Do unsealed radioisotopes improve survival in metastatic prostate cancer?
Six RCTs report survival outcomes. Results were conflicting for the four strontium 89 trials. The trial comparing strontium 89 alone with placebo reported a statistically significant improvement in survival in patients receiving strontium 89. This was one old trial with small sample size (n=44) and only actuarial survival was reported. In contrast, the addition of strontium to local radiotherapy appeared to provide no survival benefit. The larger (n=203) trial comparing strontium 89 with local external beam radiotherapy reported a statistically significant improvement in survival in patients receiving radiotherapy, whereas the smaller trial comparing strontium 89 with local (n=111) or hemibody (n=106) external beam radiotherapy showed a beneficial but not statistically significant improvement in survival with strontium 89. No survival benefit was seen with samarium 153.
Evidence summary and recommendations
| Men with hormone refractory prostate cancer and painful bone metastases
The trials examining the effect of unsealed radioisotopes on overall survival have been heterogeneous in study design, contained small patient numbers and provided conflicting results. As such no firm conclusions can be made. The role of radioisotopes in the context of modern-day systemic therapy (chemotherapy and bisphosphonates) has not been defined.
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|The impact of unsealed radioisotopes on overall survival in men with castrate-resistant metastatic prostate cancer is undefined. The relative roles of unsealed radioisotopes and the newer chemotherapeutic agents (e.g. taxanes) and bisphosphonates have also not been defined.||D|
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