The majority of patients with castration-resistant prostate cancer develop bone metastatic disease. It is often challenging to optimally palliate malignant bone pain. In case of multifocal pain due to diffuse osteoblastic metastases, treatment with bone-seeking radiopharmaceuticals can be considered.
A systematic review has evaluated the efficacy of different bone-seeking radiopharmaceuticals for palliation of malignant bone pain from prostate cancer.
The PubMed ( Medline ) and Embase databases were searched for publications on 89-Strontium-chloride ( 89Sr ), 153-Samarium-EDTMP ( 153Sm ), 186-Rhenium-HEDP ( 186Re ), 188-Rhenium-HEDP ( 188Re ), and 223-Radium-chloride ( 223Ra ).
Randomised controlled trials and prospective cohort studies were included.
This review included 36 articles of which 13 randomised trials and 23 prospective studies. Of all trials, 10 studies used 89Sr, 7 153Sm, 12 186Re, 2 188Re, and 2 223Ra; three reported on a combination of different radionuclides.
Only a few trials contained a blinding procedure and several studies contained incomplete follow-up or lack of intention-to-treat analysis.
It was not possible to calculate a pooled estimate of pain response to treatment with any of the radionuclides because different definitions of pain response were used.
In conclusion, overall, pain response percentages greater than 50-60% were seen with each radionuclide.
Haematological toxicity was reported in 26 of the 36 studies and more than half of these trials stated no grade 3/4 leukopenia or thrombocytopenia occurred. ( Xagena )
Jong JM et al, Eur Urol 2015; Epub ahead of print