Background: We investigated therapeutic outcomes of Radium-223 (Ra-223) treatment in patients with metastatic castration-resistant prostate cancer (mCRPC) and bone metastases. Materials and Methods: Outcomes were retrospectively examined in 20 patients starting Ra-223 treatment at a single university hospital from January 2017 to January 2020. Results: Median patient age was 70 years. Median values included prostate specific antigen (PSA) 10. 73 ng/ml, PSA doubling time (PSADT) 3. 7 months, alkaline phosphatase (ALP) 315 IU/L, lactate dehydrogenase (LDH) 186 IU/L, neutrophil-to-lymphocyte ratio (NLR) 2. 22, and Gleason score 9. Extent of disease (EOD) was 3 or more in 55%, and Eastern Cooperative Oncology Group performance status was 0 in 80%. 16 patients (80%) completed Ra-223 treatment. Ra-223 was administered in 11 (55%) with ≤,3 lines of treatment and 9 (45%) with ≥,4. Concomitant drug was enzalutamide and abiraterone in 6 and 7 patients, respectively. Bone modifier agents (BMA) were used in 11 patients. Symptomatic skeletal events (SSE) occurred in 5 patients and were associated with abiraterone combination. BMA during Ra-223 treatment did not affect SSE. Median overall survival from initiation of Ra-223 treatment was 32. 7 months. Prognosis was significantly better with PSADT ≤,3 months, EOD ≤,2, no SSE, no opioid use, and completion of Ra-223 treatment. PSA, LDH, NLR, PSADT, and Ra-223 treatment line after mCRPC were associated with Ra-223 completion. Anemia of Grade 3 occurred in 1 patient. Conclusion: Ra-223 treatment is safe, with good prognosis if completed. Combination treatment with abiraterone during Ra-223 treatment may cause SSE.

Introduction: Our aim was to evaluate the value of serum prostate-specific antigen doubling time (PSADT) to differentiate patients with high-grade prostate cancer who require more aggressive therapy from those with lowgrade cancer.Materials and Methods: Of 460 patients with extended 12-core transrectal ultrasonography-guided biopsy of the prostate, 59 with confirmed prostate cancer were selected. They had not received any previous treatment for prostate cancer and had at least 2 consecutive serum PSA tests with a rising trend. The PSADT was calculated in patients with 2 serum PSA levels measured with an interval more than 3 months.Results: Of 59 patients with prostate cancer, 35 (59.3%) had low-grade and 24 (40.7%) had high-grade tumors. There was no difference in age between the two groups. The median PSADT in patients with high-grade and low-grade tumors were 12.70 months (range, 0.7 to 44.8 months) and 25.00 months (range, 1.65 to 41.2 months; P = .001). A total of 21 patients with high-grade tumors (87.5%) had a PSADT less than 12 months, while only 9 of those with low-grade tumors (25.7%) had a PSADT less than 12 months. A PSADT cutoff of 12 months provided a sensitivity of 74% and a specificity of 87% for differentiation of high-grade from low-grade cancers.Conclusion: We concluded that men with a short PSADT (< 12 months) were at a higher risk of harboring a high-grade prostate cancer. Our data suggests PSADT can identify patients with high-grade tumors who require more aggressive therapy.

Background: Prostate cancer has been reported as a worldwide important kind of cancer and the second most common cause of cancer-related mortality among men. Prostate-specific antigen (PSA) serum level is one of the most important markers of prostate cancer diagnosis. While PSA level helps predict the risk of prostate cancer development, researchers still looking for ways to increase the accuracy of prognostic models. To increase the specificity of PSA and decrease of unnecessary biopsies and morbidity, PSA-related parameters such as PSA doubling time (PSADT) have been used. In this study, the relationship between this factor and the severity of prostate cancer was evaluated. Methods: In this retrospective study, the data of patients who were subjected to transrectal ultrasound-guided (TRUS) biopsy of the prostate and referred to Imam Khomeini Hospital, Tehran, between 2009 and 2017 were reviewed. We enrolled the men with at least two consecutive elevated PSA level within three months to calculate PSADT. Based on the pathology report, primary and secondary Gleason score (GS) were determined. Correspondingly, considering GS, the patients were divided into two groups with high-grade and low-grade tumor (GS<7 considered as low-grade and GS>7 considered as high-grade tumor). Results: Totally, 1712 cases of TRUS biopsy of the prostate were studied. Among them, 547 (32. 3%) had prostate cancer, of whom 73 cases were eligible based on inclusion criteria and were consented to enroll in the study. According to the data obtained, we found a significant difference in PSADT between the two groups of patients with high-grade and low-grade malignancy (mean± SD PSADT, 9. 8± 14. 2 vs. 16. 1± 14. 9 respectively, P=0. 004). Considering the seven months as the cut-off point for PSADT in determining malignancy, there was a significant difference between the two groups according to Fisher's exact test (P=0. 01). Conclusion: In our study, PSADT cut-off of 7 months provided the greatest accuracy for differentiation between low-grade and high-grade malignancy, and PSADT has acceptable accuracy for the diagnosis of high-grade tumors.