In castrate-resistant metastatic prostate cancer, how do you decide whether to offer radionuclide therapy versus external beam radiation therapy to select sites?

Since Xofigo improves survival in these patients in comparison to EBRT, if they meet trial criteria, I favor xofigo, as that would help with skeletal related events and improve survival. One other factor to consider is patients should not be on Zytiga. Concurrent Zytiga and xofigo in clinical trial ...

On ALSYMPCA, patients received Xofigo or placebo in addition to best standard of care, defined as antihormonal agents, local EBRT, ketoconazole, and treatment with glucocorticoids.

Therefore, you can give them palliative RT as indicated and proceed with Xofigo. Keep risk of myelosuppression related t...