Clinical Experience With Radiopharmaceuticals

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Clinical experience with radiopharmaceuticals in prostate cancer has evolved significantly, with radium-223 representing a cornerstone therapy that has been complemented by newer prostate-specific membrane antigen–targeted radioligand therapies. The PEACE III trial expands treatment options for first-line patients with metastatic castration-resistant prostate cancer, particularly those with limited prior therapy exposure consisting only of androgen deprivation therapy (ADT) alone or ADT plus docetaxel. Ideal candidates for the PEACE III combination include patients without visceral disease involvement, though lymph node metastases are acceptable. Importantly, the trial demonstrated efficacy in asymptomatic or minimally symptomatic patients, expanding beyond the traditional symptomatic patient population typically considered for radium therapy.

Patient selection and monitoring protocols are essential for successful radiopharmaceutical therapy implementation. Regular CBC monitoring helps identify patients requiring blood transfusions or those with reversible causes of anemia, such as iron, folate, or B₁₂ deficiency. Maintaining optimal bone marrow health through nutritional supplementation ensures patients can effectively produce new blood cells during treatment. Common management strategies include encouraging physical activity and exercise to combat fatigue while maintaining mental health and utilizing antiemetics such as compazine or ondansetron for mild nausea typically associated with radiopharmaceutical treatments.

Radiation safety considerations form a critical component of patient education and care coordination. Patients require specific guidance regarding bathroom usage, typically using their own facilities for approximately 3 days post treatment while sitting for all functions and maintaining cleanliness to prevent radioactive exposure to others. a particle–emitting radiopharmaceuticals like radium-223 are generally considered safer than other radiation forms, allowing patients to maintain normal social interactions with appropriate precautions. The unique mechanism of action offered by radiopharmaceuticals provides hope for overcoming resistance developed from prior therapies, representing a valuable addition to the advanced prostate cancer treatment armamentarium when properly managed through CBC monitoring and supportive care measures.