Molecular radiotherapy · UK
Radium-223 (Xofigo) therapy, private in London.
An alpha-particle radiopharmaceutical for metastatic castration-resistant prostate cancer with symptomatic bone metastases and no visceral disease. Six outpatient cycles, four weeks apart, delivered by a nuclear-medicine unit with an active mCRPC programme.
Why patients choose us
- 01
A nuclear-medicine unit with an active radium-223 programme
Not a pop-up service. A licensed molecular radiotherapy centre running Xofigo cycles regularly, with a dedicated radiation-safety pathway.
- 02
The right radionuclide for the right disease
Radium-223 is for symptomatic bone-only mCRPC. If your scans show visceral disease or nodal bulk, we say so and reroute to Lu-PSMA, chemo or SBRT.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What private radium-223 costs in the UK.
Indicative ranges across our partner nuclear-medicine units in London. Send imaging and PSA history and we quote firm figures across two or three options.
In short
A full six-cycle radium-223 course: £28,000–£38,000, over six months.
| Item | Indicative range | Typical duration | Cadence |
|---|---|---|---|
| Nuclear-medicine consultation and eligibility review | £350–£550 | 45 min | Same visit |
| Radium-223 (Xofigo) per cycle (drug, dose, injection) | £4,500–£6,500 | 30–60 min | Same visit |
| Full 6-cycle course (drug and administration) | £28,000–£38,000 | 6 months | Cycle every 4 weeks |
| Pre-cycle bloods (FBC, U&Es, LFTs, PSA, ALP) | £120–£220 | 15 min | 24 hours |
| Restaging bone scan or PSMA PET/CT | £1,400–£2,800 | 60–90 min | 48 hours |
| Second-opinion review of imaging and PSA trajectory | £250–£450 | 30 min | 48 hours |
Prices vary by unit, by which oncologist supervises the course, and by whether bone-targeted agents and restaging imaging are bundled. We come back with a firm quote within one working day.
What it is
An alpha-particle emitter that behaves like calcium.
Radium-223 dichloride is a calcium-mimetic radiopharmaceutical. Once injected, it selectively accumulates in areas of increased bone turnover, which is exactly where osteoblastic prostate-cancer metastases live.
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Selective bone-metastasis targeting
Radium behaves biochemically like calcium and is laid down in the hydroxyapatite of active bone metastases, sparing most healthy marrow.
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Short-range alpha radiation
Alpha particles travel under 0.1 mm in tissue. High linear energy transfer causes double-strand DNA breaks in tumour cells with limited spread to surrounding marrow.
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Improves survival and delays events
ALSYMPCA showed better overall survival and delayed symptomatic skeletal events versus best supportive care. NICE-approved under TA412.
The journey
From referral to the sixth cycle, what happens, in order.
One team from first message to restaging after cycle 6, including bloods, MDT sign-off and imaging.
Phase 1 · Before your first cycle
Concierge, off-stage for you
Phase 2 · On each cycle day
Under an hour at the unit
Phase 3 · After
Concierge, back on
- 01
Before
You send us imaging and PSA history
A short, confidential form. Recent bone scan or PSMA PET, CT chest/abdomen/pelvis, PSA trend, testosterone, current systemic therapy and prior chemo status.
- 02
Before
We come back with a recommendation
Within one working day: whether radium-223 fits ALSYMPCA criteria, or whether lutetium-177 PSMA, docetaxel or SBRT is the better call. Indicative price.
- 03
Before
We arrange the MDT and first cycle
Uro-oncology MDT sign-off, bloods (FBC, U&Es, LFTs), and booking with the nuclear-medicine unit. First injection usually within 1 to 2 weeks.
- 04
On the day
Arrival at the nuclear-medicine unit
Check-in, weight (dose is 55 kBq/kg), a quick clinician review of symptoms and bloods, then the radiopharmacy dose is drawn.
- 05
On the day
The injection itself
A slow intravenous injection over about 1 minute through a peripheral cannula, flushed with saline. No sedation, no fasting.
- 06
On the day
Home the same hour
A brief observation, written radiation-safety advice (toilet hygiene, contact with children and pregnant women for a few days), and home. You can drive.
- 07
After
Six cycles, four weeks apart
Bloods before each cycle. Symptom review, PSA and ALP trends. Restaging imaging at cycle 3 and after cycle 6.
Typical end-to-end: 1–2 weeks to first cycle. Course: 6 cycles over 6 months. Restaging: cycle 3 and after cycle 6.
When it helps
When radium-223 is the right step - and when it is not.
The patient profiles ALSYMPCA and NICE TA412 were built around, plus the disease patterns that push us to lutetium-177 PSMA, chemotherapy or a clinical trial instead.
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Symptomatic bone-only mCRPC
Metastatic castration-resistant prostate cancer with two or more painful bone metastases on scan and no visceral spread.
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Post-abiraterone or post-enzalutamide progression
Bone-dominant progression on androgen-receptor targeted therapy, once abiraterone or enzalutamide are stopped (never concurrent).
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Post-docetaxel salvage
Patients who have had chemotherapy and progressed in bone, with performance status still 0 to 2 and adequate marrow reserve.
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Chemo-unfit patients
Older patients or those with comorbidity who are not candidates for docetaxel or cabazitaxel but still have symptomatic bone disease.
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PSMA-negative bone disease
Bone metastases that do not take up on PSMA PET (about 10 to 15 percent of mCRPC), where 177Lu-PSMA is not an option.
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Pain requiring regular opioid analgesia
ALSYMPCA enrolled men with pain sufficient to need step-2 or step-3 analgesics or prior external-beam radiotherapy for pain.
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Rising ALP with bone-dominant scan
A rising alkaline phosphatase driven by osteoblastic bone metastases, with a bone scan lit up and no measurable visceral disease.
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Not for visceral or bulky nodal disease
Liver, lung or brain metastases, or lymph nodes over 3 cm, are exclusions. These patients need Lu-PSMA, chemo or a trial.
Treatment options
Radium-223 sits inside a wider sequence for mCRPC.
What each option involves, and how they sequence around radium-223. Radium is never given at the same time as abiraterone (ERA-223), and is sequenced carefully around lutetium-177 PSMA and chemotherapy.
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Radium-223 dichloride (Xofigo)
The alpha-particle emitter itself. 55 kBq/kg IV every 4 weeks for up to 6 cycles. The only alpha-emitter licensed for mCRPC in the UK.
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Lutetium-177 PSMA (177Lu-PSMA-617)
A beta-emitting radioligand for PSMA-positive mCRPC, post-chemo per VISION. Complementary, not concurrent. We sequence carefully.
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External-beam palliative radiotherapy
Single-fraction 8 Gy for a dominant painful bone site. Can be given before, between or after radium-223 cycles.
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Denosumab or zoledronic acid
Bone-targeted agents given alongside radium-223 to reduce fracture risk and skeletal-related events. Dental check first.
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Docetaxel or cabazitaxel
Taxane chemotherapy. Radium-223 can be used pre-chemo, or after chemo if performance status has recovered. Not overlapped.
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PARP inhibitors (olaparib, talazoparib)
For BRCA1/2 or HRR-mutated mCRPC. A separate treatment line, not combined with radium-223.
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Prostate SBRT for oligometastasis
Where 1 to 3 metastases dominate, stereotactic ablative radiotherapy may be added to systemic radium-223 for local control.
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Second-opinion review
A specialist review of your imaging and PSA trajectory. Sometimes the answer is a trial, or a different radionuclide, not radium.
Where it is delivered
A small panel of London nuclear-medicine units, we picked them.
Royal Marsden Private, UCLH Private (NHNN Radiopharmacy), Bupa Cromwell Nuclear Medicine, HCA London Bridge Hospital, GenesisCare (Cromwell and Windsor), and Guy's and St Thomas' Private. Introductions are made privately, once we understand your case.
Selection criteria
How we choose every unit in our network.
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Consultant clinical or medical oncologists with an active mCRPC radionuclide practice
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Nuclear-medicine units licensed for radium-223 with in-house radiopharmacy
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Uro-oncology MDT sign-off before every first cycle, per NICE TA412 and BAUS guidance
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Clear onward pathways to 177Lu-PSMA, taxane chemotherapy and clinical trials
Safety and eligibility
Who it is not for, and what to plan for.
Radium-223 is generally well tolerated. Exclusions matter: visceral metastases, nodal disease over 3 cm, severe cytopenias, poor performance status, or concurrent abiraterone all rule it out. Bone-targeted agents and a dental check are added before starting.
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Mild fatigue for a few days
The commonest side effect. Usually settles within a week of each cycle and rarely stops treatment.
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Diarrhoea, nausea and vomiting
Mild in most men. Antiemetics and loperamide are prescribed on request. Grade 3 events are uncommon.
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Cytopenias and marrow reserve
Anaemia, neutropenia and thrombocytopenia can occur. Bloods before every cycle. Less myelosuppression than 177Lu-PSMA or chemo.
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Never concurrent with abiraterone
The ERA-223 trial showed higher fractures and deaths with radium-223 plus abiraterone plus prednisolone. Abiraterone is stopped first.
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Fracture risk on bone metastases
A bone-targeted agent (denosumab or zoledronic acid) is given alongside to lower skeletal-related events. Dental check before starting.
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Radiation-safety advice
Alpha particles travel under 0.1 mm in tissue. External risk to others is negligible. Simple toilet hygiene for a week and avoid close contact with pregnant women and infants for 6 days.
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PSA can rise before it falls
Radium-223 targets bone turnover, not PSA-producing tumour cells directly. ALP is often a better marker than PSA in the first months.
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Restaging at cycle 3 and after cycle 6
Bone scan or PSMA PET, plus CT to exclude new visceral disease. Treatment is stopped early if visceral disease emerges.
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Red flags after a cycle
Fever with neutropenia, unexplained bruising, severe bone pain, breathlessness, or new visceral symptoms: call the unit or go to A&E the same day.
Reading your cycle summary
Your radium-223 cycle note in four parts. Read the last one first.
Whichever unit delivers the injection, the note the oncologist sends after each cycle keeps to the same shape.
A quiet reminder
Nuclear-medicine language is precise and can read coldly - we translate it for you.
If you would like us to talk you through the cycle note before your review, just ask.
- 01 Header
Cycle number, dose delivered and weight
Which cycle of six, the calculated 55 kBq/kg dose, patient weight, and the batch and expiry of the radiopharmaceutical.
- 02 Bloods
FBC, U&Es, LFTs, PSA and ALP
Pre-cycle haemoglobin, neutrophils and platelets, renal and liver function, and the PSA and alkaline phosphatase trend.
- 03 Findings
Symptoms, toxicity and analgesia use
Pain score, opioid dose, any diarrhoea, nausea or fatigue since the last cycle, and any skeletal events or admissions.
- 04 Impression
Continue, delay or stop
Read this first: whether to proceed with the next cycle, delay for marrow recovery, or stop for visceral progression.
Recognised by major UK insurers
Cover for radium-223 varies by insurer - usually funded when NICE TA412 criteria are met. We confirm cover before the first cycle.
Frequently asked
Everything we get asked about radium-223.
Quick answers on pain, side effects, insurance, sequencing with 177Lu-PSMA, MDT and PSA response.
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Does radium-223 relieve bone pain?
Yes. ALSYMPCA showed a meaningful delay in symptomatic skeletal events and better quality-of-life scores on the FACT-P questionnaire compared with placebo. Many men report less pain and reduced opioid use over the six cycles, although the effect builds gradually rather than in a single injection.
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What are the side effects?
Most men tolerate radium-223 well. The common effects are mild fatigue, low-grade diarrhoea, nausea and small drops in blood counts. Grade 3 or 4 toxicity is uncommon and, importantly, radium-223 causes less bone-marrow suppression than 177Lu-PSMA or taxane chemotherapy. Bloods are checked before every cycle.
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Will my insurance cover radium-223?
Most major UK insurers (Bupa, AXA, Vitality, Aviva, WPA, Cigna) cover radium-223 when NICE TA412 criteria are met: symptomatic bone metastases, no visceral disease, castration-resistant, adequate performance status. We confirm authorisation before the first cycle and quote self-pay figures if cover is declined.
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Can I have radium-223 and lutetium-177 PSMA?
Yes, but sequenced, not together. Typical practice is radium-223 first for symptomatic bone-dominant disease, then 177Lu-PSMA at bone or nodal progression if PSMA PET is positive. The MDT reviews marrow reserve before starting the second radionuclide because both draw on the same bone-marrow niche.
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Do I need an MDT before starting?
Yes. Every first cycle of radium-223 in our network is signed off by a uro-oncology multidisciplinary team, in line with NICE TA412 and BAUS guidance. That is the check that visceral disease is genuinely absent and that abiraterone or enzalutamide have been stopped.
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What PSA response should I expect?
PSA is not the primary marker for radium-223. Because the alpha particles hit the bone-tumour interface rather than PSA-producing tumour cells directly, PSA may keep rising in the first two or three cycles while alkaline phosphatase falls and symptoms improve. We track ALP, imaging and symptoms alongside PSA.
Related treatments and tests
Looking for something else?
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Lutetium-177 PSMA therapy
Beta-emitting radioligand for PSMA-positive mCRPC, often sequenced with radium-223.
Learn more -
Prostate SBRT (5 fractions)
Stereotactic radiotherapy for localised or oligometastatic prostate cancer.
Learn more -
Robotic prostatectomy
Minimally invasive radical prostatectomy for localised disease.
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MRI-US fusion prostate biopsy
Targeted biopsy for suspected prostate cancer on multiparametric MRI.
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Prostate cancer condition guide
The condition overview: staging, treatment pathways and outcomes.
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Send Enquiry
Tell us your imaging and PSA history and we come back within a working day.
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Ready to start
Radium-223 in London, arranged inside two weeks.
Send us your recent bone scan or PSMA PET, CT, PSA history and current systemic therapy. We come back inside one working day with an eligibility read, a firm quote and two or three unit options.