The large population of men who will develop metastatic prostate cancer creates a strong need for good palliative care. For many men, androgen ablation works well; however, when this fails, the quality of a man's life can quickly degrade. Pain from skeletal metastases, neurologic involvement, bleeding, and obstruction can all occur. Radiotherapy has long been the gold standard for palliation of symptomatic disease. However, a new approach using hemibody irradiation (HBI) earlier in the disease course, as well as more effective and tolerable dose and fractionation schemes for local field radiation, are providing excellent amelioration of symptoms and the possibility of living longer and more comfortably to many men with metastatic prostate cancer. The indications and use of therapeutic systemic radioisotopes to help achieve these objectives are also discussed.
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