International Journal of Clinical Oncology

, Volume 24, Issue 12, pp 1629–1631 | Cite as

Considering bone health in the treatment of prostate cancer bone metastasis based on the results of the ERA-223 trial

  • Atsushi MizokamiEmail author
  • Go Kimura
  • Yasuhisa Fujii
  • Shiro Hinotsu
  • Kouji Izumi
Letter to the Editor

ERA-223, a phase III clinical trial, was conducted globally to investigate the usefulness of radium-223 (Ra-223) administered concurrently with abiraterone acetate and prednisolone (AAP) [1]. However, in this trial, the Ra-223 + AAP group did not exhibit increased survival and had a clearly higher incidence of bone fracture than the placebo + AAP group. In this paper, we would like to discuss the reasons why this study did not produce the anticipated outcomes, and how we should use Ra-223 in consideration of both efficacy and bone health.

Testosterone and its metabolic estrogen maintain bone health by preventing loss of bone mineral density. When serum estrogen decreases, the frequency of fracture rises [ 2]. Androgen-deprivation therapy (ADT) also induces loss of bone mineral density and muscle strength, leading to frailty and consequently increased frequency of fractures [ 3]. However, the antitumor effect of ADT outweighs its adverse effect on bone health, and for this reason it is...


Compliance with ethical standards

Conflict of interest

No author has any conflict of interest.


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Copyright information

© Japan Society of Clinical Oncology 2019

Authors and Affiliations

  • Atsushi Mizokami
    • 1
    Email author
  • Go Kimura
    • 2
  • Yasuhisa Fujii
    • 3
  • Shiro Hinotsu
    • 4
  • Kouji Izumi
    • 1
  1. 1.Department of UrologyKanazawa UniversityKanazawaJapan
  2. 2.Department of UrologyNippon Medical SchoolTokyoJapan
  3. 3.Department of UrologyTokyo Medical and Dental UniversityTokyoJapan
  4. 4.Department of Biostatistics and Clinical EpidemiologySapporo Medical UniversitySapporoJapan

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