EANM guideline for radionuclide therapy with radium-223 of metastatic castration-resistant prostate cancer

  • Thorsten D. PoeppelEmail author
  • Daria Handkiewicz-Junak
  • Michael Andreeff
  • Alexander Becherer
  • Andreas Bockisch
  • Eva Fricke
  • Lilli Geworski
  • Alexander Heinzel
  • Bernd J. Krause
  • Thomas Krause
  • Markus Mitterhauser
  • Wilfried Sonnenschein
  • Lisa Bodei
  • Roberto C. Delgado-Bolton
  • Michael GabrielEmail author


Radium Ra-223 dichloride (radium-223, Xofigo®) is a targeted alpha therapy approved for the treatment of castration-resistant prostate cancer (CRPC) with symptomatic bone metastases and no known visceral metastatic disease. Radium-223 is the first targeted alpha therapy in this indication providing a new treatment option, with evidence of a significant survival benefit, both in overall survival and in the time to the first symptomatic skeletal-related event. The skeleton is the most common metastatic site in patients with advanced prostate cancer. Bone metastases are a clinically significant cause of morbidity and mortality, often resulting in bone pain, pathologic fracture, or spinal cord compression necessitating treatment. Radium-223 is selectively accumulated in the bone, specifically in areas of high bone turnover, by forming complexes with the mineral hydroxyapatite (the inorganic matrix of the bone). The alpha radiation generated during the radioactive decay of radium-223 produces a palliative anti-tumour effect on the bone metastases. The purpose of this guideline is to assist nuclear medicine specialists in evaluating patients who might be candidates for treatment using radium-223, planning and performing this treatment, understanding and evaluating its consequences, and improving patient management during therapy and follow-up.


Prostate cancer Radium-223 Alpha emitters Radionuclide therapy Bone metastases Survival benefit 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • Thorsten D. Poeppel
    • 1
    Email author
  • Daria Handkiewicz-Junak
    • 2
  • Michael Andreeff
    • 3
  • Alexander Becherer
    • 4
  • Andreas Bockisch
    • 1
  • Eva Fricke
    • 5
  • Lilli Geworski
    • 6
  • Alexander Heinzel
    • 7
  • Bernd J. Krause
    • 8
  • Thomas Krause
    • 9
  • Markus Mitterhauser
    • 10
    • 11
  • Wilfried Sonnenschein
    • 1
  • Lisa Bodei
    • 12
  • Roberto C. Delgado-Bolton
    • 13
  • Michael Gabriel
    • 14
    • 15
    Email author
  1. 1.Department of Nuclear MedicineUniversity Hospital EssenEssenGermany
  2. 2.Department of Nuclear Medicine and Endocrine OncologyCentre of Oncology - MSC InstituteGliwicePoland
  3. 3.Department of Nuclear MedicineUniversity Hospital DresdenDresdenGermany
  4. 4.Department of Nuclear MedicineAcademic Teaching Hospital FeldkirchFeldkirchAustria
  5. 5.Department of Nuclear MedicineHospital LippeLemgoGermany
  6. 6.Department of Medical Physics and Radiation ProtectionHannover Medical SchoolHannoverGermany
  7. 7.Department of Nuclear MedicineUniversity Hospital AachenAachenGermany
  8. 8.Department of Nuclear MedicineRostock University Medical CentreRostockGermany
  9. 9.Department of Nuclear MedicineInselspital, University Hospital BernBernSwitzerland
  10. 10.Department of Biomedical Imaging and Image-guided TherapyMedical University of ViennaViennaAustria
  11. 11.Ludwig Boltzmann Institute for Applied DiagnosticsViennaAustria
  12. 12.Department of RadiologyMemorial Sloan Kettering Cancer CenterNew YorkUSA
  13. 13.Department of Diagnostic Imaging (Radiology) and Nuclear MedicineUniversity Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR)LogroñoSpain
  14. 14.Institute of Nuclear Medicine and EndocrinologyKepler University HospitalLinzAustria
  15. 15.University Clinic of Nuclear MedicineMedical University of InnsbruckInnsbruckAustria

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