A newer bone targeted approach is the combination of radioisotopes with chemotherapy. In addition to its inherent systemic benefits chemotherapeutic agents can also act as radiosensitizers when combined with radiopharmaceutical. Preliminary clinical experience with the combination of radiopharmaceuticals and systemic chemotherapy indicate that this approach is feasible tolerable and potentially effective. In a randomized phase II trial metastatic HRPC patients were treated with chemotherapy: Ketoconazole and Doxorubicin alternating with Vinblastine and Estramustine (KAVE regimen). Seventy-two patients who were stable or responded after 2-3 cycles were randomized to receive a consolidation treatment with additional 6 weekly doxorubicin treatments with a single dose of 89Sr or weekly doxorubicin alone. Patients receiving the combined consolidation treatment had a significantly longer time to progression and survival (27.7 vs.16.8 months. P=0.0014).(20)