In this segment, Raoul Concepcion, MD, leads a discussion regarding the use of radium-223, an alpha emitter and calcium-mimetic agent that selectively targets the bone.

Neal Shore, MD, comments that he has used radium-223 with enzalutamide and abiraterone. Although there is currently not much evidence to support the concomitant use of these agents, Shore does not expect many tolerability issues due to the distinct mechanisms of action of these medications. With regard to use of radium-223 with docetaxel, Shore notes that clinicians should carefully consider treatment sequencing and which agent to administer first.

Although radium-223 can be tremendously helpful in patients with widespread bone pain, targeted palliative radiotherapy is effective in individuals who experience bone pain in a very specific area, comments Phillippa Cheetham, MD.

Kenneth Kernen, MD, remarks that changes in PSA level do not necessarily correlate with survival. Kernen educates patients that the goal is maintaining quality of life, not simply tracking PSA results.

Over the next few years, the treatment strategy will evolve from one of using single agents in sequence to using multiple agents in combination, adds Oliver Sartor, MD.