Serum hemoglobin levels predict response to strontium-89 and rhenium-186-HEDP radionuclide treatment for painful osseous metastases in prostate cancer

Urol Int. 2006;77(1):50-6. doi: 10.1159/000092935.


Objective: Retrospective comparative analysis of strontium-89 chloride (Sr89) and rhenium-186-hydroxyethylidene diphosphonate (Re186-HEDP) radionuclide treatment to find predictors of response in patients with painful metastases from hormone refractory prostate cancer.

Patients and methods: Clinical data from 60 hormone refractory PCA patients (i.e. rising PSA at castrate testosterone serum levels) was obtained. Twenty-nine were treated with Sr89, 31 were treated with Re186-HEDP for painful osseous metastasis. Response was defined as a patient-reported decrease in pain and/or reduction in pain medication with stable pain level. Hematological parameters and serum levels of PSA, alkaline phosphatase, and lactate dehydrogenase were assessed prior to and at 4-week intervals after treatment.

Results: Median survival of all patients was 7 months (95% CI: 6-9 months). Overall, 33/60 (55%) patients reported a decrease in pain after the first radionuclide treatment. This percentage was similar for patients treated with Re168-HEDP and Sr89. Mean duration of reported pain response was 75 days (+/- 68 days) for Sr89 and 61 days (+/- 56 days) for Re186-HEDP, which was not significantly different. A lower blood hemoglobin concentration was associated with a lower pain response rate. In a multivariate Cox regression analysis, pain response to radionuclide treatment predicted longer survival after treatment.

Conclusions: Pain response was present in 55% of patients. Serum hemoglobin concentration prior to radionuclide treatment predicted pain response for both Re186-HEDP and Sr89. A reduction in pain upon radionuclide treatment was associated with a longer survival after treatment.

MeSH terms

  • Aged
  • Bone Neoplasms / blood*
  • Bone Neoplasms / radiotherapy*
  • Bone Neoplasms / secondary
  • Etidronic Acid / therapeutic use*
  • Hemoglobins / analysis*
  • Humans
  • Male
  • Organometallic Compounds / therapeutic use*
  • Pain
  • Predictive Value of Tests
  • Prostatic Neoplasms / secondary*
  • Radioisotopes / therapeutic use*
  • Retrospective Studies
  • Strontium Radioisotopes / therapeutic use*


  • Hemoglobins
  • Organometallic Compounds
  • Radioisotopes
  • Strontium Radioisotopes
  • rhenium-186 HEDP
  • Etidronic Acid