (UroToday.com) Silke Gillessen, MD presented a study comparing two different dosing frequencies of Denusomab in patients with castration-resistant PC, and evaluating the rate of hypocalcemia in the two treatment options.
Presented by Matthew R. Smith, MD, Ph.D.
Munich, Germany (UroToday.com) Radium-223 is an alpha emitter which selectively treats bone metastases with alpha radiation.1 In a recent GU ASCO oral presentation, a radium-223 pharmacodynamic study demonstrated
Presented by Matthew R. Smith, MD, Ph.D.
Munich, Germany (UroToday.com) As has been the trend in management of advanced solid malignancies, there has been increasing interest