Radium 223 (Xofigo) for metastatic prostate cancer

Radium 223 is a type of internal radiotherapy treatment. Internal radiotherapy means giving radiotherapy to the cancer from inside the body. You might have it for cancer that began in the prostate and has spread to the bones. This is metastatic or advanced prostate cancer.

Radium 223 is a mildly radioactive form of the metal radium. It's brand name is Xofigo (pronounced zoh-fee-go). You have this treatment in the nuclear medicine department. It takes around an hour. 

Who can have radium 223 treatment?

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.

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 treatment

After the treatment, some radiation may be present in your wee (urine) and poo (stool) 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. 

  • Prostate cancer: diagnosis and management
    National Institute for Health and Care Excellence (NICE), 2019. Last updated December 2021

  • Radium-223 dichloride for treating hormone-relapsed prostate cancer with bone metastases
    National Institute for Health and Care Excellence (NICE), 2016

  • Prostate cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow up
    C Parker and others
    Annals of Oncology, 2020. Vol 31, Issue 9. Pages 1119-1134

  • Cancer: Principles and practice of oncology (11th edition)
    VT De Vita, TS Lawrence and SA Rosenberg
    Lippincott, Williams and Wilkins, 2019

  • Xofigo (radium-223 dichloride)
    European Medicines Agency, 2018

Last reviewed: 
27 Jul 2022
Next review due: 
27 Jul 2025

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