Radium 223 therapy (Xofigo)

Radium 223 is a mildly radioactive form of the metal radium. It's brand name is Xofigo (pronounced zoh-fee-go).

You might have radium 223 to treat cancers in the bone that began in the prostate. Radium 223 can treat cancers in more than one area of the bone and helps to reduce pain. 

Who can have it?

Radium 223 is for men who:

  • had hormone treatment that is no longer working
  • have either had or aren't suitable for docetaxel (a type of chemotherapy)
  • have cancer that has spread to the bones but not to other organs
  • are not having treatment with abiraterone

You might need to travel to a different hospital to have radium 223 as it's not available in every hospital.

How radium 223 works

Radium targets bone cancer cells. This is because it is similar to calcium, which is also absorbed by bone cells. The cancer cells in the bone take up radium 223 and it then releases radiation which travels a very short distance. 

This means that the cancer cells receive a high dose of radiation which can destroy them. And healthy cells receive only a low dose or no radiation. So this treatment causes few side effects.

Before treatment

You have a blood test before treatment to make sure you're well enough to have it. 

You might also have a bone scan a week or so before. You might have to stop taking calcium supplements before treatment. Your doctor will let you know about this. 

How you have radium 223

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

You normally have the injection every 4 weeks. You usually have it up to 6 times. You might have a blood test in between injections to make sure it is safe for you to have your next one. You have the treatment as an outpatient and can go home afterwards.

After radium 223 treatment

After the treatment, some radiation may be present in your urine and in your poo (faeces) for 1 week. The total amount is extremely small and gets lower each day. 

The team looking after your treatment usually ask you to take the following precautions:

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

After this treatment, men shouldn't father a baby for at least 6 months because the treatment can cause sperm damage. Talk to your doctor or nurse about effective contraception, such as condoms before having the treatment.

It might be possible to store sperm before the treatment if you are planning to have children in the future. 

Side effects of radium 223

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 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. They can give you painkillers. 

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