Bone-Targeted Imaging and Radionuclide Therapy in Prostate Cancer

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. The advantages of ¹⁸F-NaF include improved lesion detection and, when used in combination with CT, improved diagnostic confidence and specificity. In addition to being the first approved α-emitter, ²²³RaCl₂ is the first radiopharmaceutical to show an increase in overall survival, a decrease in skeletal events, palliation of bone pain, and a low profile of adverse reactions (which are mild and manageable). The management of metastatic bone disease with ²²³RaCl₂ is uniquely satisfying, as patients can be monitored directly during their monthly treatment visits.