Ján Kliment st., Hubert Poláček, Ivan Režňák
Almost all patients with metastatic castration-resistant prostate carcinoma have bone metastases which are accompanied
with pain, occurrence of painful bone complications and lowering of quality of life and shortened survival. In recent
years, several preparations, which prolong the survival and improve the quality of life in patients have been implemented
to clinical use. Here also belongs radium -223. Radium-223 is an alpha particle-emitting nucleotide, which reminds
calcium with its properties. It replaces it in the compound with hydroxyapatite in the places of increased bone changes
in bone metastases and their surroundings. A high energy and low penetration in comparison with beta particles are
characteristic for alpha particles. Radiation of alpha emitting particles causes irreversible double DNA breaks and a subsequent
strong cytotoxic effect in the sites in which the metastatic tumour cells occur. Distribution into soft tissues is limited.
The clinical study ALSYMPCA, based on which the clinical use of radium -223 showed improvement in the overall
survival and delay in symptomatic bone complications regardless the previous treatment with docetaxel. Radium-223
is perfectly tolerated by patients, has an excellent profile and low incidence of haematological complications. In the paper,
the present clinical studies with radium-223 are stated, as well as contemporary experience, practical aspects of radium-
223 and its place in nowadays possibilities of treatment for metastatic castration-resistant prostate carcinoma.