Clinical efficacy of radium-223 in simulating real-world clinical practice: a meta-analysis

Abstract
Background and objective
Prostate cancer progresses to metastatic castration-resistant prostate cancer (mCRPC) in 30–40% of patients after surgery and/or radiotherapy, with a poor prognosis and short overall survival (OS). Ra-223 therapy improves OS, progression-free survival (PFS), reduces symptomatic skeletal events (SSE), bone metastasis-related pain, and PSA/ALP responses. Although some studies show OS gains, systematic reviews are inconsistent. This meta-analysis synthesizes prior data to evaluate Ra-223’s impact on OS and overall efficacy.

Methods
A comprehensive and systematic search of the databases of PubMed/MEDLINE and Cochrane Library was performed to retrieve original articles published until March 10, 2023. Two authors independently reviewed the titles and abstracts of the retrieved articles based on the inclusion and exclusion criteria.

Result
Among 7 studies (n = 4035) in the quantitative analysis, 1894 participants received Ra-223. The pooled median OS with Ra-223 was 15.08 months (95% CI: 10.9–22.7), not significantly different from standard therapy (MSR 1.38, 95% CI: 0.89–2.15, p = 0.154). Pooled median PFS was longer with Ra-223 (6.3 months, 2.8–9.86) versus standard therapy (3.7 months, 3.3–4.1). Pooled median time to SSE incidence was also longer with Ra-223 (24.7 months, 15.6–33.9) than with standard therapy (17.5 months, 9.8–24.7).

Conclusion
Although the overall survival benefit of Ra-223 is not yet definitive, its ability to delay disease progression and skeletal events supports its role in mCRPC management. Further research optimizing patient selection and Ra-223 combination regimens could enhance outcomes in advanced prostate cancer.