Bone metastases are the most common cause of pain in prostate cancer. For palliation of pain androgen deprivation must be the first choice of treatment in androgen-sensitive disease. Radiotherapy is the mainstay in the palliation of painful localized bone metastases of prostate cancer. But patients with lytic lesions in weight-bearing bones should be considered for prophylactic surgical stabilization before radiotherapy. Systemic radionuclide therapy can be preferred, particularly for patients with multilocular metastatic disease. With these therapeutic applications complete analgesia is uncommon and, thus most patients require analgesic treatment according to the WHO “analgesic ladder” during the course of the their disease.