title: Radioisotopes in management of metastatic prostate cancer.
abstract: BACKGROUND
  Metastatic prostate cancer continues to be a leading cause of morbidity and mortality in men with prostate cancer. Over the last decade, the treatment landscape for patients with castrate-resistant disease has drastically changed, with several novel agents demonstrating an improvement in overall survival in large, multi-institutional randomized trials. Traditional treatment with radioisotopes has largely been in the palliative setting. However, the first in class radiopharmaceutical radium-223 has emerged as the only bone-directed treatment option demonstrating an improvement in overall survival.
  
  
  METHODS
  Medline publications from 1990 to 2016 were searched and reviewed to assess the use of currently approved radioisotopes in the management of prostate cancer including emerging data regarding integration with novel systemic therapies. New positron emission tomography-based radiotracers for advanced molecular imaging of prostate cancer were also queried.
  
  
  RESULTS
  Radioisotopes play a crucial role in the diagnosis and treatment of prostate cancer in the definitive and metastatic setting. Molecular imaging of prostate cancer and theranostics are currently being investigated in the clinical arena.
  
  
  CONCLUSIONS
  The use of modern radioisotopes in selected patients with mCRPC is associated with improvements in overall survival, pain control, and quality of life.
authors.affiliation: Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Amar
authors.initials: A
authors.lastname: Raval
authors.affiliation: Department of Radiation Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Tu D
authors.initials: TD
authors.lastname: Dan
authors.affiliation: Department of Radiation Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Noelle L
authors.initials: NL
authors.lastname: Williams
authors.affiliation: Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Pridjian
authors.affiliation: Department of Radiation Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Den
keywords: Alpha particle; alpharadin; bone metastases; bone-targeting; calcium mimetic; metastatic castrate; radionuclide; radiopharmaceutical; radium-223; resistant prostate cancer