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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.

A stethoscope on a clinical desk

Indicative pricing

What private radium-223 costs in the UK.

Indicative ranges across UK nuclear-medicine units in London.

In short

A full six-cycle radium-223 course: £28,000–£38,000, over six months.

Item Indicative range
Nuclear-medicine consultation and eligibility review £350–£550
Radium-223 (Xofigo) per cycle (drug, dose, injection) £4,500–£6,500
Full 6-cycle course (drug and administration) £28,000–£38,000
Pre-cycle bloods (FBC, U&Es, LFTs, PSA, ALP) £120–£220
Restaging bone scan or PSMA PET/CT £1,400–£2,800
Second-opinion review of imaging and PSA trajectory £250–£450

Prices vary by unit, by which oncologist supervises the course, and by whether bone-targeted agents and restaging imaging are bundled.

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.

  • Selective bone-metastasis targeting

    Radium behaves biochemically like calcium and is laid down in the hydroxyapatite of active bone metastases, sparing most healthy marrow.

  • 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.

  • Improves survival and delays events

    ALSYMPCA showed better overall survival and delayed symptomatic skeletal events versus best supportive care. NICE-approved under TA412.

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.

  • Symptomatic bone-only mCRPC

    Metastatic castration-resistant prostate cancer with two or more painful bone metastases on scan and no visceral spread.

  • Post-abiraterone or post-enzalutamide progression

    Bone-dominant progression on androgen-receptor targeted therapy, once abiraterone or enzalutamide are stopped (never concurrent).

  • Post-docetaxel salvage

    Patients who have had chemotherapy and progressed in bone, with performance status still 0 to 2 and adequate marrow reserve.

  • Chemo-unfit patients

    Older patients or those with comorbidity who are not candidates for docetaxel or cabazitaxel but still have symptomatic bone disease.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • Lutetium-177 PSMA (177Lu-PSMA-617)

    A beta-emitting radioligand for PSMA-positive mCRPC, post-chemo per VISION. Complementary, not concurrent. We sequence carefully.

  • External-beam palliative radiotherapy

    Single-fraction 8 Gy for a dominant painful bone site. Can be given before, between or after radium-223 cycles.

  • Denosumab or zoledronic acid

    Bone-targeted agents given alongside radium-223 to reduce fracture risk and skeletal-related events. Dental check first.

  • Docetaxel or cabazitaxel

    Taxane chemotherapy. Radium-223 can be used pre-chemo, or after chemo if performance status has recovered. Not overlapped.

  • PARP inhibitors (olaparib, talazoparib)

    For BRCA1/2 or HRR-mutated mCRPC. A separate treatment line, not combined with radium-223.

  • Prostate SBRT for oligometastasis

    Where 1 to 3 metastases dominate, stereotactic ablative radiotherapy may be added to systemic radium-223 for local control.

  • Second-opinion review

    A specialist review of your imaging and PSA trajectory. Sometimes the answer is a trial, or a different radionuclide, not radium.

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.

  • Mild fatigue for a few days

    The commonest side effect. Usually settles within a week of each cycle and rarely stops treatment.

  • Diarrhoea, nausea and vomiting

    Mild in most men. Antiemetics and loperamide are prescribed on request. Grade 3 events are uncommon.

  • Cytopenias and marrow reserve

    Anaemia, neutropenia and thrombocytopenia can occur. Bloods before every cycle. Less myelosuppression than 177Lu-PSMA or chemo.

  • Never concurrent with abiraterone

    The ERA-223 trial showed higher fractures and deaths with radium-223 plus abiraterone plus prednisolone. Abiraterone is stopped first.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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 UK clinical oncologist reviewing a radium-223 cycle summary

A quiet reminder

Nuclear-medicine language is precise and can read coldly - ask your care team to explain anything that is unclear.

Ask your care team to explain anything that is unclear.

  1. 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.

  2. 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.

  3. 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.

  4. 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

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Cover for radium-223 varies by insurer - usually funded when NICE TA412 criteria are met.

Frequently asked

Everything we get asked about radium-223.

Quick answers on pain, side effects, insurance, sequencing with 177Lu-PSMA, MDT and PSA response.

  • 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.

  • 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.

  • 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.

  • 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.

  • Do I need an MDT before starting?

    Yes. That is the check that visceral disease is genuinely absent and that abiraterone or enzalutamide have been stopped.

  • 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.

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