Prostate cancer is the first cancer in men and has a specific tropism to bones. This tropism provided the rationale to develop bone targeting radiopharmaceutical agents, such as strontium, samarium and more recently the Radium-223, an alpha-emitter.
Radium-223 (223Ra) chloride, an alpha emitter, has been shown to improve overall survival (OS) and pain control, and to delay skeletal-related events, in patients with castration-resistant prostate cancer (CRPC) and bone metastases.
Although selective metabolic and receptor-based molecular agents will surely be included in the future of prostate cancer diagnosis and therapy, currently available inorganic compounds-such as 18F-NaF for the diagnosis of bony disease and 223RaCl2 for the therapy of bone metastases-were recently shown to be superior to standard 99mTc-phosphonates for diagnosis and 153Sm-ethylenediaminetetramethylene phosphonate or 89SrCl2 for therapy.
(223) Radium ((223) Ra) is widely used in Nuclear medicine to treat patients with osseous metastatic prostate cancer. In clinical practice (223) Ra cannot be imaged directly, however gamma photons produced by its short-lived daughter nuclides can be captured by conventional gamma cameras.
Unprecedented development of therapeutics for prostate cancer in recent years has left clinicians with the challenge of adequately sequencing therapeutic agents to optimise patient benefit. No clear guidelines exist on optimal treatment sequences.
223Radium (223Ra) is the first alpha-emitting therapy proven effective in human cancer. Prospective randomized trials indicate that 223Ra, which concentrates after intravenous injection in areas of osteoblastic metastatic disease, can prolong survival in bone-dominant castrate resistant prostate cancer patients.
A 76-year-old man with symptomatic bone metastases from castration-resistant prostate cancer underwent Radium-223-dichloride (Ra-223) therapy. Before Ra-223 therapy, he had normal peripheral blood cell counts.
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