PROSTATE PROS Episode 10: Don’t Reject Radiation


“Historically, metastatic cancer has such a bleak outlook that people address this problem of progressive cancer sometimes with denial.  The thinking is ‘well, doctors can’t do much anyway.’ Fortunately in 2020 that’s just not true.” – Dr. Scholz   


For men with advanced metastatic prostate cancer, systemic radiation can prolong life with minimal side effects.  Systemic radiation is injected radiation that travels throughout the body to target metastasis.    

Types of Systemic Radiation:

  1. Spot Radiation
    1. Oligometastic prostate cancer only (5 or less mets)
    2. SBRT to spots (can be lymph node, bone, liver metastasis) 
    3. Abscopal effect– stimulate the immune system to target the cancer cells
  2. Xofigo (Radium-223)
    1. Only for bone metastasis
    2. FDA approved for prostate cancer in 2013
    3. Radium-223 gets absorbed into the bones near the metastasis and radiates it
    4. One minute injection once a month for six months
  3. Lutetium-177
    1. Not yet FDA approved
    2. Travels with PSMA proteins to PSMA receptors present on prostate cancer cells and radiates 
    3. Very promising for men with metastatic prostate cancer 
    4. Preliminary studies showing thirteen month prolonged survival
    5. Must have PSMA PET scan before starting treatment
    6. Four Lutetium treatments eight to twelve weeks apart
  4. SIR Spheres
    1. FDA approved for colon cancer liver mets, works off-label for prostate cancer liver mets as well
    2. Typically only used if traditional methods (chemotherapy,etc.) have failed
    3. Injected directly into the arterial supply of the liver


While early stage prostate cancer doesn’t have symptoms, men with bone metastasis may have bone pain.  There was a survey done by Bayer in 2015 that showed 7 out of 10 men ignore symptoms of prostate cancer progression like pain.  It is important that men discuss symptoms of discomfort, such as pain, at their onset because it is easier to treat progression the earlier it is detected.  

Learning options that target metastasis for men with advanced, castration resistant prostate cancer is important.  Metastasis indicates a much more serious situation that needs to be treated more urgently and aggressively than localized disease.  Luckily, there are plenty of options for men with metastasis, including the systemic radiation options discussed above. There are a lot of promising advancements on the horizon including the PSMA PET scan and Lutetium-177.  

Prostate Cancer Symptoms Survey: 

More on the immune-enhancing effects of spot radiation: 

PCRI’s YouTube Channel: 

Register for the 2020 PCRI Mid-Year Update: 

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The purpose of this podcast is to educate and inform.  The information presented on this podcast and corresponding blog posted on should not be used in place of a physician consult. Guests on the podcasts present their own opinions and conclusions, these views do not necessarily represent that of Prostate Oncology Specialists.

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