Safety and Toxicity Management in Metastatic Castration-Resistant Prostate Cancer

Dr. Johann De Bono and Dr. Pedro Barata discuss practical approaches to monitoring and managing toxicities associated with radiopharmaceutical therapies in metastatic castration-resistant prostate cancer (mCRPC). Dr. Barata highlights the importance of multidisciplinary coordination between medical oncology, nuclear medicine, and radiation oncology teams to support safe administration and ongoing patient monitoring. The faculty review common adverse events associated with radiopharmaceutical therapies, including fatigue, xerostomia, cytopenias, anemia, thrombocytopenia, and renal function changes, while emphasizing the need for regular laboratory assessments and close clinical follow-up throughout treatment. The conversation also addresses concerns regarding long-term toxicities, including bone marrow suppression, myelodysplastic syndromes, secondary hematologic malignancies, and cumulative radiation exposure. In addition, Dr. De Bono discusses potential differences in toxicity profiles between alpha- and beta-emitting therapies, particularly regarding xerostomia and anti-tumor activity with emerging alpha-emitting PSMA-targeted approaches. Together, the faculty emphasize the importance of long-term monitoring as radiopharmaceutical therapies continue to move earlier into the mCRPC treatment landscape.