Importance of the correct assessment of bone fractures in the clinical management of metastatic castration‑resistant prostate cancer treated with radium‑223: A case report

Lodi Rizzini,Elisa; Ghedini,Pietro; Cardano,Raffaele; Bellarosa,Chiara; Morganti,Alessio  Giuseppe; Fanti,Stefano; Monari,Fabio

doi:10.3892/mco.2019.1852

Importance of the correct assessment of bone fractures in the clinical management of metastatic castration‑resistant prostate cancer treated with radium‑223: A case report

Authors:
- Elisa Lodi Rizzini
- Pietro Ghedini
- Raffaele Cardano
- Chiara Bellarosa
- Alessio Giuseppe Morganti
- Stefano Fanti
- Fabio Monari
View Affiliations

Affiliations: Nuclear Medicine Unit, S. Orsola‑Malpighi Hospital, I‑40138 Bologna, Italy, DIMES University of Bologna, I‑40138 Bologna, Italy, Radiation Oncology Center, S. Orsola‑Malpighi Hospital, I‑40138 Bologna, Italy
Published online on: May 6, 2019 https://doi.org/10.3892/mco.2019.1852
Pages: 63-66

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Patients who undergo radium‑223 treatment for metastatic castration‑resistant prostate cancer (mCRPC) generally have a long history of androgen deprivation therapy and/or steroid therapy, which leads to bone loss and causes osteoporosis. Notably, Osteoporosis in combination with metastatic bone disease increases the risk of bone fracture. An 84‑year‑old man with multi‑metastatic bone CRPC underwent six administrations of intravenous radium‑223, which induced a good biochemical and clinical response. However, two months following the treatment, the patient reported acute pain localized to the lumbar spine mimicking bone progression disease and presented with stable prostate‑specific antigen levels. A prostate‑specific membrane antigen‑positron emission tomography scan showed no tracer uptake in that site, whereas a magnetic resonance imaging scan and subsequent vertebral biopsy confirmed the absence of cancer progression and showed the presence of vertebral crushing of L4‑L5, which was probably due to an osteoporotic process. The patient had never received bisphosphonate therapy and refused it during α‑emitting therapy with radium‑223. The osteoporotic process, in association with metastatic bone disease, more easily leads to bone fractures that have an important impact on performance status, quality of life and prognosis quoad vitam in patients with advanced prostate cancer. Use of bisphosphonates or anti‑RANKL antibody appears to be effective in improving bone mineral density. Notably, patients with multi‑metastatic bone disease who undergo radium‑223 therapy should be treated in conjunction with anti‑osteoporotic therapy (bisphosphonates or anti‑RANKL antibody) and adequate calcium and vitamin D supplementation. Early recognition and differentiation of osteoporotic processes when determining the progression of cancer‑associated bone disease is crucial in evaluating the response to radium‑223 therapy and, consequently, for further therapeutic decision making.

View Figures

View References

1	Sartor O, Coleman R, Nilsson S, Heinrich D, Helle SI, O'Sullivan JM, Fosså SD, Chodacki A, Wiechno P, Logue J, et al: Effect of radium-223 dichloride on symptomatic skeletal events in patients with castration-resistant prostate cancer and bone metastases: Results from a phase 3, double-blind, randomised trial. Lancet Oncol. 15:738–746. 2014. View Article : Google Scholar : PubMed/NCBI
2	European Medicines Agency: Zytiga (abiraterone acetate) Summary of product characteristics. https://www.ema.europa.eu/en/medicines/human/EPAR/zytigaSeptember 23–2011
3	Parker C, Nilsson S, Heinrich D, Helle SI, O'Sullivan JM, Fosså SD, Chodacki A, Wiechno P, Logue J, Seke M, et al: Alpha emitter radium-223 and survival in metastatic prostate cancer. N Engl J Med. 369:213–223. 2013. View Article : Google Scholar : PubMed/NCBI
4	Rosino-Sánchez A: Preventive management of bone disease in advanced prostate cancer. Arch Esp Urol. 71:258–266. 2018.(In Spanish). PubMed/NCBI
5	Smith MR: Osteoporosis and other adverse body composition changes during androgen deprivation therapy for prostate cancer. Cancer Metastasis Rev. 21:159–166. 2002. View Article : Google Scholar : PubMed/NCBI
6	Smith MR: Diagnosis and management of treatment-related osteoporosis in men with prostate carcinoma. Cancer. 97:789–795. 2003. View Article : Google Scholar : PubMed/NCBI
7	Tanvetyanon T: Physician practices of bone density testing and drug prescribing to prevent or treat osteoporosis during androgen deprivation therapy. Cancer. 103:237–241. 2005. View Article : Google Scholar : PubMed/NCBI
8	Diamond TH, Higano CS, Smith MR, Guise TA and Singer FR: Osteoporosis in men with prostate carcinoma receiving androgen-deprivation therapy: Recommendations for diagnosis and therapies. Cancer. 100:892–899. 2004. View Article : Google Scholar : PubMed/NCBI
9	Coleman RE and McCloskey EV: Bisphosphonates in oncology. Bone. 49:71–76. 2011. View Article : Google Scholar : PubMed/NCBI
10	Cha TL, Wu TT, Vogelzang NJ, Huang CY, Huang SP, Lin CC, Ou YC, Pang ST, Shen DH, Wu WJ and Chang WY: Optimal usage of radium-223 in metastatic castration-resistant prostate cancer. J Formos Med Assoc. 116:825–836. 2017. View Article : Google Scholar : PubMed/NCBI
11	Macherey S, Monsef I, Jahn F, Jordan K, Yuen KK, Heidenreich A and Skoetz N: Bisphosphonates for advanced prostate cancer. Cochrane Database Syst Rev. 12:CD0062502017.PubMed/NCBI
12	Poon Y, Pechlivanoglou P, Alibhai SMH, Naimark D, Hoch JS, Papadimitropoulos E, Hogan ME and Krahn M: Systematic review and network meta-analysis on the relative efficacy of osteoporotic medications: Men with prostate cancer on continuous androgen-deprivation therapy to reduce risk of fragility fractures. BJU Int. 121:17–28. 2018. View Article : Google Scholar : PubMed/NCBI
13	Yap KKL, Wong W, Ji L, Groshen SG, Quinn DI, Pinski JK, Bryce AH and Dorff TB: Impact of timing of administration of bone supportive therapy on pain palliation from radium-223. J Clin Oncol. 35 (Suppl 15):S50232017. View Article : Google Scholar
14	Saad F, Carles J, Gillessen S, Heidenreich A, Heinrich D, Gratt J, Lévy J, Miller K, Nilsson S, Petrenciuc O, et al: Radium-223 and concomitant therapies in patients with metastatic castration-resistant prostate cancer: An international, early access, open-label, single-arm phase 3b trial. Lancet Oncol. 17:1306–1316. 2016. View Article : Google Scholar : PubMed/NCBI
15	Saad F, Sternberg CN, Mulders PFA, Niepel D and Tombal BF: The role of bisphosphonates or denosumab in light of the availability of new therapies for prostate cancer. Cancer Treat Rev. 68:25–37. 2018. View Article : Google Scholar : PubMed/NCBI
16	Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, Mason M, Matveev V, Wiegel T, Zattoni F, et al: EAU guidelines on prostate cancer. Part II: Treatment of advanced, relapsing, and castration-resistant prostate cancer. Eur Urol. 65:467–479. 2014. View Article : Google Scholar : PubMed/NCBI
17	Saylor PJ: Bone targeted therapies for the prevention of skeletal morbidity in men with prostate cancer. Asian J Androl. 16:341–347. 2014. View Article : Google Scholar : PubMed/NCBI
18	Morgans AK and Smith MR: Bone-targeted agents: Preventing skeletal complications in prostate cancer. Uro Clin North Am. 39:533–546. 2012. View Article : Google Scholar
19	Bilezikian JP: Osteoporosis in men. J Clin Endocrinol Metab. 84:3431–3434. 1999. View Article : Google Scholar : PubMed/NCBI
20	Udovicich C, Perera M, Hofman MS, Siva S, Del Rio A, Murphy DG and Lawrentschuk N: ⁶⁸Ga-prostate-specific membrane antigen-positron emission tomography/computed tomography in advanced prostate cancer: Current state and future trends. Prostate Int. 5:125–129. 2017. View Article : Google Scholar : PubMed/NCBI
21	von Eyben FE, Picchio M, von Eyben R, Rhee H and Bauman G: ⁶⁸Ga-labeled prostate-specific membrane antigen ligand positron emission tomography/computed tomography for prostate cancer: A systematic review and meta-analysis. Eur Urol Focus. 4:686–693. 2018. View Article : Google Scholar : PubMed/NCBI
22	Osman OM, Fahmy YR, El-Oraby AM, El-Basmy AA and Amin YE: Role of diffusion WIs and T2 * GRE pulse sequences in dubious vertebral marrow pathological lesions. J Egypt Natl Canc Inst. 19:254–262. 2007.PubMed/NCBI
23	Cicala D, Briganti F, Casale L, Rossi C, Cagini L, Cesarano E, Brunese L and Giganti M: Atraumatic vertebral compression fractures: Differential diagnosis between benign osteoporotic and malignant fractures by MRI. Musculoskelet Surg. 97 (Suppl 2):S169–S179. 2013. View Article : Google Scholar : PubMed/NCBI
24	Brodowicz T, Hadji P, Niepel D and Diel I: Early identification and intervention matters: A comprehensive review of current evidence and recommendations for the monitoring of bone health in patients with cancer. Cancer Treat Rev. 61:23–34. 2017. View Article : Google Scholar : PubMed/NCBI
25	Sartor O, Coleman RE, Nilsson S, Heinrich D, Helle SI, O'Sullivan JM, Vogelzang NJ, Bruland Ø, Kobina S, Wilhelm S, et al: An exploratory analysis of alkaline phosphatase, lactate dehydrogenase, and prostate-specific antigen dynamics in the phase 3 ALSYMPCA trial with radium-223. Ann Oncol. 28:1090–1097. 2017. View Article : Google Scholar : PubMed/NCBI
26	Nguyen NC, Shah M, Appleman LJ, Parikh R and Mountz JM: Radium-223 therapy for patients with metastatic castrate-resistant prostate cancer: An update on literature with case presentation. Int J Mol Imaging. 2016:25680312016. View Article : Google Scholar : PubMed/NCBI