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Ra-223 (Xofigo) is a radiopharmaceutical approved by FDA for treatment of symptomatic, metastatic castration resistant prostate cancer (mCRPC). It is a calcium mimic meaning that it gets incorporated into areas of increased bone turnover such as bone metastasis. Once localized to the bone, it kills the cancer cells by emitting alpha particles. It is not indicated in patients in whom the disease has spread to the visceral organs. This therapy is administered in an outpatient setting in the supervision of an authorized nuclear medicine physician. Prior to therapy, your doctor (oncologist/urologist) will discuss with a nuclear medicine physician to determine if you are a candidate for therapy. The therapy is administered intravenously at 4 week intervals for a total of six cycles. Blood counts before the start of therapy and not later than 10 days before every therapy cycle will be done to ensure that you have adequate blood counts. In addition to blood counts, your oncologist may choose to obtain more blood work as needed.

What are the benefits of the therapy?

Treatment with Ra-223 has shown to improve overall survival. In addition, there is longer lasting decrease in PSA (Prostate specific antigen) and ALP (alkaline phosphatase) levels which are blood markers of prostate cancer and bone disease secondary to prostate cancer. These markers are used by your urologists/oncologists to track the progression of disease by means of blood work. There is improved pain control and delaying of any bone related events including fracture or vertebral compression.

What to expect after the therapy?

The most commonly observed side effects (seen in approximately 10% of the patients) include diarrhea, nausea, vomiting and decrease in platelet counts which may result in fatigue, an increased tendency to bruising/bleeding and increased susceptibility to infections. Precautions to be taken for 7 days after every treatment: The goal of observing radiation safety precautions is to expedite the excretion of radiation to minimize side effects on your own body and prevent any exposure to your care givers.

Isolation from family and/or caregivers is not required, however, following these general recommendations will help you navigate through daily activities without contaminating others including the following:

• Drink extra fluids and use bathroom frequently, especially for first 48 hours.
• Sit on the toilet to decrease splashing and clean any spills. Flush at least twice after every use.
• Wash clothing contaminated with feces or urine separately, using an extra rinse cycle. Wear gloves when handling such clothes.