prostate cancer stage | metastatic castration resistant prostate cancer |
bone metastases | ≥ 2 symptomatic bone metastases, skeletal scintigraphy not older than 6 months, other imaging modalities: 18F-NaF-PET/CT, 11C/18F-choline-PET/CT, 18F/68Ga-PSMA-PET/CT, whole-body MRI |
the absence of visceral metastases | lymph nodes ≤3 cm in the short axis are allowed in any location, CT scan, or possibly 18F-choline-PET/CT, 68Ga-PSMA-PET/CT |
symptomatology | analgesic therapy or palliative external radiotherapy due to bone pain |
ECOG PSa | patients with ECOG 0–2 |
prediction | expected survival ≥6 months |
hematological parameters | hemoglobin ≥100 g/l platelets ≥100 × 109/l neutrophils ≥1.5 × 109/l |
contraindications | no contraindications for the Radium-223 therapy are known |
warning | increased caution is indicated in patients with inflammatory bowel disease (risk of bowel disease aggravation), with diffuse skeletal metastatic affection, after chemotherapy (increased risk of myelotoxicity - bone marrow damage) |