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Radium 223 therapy

This page tells you about radium 223 therapy to treat cancer that has spread to the bones. There is information about


What radium 223 is

Radium 223 is a type of internal radiotherapy treatment. It is a mildly radioactive form of the metal radium. It used to be called Alpharadin and now has the brand name Xofigo (pronounced zoh-fee-go).

Doctors use radium 223 to treat prostate cancers that have spread to the bones. If there are cancer cells in more than one area of bone, radium 223 can work well to treat those areas and reduce pain.

You may need to travel to a different hospital for the treatment because it is not available in every hospital.


How radium 223 works

Radium is very similar to calcium. Like calcium it is taken up by active bone cells. This makes it a good way of targeting bone cancer cells. Cancer cells are more active than normal bone cells and so are more likely to pick up the radium 223.

Radium 223 treatment uses a type of radiation called alpha particles. Your doctor, specialist nurse or nuclear medicine practitioner will give you information about the treatment and possible side effects. 

You have a small tube called a cannula put into a vein in your arm. The doctor, nurse or practitioner injects the radium 223 through the cannula into your bloodstream. The treatment circulates to your bones. The cancer cells in the bone take it up. The radiation only travels a short distance, between 2 and 10 cells deep. This is much less than a millimetre. So it means that the cancer cells receive a high dose of radiation and some of them die. Healthy cells receive only a low dose or no radiation. So this treatment causes few side effects.


How you have radium 223

You have radium 223 as an injection into a vein. Usually this is through a thin short tube (a cannula) put into a vein in your arm each time you have treatment. The injection takes up to a minute.

The injection is normally repeated every 4 weeks. You may have it up to 6 times. You have the treatment as an outpatient and will be able to go home afterwards.


After radium 223 treatment

After the treatment, some radiation may be present in your urine for a few hours and in your poo (faeces) for up to 7 days.The total amount is extremely small and gets lower each day. Your radiotherapy doctor (clinical oncologist) or specialist nurse will usually ask you to take the following precautions. 

  • Drink plenty of fluids for a few days
  • For the first few days sit down on the toilet when passing urine, instead of standing up or using a urinal
  • Wash your hands thoroughly every time you use the toilet
  • For 7 days, wipe yourself very carefully after having your bowels open (some hospitals suggest that you use gloves)
  • For 7 days, flush the toilet twice after using it
  • If you share the toilet with other people, wipe the toilet seat after using it
  • If clothing becomes soiled with urine or faeces, wash it separately from other clothing

After this treatment, men should not father children for at least 6 months as the treatment can cause sperm damage. Talk to your doctor or nurse about effective contraception before having the treatment. 

It may be possible to store sperm before the treatment if you are planning to have children in the future. We have information about storing sperm.


Possible side effects

The side effects of radium 223 can include diarrhoea and sickness but these are generally mild.

The treatment can also sometimes cause low levels of blood cells after a few weeks. This can lead to an increased risk of infection, anaemia, and bruising more than usual. So you will need to have regular blood tests after the treatment.

Rarely, some people have increased pain in the area of cancer in the bone for a few days or weeks after this treatment. Let your doctor or nurse know if you have this. 


More information about radium 223

You can find information about radiotherapy to control symptoms in our radiotherapy section.

You can also find information about information about pain control in our coping with cancer section.

Your medical physicist or radiotherapy doctor will be able to explain the radium 223 treatment to you in detail if you would like them to.

Clinical trials are looking into using radium 223 for breast cancers that have spread to the bone. You can find out about radium 223 clinical trials on our clinical trials database. Type 'radium' into the free text search box.

Some of the prostate cancer organisations can put you in touch with other patients who have had radium 223 treatment. If you want to find people to share experiences with online, you could use Cancer Chat, our online forum.

There is very detailed information about radium 223 on the Electronic Medicines Compendium website at

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Updated: 30 April 2014