This review will include discussion of the role of radiation therapy for osseous metastases and metastatic spinal cord compression, as well as the use of radiopharmaceuticals for painful osseous metastases.
It is important for all of us now and then to take a step back and recapture the wonder that we all felt at the onset of our careers, when treatments we now consider simple and routine held an aura of miracle. For me, a little bit of that wonder returns every time I treat a patient with a bony metastasis—in particular, from prostate cancer.
In order to achieve maximum survival of patients with metastatic castration-resistant prostate cancer, the judicious use of all available effective agents and modalities is required. Both EBRT and radium-223 are effective at relieving pain, but both may decrease bone marrow function.
There is no question that radiopharmaceuticals have a role in the management of patients with metastatic bone disease. There is also no question that fractionated external beam radiotherapy (EBRT) is highly effective and generally well tolerated when delivered with large open or focal fields.
In a recently published study, younger men who undergo a prostatectomy for their prostate cancer cut their relative risk of dying from prostate cancer by 55%, and those with intermediate-risk disease cut their relative risk of dying from prostate cancer by 62%.