Phosphorus-32 for intractable bony pain from carcinoma of the prostate

Although multiple bony metastases from carcinoma of the prostate are common, widespread pain is a much less frequent complication but one which nevertheless presents considerable difficulties in management. Pain may be severe requiring large doses of narcotic analgesics and may render the patient virtually immobile. A total of 53 treatments with radioactive phosphorus-32 were assessed in 46 patients; in addition, five patients died before response was assessable. A worthwhile response in terms of pain reduction and improved mobility was obtained in 87%. Response was subdivided into good and moderate, with response rates of 53% and 34% respectively. The mean age of patients at treatment was 64.6 years, the median 65 years, and 30% of treated patients were 60 years or under. Median survival in the good, moderate and no response groups was 8, 6.5 and 4.5 months respectively. These differences in survival are not statistically significant. Five-year survival was 4.3%. The treatment is not intended to improve survival but with 87% of patients achieving pain relief, 32P should be considered for the treatment of severe bony pain when other options are limited by the widespread nature of the disease.