Systemic treatment of prostate cancer and the role of radium-223

Author(s): Dr Caroline Chau, Dr Stephanie Prince, Dr Simon Crabb

Hospital: University Hospital Southampton NHS Foundation Trust

Reference: RAD Magazine, 40, 472, 24


Prostate cancer is the most common malignancy in men, with 40,000 new diagnoses each year in the UK. This disease usually affects men aged 65 years and over, and there is a higher incidence and mortality in men of black African-Caribbean ethnic origin. Most cases at diagnosis are confined to the prostate gland and may be treated with either radical prostatectomy or radiotherapy (external beam or brachytherapy), or may be suitable for an observational approach termed active surveillance. However, once prostate cancer has metastasised, it is incurable by conventional approaches and the main goal of treatment is to prolong survival, maintain quality of life and palliate symptoms. Prostate cancer commonly spreads to the bones and pelvic/abdominal lymph nodes, and less commonly to visceral sites such as liver or lung. Morbidity and mortality often results from bone involvement, with debilitating pain, spinal cord compression, pathological fractures and bone marrow failure.

In recent years we have seen major advances in the options for systemic therapy for men with advanced incurable disease that achieve the main goals of treatment. This article will summarise these and focus on the role for the recently licensed radiopharmaceutical radium-223 (Xofigo, Bayer).

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