Use of radionuclides in metastatic prostate cancer:  pain relief and beyond.
OBJECTIVE
Bone metastases in prostate cancer are often the cause of significant morbidity in patients with castrate-resistant disease, and several studies have shown significant pain palliation with systemic radionuclide treatment. The purpose of this review is to discuss the place of radionuclides in the dynamic treatment landscape of metastatic prostate cancer in light of new evidence demonstrating benefit beyond palliation.


RESULTS
The recently reported ALSYMPCA trial, which was a multicentre, placebo-controlled, phase 3 randomized controlled trial in patients with symptomatic metastatic castrate-resistant prostate cancer (CRPC) has shown significant overall survival (OS) benefit in favour of Radium-223 (Alpharadin) treatment [median OS 14.0 vs. 11.2 months; P = 0.00185; hazard ratio 0.695; 95% confidence interval (CI) 0.552-0.875]. This situation led to early unblinding of the trial and patients on placebo arm being offered Radium-223 treatment.


CONCLUSIONS
It has been an exciting and challenging time for treatment of patients with metastatic CRPC with six new agents demonstrating OS benefit in phase 3 trials, in this setting since 2004. Further research should focus on appropriate sequencing and innovative strategies to use these therapeutic agents to maximize benefit for patients. In the case of radionuclides, novel strategies include repeated administration, dose intense regimens and combination with other agents.
Northern Ireland Cancer Centre, Belfast.
Salil
S
Vengalil
Joe M
JM
O'Sullivan
Christopher C
CC
Parker
D001859:Bone Neoplasms / Q000532:radiotherapy* / Q000556:secondary; D006801:Humans; D008297:Male; D054526:Men's Health; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010166:Palliative Care / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D011868:Radioisotopes / Q000627:therapeutic use*; D011883:Radium / Q000627:therapeutic use; D012211:Rhenium / Q000627:therapeutic use; D012493:Samarium / Q000627:therapeutic use; D013324:Strontium
D011868:Radioisotopes; D012493:Samarium; D012211:Rhenium; C025700:strontium chloride; D011883:Radium; D013324:Strontium