Bone metastases are the most important cause of morbidity and mortality in men with prostate cancer. Skeleton related events (SRE) associated with bone metastases is a major health and economic problem in these patients. Zoledronic acid was the first treatment choice for prevention of bone loss and metastases in prostate cancer. However due to the difficulty in application of zolendronic acid and adverse effects of the drug on renal function, other treatment options were being investigated.

Denosumab, as a new agent, is a human monoclonal RANKL antibody and delays bone metastases and reduces SRE in prostate cancer patients. Hypocalcemia and jaw osteonecrozis are the main side effects of denosumab. On the other end, the easy use of this drug without renal function monitoring are the important advantages.

Radiation therapy is another important treatment strategy of bone metastases. Bone metastases in prostate cancer are often in the axial plane, multiple and wide which increases the need of radiation. In this stage the use of radiopharmaceutical agent as an alternative to external beam radiotherapy will be crucial. 223 Ra-based.Alfaradin is a new radiopharmaceutical agent that can be used many times in low doses compared to radiotherapy in the treatment of bone metastases which is an important advantage of this drug.

Keywords: prostate cancer, bone metastasis, alfaradin, denosumab