Radium therapy for prostate cancer is a radionuclide treatment given into a vein. It uses radium-223, which behaves in the body much as calcium does, so it concentrates in areas of active bone formation where bone metastases sit. There it emits alpha radiation with a very short range, a fraction of a millimetre, so it acts on nearby tumour cells with limited damage to the healthy tissue around them and to more distant bone marrow. The treatment is considered in a specific situation: castration-resistant prostate cancer that has spread to bone and is causing symptoms, without significant visceral spread to the liver or lungs. The decision is made within an oncology team and is based on imaging, blood counts, kidney and liver function and the treatments you have already received. It is given as repeated sessions at regular intervals, with a blood count checked before each one. On radiation and precautions: the activity given is calculated and justified, and the very short range of alpha radiation means the risk to people around you is minimal. The precautions asked of you are practical and simple: careful toilet hygiene, because part of the treatment is cleared in stool and urine, thorough hand washing, and washing soiled clothing separately, for the period the nuclear medicine team specifies. **Tell your doctor if anyone in your household or accompanying you is pregnant or breastfeeding, and use the contraception advised for the period your team defines.** The limits must be stated plainly. **This is not a cure for cancer.** Its purpose is to relieve bone pain, delay skeletal complications and protect quality of life. It does not help when the disease has spread to the viscera or to bulky lymph nodes, it does not replace the hormonal or systemic therapy your oncologist prescribes, and it is not a substitute for targeted external radiotherapy to a single painful site. It can lower blood cell and platelet counts, so regular laboratory monitoring is required, and it may cause diarrhoea, nausea or fatigue. Eligibility is decided by full medical assessment, not by reading a page.
Procedure steps
- 1
Team assessment and confirming eligibility
The oncology and nuclear medicine team review the diagnosis, imaging, extent of spread and previous treatments, confirm the absence of significant visceral disease, and explain the realistic goal of treatment and its alternatives.
- 2
Blood tests before each session
A full blood count and kidney and liver function are checked before every dose, and a session may be postponed if counts are low until they recover. This monitoring is what makes repeated dosing safe.
- 3
Intravenous administration
The dose is given as a slow intravenous injection in the nuclear medicine unit, without anaesthesia and with little discomfort, followed by a short observation period before you go home the same day.
- 4
Hygiene precautions after the session
Written instructions are explained to you: sitting to use the toilet and flushing twice, washing hands thoroughly, laundering any soiled clothing or bedding separately, and drinking enough fluids, for the period the team specifies.
- 5
Monitoring symptoms and repeating sessions
Pain severity, analgesic needs and blood results are reviewed between sessions, and the plan is reassessed with your oncologist to decide whether to continue the course or change direction according to response and tolerance.
Before the procedure
Tell the team about every treatment you are receiving: hormonal therapy, chemotherapy, any bone-strengthening agent, painkillers and blood thinners, and every supplement you take, especially calcium and vitamin D, since their timing may need adjusting. Mention any kidney or bowel problem, previous bleeding, or low blood counts. Complete dental assessment and any needed dental work before starting bone-directed medicines if your doctor advises it, and report any tooth extraction or jaw pain. Tell your doctor if a pregnant woman or young children live with you, so that toilet and laundry precautions can be organised, and use the contraception advised for the period specified. Bring your reports, imaging and laboratory results, arrange transport home, and ask what the treatment aims to achieve and when that will be assessed.
After the procedure
Drink enough fluids and follow the toilet hygiene instructions for the period your team specified, wash your hands thoroughly, and launder any soiled clothing or bedding separately. Expect fatigue, nausea, diarrhoea, or a temporary flare of bone pain that may increase slightly in the first days before settling, and report severe diarrhoea, because dehydration harms the kidneys. Do not start any new supplement, herbal product or painkiller on your own, and keep your blood test appointments, since they are a condition for continuing the course. **Seek care immediately for fever, chills or a sore throat, which may indicate a low white cell count, for bleeding, bruising, pinpoint skin spots, or blood in the urine or stool, or for vomiting and diarrhoea that stop you drinking. Go to the emergency department at once for severe back pain with leg weakness or numbness, urinary retention or loss of bladder control, or sudden severe bone pain after a minor movement**, as these may signal spinal cord compression or a pathological fracture.
Expected duration
The consultation and assessment visit usually takes 30 to 45 minutes. The pre-session blood draw takes minutes plus waiting for the result. The intravenous injection itself commonly takes a minute to a few minutes, followed by a short observation period before same-day discharge, so plan a visit of one to two hours. Sessions are repeated at regular intervals set by the team over several months, with laboratory monitoring in between.
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