Table 1.

Main studies showing bone flare phenomenon in advanced prostate cancer patients.

Study	Treatment	Study design	Type of imaging	No. of patients	Worsened bone scan at 3rd month	Bone flare	Pain flare	PSA flare
Pollen23	ADT ± CHT	Prospective	BS	33	9% (3/33)	6% (2/33)	n/a	n/a
Johns22	Leuprolide	Prospective	BS	26		19% (5/26)	n/a	n/a
Cook21	Leuprolide	Prospective	BS	22	0/22	41% (9/22)	n/a	n/a
Ryan5	Abiraterone	Prospective	BS/ CT/MRI	23	52% (12/23)	48% (11/23)	24%	n/a
Messiou25	CYP17 inhibitor	Retrospective	CT	39	21% (8/39)	8% (3/39)	n/a	n/a
De Giorgi36	Abiraterone	Retrospective	FCH PET/CT	43	29% (12/42)	10% (4/42)	n/a	n/a
Morris37	Abiraterone	Retrospective	BS/ CT/MRI	1088	15% (166/1088) at week 8	2.5% (27/1088) at week 12	n/a	n/a
Modi46	Radium-223	Retrospective	BS	29	n/a	21% (6/29)	52%	10%
Keizman47	Radium-223 ± abiraterone or enzalutamide	Retrospective	BS or CT	113	26% (29/113)	20% (23/113)	27%	n/a
Aggarwal29	Enzalutamide	Prospective	PSMA PET	8#	n/a	6/8 (75%)	n/a	n/a
Isensee52	Radium-223	Retrospective	BS	19	21% (4/19)	15.8% (3/19)	n/a	n/a
Kadomoto53	Abiraterone or enzalutamide	Retrospective	BS	31	45% (14/31)	26% (8/31)	n/a	n/a
De Laroche54	Abiraterone	Prospective	SPECT-CT	19	26% (5/19)	21% (4/19)	n/a	n/a
Armstrong42	Enzalutamide	Post hoc retrospective	BS	872* 800**	20%* (177/872) 9%** (73/800)	27.5%* at week 9 and 13 18.1%** at weeks 17 and 25	n/a	n/a

^*Chemotherapy-naive patients enrolled in the PREVAIL trial.

^**Chemotherapy-treated patients enrolled in the AFFIRM trial.

#Four castration-sensitive prostate cancer + four castration-resistant prostate cancer patients.

ADT, androgen deprivation therapy; BS, bone scan; CHT, chemotherapy; CT, computed tomography; FCH PET/CT; 18F-fluorocholine positron emission tomography/computed tomography; MRI, magnetic resonance imaging; n/a, not available; SPECT, single photon emission computed tomography.