Radium 223 (Xofigo)

Radium 223 is a type of internal radiotherapy treatment for cancer that began in the prostate and has spread to the bones. You might hear it called radioisotope treatment. 

You have the treatment in the nuclear medicine department. It takes around an hour. 

What is radium 223?

Radium 223 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).

Radium 223 can shrink areas of cancer cells that have spread to the bone. This reduces symptoms, such as pain, and helps you feel more comfortable.

You might need to travel to a different hospital for the treatment because it isn’t available in every hospital.

Radium 223 is for people with prostate cancer who:

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

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.

How you have treatment

You usually have radium 223 as an injection into the bloodstream through a small tube (cannula) put into a vein. The injection takes up to a minute.

You normally have the injection repeated every 4 weeks. You usually have it 6 times. You have the treatment as an outpatient and can go home afterwards.

After treatment

After the treatment, some radiation may be present in your wee (urine) and poo (faeces) for up to 7 days. The total amount is extremely small and gets lower each day. The team looking after you might 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 shouldn't father children for at least 6 months because the treatment can cause sperm damage. Talk to your doctor or nurse about effective contraception before having the treatment.

It might be possible to store sperm before the treatment if you plan to have children in the future. You can ask your doctor about this.

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.