Official websites use. Share sensitive information only on official, secure websites. Email: brian. Radiopharmaceuticals have been utilized for men with advanced prostate cancer for decades. Older agents, seldom used today, provided palliation for bone metastatic pain. In , the alpha emitter radium provided a catalyst for the field by prolonging survival in men with metastatic castrate-resistant prostate cancer mCRPC. Recently radioisotopic therapies have gained further interest with the development and FDA approval of lutetium Lu -PSMA also known as lutetium Lu vipivotide tetraxetan.
This agent targets the prostate-specific membrane antigen PSMA expressed on the cell surface of prostate cancer cells with a beta-emitting isotope Lu.
The current field of radiopharmaceuticals is in a rapid state of flux. The results from these potential practice-changing trials are highly anticipated. Studies of PSMA-targeted therapies using both beta emitters such as Lu and novel alpha emitters such actinium are in progress. During the next decade, radiopharmaceuticals will likely play a central role in the management of patients with advanced prostate cancer.
A review on the current landscape of radiopharmaceutical therapy in prostate cancer as well as future directions. This review summarizes the current and future role of radiopharmaceutical therapies in the management of patients with advanced prostate cancer. Fatalities typically result from metastatic castrate-resistant prostate cancer mCRPC. Agents commonly used to manage patients with metastatic prostate cancer include hormonal therapy such as gonadotropin-releasing hormone GnRH agonists and antagonists; androgen receptor pathway inhibitors ARPIs such as abiraterone, enzalutamide, darolutamide, and apalutamide; chemotherapy such as docetaxel and cabazitaxel; targeted agents such as the poly ADP ribose polymerase PARP inhibitors rucaparib and olaparib; immunotherapies such as sipuleucel-T and pembrolizumab; as well as radiopharmaceuticals which will be the primary focus of this article.
Radiopharmaceuticals induce cell death by using radiation, typically emitted in the form of alpha or beta particles from radioisotopes, in order to induce single- and double-strand breaks in DNA which initiates apoptosis. Beta particles have been shown to be less effective than alphas at delivering significant amounts of radiation to smaller tumors 7 while alpha particles have been shown to be more deleterious. Alphas cause multiple damage sites in DNA, thus having a higher relative biological effectiveness.
