Radium-223 for the treatment of bone metastases in castration-resistant prostate cancer: when and why.

Radium-223 dichloride (223Ra) is the first, recently approved, α-particle-emitting radiopharmaceutical for the treatment of patients with bone metastases in castration-resistant prostate cancer (CRPC) and no evidence of visceral metastases. We explored MEDLINE, relevant congresses, and websites for data on 223Ra and prostate cancer therapies, focusing on therapeutic strategies and timing, bone metastases, and diagnostic assessment. 223Ra represents the only bone-targeting agent that has significantly extended patients' overall survival while reducing pain and symptomatic skeletal events. Unlike other radiopharmaceuticals, such as strontium-89 and samarium-153 EDTMP, 223Ra (11.4-days half-life) has shown a high biological efficiency mainly due to its short penetration range. These features potentially allow reduced bone marrow toxicity and limit undue exposure. 223Ra has been validated under the product name Xofigo® by the US Food and Drug Administration and the European Medicines Agency. Patient selection, management, and treatment sequencing is recommended to be discussed in the context of a multidisciplinary environment, including oncology, urology, nuclear medicine, and radiation therapy physicians. No consensus has been achieved regarding the optimal timing and its administration as single agent or in combination with zoledronic acid or chemotherapy, so far. This review aims to provide a rationale for the use of 223Ra in treating metastases from CRPC, highlighting the crucial role of a multidisciplinary approach, the disputed inclusion and exclusion criteria on the basis of agencies regulations, and the value of diagnostics for therapy assessment.

Diffusion-weighted magnetic resonance imaging in patients with prostate cancer treated with radiotherapy.

AIMS: To evaluate the utility of a multiparametric 3T magnetic resonance imaging (MRI) study using diffusion-weighted images (DWI) for the assessment of prostate cancer before and after radiotherapy (RT). METHODS: A total of 34 patients, who received a histologic diagnosis of prostate adenocarcinoma, underwent MRI examination before and after local RT for the assessment of response to treatment. Apparent diffusion coefficient (ADC) values were calculated and compared. RESULTS: Before RT, DWI shows pathologic restriction of signal, while after RT pathologic restriction of signal was reduced or disappeared. The ADC values were significantly increased after therapy (p<0.05). CONCLUSIONS: The use of DWI with ADC measurements may be an imaging biomarker in the assessment of prostate cancer.

Could be ureteral endometriosis considered a symptomatic and severe urological disease?

Ureteral endometriosis is a rare localization of gynecological disease. We presented a case of left ureteral endometriosis in a 30-year-old woman with left abdominal pain and a radiological nonfunctioning kidney. Surgical treatment with ureteral resection and uretero-uretero anastomosys was conducted. Pathological examination of surgical specimen revealed endometriosis. The diagnosis of ureteral endometriosis should be considered in women with renal symptoms of noncalculous obstruction, particularly in premenopausal women with an anamnesys of polycistic ovary disease (POD) or severe menstrual related symptoms, although the disease is often strictly associated with silent renal obstruction. Only a high index of suspicion and the radiological support may help the urologist to obtain a early diagnosis. Early detection and prompt treatment strategy, surgical too, are extremely important to relieve symptoms and preserve renal function. The literature was reviewed.