Radium-223 dichloride for metastatic castration-resistant prostate cancer: the urologist's perspective.

Radium-223 dichloride (radium-223) is an important therapeutic option for the treatment of patients with castration-resistant prostate cancer, symptomatic bone metastases, and no visceral disease. The unique mechanism of action of this first-in-class alpha-emitting radiopharmaceutical underlies its favorable safety profile and low incidence of myelosuppression. In the pivotal phase 3 ALpharadin in SYMptomatic Prostate CAncer Patients study, radium-223 reduced the risk of death by 30% and prolonged time to first symptomatic skeletal event by 5.8 months. This article summarizes current guidelines and clinical studies that led to the approval of radium-223 as an overall survival therapy, and discusses the urologist's perspective on using radium-223 in clinical practice.