Fractionated Docetaxel and Radium 223 in Metastatic Castration-Resistant Prostate Cancer

Inclusion Criteria:

Histologically or cytologically confirmed adenocarcinoma of the prostate
Documented metastatic castration resistant disease with PSA progression, radiographic progression, or both, despite medical or surgical castration
Two or more bone metastases detected on skeletal scintigraphy
Eligible for docetaxel chemotherapy
ECOG Performance Status 0-2

Adequate organ function:

Hemoglobin > 10 g/dL
Absolute Neutrophil Count ≥ 1,500 K/mL
Platelet count ≥ 150,000 x 10^9/L
Total bilirubin ≤ 1.5x upper limit of normal range, excluding Gilbert syndrome
Serum AST ≤ 1.5 x upper limit of normal range
Serum ALT ≤ 1.5 x upper limit of normal range
Estimated glomerular filtration rate (GFR) > 30mL/min
Ongoing castration (androgen deprivation therapy or prior orchiectomy)
Male subjects with female sexual partners of childbearing potential must agree to use at least one highly effective methods of birth control.
Ability to understand and willingness to sign an informed consent form prior to initiation of any study procedures.
Age ≥ 18 years

Exclusion Criteria:

Prior radionuclide therapy for CRPC
Prior docetaxel for CRPC. (Permitted if given for castration sensitive disease > 6 months prior).
Antiandrogen therapy within 4 weeks of enrollment. However, patients with primary failure of secondary anti-androgen therapy OR symptomatic progression, objective progression and/or biochemical evidence of rising PSA less than 4 weeks after discontinuation of anti-androgen therapy will not have anti-androgen withdrawal responses and will not be excluded.
Preexisting peripheral neuropathy grade 2 or higher.
Other serious medical condition as judged by the investigator.
Active second malignancy that requires therapy.
Known brain or leptomeningeal metastases
Concurrent enrollment in any other investigational anticancer therapy
Treatment with any myelosuppressive agent within 30 days of enrollment

Presence of bulky visceral metastases, defined as any of the following:

≥ 4 lung lesions (at least 1cm each in size in the longest diameter) or pulmonary lymphangitic metastasis
Liver metastases with sum of lesion diameters totaling ≥ 5cm
Evidence of neuroendocrine or small cell differentiation on prior biopsy
History of severe hypersensitivity reactions to docetaxel or to drugs formulated with polysorbate 80