Interesting Image

Radium-223 Treatment in mCRPC Patient with Polycythemia Vera


  • Cristina de Angelis
  • Viviana Frantellizzi
  • Mariano Pontico
  • Maria Silvia de Feo
  • Julia Lazri
  • Giuseppe de Vincentis

Received Date: 27.03.2020 Accepted Date: 05.08.2020 Mol Imaging Radionucl Ther 2021;30(3):193-196 PMID: 34660164

There have been several studies on the clinical outcomes of Radium-223 treatment in patients with metastatic castration-resistant prostate cancer (mCRPC) who may have an increased risk of hematologic comorbidities. To the best of our knowledge, this is the first study to explore the potential bone marrow adverse effects (AEs) of Radium-223 administered with specific drugs used for hematologic conditions, such as polycythemia vera (PV). We report the case of a patient with mCRPC who was administered a combined treatment of Radium-223 and hydroxyurea for PV, aiming to support clinicians in predicting eventual AEs.

Keywords: Prostate cancer, mCRPC, Radium-223, polycythemia vera, hematogical toxicity

Prostate cancer (PCa) represents the second most prevalent cancer in men and the fifth cause of cancer-related mortality worldwide (1). Bone secondary tumor localizations are the most frequent expression of advanced PCa, representing the cause of morbidity and mortality and determining a poor prognosis. Several studies have been provided concerning the clinical outcomes of Radium-223 treatment in patients with metastatic castration-resistant prostate cancer (mCRPC) (2,3). Moreover, patients with mCRPC could suffer from hematologic comorbidities. Notably, to our knowledge, there are no studies involving the use of Radium-223 in patients with mCRPC and preexisting hematological conditions, such as polycythemia vera (PV), a chronic myeloproliferative disorder. Thus, studies that could support clinicians to predict eventual adverse effects (AEs) in these cases are warranted.


Informed Consent: Informed consent was obtained from the patient.

Peer-review: Externally peer-reviewed.

Authorship Contributions

Surgical and Medical Practices: C.A., J.L., M.S.F., Concept: G.V., V.F., Design: G.V., V.F., M.P., Data Collection or Processing: V.F., C.A., Analysis or Interpretation: G.V., V.F., M.P., Literature Search: C.A., J.L., M.S.F., Writing: C.A., M.P., J.L.

Conflict of Interest: No conflict of interest was declared by the authors.

Financial Disclosure: The authors declared that this study received no financial support.


  1. Wong MC, Goggins WB, Wang HH, Fung FD, Leung C, Wong SY, Ng CF, Sung JJ. Global Incidence and Mortality for Prostate Cancer: Analysis of Temporal Patterns and Trends in 36 Countries. Eur Urol 2016;70:862-874.
  2. Parker C, Nilsson S, Heinrich D, Helle SI, O’Sullivan JM, Fosså SD, Chodacki A, Wiechno P, Logue J, Seke M, Widmark A, Johannessen DC, Hoskin P, Bottomley D, James ND, Solberg A, Syndikus I, Kliment J, Wedel S, Boehmer S, Dall’Oglio M, Franzén L, Coleman R, Vogelzang NJ, O’Bryan-Tear CG, Staudacher K, Garcia-Vargas J, Shan M, Bruland ØS, Sartor O; ALSYMPCA Investigators. Alpha emitter radium-223 and survival in metastatic prostate cancer. N Engl J Med 2013;369:213-223.
  3. De Vincentis G, Follacchio GA, Frantellizzi V, Prelaj A, Farcomeni A, Giuli A, Bianco V, Tomao S. 223Ra-dichloride therapy in an elderly bone metastatic castration-resistant prostate cancer patient: a case report presentation and comparison with existing literature. Aging Clin Exp Res 2018;30:677-680.
  4. Ricci M, Frantellizzi V, Bulzonetti N, De Vincentis G. Reversibility of castration resistance status after Radium-223 dichloride treatment: clinical evidence and review of the literature. Int J Radiat Biol 2019;95:554-561.
  5. De Vincentis G, Monari F, Baldari S, Salgarello M, Frantellizzi V, Salvi E, Reale L, Napolitano S, Conti G, Cortesi E. Narrative medicine in metastatic prostate cancer reveals ways to improve patient awareness & quality of care. Future Oncol 2018;14:2821-2832.
  6. Vogelzang NJ, Coleman RE, Michalski JM, Nilsson S, O’Sullivan JM, Parker C, Widmark A, Thuresson M, Xu L, Germino J, Sartor O. Hematologic Safety of Radium-223 Dichloride: Baseline Prognostic Factors Associated With Myelosuppression in the ALSYMPCA Trial. Clin Genitourin Cancer 2017;15:42-52.e8.
  7. Saad F, Carles J, Gillessen S, Heidenreich A, Heinrich D, Gratt J, Lévy J, Miller K, Nilsson S, Petrenciuc O, Tucci M, Wirth M, Federhofer J, O’Sullivan JM; Radium-223 International Early Access Program Investigators. 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 2016;17:1306-1316.
  8. De Vincentis G, Follacchio GA, Frantellizzi V, Liberatore M, Monteleone F, Cortesi E. Prostate-Specific Antigen Flare Phenomenon During 223Ra-Dichloride Treatment for Bone Metastatic Castration-Resistant Prostate Cancer: A Case Report. Clin Genitourin Cancer 2016;14:e529-e533.