[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 34.204.191.0. Please contact the publisher to request reinstatement.
[Skip to Content Landing]
Views 848
Citations 0
Invited Commentary
December 12, 2019

Radioisotope Imaging and Therapy for Bone Metastasis in Men With Castration-Resistant Prostate Cancer

Author Affiliations
  • 1Division of Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City
  • 2Department of Radiology and Imaging Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City
JAMA Oncol. 2020;6(2):225-226. doi:10.1001/jamaoncol.2019.4635

The current issue of JAMA Oncology includes 2 studies focusing on the use of radioisotopes for the management of bone lesions in patients with metastatic castration-resistant prostate cancer (mCRPC).1,2 In the first study, Armstrong and colleagues1 report the association between new unconfirmed bone lesions detected on the first or second posttreatment bone scans and outcomes in patients with mCRPC undergoing treatment with enzalutamide who otherwise had stable or decreasing prostate-specific antigen levels or soft-tissue lesions. This retrospective analysis involved 1672 men with mCRPC from 2 randomized clinical placebo-controlled phase 3 studies that investigated enzalutamide in the docetaxel-naive (PREVAIL [A Safety and Efficacy Study of Oral MDV3100 in Chemotherapy-Naive Patients With Progressive Metastatic Prostate Cancer; NCT01212991]) and postdocetaxel (AFFIRM [Safety and Efficacy Study of MDV3100 in Patients With Castration-Resistant Prostate Cancer Who Have Been Previously Treated With Docetaxel-based Chemotherapy; NCT00974311]) settings. Early pseudoprogression was defined as 1 or more new unconfirmed lesions detected on the first posttreatment bone scan in patients with disease otherwise responding to treatment at week 9 in PREVAIL and at week 13 in AFFIRM, and late pseudoprogression was defined as 1 or more new unconfirmed lesions detected on the second posttreatment bone scan in patients with disease otherwise responding to treatment at week 17 in PREVAIL and at week 25 in AFFIRM. Unconfirmed bone lesions were found in 27.5% of patients in the predocetaxel setting (PREVAIL) and 18.1% of patients in the postdocetaxel setting (AFFIRM). Patients with stable disease and disease responding to treatment with pseudoprogression in the predocetaxel group had similar overall survival (OS) as those with no new unconfirmed bone lesions, confirming pseudoprogression. However, the postdocetaxel group of patients with bone pseudoprogression had significantly worse OS (HR, 1.94; 95% CI, 1.10-3.44) compared with responding patients with no new unconfirmed bone lesions, suggesting true progression of disease.

Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    ×