A radioactive medicine for prostate cancer that has spread to bone
Radium-223
A radioactive medicine given by injection to treat prostate cancer that has spread to the bones.
What is Radium-223?
Radium-223 is a specialist radioactive medicine (a radiopharmaceutical) used to treat prostate cancer that has spread to the bones. It is given as an injection into a vein in a nuclear-medicine centre. It works by travelling to areas of active bone where the cancer is and delivering radiation right at those spots. Its most important effects are lowering the blood cells made in the bone marrow, so blood tests are done before each dose, and stomach effects such as nausea and diarrhoea. Because it is radioactive, simple radiation-safety precautions are needed for a few days, especially around bodily fluids such as urine and stool.
Education and reference only. This is a plain-language guide to Radium-223 — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Radium-223 is a radioactive medicine, known as a radiopharmaceutical, used to treat prostate cancer that has spread to the bones. It is given as an injection into a vein, only in specialist nuclear-medicine centres equipped to handle radioactive treatments. Radium behaves rather like calcium, so it naturally collects in areas of bone where the cancer is most active. Once there, it gives off a type of radiation that travels only a very short distance, treating the cancer in the bone while limiting the dose to nearby healthy tissue. It is given as a course of injections spaced apart under specialist care.
How it works
Because radium behaves chemically like calcium, radium-223 is taken up into areas of bone where the cancer is causing the most activity. There it releases radiation that travels only a tiny distance, so it damages the nearby cancer cells in the bone while sparing tissue further away. This targeted, short-range radiation is what makes it useful for cancer that has spread to bone and is causing symptoms. It does not treat cancer that has spread to soft organs, so it is used in carefully selected situations. The treatment is given as several injections over a number of weeks.
Company & origin
Originated / developed by: Specialist manufacturer.
A specialist radioactive medicine used in the UK in nuclear-medicine centres to treat prostate cancer that has spread to the bones.
Practical use
How to take Radium-223
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- It is given by specialist staff as an injection into a vein in a nuclear-medicine centre.
- Have the blood tests before each dose, as treatment may be delayed if blood cell levels are too low.
- Follow the radiation-safety advice for a few days after each dose, especially around urine and stool.
- Flush the toilet well and wash your hands carefully, and follow the centre's advice on contact with others.
- Report any signs of infection, unusual bruising or bleeding, or marked tiredness to your team.
Weighing it up
Advantages & disadvantages of Radium-223
Advantages
- Targets prostate cancer that has spread to the bones, delivering radiation right where it is needed.
- Its radiation travels only a very short distance, helping to spare nearby healthy tissue.
- Given as a course of injections under specialist nuclear-medicine care.
Disadvantages
- Lowers the blood cells made in the bone marrow, so blood tests and possible dose delays are needed.
- Requires radiation-safety precautions for a few days, especially around bodily fluids.
- Treats cancer in the bone but not cancer that has spread to soft organs, so it suits selected situations only.
Practical use
Good to know
Two things stand out with radium-223. First, it lowers the blood cells made in the bone marrow, including those that fight infection, help clotting and carry oxygen, so blood tests are done before each dose and a dose may be delayed if levels are too low; report any signs of infection, unusual bruising or bleeding, or marked tiredness. Second, because it is radioactive, simple radiation-safety precautions are needed for a few days after each dose, particularly around bodily fluids: flush the toilet well, wash hands carefully, and follow the centre's specific advice on handling urine and stool and on contact with others. Stomach effects such as nausea, diarrhoea and vomiting are common. It is given only in nuclear-medicine centres, where staff explain all the precautions.
Who should not take it / use with caution
- It is not suitable for people whose prostate cancer has spread mainly to soft organs rather than bone.
- It is used with caution, or delayed, in people whose blood cell counts are too low.
- It is a treatment for men with prostate cancer and is given only in specialist nuclear-medicine centres.
Monitoring
- Blood tests before each dose to check the cells made in the bone marrow.
- Watching for signs of infection, bleeding or bruising, and marked tiredness.
- Reviewing how well the cancer and bone symptoms are responding over the course of treatment.
Side effects
- Lower blood cell counts made in the bone marrow, raising the risk of infection, bruising, bleeding or tiredness.
- Stomach effects such as nausea, diarrhoea and vomiting.
- Swelling of the legs, or a short-lived flare of bone pain after a dose in some people.
Key interactions
- It may be used with caution alongside certain other prostate cancer treatments, guided by the specialist team.
- Other treatments that lower blood cell counts can add to the effect on the bone marrow.
- Tell your team about all your medicines, including calcium and vitamin supplements, before treatment.
Available as: A radioactive solution given as an injection into a vein in a nuclear-medicine centre.
Answers
Radium-223: frequently asked questions
What is radium-223 used for?
It is a radioactive medicine used to treat prostate cancer that has spread to the bones, delivering targeted radiation to the affected areas of bone.
How does it find the cancer in my bones?
Radium behaves like calcium, so it collects in areas of bone where the cancer is most active, then releases short-range radiation that treats the cancer there while sparing tissue further away.
Why do I need blood tests before each dose?
It lowers the blood cells made in the bone marrow, so blood counts are checked before each dose and treatment may be delayed if levels are too low.
What radiation precautions do I need?
For a few days after each dose, follow the centre's advice on handling bodily fluids: flush the toilet well, wash your hands carefully, and follow their guidance on contact with others.
Where is it given?
It is given as an injection into a vein only in specialist nuclear-medicine centres, where staff are trained to handle radioactive treatments and explain the precautions.
Authoritative sources
- BNF
- NICE CKS
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