Advice for healthcare professionals:
• radium-223 should only be used as monotherapy, or in combination with hormone (LHRH) analogues, for the treatment of men with metastatic castration-resistant prostate cancer, symptomatic bone metastases, and no known visceral metastases, and who are in progression after at least 2 prior lines of systemic therapy (other than LHRH analogues) or who are ineligible for any available systemic treatment• radium-223 dichloride is not recommended in patients with a low level of osteoblastic bone metastases or in patients with asymptomatic bone metastases only• carefully assess the benefits and risks of treatment before deciding whether to use radium-223 in patients with mildly symptomatic bone metastases (see below)• do not use radium-223 in combination with, or within 5 days of discontinuation of, abiraterone acetate and prednisone/prednisolone• the combination of radium-223 with other systemic cancer therapies other than LHRH analogues is not recommended; subsequent systemic cancer treatment should not be initiated for at least 30 days after the last administration of radium-223 dichloride• radium-223 dichloride can cause fractures — assess bone health status and risk of fractures before and during treatment and closely monitor bone health for at least 24 months after discontinuation; consider the use of bisphosphonates or denosumab to reduce fracture risk• report any suspected adverse drug reactions to Xofigo on a Yellow Card