We agree that much more research is needed on radium-223 timing and utilization. However, we just want to clarify one point. The fact that 55% of radium users were in 2015 does not mean that 55% of metastatic castration-resistant prostate cancer patients were using radium in 2015. Rather, within our cohort, the majority of patients were in the earlier years. Given we only abstracted data up to 2017, this may explain the apparent decreased use in more recent years. However, to fully address this, one would need to look at the entire metastatic castration-resistant prostate cancer population and assess the percentage that received radium, which is not what we did. Thus, while we agree it appears radium use is decreasing, possibly related to increased use of androgen receptor-targeted agents, because of the way we designed the study, we cannot specifically address this question.
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