Systemic radiation is injected radiation that circulates through the body to target metastasis.  There are several types of systemic radiation all of which have been shown to prolong life with limited side effects.  This episode covers current systemic radiation options as well as exciting, new advancements on the horizon.    

If you have advanced prostate cancer, you don’t want to miss this episode!

Dr. Scholz: [00:04] Welcome to PROSTATE PROS. I’m Dr. Mark Scholz and this is my cohost Liz Graves.

Liz: [00:10] We’ve talked about computerized beam radiation and seed radiation, but there’s yet another category of radiation called systemic radiation. This is radiation that can be injected into the bloodstream to target metastasis throughout the body. Dr. Scholz, can you start off by talking about some benefits of systemic radiation?

Dr. Scholz: [00:31] Injectable radiation offers some specific opportunities that we can’t do with beam radiation. We’ve talked about oligometastatic disease and how if there’s only a limited number of spots, radiation therapists can target those spots with beam radiation, but when you have multiple spots, beam radiation will cause excess suppression of the immune system. This is the advantage of injectable radiation, that it can target multiple spots throughout the body.

Liz: [01:09] So how this works is it gets injected via infusion into the bloodstream.

Dr. Scholz: [01:15] Yes, and it’s quote, smart enough, unquote, to be able to go seek out the metastasis in different areas of the body and radiate them directly.

Liz: [01:27] We’re talking about metastatic disease, which means the types of systemic radiation we’ll be talking about today are typically for men with advanced prostate cancer that’s usually resistant to hormone therapy.

Dr. Scholz: [01:40] That’s entirely correct. There is some very preliminary research looking at preventing future metastases, but that is only at the very beginning stage.

Liz: [01:52] Before we get into the different types, can you talk a little bit about which kind of doctor administers these radiations?

Dr. Scholz: [01:59] So most men with advanced metastatic prostate cancer are going to be seeing either a urologist or a medical oncologist, but neither of these specialties actually give this type of treatment. You’re typically going to see either a radiation therapist or a nuclear medicine specialist. Nuclear medicine specialists are the same doctors that administer bone scans, pet scans, and other nuclear based treatments.

Liz: [02:27] So the first type we’re going to talk about today is Xofigo, which might be familiar to listeners. It was FDA approved for prostate cancer in 2013.

Dr. Scholz: [02:37] So Xofigo is a clever invention. Some doctors discovered that radium behaves very similar to calcium. When people have metastatic disease in the bones, the calcium metabolism is accelerated, the body incorporates the calcium into the bones at an accelerated rate. Since radium is mistaken for calcium, the radium gets incorporated into the bones right next to the tumor. Radium-223 is a very powerful alpha particle and just a single hit of an alpha particle can kill a cancer cell.

Liz: [03:19] So, Xofigo treats only bone mets, which means patients and doctors need to be selective in who is getting this treatment. How do we find out if someone has bone mets, Dr. Scholz?

Dr. Scholz: [03:32] So there’s a variety of different scans. Of course, these again are people that have elevated PSAs, but bone scans, CAT scans, and PET scans can all detect bone mets. It’s important that the prostate cancer patient has mostly bone mets, a few small lymph node mets are acceptable because lymph node mets are not as dangerous as bone mets. But if people have lung m