Palliative radiotherapy in prostate cancer

Progressive, hormonally resistant prostate cancer presents a multitude of challenges to the patient and physician. The appropriate delivery of palliative care requires a full assessment of the patients medical condition, and the treatment offered must take into account the patients physical, psychological, and social needs. Opinions from medical oncology, surgical oncology, radiation oncology, pain management, and palliative care specialists are often required to devise the most appropriate treatment strategy. The pain from osseous metastases is the most common indication for palliative radiotherapy in this setting. Localized external beam therapy will provide prompt pain relief in the treated area for 80% to 90% of treated individuals, but the optimum dose/fractionation schedule remains to be determined. Wide field radiotherapy with hemibody irradiation or strontium89 (89Sr) isotope therapy will relieve the pain of widespread metastases in 50% to 90% of individuals, depending on the dose and extent of disease. Hemibody irradiation has a quicker onset of action, and will also treat extraosseous disease, but is more likely to produce gastrointestinal toxicity than 89Sr. Both modalities can delay the progression of asymptomatic bony metastases, with 89Sr being slightly more effective in this regard. Palliative radiotherapy provides a simple and effective method of treating many of the other complications of progressive prostate cancer and these are discussed.