Radium-223 for metastatic prostate cancer

Radium-223 can control painful bone metastases. It has also been shown to delay other potential complications of bone metastases, such as fractures, and to improve survival.

You should notice the benefits of radium-223 therapy within a few weeks of starting the treatment.

There are risks associated with any treatment or procedure. Specific to radium-223 therapy, there is an increased risk of:

• anaemia (affecting one in three patients)
• infection (affecting about one in 30 patients)
• bruising and bleeding (affecting about one in 10 patients)

This is because radium-223 therapy can lower the levels of your red blood cells (involved in carrying oxygen around the body), white cells (involved in fighting infection) and platelets (cells involved in clotting).

If you notice any unusual bruising or bleeding, or have a fever, it is important that you contact the hospital immediately.

However, you may not feel any different and the low blood count may only be picked up from your blood test results. If your blood cell numbers are low, further treatments may need to be postponed until your blood cells recover. Your doctor will discuss this with you.

There are alternative treatments you may wish to consider. Please see the next section for details.

The alternative options to radium-223 are:

• radiotherapy
• chemotherapy, or
• supportive care, which involves the use of medication to control symptoms and maintain good quality of life

Your doctor will discuss with you in detail the options that are most appropriate for you.

Tell the team treating you about all the medicines you are taking, including medicines you have bought yourself, or any natural or herbal remedies.
You should avoid taking calcium supplements for seven days before the radium-223 treatment. Please drink plenty of fluid to keep well hydrated.
If you have any problems with bladder or bowel control, or if you dribble urine, please tell your doctor.
Before treatment with radium-223, you will have blood tests and you will also be weighed. These are required to ensure that the correct dose of radium-223 is prescribed and ordered by your doctor.

We want to involve you in all the decisions about your care and treatment. The team treating you will answer any questions you may have so please ask if anything is unclear. If you decide to go ahead, we will ask you to sign a consent form. This confirms that you agree to have the procedure and understand what it involves.

We want to involve you in all the decisions about your care and treatment. The team treating you will answer any questions you may have so please ask if anything is unclear. If you decide to go ahead, we will ask you to sign a consent form. This confirms that you agree to have the procedure and understand what it involves.

You will have your treatment in the Nuclear Medicine Department as an outpatient, which means that you will not have to stay in hospital overnight.

Radium-223 is given as an intravenous (directly into a vein) injection. A cannula (small plastic tube) will be placed in a vein in your arm, through which radium-223 will be given.

The full course of treatment is six injections of radium-223 – one injection every four weeks.

You can go home straight after the treatment, following the precautions listed in the section below, Precautions to take after the treatment.

You should have an appointment booked in the Oncology Clinic approximately 3 weeks after your treatment. At each of these clinic appointments your Doctor will ensure they are happy for you to continue on to your next cycle of treatment and schedule your next appointment in the Nuclear Medicine Department.

The most common side effects of the treatment are:

• nausea/sickness (affecting one in three patients)
• diarrhoea (affecting one in four patients)
• fatigue/tiredness (affecting one in four patients)
• vomiting (affecting one in five patients)

It is important that you follow the precautions listed below when you are at home to protect other people from being exposed to radium-223. This is because your body fluids will be slightly radioactive for a week after each radium treatment. These precautions should be followed immediately after your treatment and for 7 days after each cycle of treatment.

• Sit on the toilet to pass urine instead of standing.
• Do not use a urinal.
• Flush toilet twice with the lid down.
• Wash hands well every time you go to the toilet.
• Wear gloves if cleaning spillage.
• If you throw away anything that has come into contact with your body fluid, place it in a plastic bag before you put it in your household bin.
• Wash clothing immediately and separately from other items if it is stained with body fluid.
• Use a reliable contraceptive. You should not father a child during your treatment and for six months afterwards because the treatment may damage the sperm.

Close contact with your loved ones, such as sleeping with your partner or cuddling children, does not require any special precautions.

Before each radium-223 treatment, you will have a blood test and you will be weighed. This is to ensure that it is safe for you to continue the treatment and that you receive the correct dose.

Cancer Research UK:

www.cancerresearchuk.org/about-cancer

Reference 

Alpha-Emitter Radium-223 and Survival in Metastatic Prostate Cancer. New England Journal of Medicine 2013; 369: 213-223 

If you have any questions or concerns, please contact us on one of the following numbers (Monday to Friday, 9am to 5pm):
Nuclear Medicine Department, 020 3447 0565 or uclh.NucMed@nhs.net
Uro-oncology clinical nurse specialist team, 020 3447 7151

If you need urgent advice and it is out of hours, please call 07947 959020.

Hospital switchboard: 020 3456 7890 or 0845 155 5000