Radium-223 Is the Preferred Therapy in Bone-Predominant Symptomatic Metastatic Castration-Resistant Prostate Cancer

Despite much progress in mCRPC treatment in recent years, optimal treatment sequences are still unclear, particularly in the post-abiraterone or post-enzalutamide treatment space. For men with bone-predominant disease (ie, no visceral or bulky nodal metastases) and symptomatic progression, current offprotocol options include crossover therapy to another oral novel hormonal agent (enzalutamide to abiraterone, or abiraterone to enzalutamide), docetaxel, or radium-223. Given the limited efficacy to support enzalutamide after abiraterone or abiraterone after enzalutamide1,2,3 owing to cross-resistance mechanisms, this position piece will explore the therapeutic choice between docetaxel and radium-223 and will advocate for radium-223. More than 90% of patients with mCRPC have radiologic evidence of bone metastasis,4 which is the major