Radiotherapy for the palliation of prostate cancer

The large population of men who will develop metastatic prostate cancer cre ates a strong need for good palliative care. For many men, androgen ablatio n works well; however, when this fails, the quality of a man's life can qui ckly degrade. Pain from skeletal metastases, neurologic involvement, bleedi ng, and obstruction can all occur. Radiotherapy has long been the gold stan dard for palliation of symptomatic disease. However, a new approach using h emibody irradiation (HBI) earlier in the disease course, as well as more ef fective and tolerable dose and fractionation schemes for local field radiat ion, are providing excellent amelioration of symptoms and the possibility o f living longer and more comfortably to many men with metastatic prostate c ancer. The indications and use of therapeutic systemic radioisotopes to hel p achieve these objectives are also discussed. (C) 2000 Wiley-Liss, Inc.