A radioactive material injected into your arm to treat prostate cancer which has spread to the bones.

What is Radium-223?

  • Radium-223 is a radioactive medicine that works within the body. Doctors use it for people who have prostate cancer that has spread to their bones. It can help to control bone pain and allow some prostate cancer patients to live longer. 
  • Its brand name is Xofigo.

Important things to know

Who can have radium-223?

People who have advanced prostate cancer:

  • Whose prostate cancer has grown even when they have been treated with hormone therapy. This is called castration-resistant or hormone-resistant prostate cancer.
  • Where the prostate cancer has spread to the bones (metastases) and is causing pain.
  • Who have already had or are unable to have chemotherapy and other types of treatment.
  • Whose bone marrow is working reasonably well. Bone marrow is the spongy substance inside bones. It helps to make some blood cells. 

Who can’t have radium-223?

People who have advanced prostate cancer:

  • Whose prostate cancer has spread to other internal parts of the body, e.g. lungs, liver, etc. 
  • Who currently take medicines called Abiraterone (Zytiga) or Enzalutamide (Xtandi). Neither of these medicines can be taken at the same time as Radium 223. Taking either of these alongside radium-223 may increase the risk of broken bones.
  • Who have bone metastases but have no pain or other symptoms.

What are the benefits of radium-223?

  • It can ease your pain
  • It can slow down the progress of your cancer
  • You can carry on with your normal activities if you feel able
  • It may be suitable if you can’t have chemotherapy.
Frequently asked questions (FAQs) about radium-223
  • Bone metastases are cancer cells that have travelled from the prostate to the bones. In prostate cancer, the most common areas of bone metastases are the:
    • Ribs 
    • Pelvis 
    • Spine.


Does this mean I have bone cancer?

What happens to my bones?

  • The cancer cells cause the bone to grow more quickly. So, they thicken and become weak and inflexible. This means that the bones are more likely to break (fracture).
  • Bone pain is often the first symptom of bone metastases. The pain may come and go but is often continuous. It can be worse at night.
  • Radium-223 looks for areas where bone is growing quickly. 
  • It is even more attracted to the damaged part of the bone.
  • Once it reaches the damaged area of bone, it gives off energy (radiation).
  • The radium-223 only has a short range. So, it kills the cancer cells that are close by. But it does less damage to the healthy cells around it.
Radium 223 in the body
  • You will have 6 treatments. One treatment every 4 weeks (every month) for 6 months. 
  • The dose you get will depend on your body weight. Your doctor will calculate the correct dose for you. 
  • You will have a pre-treatment check about two weeks before you have your radium-223. You will: 
    • Have a blood test. This is to check whether your levels of red cells and platelets are normal. Platelets are a type of blood cell that help your blood to clot.blood in test tube
    • Be weighed. This is so that the doctor can calculate the amount of radium you will need.
  • You may be advised to:
    • Stop taking any calcium supplements for seven days before your treatment
    • Drink plenty of fluids the day before each treatment.
  • You should not feel any pain during the treatment. You may have some short-lived pain a week or two after treatment.
  • You will need to take time off to go for your six treatments. 
  • Having the treatment may affect your ability to work in certain jobs. Talk to your doctor about going back to work.
  • Radium-223 is given as an injection into the vein in the back of your hand. A healthcare professional will put a small, flexible, plastic tube into the vein in the back of your hand using a needle. This is called a cannula. This will feel the same as having a blood test. 
cannula in teh back of a hand
  • The radium-223 is then given slowly through the cannula. The cannula is then taken out. The whole process can take up to one hour. You should be able to go home straight away. The time it takes may differ between hospitals. 
  • hormone therapy injectionsIf you are having hormone therapy injections, you will carry on having them. 
  • If you aren‘t having hormone therapy injections, you will be offered them. Go to our hormone therapy page (this link will open in a new tab) for more information.
  • For the first seven days after treatment, you might have some radiation in your pee, poo and other bodily fluids. 
  • You can still have normal contact with adults. Talk to your doctor if you think you may have contact with pregnant women and children.
  • There are some things that you will be asked to do:
    • Sit on the toilet. Do not use a urinal. You will need to flush the toilet twice. Wash your hands well when you have finished.person sitting on the toilet
    • Wash any soiled bedlinen or clothes in a separate wash. 
    • If you need to touch any bodily fluids (e.g. spillages), always use gloves. If you use toilet tissues to clean up, flush them down the toilet.
    • You may get a card to keep with you while you are having your course of treatment. This will give details of the treatment you are having. You will need to show this to any healthcare professional that you see. You will get the contact details of someone that you can contact if you start to feel unwell.
    • If you should die within four weeks of treatment, your relatives will need to tell your doctors as soon as possible. There may need to be a delay before a post-mortem or cremation. This is because some radiation may still be present in your body. 

About this information

  • This information was published in March 2023. We will revise it in March 2024.
  • References and bibliography available on request.
  • If you want to reproduce this content, please see our Reproducing Our Content page (this link will open in a new tab).

What is risk?


  • Risk is the chance something bad could happen when we do something. Even simple things such as walking down the stairs can have risks. But we take risks because we think it will be worth it. We need to think about both the benefits and risks of what might happen when we do something.
  • You should always ask your healthcare team about both the benefits and risks of any treatment.
  • Remember if they tell you about a risk, it doesn‘t mean it will happen to you. They may say one man in ten who has this treatment will have a side effect. But they can‘t tell you if you will be the ‘one’ man who gets this side effect.
 showing a see saw with risk on one side and benefits on the other

Very common side effects


1 in 10 people
  • Diarrhoea.
  • Nausea (feeling sick).
  • Vomiting.
  • A shortage of platelets in your blood (thrombocytopenia). Platelets are a type of blood cell that help your blood to clot.
  • Broken bones (bone fracture). It is recommended that you speak to your doctor about the need for medicines that can help your bone health.

There is also the risk of dehydration. This means that your body does not have as much water as it needs. You may be losing fluid through sweat, vomiting, pee or diarrhoea. You will need to talk to your doctor if you get any of these symptoms: 

  • Dizziness
  • Feeling really thirsty
  • Decreased peeing
  • Dry skin.


Common side effects

May affect UP TO

  • Drop in the number of white blood cells (leukopenia).
  • Drop in the number of neutrophils (a type of white blood cell). This is called neutropenia. These cells are the first line of defence against infections and viruses. They are part of your immune system. Low levels may lead to a greater chance of an infection.
  • Drop in the number of red and white cells and platelets (pancytopenia).
  • The injection site may become red, swollen and painful.

Electronic Medicines Compendium (EMC)

  • The EMC contains the most up to date, approved and regulated prescribing and patient information for all UK licensed medicines.
  • You can find more information about the side effects of this treatment from the Electronic Medicines Compendium (link opens in a new external tab).
  • You can see the patient information leaflet for Radium-223 on the EMC website (this link will open in a new external tab).
  • The information on the risks comes from very large clinical studies. These typically involved thousands of people being watched over many years. 
  • There may be local data from your area. You can ask your healthcare team if they have this information too. 

About this information

  • This information was published in March 2023. We will revise it in March 2024.
  • References and bibliography available on request.
  • If you want to reproduce this content, please see our Reproducing Our Content page (This link will open in a new tab).

What is the impact?

  • We asked real visitors to the infopool to share their experience of this treatment. They told us how this treatment had impacted their everyday lives in a number of different areas.
  • The numbers and images below represent how many people said this treatment had impacted them ‘a lot’ in each of the different areas. As this site is new, this is currently based on a relatively small group of people who have responded about this treatment. Please take this into account when reviewing the information below.
  • For example, imagine it says ‘25 in 100’ underneath ‘physical and social wellbeing’. This means that 25 out of 100 people who shared their experience of this treatment told us it impacted their ‘physical and social wellbeing’ a lot. However it would also mean that 75 out of 100 people said it had not impacted them a lot.

Physical and social wellbeing

Enjoying activities such as walking or going out to the pub

75 out of 100

Effect on relationships

Ability to make good connections with others

50 out of 100

Sexual activity

Ability to reach sexual arousal, either physically or emotionally

50 out of 100

Sense of self

Knowing who you are and what motivates you

50 out of 100

Wellbeing and quality of life

Feeling good and functioning well in your personal and professional life

75 out of 100

Mental and emotional health

Ability to think clearly, make good decisions, and cope with your emotions

75 out of 100


Feeling of constant physical and/or mental tiredness or weakness

75 out of 100

Sexual Orientation